Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap

Abstract

Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap.

The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks

“…The VOSTARS device can have prospective use also in tumor and head and neck reconstructive surgery, e.g., in providing anatomical visualization and in supporting mandibular complex reconstruction. Some previous studies reported experiences of AR-assisted navigation used in combination with CAD/CAM technology to guide the positioning of the fibular osteotomy cutting guide [7], as well as to facilitate anatomical visualization during free flap harvesting [42], but in both cases, the AR guidance was performed using hand-held mobile devices (smartphone or tablet). VOSTARS can represent an improved AR-assisted navigation system that allows the surgeon to view directly in front of his eyes the virtual content superimposed on the patient.…”

Periosteal Flaps Enhance Prefabricated Engineered Bone Reparative Potential

“…Elucidating the factors that influence the periosteal inherent regenerative capacity is mandatory for a predictable application in reconstructive approaches. The pericranium is a clinically relevant source due to the feasibility for harvesting larger periosteal tissues (Battaglia et al 2020). In this study, the ectopic employment of periosteal grafts and flaps in muscle IVBs was assessed.…”

AEducaAR, Anatomical Education in Augmented Reality: A Pilot Experience of an Innovative Educational Tool Combining AR Technology and 3D Printing

“…Unlike VR, which creates a totally artificial environment, AR uses the existing real environment and overlays new information on top of it, thus providing a composite view. In recent years, AR has been proposed and applied as an aiding tool in many healthcare sectors, including neurosurgery [13], urology [14][15][16], orthopedics [17,18], and craniomaxillofacial surgery [19][20][21][22][23]. AR is rapidly growing with many new potential applications also in the medical education field [24].…”