Using Virtual Reality for Deep Inferior Epigastric Perforator Flap Preoperative Planning

Abstract

Autologous breast reconstruction is a standard procedure performed during mastectomy for the treatment of breast cancer. [1][2][3][4][5][6] The transverse rectus abdominis muscle (TRAM) and the deep inferior epigastric perforator (DIEP) are the most common flaps used, both of which are harvested from the lower abdomen. 4,7,8 To ensure flap viability, high-resolution imaging and meticulous surgical planning are required. The procedure itself can still involve complications, including venous congestion, fat necrosis in 1.28%-2.93% of cases, and even total flap loss in 1.16%-3.61% of all patients whether performed unilaterally or bilaterally, according to Serletti et al. 9 Virtual reality (VR) has recently emerged as a comprehensive tool for stereoscopic three-dimensional (3D) imaging since it provides an interactive, realistic, and intuitive understanding of anatomical and pathological Breast Original articleIntroduction: This study was designed to compare VR stereoscopical three-dimensional (3D) imaging with two-dimensional computed tomography angiography (CTA) images for evaluating the abdominal vascular anatomy before autologous breast reconstruction. Methods: This prospective case series feasibility study was conducted in two tertiary medical centers. Participants were women slated to undergo free transverse rectus abdominis muscle, unilateral or bilateral deep inferior epigastric perforator flap immediate breast reconstruction. Based on a routine CTA, a 3D VR model was generated. Before each procedure, the surgeons examined the CTA and then the VR model. Any new information provided by the VR imaging was submitted to a radiologist for confirmation before surgery. Following each procedure, the surgeons completed a questionnaire comparing the two methods. Results: Thirty women between 34 and 68 years of age were included in the study; except for one, all breast reconstructions were successful. The surgeons ranked VR higher than CTA in terms of better anatomical understanding and operative anatomical findings. In 72.4% of cases, VR models were rated having maximum similarity to reality, with no significant difference between the type of perforator anatomical course or complexity. In more than 70% of the cases, VR was considered to have contributed to determining the surgical approach. In four cases, VR imaging modified the surgical strategy, without any complications. Conclusions: VR imaging was well-accepted by the surgeons who commented on its importance and ease compared with the standard CTA presentation. Further studies are needed to determine whether VR should become an integral part of preoperative deep inferior epigastric perforator surgery planning.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review

“…The present review captured articles on free flaps more commonly used in FPRS, but XR has been used for planning and mapping of DIEP flaps for breast reconstruction as well 75–77 . Especially for head and neck defects, AR may provide surgeons potential advantages for visualizing complex flap reconstructions, understanding the course of skin perforators, and verifying any pre‐planned osteotomies.…”

“…The present review captured articles on free flaps more commonly used in FPRS, but XR has been used for planning and mapping of DIEP flaps for breast reconstruction as well. [75][76][77] Especially for head and neck defects, AR may provide surgeons potential advantages for visualizing complex flap reconstructions, understanding the course of skin perforators, and verifying any preplanned osteotomies. A significant challenge for intraoperative use of AR during soft tissue dissection is the progressive deformation of landmarks which may impede accurate navigation using this technology.…”