Hybrid modeling techniques for 3D printed deep inferior epigastric perforator flap models

Abstract

Background Deep Inferior Epigastric Perforator Flap (DIEP) surgical procedures have benefited in recent years from the introduction of 3D printed models, yet new technologies are expanding design opportunities which promise to improve patient specific care. Numerous studies, utilizing 3D printed models for DIEP, have shown a reduction of surgical time and complications when used in addition to the review of standard CT imaging. A DIEP free flap procedure requires locating the inferior epigastric perforator vessels traversing and perforating the rectus abdominis muscle, perfusing the abdominal skin and fatty tissue. The goal of dissecting the inferior epigastric perforator vessels is complicated by the opacity of the fatty tissue and muscle. Previous attempts to 3D print patient specific models for DIEP free flap cases from CT imaging has shown a wide range of designs which only show variations of perforator arteries, fatty tissue, and the abdominis rectus muscle. Methods To remedy this limitation, we have leveraged a voxel-based modeling environment to composite complex modeling elements and incorporate a ruled grid upon the muscle providing effortless ‘booleaning’ and measured guidance. Results A limitation of digital surface-based modeling tools has led to existing models lacking the ability to composite critical anatomical features, such as differentiation of vessels through different tissues, coherently into one model, providing information more akin to the surgical challenge. Conclusion With new technology, highly detailed multi-material 3D printed models are allowing more of the information from medical imaging to be expressed in 3D printed models. This additional data, coupled with advanced digital modeling tools harnessing both voxel- and mesh-based modeling environments, is allowing for an expanded library of modeling techniques which create a wealth of concepts surgeons can use to assemble a presurgical planning model tailored to their setting, equipment, and needs. Trial registration COMIRB 21–3135, ClinicalTrials.gov ID: NCT05144620.

3D printing for an anterolateral thigh phalloplasty

“…The segmentations were made up of the bones (femur, pelvis, patella), the total volume of the thigh, the intermuscular septum between the rectus femoris and vastus lateralis, and the vasculature supplying the ALT flap area. The goal is to combine the structures to preserve the relation of the vessels with the surrounding bone and soft tissue [ 11 ]. These segmentation models are then exported into Rhinoceros 3D 5.0, a surface-based modeling program, where a bounding box is created around the models, and the inferior-medial point of the box is moved to (0,0,0).…”

“…Moreover, using 3D models for surgical planning and anatomical reference has been shown to reduce surgical times and complications [ 10 ]. In this study, we adapted a methodology for deep inferior epigastric perforator (DIEP) flap surgeries to create an accurate patient-specific 3D printed model from CT scans [ 11 ]. This method could more accurately represent the relevant vasculature in the ALT flap and improve phalloplasty procedures by reducing overall surgery times and complications.…”

Future of autologous breast reconstruction: a review of novel technological innovations

“…Looking ahead, with adequate preoperative and postoperative data, the combination of established methods with ML and computer vision AI could be harnessed to analyze the characteristics of perforators and associated complications [18,19] . This approach could enable the learning and selection of perforators that optimize clinical outcomes [13] .…”

“…In addition, the use of standard preoperative evaluation methods results in changes in surgical plan intraoperatively in nearly 25% of cases, which prolongs operative time, increasing the risk to the patient and financial burden [10] . Recent advancements in 3D printing, augmented reality, and artificial intelligence have been applied to autologous breast reconstruction to address these limitations to improve complication risk and optimize efficiency in the operating room [11][12][13] .…”