PDF(Pubmed)
Abstract：
OBJECTIVE: In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators.
METHODS: The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound.
RESULTS: The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred.
CONCLUSIONS: Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.
METHODS: The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound.
RESULTS: The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred.
CONCLUSIONS: Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.
摘要：
目的：在软组织重建手术中，穿孔器定位和皮瓣收获一直是关键的挑战，但是增强现实（AR）已经成为帮助绘制穿孔器的主要技术。
方法：连续患者（N=14）通过CTA重建旋股外侧动脉（LCFA）及其穿支。然后，大腿前外侧穿孔器和穿孔器从深筋膜出现的点被标记并投射到皮肤表面。当虚拟图像根据骨骼标记投影到患者身上时，在皮肤表面描绘了LCFA及其穿孔器的病程,以利于术中指导.最后,出现点的位置通过术中发现进行验证,并与手持式多普勒超声确定的位置进行比较.
结果：来源，地点,通过CTA确定射孔器的数量。通过便携式投影仪将穿孔器及其出现点准确地绘制在皮肤表面上，以收获股前外侧穿孔器皮瓣。在操作过程中,CTA&AR方法的准确度为90.2%(37/41)，灵敏度达到97.4%(37/38)，远高于多普勒超声的相应值。此外,AR标记点和术中发现之间的差异远小于多普勒超声观察到的差异（P<0.001）。因此,所有的襟翼都设计得很好并且幸存下来，只有一个并发症发生。
结论：增强现实，即,在这项研究中，CTA与投影相结合，在定位射孔器出射点和指导手术收获皮瓣中起着至关重要和可靠的作用，潜在风险较小。
方法：连续患者（N=14）通过CTA重建旋股外侧动脉（LCFA）及其穿支。然后，大腿前外侧穿孔器和穿孔器从深筋膜出现的点被标记并投射到皮肤表面。当虚拟图像根据骨骼标记投影到患者身上时，在皮肤表面描绘了LCFA及其穿孔器的病程,以利于术中指导.最后,出现点的位置通过术中发现进行验证,并与手持式多普勒超声确定的位置进行比较.
结果：来源，地点,通过CTA确定射孔器的数量。通过便携式投影仪将穿孔器及其出现点准确地绘制在皮肤表面上，以收获股前外侧穿孔器皮瓣。在操作过程中,CTA&AR方法的准确度为90.2%(37/41)，灵敏度达到97.4%(37/38)，远高于多普勒超声的相应值。此外,AR标记点和术中发现之间的差异远小于多普勒超声观察到的差异（P<0.001）。因此,所有的襟翼都设计得很好并且幸存下来，只有一个并发症发生。
结论：增强现实，即,在这项研究中，CTA与投影相结合，在定位射孔器出射点和指导手术收获皮瓣中起着至关重要和可靠的作用，潜在风险较小。
