The Application Of Digital Visualization Technology Based On MRI In Superficial Tumor Excision And Perforator Flap Operations In Plastic Surgery

ObjectiveTo explore the application of digital visualization technology in the field of plastic surgery.Specifically,to study a variety of digital visualization means to apply the MRI data to guide the precise resection of common superficial tumors and the precise design of perforator flap operations in plastic surgery.MethodsThe subjects of this study were from the patients admitted to the plastic surgery department of the PL A general hospital from January 2017 to December 2018.The patients were in need of surgical resection for superficial tumors or surgical repair with perforator flaps for large wounds.They were enrolled according to the corresponding requirements.All the patients underwent high-resolution MRI scan,and the data were imported into the post-processing software for 3D reconstruction and model designing.Afterwards:1.For patients with superficial tumors,a digital tumor model was constructed and a personalized guide plate for tumor resection was designed.They were molded by 3D printing and used to guide the surgery.2.For patients with superficial tumors,a personalized "tumor map" was designed and a portable projector was used to project the three-dimensional tumor model and "tumor map" onto the patient's body surface to guide the surgery.3.For patients in need of perforator flap surgery,the perforator arteries were analyzed,and a personalized "perforator map" was designed.Three different methods were used to locate the "perforator map" onto the patient's body surface to guide surgery including:LDM(Localization with Distance Measurement)?LIP(Localization with Image Projection)and LPPF(Localization with Printed Plastic Film).Results1.For every case,a digital tumor model can be obtained via 3D reconstruction with MRI data and a personalized guide plate for tumor resection can be designed accordingly.The models can be molded by 3D printing and showed significant values in guiding surgery.The pathological results suggested that the accuracy of 3D-printed guide plate for tumor resection based on MRI in guiding superficial tumor resection was 100%.2.For every case,a personalized "tumor map" can be designed.The digital tumor model and "tumor map" can be projected onto the patient's body surface,which is of guiding value for surgery.3.MRA can display partial perforator arteries,with an average number of 4.5±2.1 per case.For every case,a personalized "perforator map" can be designed.By means of three methods(LDM?LIP and LPPF)it can be located onto the patients' body surface accurately to assist the operator to select the best perforator for surgery.Conclusions1.3D thin layer MRI sequence can clearly image superficial tumors and meet the requirements of 3D reconstruction.2.For patients with superficial tumors,a 3D-printed tumor model is helpful for surgeons to accurately understand the tumor morphology and the projection of 3D tumor model onto the body surface is helpful for surgeons to accurately determine the tumor range.3.For patients with complex superficial tumors,we recommend the use of " guide plate for tumor resection method".The clinical process is:"MRI scan?Design personalized guide plate for tumor resection 3D printing?Surgical application ".Besides,we recommend the use of "tumor map projection method".The clinical process is:"MRI scan?Design personalized" tumor map"?Body surface projection?Surgical application".In this way,the accuracy of tumor resection can be improved.4.High resolution MRA can display part of the perforators,which is of unique value in perforator flap surgery.5.For patients with complicated conditions that are requiring perforator flap surgery,we recommend the use of "perforator map method".The clinical process is:"MRI scan?Design personalized 'perforator map'?Body surface localization(LDM?LIP and LPPF)?Surgical application",which is helpful for surgeons to make the best perforator flap designing.