| BackgroundThe face is a window and business card for human social communication.With the development of the times,people's aesthetic requirements on the face are getting higher and higher.People change the facial shape through the transplantation of autologous or foreign materials in the face to achieve the ideal facial shape.Although there is no fixed standard for aesthetics,the fullness of the basic facial contour is the basic element to judge whether a person's facial shape conforms to aesthetics.Congenital facial depressions or acquired facial depressions due to trauma can affect a person's facial morphology,and facial autologous fat absorption during aging can also affect a person's facial morphology.For such patients,current plastic surgery often uses autologous fat transplantation to fill the concave area of the patient,so as to change the shape of the concave area of the face to return to the ideal state.However,there are two uncertainties in the process of autologous fat transplantation,one is the uncertainty of filling the back shape,and the other is the uncertainty of the autologous fat absorption rate.In the past,the operation of autologous fat filling was basically based on the experience of the doctor,that is,the location and amount of autologous fat filling were determined empirically.Therefore,it has greater blindness and limitations,and sometimes it is difficult to achieve the desired treatment effect.These have long been major problems with autologous fat filling.Digital surgical technology is based on computer 3D image and cloud data processing,using 3D surface sca nning technology,3D digital imaging and printing technology,augmented reality(virtual reality)-based surgical simulation system,etc.Combining digitalization,intelligence and material science to achieve precise guidance for surgery and personalized repair is the focus of today's medical research.There is an opportunity to provide effective methods for solving problems in the process of autologous fat transplantation.ObjectiveBy studying 3D natural light surface scanning technology,3D printing technology,and augmented reality technology and other digital surgical techniques to estimate the rate of facial autologous fat absorption,guide single or multi-site autologous fat filling of the face,improve the accuracy of intraoperative operations.Methods1.From January 2018 to November 2018,37 patients with facial depression were required to undergo surgical treatment for facial autologous fat transplantation,of which 17 cases used traditional autologous fat transplantation and 20 cases used autologous fat supplemented with platelet-rich plasma transplant.Three days and three months after the end of the operation,the three-dimensional data of the patient's face were reconstructed using a hand-held natural light three-dimensional scanner to calculate the autologous fat absorption rate.2.From November 2018 to June 2019,39 patients with short chin were treate d and randomly divided into a control group(19 cases)and a test group(20 cases).The control group used traditional autologous fat filling based on the surgeon ?s clinical experience;the test group collected the patient ?s facial information through a handheld natural light 3D scanner to reconstruct the facial 3D model,and designed the postoperative shape on this basis,using 3D printing and other rapid shaping Technology to make personalized three-dimensional transparent shell and sterilize it for future use.When performing facial filling surgery,place it on the surface of the operation area,and operate under the guidance of the shell.Three months after the operation,the patient's operation area was scanned again and the postoperative model designed before the operation was analyzed for divergence to evaluate the surgical effect.Six months after the operation,the patient satisfaction of the two groups was collected using the Likert scale,and the t-test was used to compare the intraoperative autologous fat usage rate,patient satisfaction,and operation time.Difference analysis with P <0.05 was considered statistically significant.3.Including 38 patients with facial depression who came to our hospital from November 2018 to December 2019 and required facial autologous fat transplantation,the number of facial autologous fat-filled areas was greater than or equal to 2.Randomly divided into a control group(17 cases)and a test group(21 cases).The control group used the previous autologous fat transplantation method.According to the experience of the surgeon,the facial autologous fat transplantation was performed with reference to the plan shown in the display.The test group underwent facial autologous fat transplantation on the basis of wearing augmented reality glasses.Six months after surgery,the patient satisfaction of the two groups was collected using the Likert scale,and the t-test was used to compare the intraoperative autologous fat usage rate,patient satisfaction and op eration time.Difference analysis with P <0.05 was considered statistically significant.Results1.The volume of the transplanted area became smaller within 3 months after the operation,and the shape became stable after 3 months.After reconstructing the three-dimensional image of the patient's face,the volume change of each part was calculated after 3 months.In patients with pure autologous fat transplantation,the zygomatic absorption rate is(38 ± 3.5)%,the frontal absorption rate is(34 ± 5.3)%,the temporal absorption rate is(57 ± 5.2)%,and the chin absorption rate is 40 ± 4.2)%.Patients with platelet-rich plasma added autologous fat transplantation had a zygomatic absorption rate of(32 ± 4.3)%,a frontal absorption rate of(29 ± 3.2)%,a temporal absorption rate of(41 ± 2.5)%,and a lower chin The absorption rate is(34 ± 2.1)%.The absorption rate of autologous fat in each area added with platelet-rich plasma was lower than that after simple autologous fat transplantation,and the difference was statistically significant(P <0.05).Temporal autologous fat absorption rate is greater than that of other parts,the difference is statistically significant(P <0.05).2.The reconstructed model of the patient three months after the operation was compared with the preoperative model designed before the operation,and it was found that the proportion of the degree of divergence within 1 mm was 94%,which basically achieved the surgical effect.Compared with the control group half a year after surgery,the satisfaction of the plastic effect of the test group was higher than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the satisfaction of surgical complications and satisfaction of quality of life(P>0.05).The utilization rate of autologous fat in the test group(average 91%)was greater than that in the control group(average 71%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in operation time(P>0.05).Postoperative facial surgery is effective,without complications for half a year.3.The operation time of the control group was longer than that of the test group,and the difference was statistically significant(P <0.05).There was no significant difference in the utilization rate of autologous fat between the experimental group and the control group(P> 0.05).The satisfaction of the patients in the test group with the expected plastic effe ct was higher than that in the control group,and the difference was statistically significant(P <0.05).There was no significant difference in surgical complications and quality of life satisfaction(P> 0.05).Conclusions1.Natural light three-dimensional scanning technology can effectively assess the absorption rate of autologous fat on the face,and the operation is convenient,which can provide a reference for the autologous fat absorption rate of each part in the subsequent research.2.The personalized three-dimensional printing shell can provide a surgical reference for single-site facial autologous fat transplantation and improve the surgical precision.It is convenient for the surgeon to judge the amount of autologous fat injection more intuitiv ely,improve the utilization rate of autologous fat,and can improve the patient's satisfaction with the plastic effect.3.Augmented reality eyepieces can provide doctors with images of multi-part fat filling surgery in the field of view,shorten the operation time,improve the operation efficiency,and can improve the satisfaction of the plastic effect.4.Graphic scanning analysis,design,manufacturing,and augmented reality navigation technology in digital surgery technology can accurately and effectively evaluate the absorption rate after facial autologous fat transplantation,and more accurately guide the doctor to select the autologous fat filling location and filling amount. |
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