A Novel Approach to Surgical Markings Based on a Topographical Map and a Projected 3D Hologram

Purpose

Surgical markings play an important role in planning most plastic surgery procedures. However, these drawings are largely subjective. Here we describe an objective computer-generated roadmap to guide facial lipostructure, whereby a digital 3D topographical surgical map is projected onto the patient during surgery.

Methods

Patients undergoing autologous fat grafting for facial asymmetry had pre-operative 3D photographs taken using the handheld VECTRA¨ H1 (Canfieldİ 2013). Facial asymmetry was analyzed by bisecting the 3D model into two distinct hemi-faces. The reference hemi-face was reflected onto the deficient side, creating a new hemi-composite, which served as the reference 3D surface. (Figure 1) Using the overlay function on Canfield VECTRA¨ Analysis Module (VAM) software, a color map was generated which outlined the projection differences between the two surfaces. To create the topographic map, tracings were made at 2mm projection intervals and uploaded onto an iPhone 5s¨ and projected using a hand-held LED Pocket Projector (axaa Technologies, USA). Colored marking pens assigned to specific projection values were used to trace the map on the patients. (Figure 2).

Results

Fat was injected according to the region and degree of deficiency as indicated on the topographic map, beginning centrally in the most deficient regions. Furthermore, the map was projected onto the patient intra-operatively for guidance.  By referencing markings generated by computer analysis and surgical simulation, the surgeon had access to a soft tissue surgical plan that precisely describes the relevant anatomy and highlights areas not appreciated on physical exam.

 

Conclusion

Rather than relying surgeon assessment alone, we applied 3D scanning technology to perform an objective symmetry analysis and then translated this virtual plan to the OR. Topographic maps are a simplified translation of the complex three-dimensional facial contour. They provide an easy-to-follow guide tailored to the patient's unique volume needs which are often not appreciated on standard 2D photographs. The value of this technology and its applications in other aspects of plastic surgery has yet to be explored, but offers great potential.

 

 

Legend:

Figure 1. Creating the hemi-composite from reflection of non-deficient hemiface.

Figure 2. Projection of topographic map and transfer to the patient for intra-operative guidance.

Figure 1.

Figure 2.