Abstract
Background: In the second of a two-part series, we evaluate emerging three-dimensional (3D) imaging and printing techniques based on computed tomography angiography (CT) and magnetic resonance angiography (MRA) for use in plastic and reconstructive surgery.
 Method: A review of the published English literature dating from 1950 to 2017 was taken using databases such as PubMed, MEDLINE®, Web of Science and EMBASE.
 Results: Image-guided navigation systems using fiducial markers have demonstrated utility in numerous surgical disciplines, including perforator-based flap surgery. However, these systems have largely been superseded by augmented reality (AR) and virtual reality (VR) technologies with superior convenience and speed. With the added benefit of tactile feedback, holograms also appear promising but have yet to be developed beyond the prototypic stage. Aided by a growing volume of digitalised clinical data, machine learning (ML) poses significant benefits for future image-based decision-making processes.
 Conclusion: Most studies of image-guided navigation systems, AR, VR, holograms and ML have been presented in small case series and they remain to be analysed using outcomes-based validation studies. However, together they illustrate an exciting future where clinicians will be armed with intuitive technologies for surgical planning and guidance.
Highlights
Recent technological advances have led to the use of image-guided navigation systems, augmented reality (AR), virtual reality (VR), holograms and machine learning (ML) in surgical planning
Rozen et al demonstrated that registration systems using fiducial markers—six to seven in deep inferior epigastric artery perforator (DIEP) and nine to 10 in anterolateral thigh (ALT) flaps—are reliable for viewing computed tomography angiography (CTA)-derived perforator anatomy.[23,24,25,26]
Most studies of image-guided navigation systems, AR, VR, holograms and ML have been presented in small case series and they remain to be analysed using outcomes-based validation studies
Summary
A plethora of imaging modalities has been used in plastic and reconstructive surgery to aid preoperative planning, intraoperative guidance and medical education.[1,2] Conventional tomographic imaging modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) remain relatively affordable and commonly accessible.[3,4,5,6,7,8] As a result, clinicians have investigated novel technologies to expand their use such as image-guided navigation systems, augmented reality (AR), virtual reality (VR), holograms and machine learning (ML). In the second of a two-part series, we evaluate emerging 3D imaging and printing techniques based on CTA and MRI. In the second of a two-part series, we evaluate emerging three-dimensional (3D) imaging and printing techniques based on computed tomography angiography (CT) and magnetic resonance angiography (MRA) for use in plastic and reconstructive surgery
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