Surgeon-Generated Reconstructed Three-Dimensional Tomography Images Improve Surgical Outcomes on Deep Soft Tissue Lesions

Abstract

Background: Recent advances in three-dimensional (3D) reconstruction of tomographic imaging have rarely been applied to wound management and soft tissue-related diseases due to the nature of imaging modality hindering automatic segmentation of the region of interest (ROI). The authors created 3D images of soft tissue lesions using open-source software and evaluated their usefulness through four clinical cases.Methods: Patients with wounds or soft tissue lesions underwent enhanced tomography. The surgeon manually segmented the ROIs and reconstructed them using 3D Slicer. The reconstructed images were overlaid on an anatomy plate or clinical pictures for clinical application. The authors conducted hands-on training and surveyed the participants before and after the course to evaluate clinical applicability and efficacy.Results: Nine plastic surgeons were enrolled. After training, their perception of applying 3D imaging on deep pus pocket drainage, foreign body removal, and deep-located lesion biopsy remained unchanged. However, their response significantly changed from likely to very likely in whether 3D reconstruction imaging of deep soft tissue lesions would help improve the surgical outcome. They answered positively in their recommendation of 3D reconstruction and its application to clinical practice. However, they responded neutrally to whether it was easy to learn. This method was found most useful for deep lesion excision planning, followed by drainage of deep concealed pus pockets, foreign body removal, and biopsies of lesions difficult to localize.Conclusion: Surgeon-generated 3D reconstruction of wounds and soft tissue lesions using open-source software can aid clinical practice, significantly improving surgical outcomes in deep soft tissue lesions.