Patete Paolo, Rigotti Gino, Marchi Alessandra, Baroni Guido
Department of Bioengineering, Politecnico di Milano, Milan, Italy.
Comput Aided Surg. 2013;18(1-2):10-8. doi: 10.3109/10929088.2012.745169. Epub 2012 Dec 20.
Autologous fat grafting is an emerging and promising surgical technique in regenerative medicine, and its application is quickly spreading in plastic and reconstructive surgery of the breast. However, despite the advantages of the technique, surgical complications may occur, such as implanted tissue necrosis and resorption and onset of microcalcifications. In view of the hypothesis that the uniformity of the lipoaspirate transplantation is related to graft survival and a lower probability of complications, we developed an interactive lipomodeling planning software application based on a genetic algorithm that allows automatic optimization of the uniformity of fat tissue distribution. The input dataset consists of a 3D model of the patient's thorax, created from MRI scans, on which relevant structures are segmented. The developed software was tested starting from either an automatically generated plan or an initial guess of the optimal surgical plan, and in both cases the application yielded a consistent improvement in the planned fat tissue distribution by optimizing the position of the insertion points and the direction of the insertion pathways. On the basis of the simulations performed, the use of genetic algorithms for optimization of the geometry of autologous fat transfer in the breast proved to be effective. These results will foster further activities focused on the comparison of predicted optimized geometries and those obtained in real surgical cases as a means of obtaining a deeper knowledge of the potential influence of a uniform fat tissue distribution on the quality of the surgical outcome. The presented application is also put forward as representing a noteworthy step towards the clinical application of computer assisted planning tools in breast surgery.
自体脂肪移植是再生医学中一种新兴且有前景的外科技术，其应用正在乳房整形与重建手术中迅速普及。然而，尽管该技术具有诸多优势，但仍可能出现手术并发症，如植入组织坏死、吸收以及微钙化的发生。鉴于抽脂物移植的均匀性与移植存活率及较低并发症发生率相关这一假设，我们基于遗传算法开发了一款交互式脂肪建模规划软件应用程序，该程序可自动优化脂肪组织分布的均匀性。输入数据集包括由MRI扫描创建的患者胸部3D模型，相关结构已在该模型上进行了分割。所开发的软件从自动生成的计划或最佳手术计划的初始猜测开始进行测试，在这两种情况下，该应用程序通过优化插入点的位置和插入路径的方向，使计划的脂肪组织分布得到了持续改善。基于所进行的模拟，事实证明使用遗传算法优化乳房自体脂肪移植的几何形状是有效的。这些结果将推动进一步的活动，重点是比较预测的优化几何形状与实际手术案例中获得的几何形状，以此深入了解均匀脂肪组织分布对外科手术结果质量的潜在影响。所展示的应用程序也被视为朝着在乳房手术中临床应用计算机辅助规划工具迈出的重要一步。
