Walker Maxwell W, Kaoutzanis Christodoulos, Jacobson Nicholas M
School of Engineering, Computation, and Design - Inworks Innovation Initiative, University of Colorado Anschutz Medical Campus, Aurora, USA.
Anschutz Medical Campus; School of Medicine; Plastic Surgery, UCHealth University of Colorado Hospital, Aurora, USA.
3D Print Med. 2023 Dec 19;9(1):35. doi: 10.1186/s41205-023-00200-z.
Phalloplasty procedures are performed to create a phallus, typically as a gender-affirming surgery for treating gender dysphoria. Due to the controversial nature of this specific procedure, more innovation is needed to directly assist surgical teams in this field. As a result, surgeons are left to improvise and adapt tools created for other procedures to improve surgical outcomes. This study developed a patient-specific 3D printed model from segmented computed tomography (CT) scans to accurately represent the relevant vasculature necessary for anterolateral thigh (ALT) flap phalloplasty. The surgical procedure seeks to maintain intact vessels that derive from the descending branch of the lateral circumflex femoral artery, typically found traveling within the intermuscular septum between the rectus femoris and vastus lateralis.
In this study, we created and printed 3D models of the leg and vasculature using two techniques: (1) a standard segmentation technique with the addition of a reference grid and (2) a bitmap method in which the total CT volume is colorized and printed.
The results gathered included the physician's view on the model's accuracy and visualization of relevant anatomy. Bitmap-printed models resulted in a high amount of detail, eliciting surgeons' undesirable reactions due to the excess of information. The hybrid method produced favorable results, indicating positive feasibility.
This study tested the ability to accurately print a patient-specific 3D model that could represent the vasculature necessary for ALT flap procedures and potentially be used in surgical reference and planning in the future. A surgeon performing phalloplasty procedures discussed their approval of both models and their preference for grid creation and application.
阴茎成形术用于构建阴茎，通常作为治疗性别焦虑症的性别确认手术。由于该特定手术具有争议性，需要更多创新来直接协助该领域的手术团队。因此，外科医生只能临时拼凑并改造为其他手术设计的工具，以改善手术效果。本研究通过对计算机断层扫描（CT）图像进行分割，开发了一种针对患者的3D打印模型，以精确呈现股前外侧（ALT）皮瓣阴茎成形术所需的相关血管系统。该手术旨在保留源自旋股外侧动脉降支的完整血管，这些血管通常走行于股直肌和股外侧肌之间的肌间隔内。
在本研究中，我们使用两种技术创建并打印腿部及血管系统的3D模型：（1）添加参考网格的标准分割技术；（2）对整个CT容积进行彩色处理并打印的位图方法。
收集的结果包括医生对模型准确性及相关解剖结构可视化程度的看法。位图打印模型细节过多，因信息量过大引发了外科医生的不良反应。混合方法产生了良好的结果，表明具有积极的可行性。
本研究测试了精确打印针对患者的3D模型的能力，该模型可呈现ALT皮瓣手术所需的血管系统，并可能在未来用于手术参考和规划。一位进行阴茎成形术的外科医生讨论了他们对两种模型的认可，以及对网格创建和应用的偏好。
