Necker Fabian N, Cholok David J, Shaheen Mohammed S, Fischer Marc J, Gifford Kyle, El Chemaly Trishia, Leuze Christoph W, Scholz Michael, Daniel Bruce L, Momeni Arash
Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, CA, USA.
Institute of Functional and Clinical Anatomy, Digital Anatomy Lab, Faculty of Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Aesthetic Plast Surg. 2025 Aug 28. doi: 10.1007/s00266-025-05167-2.
Deep Inferior Epigastric Artery perforator flaps (DIEP flaps) have become the gold standard in autologous breast reconstruction; yet they remain complex procedures due to highly individual perforator anatomy. Increasingly, computed tomography (CT) angiography is used for preoperative planning but is conventionally viewed on 2D screens in black and white. With the rise of Virtual and Mixed Reality, early case studies have demonstrated the utility of 3D-Mixed Reality headsets for DIEP flap planning by immersively exploring projections of perforator anatomy. However, thus far, only segmentation- and volume rendering-based approaches have been used clinically. These techniques lack photorealism and do not ideally depict soft-tissue or high-resolution vascular detail. We describe a new holographic photorealistic rendering workflow on Mixed Reality headsets using Cinematic Anatomy that allows more accurate depth perception and, thus, a better understanding of perforator anatomy. Using hand-gestures to interact with a hologram derived by CT angiography, the surgeon can modify the rendering in real-time and interactively dissect parts of the Rectus Abdominis Muscle to get a more nuanced understanding of the sub- and intramuscular course of the vascular tree. Using different visualization settings, the spatial relationship of perforators to surrounding anatomical structures-especially the subcutaneous tissue and the Rectus Abdominis Muscle-can be understood more intuitively. Our technique can be performed by surgeons independently with a laptop and a Microsoft HoloLens, making CT angiography data more accessible and practical for use in plastic surgery. We demonstrate the first use of photorealistic rendering in Mixed Reality to explore perforator anatomy.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
腹壁下动脉穿支皮瓣（DIEP皮瓣）已成为自体乳房重建的金标准；然而，由于穿支解剖结构高度个体化，这些手术仍然复杂。越来越多的计算机断层扫描（CT）血管造影用于术前规划，但传统上是在黑白二维屏幕上查看。随着虚拟现实和混合现实的兴起，早期案例研究表明，通过沉浸式探索穿支解剖结构的投影，三维混合现实头显在DIEP皮瓣规划中具有实用性。然而，到目前为止，临床上仅使用了基于分割和容积渲染的方法。这些技术缺乏照片般的真实感，无法理想地描绘软组织或高分辨率血管细节。我们描述了一种在混合现实头显上使用电影解剖学的新的全息照片般真实感渲染工作流程，该流程允许更准确的深度感知，从而更好地理解穿支解剖结构。通过手势与CT血管造影得出的全息图进行交互，外科医生可以实时修改渲染，并交互式解剖腹直肌的各个部分，以更细致地了解血管树在肌肉下和肌肉内的走行。使用不同的可视化设置，可以更直观地理解穿支与周围解剖结构（尤其是皮下组织和腹直肌）的空间关系。我们的技术外科医生可以使用笔记本电脑和微软HoloLens独立完成，使CT血管造影数据在整形外科中更易于获取和实用。我们展示了在混合现实中首次使用照片般真实感渲染来探索穿支解剖结构。未指定证据等级 本期刊要求作者为每篇适用循证医学排名的投稿指定证据等级。这排除了综述文章、书评以及涉及基础科学、动物研究、尸体研究和实验研究的手稿。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
