Pushing the Limits in Extremity Reconstruction Using Virtual Surgical Planning: A Case Series Study

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Medical Imaging

Background:

• Preoperative planning is crucial for successful reconstructive surgery.
• Virtual surgical planning (VSP) has advanced craniomaxillofacial surgery.
• Limited data exists on VSP for extremity reconstruction.

Purpose of the Study:

• To evaluate the utility of VSP with 3D imaging for complex extremity defect reconstruction.
• To assess the use of free, open-source software for VSP in microsurgery.
• To explore the application of VSP in challenging upper and lower extremity reconstructions.

Main Methods:

• Utilized computed tomography angiography (CTA) for VSP.
• Employed Horos software (free, open-source) for 3D image analysis.
• Reconstructed ten extremities (2 upper, 8 lower) using free flaps.

Main Results:

• Successfully reconstructed complex extremity defects in all ten cases.
• Six cases involved multiple defects; four required reconstruction of diverse tissue components.
• Achieved uneventful postoperative periods with no flap failures.

Conclusions:

• Virtual surgical planning is a powerful method for complex extremity defect reconstruction.
• The study demonstrates the efficacy of VSP using 3D imaging and open-source software.
• Authors advocate for the adoption of VSP in challenging extremity microsurgical cases.