Increasing DIEA Perforator Detail in Three-Dimensional Photorealistic Volume-Rendering Visualizations

Area of Science:

• Medical Imaging
• Surgical Reconstruction
• 3D Visualization

Background:

• Preoperative computed tomographic angiography (CTA) is crucial for perforator flap surgery.
• Traditional 2D CTA slices hinder intuitive interpretation and intraoperative correlation.
• Existing 3D volume rendering is limited by skin obstruction of vital anatomical details.

Purpose of the Study:

• To introduce a novel, user-friendly skin-masking technique for CTA.
• To enhance the visualization of perforator anatomy, particularly in deep inferior epigastric perforator flaps.
• To demonstrate the utility of free, open-source software in improving 3D anatomical understanding for surgeons.

Main Methods:

• Development of a skin-masking workflow using free, open-source software.
• Application of the mask to toggle skin visibility in 3D volume renderings of CTA data.
• Utilizing Cinematic Anatomy software for photorealistic rendering and interactive exploration.
• Virtual partial muscle dissection to visualize perforator courses.

Main Results:

• The skin-masking workflow is completed in under 5 minutes.
• Removing the skin significantly sharpens and details the view of abdominal wall anatomy and perforators.
• The technique allows for clear visualization of intramuscular and submuscular perforator courses.
• The workflow is easily adaptable to various perforator flap reconstructions.

Conclusions:

• The skin-masking technique offers a rapid and effective method to improve arterial and perforator detail in CTA volume renderings.
• This workflow enhances surgical planning and understanding of complex anatomy.
• The use of open-source software makes this advanced visualization accessible and cost-effective for surgeons.