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The Application of Augmented Reality Technology in Free Flap Reconstruction: A Systematic Review.
Thao T Wolbert1, Anna E White2, Joohee Han3
1Division of Plastic and Reconstructive Surgery, Yale University, New Haven, Connecticut, USA.
Microsurgery
|June 18, 2025
Summary
Augmented reality (AR) enhances microsurgery for free flap reconstruction by improving perforator identification and reducing operative time. While promising, more multi-center studies are needed to confirm its widespread clinical impact.
Area of Science:
- Microsurgery
- Surgical Technology
- Reconstructive Surgery
Background:
- Augmented reality (AR) is an emerging technology in microsurgery, offering superimposed preoperative imaging for enhanced anatomical insight during free flap reconstruction.
- Limited empirical evidence currently supports the effectiveness of AR in improving surgical outcomes for this procedure.
- This systematic review investigates the correlation between AR device use and improved outcomes in free flap reconstruction.
Purpose of the Study:
- To systematically review the existing literature on the use of augmented reality (AR) in free flap reconstruction.
- To evaluate the impact of AR technology on surgical outcomes, including accuracy, efficiency, and complications.
- To compare AR-assisted techniques with traditional methods and other navigation systems.
Main Methods:
- A comprehensive systematic search of PubMed, Embase, and Scopus was conducted up to February 19, 2025.
- Included studies involved intraoperative AR use in any free flap reconstruction with reported surgical outcomes.
- Eight articles were selected from an initial 158 for review of technical accuracy, usability, operative time, complications, and costs.
Main Results:
- AR improves surgeon confidence and efficiency, especially for less experienced surgeons, by enhancing perforator identification accuracy compared to Doppler ultrasound.
- AR significantly reduces flap harvesting time compared to traditional techniques and demonstrates greater accuracy and efficiency than CAD/CAM navigation systems.
- AR devices offer advantages over cutting guides, including cost savings, reduced preparation time, increased flexibility, and improved hand-eye coordination, with no reported conclusive postoperative complications.
Conclusions:
- Current literature on AR in free flap surgery primarily consists of small clinical studies.
- Widespread, multi-center studies are essential to definitively establish the clinical impact and benefits of AR technology in microsurgery.
- Further research is needed to validate the findings and guide the broader adoption of AR in reconstructive procedures.
