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Changing the face of surgery

Plastic Surgery Research Team

The research team at Peninsula Health has made advances, which include using 3D printing and augmented reality, to help surgeons better understand the anatomy of blood vessels in reconstructive flaps before and during surgery.

The Plastic Surgery team at Peninsula Health is breaking new ground in reconstructive and trauma surgery, after more than a decade of dedicated and innovative research to improve the patient and surgeon experience.

“Due to some of the significant successes we have enjoyed, we can now plan operations before we undertake them, so that it’s safer surgery, it’s quicker surgery and it’s less stress for the surgeon intra-operatively,” says Professor Warren Rozen, Plastic and Reconstructive Surgeon at Peninsula Health.

The team is now working on bringing augmented reality into the operating room.

“The use of augmented reality is absolutely hot off the press,” says Warren.

“Dr Ratchna Ram is starting a PhD with us and she is going to be taking this technology we’ve developed into the augmented and virtual reality sphere.”

“We’re going to be able to use augmented reality to look at the scan data projected onto the patient,” he adds. “This will be 3D-guided surgery.”

The introduction of 3D printing has enabled Professor Rozen, Associate Professor David Hunter-Smith and the research team to learn even more about the blood vessels.

The research team at Peninsula Health has made advances, which include using 3D printing and augmented reality to help surgeons better understand the anatomy of blood vessels in reconstructive flaps before and during surgery

“Dr Michael Chae introduced 3D printing and other 3D software techniques to further help surgeons pre-operatively as part of his PhD,” says Warren. “Before surgery, we do a scan using some of the protocol I worked on in my PhD, and now with Dr Chae’s research work, we can also do a 3D print of these tiny blood vessels. That allows us to create a template to use intraoperatively for surgeons to use that anatomy.”

Another significant advancement made by the plastic surgery team is a project led by Dr Rachael Leung, which has quantitatively described the anatomy of blood vessels.

“Whereas previously we looked for individual anatomy, Dr Leung has actually given us a targeted understanding of the general anatomy of people’s blood vessels,” explains Warren.

“What Dr Leung is doing, together with student Jessica Paynter, is looking at the vascular anatomy and comparing it to the surrounding muscles and other aspects of surrounding anatomy, so that we can describe this anatomy even further.”

Professor Rozen says the collaborative research group at Frankston deserves significant accolades, having progressed so far in the last decade, especially in reconstructive procedures.

“In plastic surgery, we plan our reconstructive flaps on the blood supply to tissues. We need to know what the anatomy of the blood vessels is for each individual person, so we can base our reconstructive flaps on that anatomy.”

“In the past, the main operation for breast reconstruction required surgeons to take skin, fat and muscles from the abdominal wall to give it a blood supply,” he adds.

“Now that we know what the blood supply is, we can trace smaller vessels and not take the muscle,” continues Warren. “So we can now improve the donor site of where we get the tissue from to make a breast, meaning that we can reconstruct the breast to leave women with their rectus abdominus muscles.”

Professor Rozen developed imaging technologies to look at these blood vessels as part of his PhD 10 years ago.

Since then, the research team at Peninsula Health has made further advances, which include using 3D printing and augmented reality to help surgeons better understand the anatomy of blood vessels in reconstructive flaps before and during surgery.

“For my research, I used CT angiography, manipulated computer software and the scanning protocol so that we were able to see increasingly small blood vessels,” explains Warren.

“This was a technology that didn’t really exist, and it wasn’t used clinically in this setting before. By the end of my PhD, it was introduced internationally and became the mainstay of investigations before surgery.”

“These breakthroughs by our current students are all branches of the one project, and we are developing this technology that is making a significant difference to surgeons and patients.”

Reconstructive flaps:

+ One of the most common uses of reconstructive flaps is in breast reconstruction

+ Flaps are also used in cancer reconstruction surgery and to fix traumatic defects

This article was first published in the 2018 Research Report. Read the full edition online here.