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Image-guided, stereotactic perforator flap surgery: a prospective comparison of current techniques and review of the literature

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Abstract

Background

Image-guided stereotaxy is a recent advancement in imaging technology, allowing computer guidance to aid surgical planning and accuracy. Despite the use of multiple techniques for patient registration in several surgical specialities, only fiducial marker registration has been described for use in soft tissue reconstructive surgery. The current study comprises an evaluation of the current techniques available for this purpose.

Methods

A cohort of nine consecutive patients planned for elective free flaps were recruited, with the first five patients (four for the abdominal wall and one anterolateral thigh donor site) undergoing fiducial marker registration with a variable number of fiducial markers in order to determine the optimal number of fiducial markers to be used. Four subsequent patients undergoing perforator flap surgery underwent registration using three available registration modalities: fiducial marker registration, surface matching pointer/landmark and surface matching laser registration.

Results

For the abdominal wall, registration was not able to be achieved with five fiducial markers, and was successfully achieved in all cases with either six or seven fiducial markers. For the anterolateral thigh, registration was achieved with either nine or ten markers. The four patients who also underwent surface-landmark registration and ‘Z-touch’ laser surface matching registration all failed the registration process.

Conclusion

Stereotactic navigation is a useful adjunct to the preoperative imaging of perforator flaps. Fiducial marker registration was able to be achieved in all cases, can be successfully achieved with a low and predictable number of fiducial markers, is highly accurate, and was the only reliable registration process in our experience.

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Acknowledgments

The authors are thankful to Ms Joanna Talis, Biomedical Engineer, BrainLAB; Ms Francesca Langenberg, CT Supervisor, Royal Melbourne Hospital; Dr. Ola Niewiadomski, Department of Medicine, Royal Melbourne Hospital.

Conflict of interest statement

There was no source of funding for the article. The authors declare that there is no source of financial or other support, or any financial or professional relationships which may pose a competing interest.

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Correspondence to W. M. Rozen.

Additional information

W. M. Rozen and A. Buckland are equal first authors.

Ethical Approval: Institutional Ethical Approval was obtained through Melbourne Health HREC #2006.231.

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Rozen, W.M., Buckland, A., Ashton, M.W. et al. Image-guided, stereotactic perforator flap surgery: a prospective comparison of current techniques and review of the literature. Surg Radiol Anat 31, 401–408 (2009). https://doi.org/10.1007/s00276-008-0457-8

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  • DOI: https://doi.org/10.1007/s00276-008-0457-8

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