PLASTIC SURGERY By Dr VS Gorantla & Dr DM Smith Integrated 3-D Imaging facilitates
human face transplantation The goal of facial transplant surgery is to restore facial form and function in patients with devastating injuries to the face. Combining multiple imaging exams with computer modeling may improve surgical planning and aid in monitoring outcomes of human face transplantation. 3-D modeling offers crit- ical insight into structural relationships among different facial tissues, such as skin, muscle, blood vessels and bone.
Results of a new study on human face transplantation, led by Darren M. Smith, M.D., plastic surgery resident at the University of Pittsburgh Medical Center (UPMC), were pre- sented at last year’s annual meeting of the Radiological Soci- ety of North America (RSNA). Devastating injuries or defects of the face are extremely
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challenging, if not impossible, to satisfactorily reconstruct by traditional surgical techniques. In face transplantation, facial tissue from a donor is transferred to reconstruct the defect, restore essential life-sustaining functions—such as breathing, chewing and speaking—and, above all, reestablish normal human appearance. Clearly defining and understanding the complex tissue
deficits and defects that accompany devastating facial inju- ries like electric burns, blast wounds and accidental trauma are critical for both technical success and objective analysis of the return of function after face transplantation. Medical imaging plays a major role in the entire spectrum
of face transplantation, ranging from patient selection, donor and recipient surgical planning, and postoperative assess- ment of returning motor and sensory function. Face trans- plantation is a lengthy, complicated procedure that involves reconstruction of multiple tissues—such as skin, muscle, blood vessels, nerves and bone—by a team of surgeons. Currently, to prepare for facial transplantation, plastic or
plaster models are first created based on 3-D CT or angio- graphic images or reconstruction. Following this, mock cadav- eric dissections are performed to allow surgeons to plan for the donor and recipient surgeries. MRI and other imaging exams may also be used to provide supplemental information. By combining information from multiple imaging exams and creating a sophisticated 3-D computer model, the
Dr VS Gorantla and Dr DM Smith are at the Reconstructive Transplantation Program University of Pittsburgh Medical Center. Pittsburgh, PA, USA.
APRIL/MAY 2012
Using sophisticated computer modeling software, information from 3-D CT, CT angiography, MRI and high-definition tractography are used to create a 3-D model of the patient’s head and neck anatomy.
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y combining conventional medical imaging with some of the same 3-D modeling techniques used in Hollywood blockbusters, researchers are offer- ing new hope to victims of serious facial injuries.
researchers for this study were better able to assess the facial structure and contours, the underlying bone, muscles, nerves and vessels, as well as the extent of damage. Using sophisticated computer modeling software, Drs.
Smith and Gorantla, integrated information from 3-D CT, CT angiography, MRI and high-definition tractography to create a 3-D model of the patient’s head and neck anatomy. The same type of modeling technology is often used in mov- ies to animate computer-generated characters with detailed three-dimensional human features and realistic expressions. “We have integrated data from multiple imaging sources
into a single 3-D representation that allows for real-time user interaction and modification,” Dr. Smith said. “In assess- ing eligibility for this procedure, it is critical to understand whether the patient has enough blood vessels and bone structure to support new facial tissue. This 3-D modeling helps us customize the procedure to the patient’s individual anatomy so that the donor tissue will fit like a puzzle piece onto the patient’s face.” Using computer modeling, the team also overlaid the
patient model with a polygon mesh of a generic human face and then customized it to the recipient facial anatomy. Dr. Smith said the ability to manipulate this 3-D facial envelope over the residual face model allows the entire surgical team to participate in planning exactly where bone, blood vessel and nerves will be cut and connected, as well as to evaluate the outcomes of reconstructive transplantation, including nerve regeneration within the transplanted facial tissue.
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