title: The virtual reality tool VirSSPA in planning DIEP microsurgical breast reconstruction.
abstract: BACKGROUND
  The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a DIEP (deep inferior epigastric artery perforator) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Variability in perforator anatomy makes DIEP flap surgery a suitable candidate for computer and virtual reality bio models. In this context, a study was undertaken to determine the feasibility of CTA-guided by VirSSPA application. VirSSPA is a virtual reality tool developed in our Hospital for surgical planning and training. This application allows surgeons to generate the three-dimensional (3D) model of the patient.
  
  
  OBJECTIVE
  In this paper, we present a study about VirSSPA tool for virtual reality navigation in DIEP flap surgery and compare findings with operative measurements.
  
  
  METHODS
  We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared to operative findings.
  
  
  RESULTS
  3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared to operative findings, showing an average error rate of 0.228 cm (95% CI, 0.17-0.30). The Pearson product-moment correlation coefficient was found to be 0.99 (p = 0.01), reflecting an almost linear relationship between the two distances, intraoperative and the one measured in the 3D reconstruction.
  
  
  CONCLUSIONS
  VirSSPA provides additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle for DIEP micro-vascular surgery.
authors.affiliation: Unidad de Gestión Clínica de Cirugía Plástica y Reconstructiva y Unidad de Quemados, Hospitales Universitarios Virgen del Rocío de Sevilla, Avda Manuel Siurot, Seville, Spain. tomas.gomez.sspa@juntadeandalucia.es
authors.forename: T
authors.initials: T
authors.lastname: Gómez-Cía
authors.forename: P
authors.initials: P
authors.lastname: Gacto-Sánchez
authors.forename: D
authors.initials: D
authors.lastname: Sicilia
authors.forename: C
authors.initials: C
authors.lastname: Suárez
authors.forename: B
authors.initials: B
authors.lastname: Acha
authors.forename: C
authors.initials: C
authors.lastname: Serrano
authors.forename: C
authors.initials: C
authors.lastname: Parra
authors.forename: J
authors.initials: J
authors.lastname: De La Higuera
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface