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Computerized Surgical Planning. 计算机化手术规划。
IF 2.3 3区 医学 Q2 SURGERY Pub Date : 2024-08-07 eCollection Date: 2024-08-01 DOI: 10.1055/s-0044-1786985
Michael Alperovich
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引用次数: 0
Computer-Assisted Surgery in Mandible Reconstruction 下颌骨重建中的计算机辅助手术
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-27 DOI: 10.1055/s-0044-1786805
Farooq Shahzad

Computer-assisted surgery is the most significant recent advancement in osseous head and neck reconstruction. Computer-aided design (CAD) software allows computerized planning of resection and reconstruction. Computer-aided manufacturing (CAM) can be used to create models, cutting guides, and patient-specific plates. Several studies have shown that these techniques are more accurate and result in decreased flap ischemia times compared with conventional techniques. CAD also facilitates the immediate placement of dental implants. The most useful application of computer-assisted surgery is delayed reconstruction, in which soft tissue contraction and the absence of a specimen as a reference make accurate estimation of the defect challenging. The drawbacks of CAD/CAM are lack of intraoperative flexibility and cost. Some centers have created in-house CAD/CAM processes using open-source software and commercially available three-dimensional printers.

计算机辅助手术是头颈部骨性重建的最新进展。计算机辅助设计(CAD)软件可对切除和重建进行计算机规划。计算机辅助制造(CAM)可用于创建模型、切割导板和患者专用板。多项研究表明,与传统技术相比,这些技术更加精确,并能缩短皮瓣缺血时间。计算机辅助设计(CAD)还有助于立即植入牙科种植体。计算机辅助手术最有用的应用是延迟重建,在这种情况下,由于软组织收缩和没有标本作为参照物,准确估计缺损情况具有挑战性。CAD/CAM 的缺点是缺乏术中灵活性和成本高。一些中心利用开源软件和市面上的三维打印机创建了内部 CAD/CAM 流程。
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引用次数: 0
Computerized Surgical Planning in Face Transplantation 计算机化面部移植手术规划
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-27 DOI: 10.1055/s-0044-1786991
Alay Shah, Sachin Chinta, Eduardo D. Rodriguez

Face transplantation (FT) has emerged as a critical intervention for patients with complex facial deformities unsuitable for conventional reconstructive methods. It aims to restore essential functions such as facial expression, mastication, and speech, while also improving psychosocial health. The procedure utilizes various surgical principles, addressing unique challenges of craniofacial complexity and diverse injury patterns. The integration of Computerized Surgical Planning (CSP) leverages computer-aided technologies to enhance preoperative strategy, intraoperative navigation, and postoperative assessment. CSP utilizes three-dimensional computed tomography, printing, angiography, and navigation systems, enabling surgeons to anticipate challenges and reduce intraoperative trial and error. Through four clinical cases, including a groundbreaking combined face and bilateral hand transplant, CSP's role in FT is highlighted by its ability to streamline operative processes and minimize surgical revisions. The adoption of CSP has led to fewer cadaveric rehearsals, heightened operative precision, and greater alignment with preoperative plans. Despite CSP's advancements, it remains complementary to, rather than a replacement for, clinical expertise. The demand for technological resources and multidisciplinary teamwork is high, but the improved surgical outcomes and patient quality of life affirm CSP's value in FT. The technology has become a staple in reconstructive surgery, signaling a step forward in the evolution of complex surgical interventions.

面部移植(FT)已成为对不适合采用传统重建方法的复杂面部畸形患者的重要干预手段。其目的是恢复面部表情、咀嚼和语言等基本功能,同时改善社会心理健康。该手术利用各种手术原则,应对颅面复杂性和不同损伤模式带来的独特挑战。计算机化手术规划(Computerized Surgical Planning,CSP)利用计算机辅助技术加强术前策略、术中导航和术后评估。CSP 利用三维计算机断层扫描、打印、血管造影和导航系统,使外科医生能够预测挑战并减少术中试验和错误。通过四例临床病例(包括一项开创性的面部和双侧手部联合移植手术),CSP 在 FT 中的作用突出表现在其简化手术流程和最大限度减少手术修改的能力上。CSP 的采用减少了尸体演练次数,提高了手术精确度,并使手术更符合术前计划。尽管 CSP 取得了进步,但它仍然是临床专业知识的补充,而不是替代。对技术资源和多学科团队合作的要求很高,但手术效果和患者生活质量的提高肯定了 CSP 在创伤外科领域的价值。该技术已成为整形外科的主要技术,标志着复杂外科干预技术的发展又向前迈进了一步。
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引用次数: 0
Jong O. Lee, MD, FACS, FCCM, FABA. Jong O. Lee, MD, FACS, FCCM, FABA.
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-13 eCollection Date: 2024-05-01 DOI: 10.1055/s-0044-1786010
Edward P Buchanan
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引用次数: 0
Computerized Surgical Planning for Mandibular Distraction Osteogenesis 下颌骨牵引成骨的计算机化手术规划
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-13 DOI: 10.1055/s-0044-1786757
Kevin G. Hu, Ali Aral, Albert Rancu, Michael Alperovich

Mandibular distraction osteogenesis is a technically challenging procedure due to complex mandibular anatomy, especially in the treatment of Pierre-Robin Sequence due to variable bone thickness in the infant mandible and the presence of tooth buds. Computerized surgical planning (CSP) simplifies the procedure by preoperatively visualizing critical structures, producing cutting guides, and planning distractor placement. This paper describes the process of using CSP to plan mandibular distraction osteogenesis, including discussion of recent advances in the use of custom distractors.

由于下颌骨解剖结构复杂,特别是在治疗皮埃尔-罗宾序列(Pierre-Robin Sequence)时,由于婴儿下颌骨骨厚度不一且存在牙芽,下颌骨牵张成骨术是一项具有技术挑战性的手术。计算机化手术规划(CSP)通过术前可视化关键结构、制作切割导板和规划牵引器的放置,简化了手术过程。本文介绍了使用 CSP 规划下颌骨牵引成骨的过程,包括讨论了使用定制牵引器的最新进展。
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引用次数: 0
Pediatric Burn Care. 小儿烧伤护理。
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-13 eCollection Date: 2024-05-01 DOI: 10.1055/s-0044-1786011
Jong O Lee
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引用次数: 0
Application of Computerized Surgical Planning in Craniosynostosis Surgery 计算机化手术规划在颅颧骨整形手术中的应用
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-13 DOI: 10.1055/s-0044-1786803
Neil Parikh, Ali Aral, Katelyn Lewis, Michael Alperovich

Craniosynostosis, a medical condition characterized by premature fusion of one or multiple cranial sutures, has historically been treated through surgical correction. Computerized Surgical Planning (CSP) and three-dimensional (3D) modeling have gained significant popularity across craniofacial surgery. Through a collaborative effort between surgeons and engineers, it is now possible to virtually execute a surgical plan based on preoperative imaging using computed tomography scans. The CSP workflow involves several elements including virtual 3D modeling, CSP computer-aided surgical guide design, manufacturing of guides and templates, and intraoperative implementation. Through the gradual optimization of this workflow, it has been possible to achieve significant progress in the surgical process including improvements in the preoperative planning of complex craniosynostosis cases and reduction of intraoperative time. Furthermore, CSP and 3D modeling have had a positive impact on surgical simulation and residency training, along with patient education and counseling. This article summarizes the CSP workflow in the treatment of craniosynostosis and the implications of this treatment modality on medical trainee education and patient management.

颅颧骨发育不良是一种以一条或多条颅缝过早融合为特征的病症,历来通过手术矫正进行治疗。计算机化手术规划(CSP)和三维(3D)建模在颅颌面外科领域大受欢迎。通过外科医生和工程师的通力合作,现在可以根据计算机断层扫描的术前成像虚拟执行手术计划。CSP 工作流程涉及多个要素,包括虚拟 3D 建模、CSP 计算机辅助手术导板设计、导板和模板制造以及术中实施。通过对这一工作流程的逐步优化,手术过程取得了重大进展,包括改进了复杂颅骨发育不良病例的术前规划,缩短了术中时间。此外,CSP 和三维建模还对手术模拟和住院医师培训以及患者教育和咨询产生了积极影响。本文总结了治疗颅颧骨发育不良的 CSP 工作流程,以及这种治疗方式对医学学员教育和患者管理的影响。
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引用次数: 0
Computerized Surgical Planning in Gender Affirming Facial Surgery 性别平权面部手术中的计算机化手术规划
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-05-13 DOI: 10.1055/s-0044-1786804
Jacqueline M. Ihnat, Ali Aral, Thayer Mukherjee, Michael Alperovich

Computerized Surgical Planning (CSP) is a surgical tool that enables precise bony changes through the creation of custom cutting guides and/or custom plates. CSP has been shown to be a safe and effective tool in gender affirming facial surgery as well, specifically with regard to frontal sinus setback, zygomatic remodeling, genioplasty, and mandibular angle and body reshaping. CSP aids in trainee education, improves symmetry, reduces operative time, and can produce idealized results during complex revisions. Overall, CSP is a valuable tool in the field of gender affirming facial surgery that helps surgeons achieve optimal aesthetic and safety outcomes for patients.

计算机化手术规划(CSP)是一种手术工具,通过创建定制的切割导板和/或定制板来实现精确的骨性改变。CSP 已被证明是一种安全有效的面部性别平权手术工具,特别是在额窦后移、颧骨重塑、股骨头成形术以及下颌角和下颌体重塑方面。CSP 有助于对受训者进行教育,改善对称性,缩短手术时间,并能在复杂的翻修手术中获得理想的效果。总之,CSP 是性别平权面部手术领域的重要工具,可帮助外科医生为患者实现最佳的美学和安全效果。
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引用次数: 0
Airway Management for Acute and Reconstructive Burns: Our 30-year Experience 急性和整形烧伤的气道管理:我们 30 年的经验
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-04-26 DOI: 10.1055/s-0044-1786008
Brita M. Mittal, Robert A. McQuitty, Mark Talon, Alexis L. McQuitty

Airway management in both acute and reconstructive burn patients can be a major challenge for evaluation, intubation, and securing the airway in the setting of altered airway structure. Airway evaluation in both acute and reconstructive patients includes examination for evidence of laryngeal and supraglottic edema and structural changes due to trauma and/or scarring that will impact the successful approach to acquiring an airway for surgical procedures and medical recovery. The approach to acquiring a successful airway is rarely standard laryngoscopy and often requires fiberoptic bronchoscopy and a variety of airway manipulation techniques. Tracheostomy should be reserved for those with classic requirements of ventilatory and/or mechanical failure or severe upper airway burns. Even securing an airway for surgical procedures, especially with patients suffering injuries involving the head and neck, can be nonstandard and requires creative and flexible approaches to be successful. After much trial and error over the past 30 years in a large burn center, our multidisciplinary team has learned many valuable lessons. This review will focus on our current approach to safe airway management in acute and reconstructive burn patients.

在气道结构发生变化的情况下,急性烧伤和烧伤后重建患者的气道管理对于气道评估、插管和气道固定都是一大挑战。对急性期和重建期患者的气道评估包括检查喉部和声门上水肿的证据,以及因创伤和/或疤痕而导致的结构变化,这些变化将影响手术和医疗恢复过程中获得气道的成功方法。获得成功气道的方法很少是标准喉镜检查,通常需要纤维支气管镜检查和各种气道操作技术。气管切开术应保留给那些有典型通气和/或机械衰竭要求或严重上气道烧伤的患者。即使是外科手术中的气道保护,尤其是头颈部受伤的患者,也可能是非标准的,需要创造性和灵活的方法才能成功。在大型烧伤中心工作的 30 年里,我们的多学科团队经过反复试验,总结出了许多宝贵的经验。本综述将重点介绍我们目前对急性和整形烧伤患者进行安全气道管理的方法。
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引用次数: 0
Pediatric Facial Burn Reconstruction 小儿面部烧伤重建
IF 2 3区 医学 Q2 SURGERY Pub Date : 2024-04-26 DOI: 10.1055/s-0044-1786009
Tina Moon, Daniel N. Driscoll

Contrary to prior pediatric burn treatment philosophies, we now know that early burn excision and grafting for non life-threatening burns can compromise future reconstruction. Extensive scar excision should be minimized and scar rehabilitation maximized, as secondary iatrogenic deformities can become even more difficult to fix. Scar remodeling with local tissue rearrangement can relieve tension and soften scars over time. The majority of facial burns often only involve skin and can be adequately treated without the need for complex flap reconstruction. Facial burn scars are a different problem than facial burn scar contracture. The former needs scar rehabilitation, whereas the latter needs the addition of skin. Laser therapy has transformed the treatment of burn scars and is an incredibly valuable adjunct to local tissue rearrangement and grafting. The most favorable functional, aesthetic, and psychological outcomes require a long-term multidisciplinary effort and customized protocol utilizing the vast armamentarium of reconstructive tools described below.

与之前的小儿烧伤治疗理念相反,我们现在知道,对无生命危险的烧伤进行早期烧伤切除和移植可能会影响未来的重建。应尽量减少大面积的疤痕切除,最大限度地进行疤痕康复,因为继发的先天性畸形会变得更加难以修复。通过局部组织重新排列进行疤痕重塑可以缓解张力,并随着时间的推移软化疤痕。大多数面部烧伤通常只涉及皮肤,无需进行复杂的皮瓣重建,即可得到充分治疗。面部烧伤疤痕与面部烧伤疤痕挛缩是两个不同的问题。前者需要疤痕修复,而后者需要增加皮肤。激光疗法改变了烧伤疤痕的治疗方法,是局部组织重新排列和移植的重要辅助手段。要想获得最理想的功能、美学和心理效果,就需要多学科的长期合作,并利用下文介绍的各种重建工具,制定个性化方案。
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Seminars in Plastic Surgery
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