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. 2020 Jul 13;9(7):2211.
doi: 10.3390/jcm9072211.

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap

Salvatore Battaglia  1 , Stefano Ratti  2 , Lucia Manzoli  2 , Claudio Marchetti  1 , Laura Cercenelli  3 , Emanuela Marcelli  3 , Achille Tarsitano  1 , Alessandra Ruggeri  2
Affiliations

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap

Salvatore Battaglia et al. J Clin Med. .

Abstract

Head and neck reconstructive surgeons have recently explored new perspectives in bone restoration using periosteum carrier flaps. Following this idea, we explored the possibility of harvesting a galeo-pericranial flap. The present work studies the vascular supply of the pericranial temporo-parietal region in order to assess the possibility of harvesting a galeo-pericranial flap based on the superficial temporalis vascularization. Anatomical dissections were performed at the Anatomical Institute of the University of Bologna on eight donor cadavers. Then we performed the harvesting of the flap in vivo on eight patients. We introduced augmented reality (AR) to facilitate anatomical visualisation during free flap harvesting. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field. No post-operative major or minor complications occurred. We encountered no post-operative functional issues on the donor or recipient sites, and good clinical healing was observed in all patients. In conclusion, we believe that the galea-pericranium flap could represent a new donor site for the harvesting of a periosteum carrier flap.

Keywords: 3D technologies; augmented reality; head and neck reconstruction; periosteum flap; reconstruction; temporalis flap.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Exposure of the entirety of the frontal, temporal, and parietal regions of fixed cadavers. The superficial temporal artery, anterior and posterior branches (arrows) and superficial temporal vein, anterior and posterior branches (stars) are shown.
Figure 2
Figure 2
Completion of pericranium dissection and flap harvesting. Detachment and measurement of the flap and vessels. (A): A large view. (B): Donor area measurement. (C): Flap measurement. (D): Vessel measurement.
Figure 3
Figure 3
(A): The pericranium is incised followed by blunt dissection of the pericranium from the bone. (B): Skin flap showing preserved superficial temporalis vessels.
Figure 4
Figure 4
Flap harvesting. The deep temporal fascia remains attached to the temporal muscle.
Figure 5
Figure 5
Raising of the flap. (A): Superficial view. (B): Deep view.
Figure 6
Figure 6
Tunnelling and rotation of the flap. (A): Flap rotation in the oral cavity. (B): Insertion of the flap.
Figure 7
Figure 7
Comprehensive harvesting of a composite skin flap. (A): Augmented reality (AR)-assisted flap design prior to skin incision. (B): Raising of the flap.
Figure 8
Figure 8
The anatomical blood supply to the parieto-temporal pericranial region. Perforators arising from superficial temporal vessels are visible in both embalmed and fresh cadavers.
Figure 9
Figure 9
Reconstruction outcomes. Case 1. (A): The intraoral insert. (B): 2 weeks after surgery. (C): 3 months after surgery.
Figure 10
Figure 10
Further reconstruction outcomes. Case 2 at 2 months after surgery. Right palate healing after composite skin/pericranium flap transfer.
See this image and copyright information in PMC

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