Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects_Journal of Biomedical Engineering

Authors：

CHEN Chao ^1,2,3 ,  LIU Yunfeng ^1,2,3 , XU Jiajie ⁴ , JIANG Xianfeng ^1,2 , ZHENG Chuanming ⁴ , GE Minghua ⁴ ,  CHENG Kangjie ^1,2,3

1. College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, P. R. China;
2. Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou 310023, P. R. China;
3. National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou 310023, P. R. China;
4. Department of Head and Neck Surgery, Otolaryngology & Head and Neck Center, Hangzhou Medical College Affiliated People’s Hospital, Zhejiang Provincial People’s Hospital, Hangzhou 310014, P. R. China;

Corresponding?author：

LIU Yunfeng, Email: liuyf76@126.com; CHENG Kangjie, Email: chengkangjie@zjut.edu.cn

Keywords：

Head and neck; Soft tissue defects; Curved surface developability; Accurate reconstruction

DOI：

10.7507/1001-5515.202305011

Video：

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Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients’ postoperative satisfaction.

Citation： CHEN Chao, LIU Yunfeng, XU Jiajie, JIANG Xianfeng, ZHENG Chuanming, GE Minghua, CHENG Kangjie. Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects. Journal of Biomedical Engineering, 2023, 40(6): 1175-1184. doi: 10.7507/1001-5515.202305011 Copy

1.	Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020 Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-Cancer J Clin, 2021, 3(71): 209-249.
2.	Wang S, Yin S, Zhang Z, et al. Quality of life after oral cancer resection and free flap reconstruction. J Oral Maxil Surg, 2019, 77(8): 1724-1732.
3.	Cheng K, Liu Y, Wang R, et al. Topological optimization of 3D printed bone analog with PEKK for surgical mandibular reconstruction. J Mech Behav Biomed, 2020, 107: 103758.
4.	Jozaghi Y, Phan J, Hanna E Y, et al. Functional outcomes and quality of life in patients with sinonasal, nasopharyngeal, and anterior skull base tumors. Curr Oncol Rep, 2022, 24(6): 775-781.
5.	Cheng K, Shi Z, Wang R, et al. 3D printed PEKK bone analogs with internal porosity and surface modification for mandibular reconstruction: An in vivo rabbit model study. Biomaterials Advances, 2023, 151: 213455.
6.	熊文龍, 張良. 局部皮瓣修復面部皮膚手術缺損. 中國中西醫結合皮膚性病學雜志, 2018, 17(4): 354-355.
7.	武凱, 高瑞霞. 局部皮瓣在修復皮膚軟組織缺損創面中的應用價值分析. 內蒙古醫科大學學報, 2019, 41(6): 617-619.
8.	Chang W, Chang C, Cheng C, et al. Comparison of the hospitalization period after microvascular reconstruction flap in trismus patients: free anterolateral thigh flap versus free forearm flap. Clin Oral Invest, 2020, 23: 2951-2957.
9.	Rao P, Luo S, Wang L, et al. Computed tomography angiography–aided individualized anterolateral thigh flap design in the reconstruction of oral and maxillofacial soft tissue defects. Oral Surg Oral Med O, 2022, 34(2): 143-150.
10.	Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskel Dis, 2021, 22: 643-652.
11.	Sun R, Zhou Y, Malouta M Z, et al. Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect. World J Surg Oncol, 2022, 20: 220-234.
12.	王永標, 梁國平, 胡穎, 等. 數字化技術在穿支皮瓣中的臨床應用. 中國骨科臨床與基礎研究雜志, 2018, 10(2): 80-85.
13.	Largo R D, Garvey P B. Updates in head and neck reconstruction. Plast Reconstr Surg, 2018, 141(2): 271e-285e.
14.	Bosc R, Fitoussi A, Pigneur F, et al. Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap. Annales de Chirurgie Plastique et Esthetique, 2017, 62(4): 336-339.
15.	Michael P C, David J H, Marie R, et al. Enhanced preoperative deep inferior epigastric artery perforator flap planning with a 3D-printed perforasome template. Plast Reconstr Surg Glob Open, 2018, 6(1): e1644.
16.	Shen Y, Lu L, Low D, et al. Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction. J Plast Reconstr Aes, 2018, 72(6): 990-999.
17.	王幼寧, 劉繼志. 微分幾何講義. 北京: 北京師范大學出版社, 2003: 56-78, 113.
18.	Bao T, He J, Yu C, et al. Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap. Oral Oncol, 2017, 75: 133-139.
19.	Liu Y, Wu J, Zhang J, et al. Numerical and experimental analyses on the temperature distribution in the dental implant preparation area when using a surgical guide. J Prosthodont, 2018, 27(1): 42-51.
20.	Tarsitano A, Bataglia S, Ricotta F, et al. Accuracy of CAD/CAM mandibular reconstruction: A three-dimensional, fully virtual outcome evaluation method. J Cranio Maxill Surg, 2018, 46(7): 1121-1125.
21.	Liu X, Liu Y, Lu W, et al. Combined application of modified three-dimensional printed anatomic templates and customized cutting blocks in pelvic reconstruction after pelvic tumor resection. J Arthroplasty, 2019, 34(2): 338-345.
22.	Yan Q, Dong H, Su J, et al. A review of 3D printing technology for medical applications. Engineering, 2018, 4(5): 729-742.
23.	Elliot D, Adani R, Woo S H, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg-Eur Vol, 2017, 43(10): 1019-1029.
24.	Cheng K, Liu Y, Wang J H, et al. Biomechanical behavior of mandibles reconstructed with fibular grafts at different vertical positions using finite element method. J Plast Reconstr Aes, 2019, 72(2): 281-289.
25.	Petrovic I, Rosen E B, Matros E, et al. Oral rehabilitation of the cancer patient: A formidable challenge. J Surg Oncol, 2018, 117(8): 1729-1735.
26.	Kwon D, Genden E M, de Bree R, et al. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx, 2018, 45(6): 1135-1142.
27.	Patel S Y, Meram A T, Kim D D. Soft tissue reconstruction for head and neck ablative defects. Oral Maxil Surg Clin, 2019, 31: 39-68.
28.	Koumoullis H, Burley O, Kyzas P. Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap. Brit J Oral Max Surg, 2020, 58(6): 681-686.
29.	Jeong H H, Jeong W S, Choi J W, et al. 3D computer simulation analysis of the flap volume change in total tongue reconstruction flaps. J Cranio Maxill Surg, 2018, 46(5): 844-850.

1. Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020 Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-Cancer J Clin, 2021, 3(71): 209-249.
2. Wang S, Yin S, Zhang Z, et al. Quality of life after oral cancer resection and free flap reconstruction. J Oral Maxil Surg, 2019, 77(8): 1724-1732.
3. Cheng K, Liu Y, Wang R, et al. Topological optimization of 3D printed bone analog with PEKK for surgical mandibular reconstruction. J Mech Behav Biomed, 2020, 107: 103758.
4. Jozaghi Y, Phan J, Hanna E Y, et al. Functional outcomes and quality of life in patients with sinonasal, nasopharyngeal, and anterior skull base tumors. Curr Oncol Rep, 2022, 24(6): 775-781.
5. Cheng K, Shi Z, Wang R, et al. 3D printed PEKK bone analogs with internal porosity and surface modification for mandibular reconstruction: An in vivo rabbit model study. Biomaterials Advances, 2023, 151: 213455.
6. 熊文龍, 張良. 局部皮瓣修復面部皮膚手術缺損. 中國中西醫結合皮膚性病學雜志, 2018, 17(4): 354-355.
7. 武凱, 高瑞霞. 局部皮瓣在修復皮膚軟組織缺損創面中的應用價值分析. 內蒙古醫科大學學報, 2019, 41(6): 617-619.
8. Chang W, Chang C, Cheng C, et al. Comparison of the hospitalization period after microvascular reconstruction flap in trismus patients: free anterolateral thigh flap versus free forearm flap. Clin Oral Invest, 2020, 23: 2951-2957.
9. Rao P, Luo S, Wang L, et al. Computed tomography angiography–aided individualized anterolateral thigh flap design in the reconstruction of oral and maxillofacial soft tissue defects. Oral Surg Oral Med O, 2022, 34(2): 143-150.
10. Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskel Dis, 2021, 22: 643-652.
11. Sun R, Zhou Y, Malouta M Z, et al. Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect. World J Surg Oncol, 2022, 20: 220-234.
12. 王永標, 梁國平, 胡穎, 等. 數字化技術在穿支皮瓣中的臨床應用. 中國骨科臨床與基礎研究雜志, 2018, 10(2): 80-85.
13. Largo R D, Garvey P B. Updates in head and neck reconstruction. Plast Reconstr Surg, 2018, 141(2): 271e-285e.
14. Bosc R, Fitoussi A, Pigneur F, et al. Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap. Annales de Chirurgie Plastique et Esthetique, 2017, 62(4): 336-339.
15. Michael P C, David J H, Marie R, et al. Enhanced preoperative deep inferior epigastric artery perforator flap planning with a 3D-printed perforasome template. Plast Reconstr Surg Glob Open, 2018, 6(1): e1644.
16. Shen Y, Lu L, Low D, et al. Perforator navigation using color Doppler ultrasound and three-dimensional reconstruction for preoperative planning of optimal lateral circumflex femoral artery system perforator flaps in head and neck reconstruction. J Plast Reconstr Aes, 2018, 72(6): 990-999.
17. 王幼寧, 劉繼志. 微分幾何講義. 北京: 北京師范大學出版社, 2003: 56-78, 113.
18. Bao T, He J, Yu C, et al. Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap. Oral Oncol, 2017, 75: 133-139.
19. Liu Y, Wu J, Zhang J, et al. Numerical and experimental analyses on the temperature distribution in the dental implant preparation area when using a surgical guide. J Prosthodont, 2018, 27(1): 42-51.
20. Tarsitano A, Bataglia S, Ricotta F, et al. Accuracy of CAD/CAM mandibular reconstruction: A three-dimensional, fully virtual outcome evaluation method. J Cranio Maxill Surg, 2018, 46(7): 1121-1125.
21. Liu X, Liu Y, Lu W, et al. Combined application of modified three-dimensional printed anatomic templates and customized cutting blocks in pelvic reconstruction after pelvic tumor resection. J Arthroplasty, 2019, 34(2): 338-345.
22. Yan Q, Dong H, Su J, et al. A review of 3D printing technology for medical applications. Engineering, 2018, 4(5): 729-742.
23. Elliot D, Adani R, Woo S H, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg-Eur Vol, 2017, 43(10): 1019-1029.
24. Cheng K, Liu Y, Wang J H, et al. Biomechanical behavior of mandibles reconstructed with fibular grafts at different vertical positions using finite element method. J Plast Reconstr Aes, 2019, 72(2): 281-289.
25. Petrovic I, Rosen E B, Matros E, et al. Oral rehabilitation of the cancer patient: A formidable challenge. J Surg Oncol, 2018, 117(8): 1729-1735.
26. Kwon D, Genden E M, de Bree R, et al. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx, 2018, 45(6): 1135-1142.
27. Patel S Y, Meram A T, Kim D D. Soft tissue reconstruction for head and neck ablative defects. Oral Maxil Surg Clin, 2019, 31: 39-68.
28. Koumoullis H, Burley O, Kyzas P. Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap. Brit J Oral Max Surg, 2020, 58(6): 681-686.
29. Jeong H H, Jeong W S, Choi J W, et al. 3D computer simulation analysis of the flap volume change in total tongue reconstruction flaps. J Cranio Maxill Surg, 2018, 46(5): 844-850.

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