Future Applications for 3-dimensional Printed Virtual Surgical Planning in Microsurgery.

Three-dimensional printing (3DP) has been used in many surgical specialties for virtual surgical planning, such as head and neck surgery, orthopedic surgery, and craniofacial surgery. A medical image is fed into modeling software, converted to a print file, and then printed from a variety of materials, usually soft or hard plastic. The result is a 3-dimensional model of the original image that can be used to guide preoperative and intraoperative decision-making. In microsurgery, computed tomography angiography is often used for virtual surgical planning to identify major vessels capable of supporting flaps. Despite this, actual anatomy may differ from the computed tomography-generated images, necessitating a change in intraoperative decision-making. Three-dimensional printing provides an opportunity to create accurate 3-dimensional replicas of abdominal vasculature for use in surgical planning. At least 1 study has shown that using 3DP models as guidelines results in decreased intraoperative decision-making in breast free flaps. Similar virtual surgical planning strategies in head and neck reconstructive surgery have been shown to result in overall decreased intraoperative decision-making, decreased procedure times, and improved microvascular ischemic time in free flaps. In summary, there are significant future applications of 3DP in microsurgery. Implementation of 3DP in microsurgery could reduce intraoperative changes to preoperative plan and decrease overall procedure time. Additionally, 3DP could be used to map where nerves course in 3-dimensional space, allowing the surgeon to identify landmarks for nerve preservation.