Viewtify: A Three-Dimensional Real-Time Computer Graphic Software that Allows for Clear Visualization of Tiny Vessels of Surgical Importance.

[BACKGROUND] Preoperative evaluation of tiny blood vessels is critical in flap surgery to improve safety and postoperative outcomes. This study assessed the efficacy of Viewtify, a 3-dimensional computer graphics (3DCG) software, in evaluating vascular pedicle and perforator locations in free flap surgery.

[METHODS] This retrospective study included 30 patients who underwent reconstructive surgery with a deep inferior epigastric artery perforator, profunda artery perforator, or fibular flaps between January 2021 and July 2024. The thickness of adipose tissue was measured using contrast-enhanced computed tomography at the flap harvest sites. Perforator visibility scores were assigned based on 3D reconstructed images from Viewtify, and correlations with patient factors (age, body mass index, and adipose thickness) were analyzed.

[RESULTS] Vascular pedicle was successfully identified in all patients. The perforator visibility was higher in the abdomen (4.9 ± 0.16) and thigh (4.6 ± 0.42) than in the lower leg (3.1 ± 0.90) ( < 0.05). A significant positive correlation was found between adipose thickness and the perforator visibility score ( = 0.533, = 0.0025); however, no significant correlations with other factors were observed.

[CONCLUSIONS] Viewtify is an effective method for visualizing tiny blood vessels during preoperative planning, particularly in areas with thicker adipose tissue. Its use may improve surgical safety and precision, particularly in flap surgery involving abdominal and thigh regions. Further studies are required to optimize the imaging protocols for areas with thinner adipose tissue, such as the lower legs.