Advances in perforator imaging through holographic CTA and augmented reality: a systematic review

Introduction Free tissue transfer has become a mainstay in reconstructive plastic surgery, and techniques to plan such surgery continue to evolve. Novel technologies and increases in computational power have enabled computed tomographic angiography (CTA) data augmentation onto patients to assist in pedicle identification and dissection. Given the rapidly evolving field and research in this domain, a systematic review was un-undertaken to establish the evidence for its usefulness in pedicle identification and dissection. Methods An extensive search using keywords in EMBASE and PubMed® with bibliographic linkage following PRISMA guidelines was performed. We identified 107 articles. Duplicate articles were removed prior to review. Two reviewers independently screened the titles for appropriate topic relevance. Full articles were then screened for review. Results Eleven articles were appropriate for review. Two articles analysed the time taken to identify perforators using augmented reality (AR) compared to Doppler ultrasound. The remainder of the articles analysed time to perforator identification, differences between projected location and dissected perforator location, qualitative feedback from surgeons on the use of AR systems for perforator identification and proof of concept and the usefulness of AR in perforator flap surgery. Conclusion This review demonstrates that while established methods of data rendering and projection can achieve holographic projection and AR, there is a lack of objective outcome data to demonstrate its usefulness. This, combined with a cost analysis, are the main obstructions to this technology being more widely adopted.