CAD/CAM Techniques Advance Plastic and Reconstructive Surgery

By HospiMedica International staff writers
Posted on 07 Mar 2016

Three dimensional (3D) planning and computer-aided design/computer-aided manufacturing (CAD/CAM) have the potential to advance practically every area of plastic and reconstructive surgery, according to a new review.

The review, by researchers at Yale University (New Haven, CT, USA), provides an overview of virtual surgical planning (VSP) and CAD/CAM technology, as well as an outline of emerging applications in plastic and reconstructive surgery. Originally developed for the automotive and aerospace industries, CAD/CAM is being used in medicine to help surgeons solve complex problems in craniofacial reconstruction. When properly implemented, VSP and CAD/CAM technologies can enhance the efficiency, accuracy, reproducibility, and creativity of craniomaxillofacial plastic surgery.

Image: Corrective VSP in a 24-year-old woman with midface deficiency, nasal deformity, and mandibular deviation (Photo courtesy of Plastic and Reconstructive Surgery).

Image: Corrective VSP and surgery aftermath in a 24-year-old woman with midface deficiency, nasal deformity, and mandibular deviation (Photo courtesy of Plastic and Reconstructive Surgery).

The authors define five core components: analysis, planning, virtual surgery, 3D printing, and the comparison of the planned and actual results. To perform the analysis, surgeons can manipulate data from computed tomography (CT) scans to create a digital 3D structure, which can then be used for the VSP. The 3D model also allows surgeons to study the patient's specific defect in detail from every angle, assisting in the selection of the appropriate reconstructive approach. Procedures can even be simulated through multiple treatment strategies to determine the optimal approach.

Finally, the 3D digital information can be used in CAD/CAM and other advanced manufacturing techniques to create biocompatible implants, splints, or treatment guides. After surgery, planned and actual results can be compared to assess the accuracy and effectiveness of the procedure, which in turn can help refine future reconstructions. The review includes case studies of 3D analysis and VSP for complex reconstructive surgery in patients with extensive facial wounds and congenital deformities of the skull and facial bones. The review was published in the March 2016 issue of Plastic and Reconstructive Surgery.

“As access to CT and 3D photo imaging improve, VSP and CAD/CAM procedures will become the standard of care. In the future, VSP will provide lifelike simulations of a wide range of plastic surgery procedures, enhancing outcomes and providing better communication between the surgeon and patient,” concluded review authors Miles Pfaff, MD, and Derek Steinbacher, MD, DMD. “When properly implemented, virtual surgical planning and CAD/CAM technology enhance efficiency, accuracy, reproducibility, and creativity in aesthetic and craniomaxillofacial plastic surgery.”

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Yale University