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3D Image Guided Reconstructive Microsurgery Using Ultra High Speed Fourier Domain Optical Coherence Tomography
Zuhaib Ibrahim, MD, Qi Mao, MD, Johanna Grahammer, BS, Kate Buretta, BS, Yong Huang, MS, Joani Christensen, BS, Nance Yuan, BS, Jin U Kang, PhD, WP Andrew Lee, MD, Gerald Brandacher, MD.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE:
Micro-vascular anastomosis is an integral component of free tissue transfer and reconstructive transplantation. Even in the era of highly magnified images from optical microscopes, this technique still requires the highest level of skill and surgical expertise especially for small vessels (Diameter < 1.0mm). We designed an innovative surgical imaging modality that can provide depth perception and real time 3-D intraoperative guidance for microvascular surgery. 3D guidance can potentially decrease the technical complications and improve surgical outcome of reconstructive microsurgery.
METHODS:
We incorporated an ultra-fast 3D optical coherence tomography (OCT) imaging system that provides real-time intraoperative image of the surgical site during the micro-surgical procedures. The system is based on a Fourier-Domain OCT (FD-OCT) integrated with a CPU-GPU heterogeneous computing architecture, capable of providing real-time 3-D video image of surgical site and tool tips. The FD-OCT system was optimzed to visualize rat femoral artery (Diameter < 0.8 mm) during the procedure (Figure 1).
RESULTS:
Utilizing ultra fast real-time intraoperative imaging, we visualized the cut end of the vessels with all the layers of the vessel wall and lumen in six different views. Thus we could precisely place 11-0 sutures through the vessel wall without the use of optical microscope. 3D image assistance was crucial in avoiding accidental suturing of the back wall of the vessel during anastomosis. In addition, we could obtain an optimized view of the conventional microsurgical instruments, needle and thread in real time. Ultra fast imaging capture and display was sufficient to maneuver the instrument with advanced precision (Figure 2).
CONCLUSION:
3D-OCT assistance during critical portions of mcirovascular anastomosis can provide better precision and can minimize human error. In addition, the system can determine the diameter of vessel post anastomosis and can also determine the blood flow-using speckle/Doppler OCT. These additional properties can promptly diagnose diminished flow or vessel narrowing at anastomosis site and hence the dreading complication of flap necrosis can potentially be avoided.


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