This is an extended case report and something I would not normally review for the purposes of PMFA News. However, we should welcome innovation and use of simple technologies to potentially improve clinical care. This study describes the use of a simple computer based program that uses CT images to construct a scaled image of the patient’s face. For the purpose of facial contouring following congential or tumour related soft tissue deformity, a mirror image of the ‘good side’ was created. This allowed accurate estimation of the tissue volume required to restore a normal or near normal facial contour. A bespoke free flap was then transplanted into the defects with the images as a guide to the required flap size. The advantages of doing this may be fewer revisional procedures are required to obtain the best result. We know, regardless of artistic skill, replacement of soft tissue can incur numerous additional procedures to satisfy both patient and surgeon. Using this computer based 3D modelling will probably augment the surgeon’s ability to deliver a single stage reconstruction. Moreover, the 3D images could also be assessed by the patient to ensure they are satisfied. It is plausible these computer images could then be used to make a 3D printed model that can be sterilised and used intra-operatively to aid matching the volume of the flap to what was computer generated. The authors quite rightly point out that computers and models do not replicate the quality of the patient’s tissues, nor can the surgeon exactly match the pocket for the flap with the topography on the 3D computer model. Nonetheless this is a welcome use of digital technology that can only be refined and improved to aid contouring type procedures. 

Three dimensional visualization of the human face using DICOM data and its application to facial contouring surgery using free anterolateral thigh flap.
Shimizu F, Uehara M, Oatari M, Kusatsu M.
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Daniel B Saleh

Newcastle Hospitals, UK.

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