Technological innovations in the field of reconstructive surgery
Written by Danielle Rowe
Reconstructive surgery is the primary treatment option for people who have suffered serious injuries or have an illness that alters their physical appearance. A sub-field of the plastic and cosmetic surgery industries, the procedures that fall into the reconstructive category can be crucial for the health and well-being of the patients that receive them.
Breast cancer threatens the lives of millions of women each year and in some cases, doctors may recommend a complete or partial mastectomy to remove the breast tissue before the cancer can spread through it. Losing an important part of their bodies can take a toll on the mental and emotional health of women who go through a mastectomy, but recent developments in this field have allowed doctors to add safe implants as part of the same surgery to remove the breast tissue. The patient wakes up with nearly the same breast size as she had before going under, which can reduce mental trauma and discomfort.
In some cases, it is not possible to add implants during the mastectomy due to surgical complications and the remaining breast tissue and skin usually hardens and stiffens as it heals, making it difficult to add implants later. However, two new technologies have appeared in the last year, and are making big differences for cancer survivors all over the world.
The first is a tissue expander that can be inflated without additional surgeries. Reconstructive surgeons can use the tissue expander to stretch the skin slowly so it can accommodate an implant. Prior to the development of this inflating expander, multiple surgeries were necessary to add bigger expanders. Now the surgeon simply inflates the tissue expander until there is plenty of space to hold an implant.
The new SPY Elite technology also helps deal with the serious issue of tissue death, when reconstructive breast surgeries lead to the death of the skin and tissue around the breast. SPY is a unique system that allows surgeons to monitor the blood vessels around the tissue expander or implant. When these blood vessels are damaged, they cannot keep the tissue in the breast alive, causing open wounds to develop that take a long time to heal. SPY prevents unnecessary blood vessel damage and helps surgeons predict exactly where tissue death might occur, allowing them to deal with it before putting in an implant.
The Florida Hospital is one hospital using the SPY Elite technology:
Dr Michael Zenn, from Duke University Medical Center discusses the use of SPY technology in breast reconstruction:
After a car accident or struggle with a severe sinus ailment, patients can be left with serious facial issues. Missing bones and damaged tissue can cause trouble with chewing, breathing and facial expressions and ultrasound and advanced modelling technology are both leading the way in facial reconstruction.
Ultrasound has recently become popular for stimulating the growth of skin tissue below the surface. Since most facial reconstruction surgeries involve some amount of scar tissue, regular ultrasound stimulation can prevent scars from limiting facial movement by encouraging flexible skin to grow in its place.
Meanwhile, three dimensional computer modelling is helping some surgeons create a more natural moving and looking face for their patients. Due to the complexities of facial muscles, adding bone replacements for missing jaw or sinus sections can cause pain. It is also hard to guess how the face will look after the surgery due to the healing process, but a modelling system created by several medical researchers may unlock the key to better reconstruction of the face.
The researchers are building a system that allows doctors to input a scan of the bone structure and tissue of the face. Then, missing sections are replaced by the computer using a complex algorithm that accounts for movement, depth and comfort. The model is designed to recommend changes that give the patient maximum use of their restored features and actually creates custom bone and tissue replacement pieces. In early testing, the custom replacements have been shown to work remarkably better than natural-modelled replacements.
Technology has advanced the field of medicine and the advances can make the difference between life and death for millions of patients. But technological advances in reconstructive surgery are also helping people live normal and happier lives.
Skin Analytics wins NHSX award for AI skin cancer tool
An artificial intelligence-driven tool that identifies skin cancers has received an award from NHSX, the NHS England and Department of Health and Social Care's initiative to bring technology into the UK's national health system.
NHSX has granted the Artificial Intelligence in Health and Care Award to DERM, an AI solution that can identify 11 types of skin lesion.
Developed by Skin Analytics, DERM analyses images of skin lesions using algorithms. Within primary care, Skin Analytics will be used as an additional tool to help doctors with their decision making.
In secondary care, it enables AI telehealth hubs to support dermatologists with triage, directing patients to the right next step. This will help speed up diagnosis, and patients with benign skin lesions can be identified earlier, redirecting them away from dermatology departments that are at full capacity due to the COVID-19 backlog.
Cancer Research has called the impact of the pandemic on cancer services "devastating", with a 42% drop in the number of people starting cancer treatment after screening.
DERM is already in use at University Hospitals Birmingham and Mid and South Essex Health & Care Partnership, where it has led to a significant reduction in unnecessary referrals to hospital.
Now NHSX have granted it the Phase 4 AI in Health and Care Award, making DERM available to clinicians across the country. Overall this award makes £140 million available over four years to accelerate the use of artificial intelligence technologies which meet the aims of the NHS Long Term Plan.
Dr Lucy Thomas, Consultant Dermatologist at Chelsea & Westminster Hospital, said: “Skin Analytics’ receipt of this award is great news for the NHS and dermatology departments. It will allow us to gather real-world data to demonstrate the benefits of AI on patient pathways and workforce challenges.
"Like many services, dermatology has severe backlogs due to the COVID-19 pandemic. This award couldn't have come at a better time to aid recovery and give us more time with the patients most in need of our help.”