Jette J. Peek BSc a b ∗, Amir H. Sadeghi MD a ∗, Alexander P.W.M. Maat MD a, Joost RothbarthMD, PhD c, Marc A.M. Mureau MD, PhD d, Cornelis Verhoef MD, PhD c, Ad J.J.C. Bogers MD, PhD a

Abstract

We present the case of a 74-year-old man with a history of a squamous cell carcinoma in the left axilla. The patient underwent a multidisciplinary surgical resection through an extended forequarter amputation with thoracic wall resection and reconstruction. With regard to the complexity of the case, three-dimensional virtual reality–based patient-specific reconstructions were used as a supplemental tool to conventional computed tomography imaging to plan the procedure. With this report, we aim to stimulate further research to improve and automate the workflow and to bring virtual and augmented reality reconstructions into the surgical theater of the future.

A forequarter amputation is a radical ablative surgical procedure that includes the resection of the entire upper extremity, the scapula, and the clavicle.1,2 Forequarter amputation can offer a potential curative treatment in a localized malignancy of the shoulder and axillary region, or can serve as palliative therapy if patients have uncontrollable clinical complications such as pain, functional loss, ulceration, or infections. However, forequarter amputation is a mutilating procedure and may result in severe complications, including phantom-related pain, necrosis, and intrathoracic complications.1,2

In specific cases, patient anatomy can be distorted due to tumor invasion into surrounding anatomic structures. Therefore, knowledge of the spatial relation of the tumor and the surrounding structures is crucial. Consequently, a thorough and detailed preoperative assessment of patient-specific anatomy is essential.1 The use of virtual reality (VR) to evaluate computed tomography (CT) scans in three-dimensions (3D) contributes significantly to the understanding of anatomy by the surgical team.3,4 In addition, by improving anatomic understanding, VR contributes to discussions within multidisciplinary teams and increases patient understanding of the disease. Moreover, the use of VR could result in improved didactive methods for students and resident physicians.5