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Table of Contents
Year : 2021  |  Volume : 29  |  Issue : 5  |  Page : 75-76

Augmented reality-assisted planning of midpalmar space infection of the hand

Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey

Date of Submission15-Jul-2020
Date of Acceptance08-Sep-2020
Date of Web Publication17-Mar-2021

Correspondence Address:
Dr. Burak Ozkan
Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara 06900
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjps.tjps_79_20

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How to cite this article:
Ozkan B, Akinci K, Savran S, Uysal AC, Ertas NM. Augmented reality-assisted planning of midpalmar space infection of the hand. Turk J Plast Surg 2021;29, Suppl S1:75-6

How to cite this URL:
Ozkan B, Akinci K, Savran S, Uysal AC, Ertas NM. Augmented reality-assisted planning of midpalmar space infection of the hand. Turk J Plast Surg [serial online] 2021 [cited 2022 Jun 29];29, Suppl S1:75-6. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/5/75/311437

Dear Editor,

Augmented reality (AR) utilizes conventional radiological images, such as X-ray, computed tomography, and magnetic resonance imaging (MRI) to visualize the anatomy of the patients in the surgical field. AR has been used for the purposes of surgical planning and education.[1] High-technology AR products such as Google Glass and Microsoft HoloLens have been used in plastic, reconstructive, and aesthetic surgery.[1],[2] Among these high-technology products, smartphones can be used as an AR device with the help of third-party applications.[3] Superimposed images created by smartphone app increase the depth perception of surgical anatomy and help surgeons prior to surgery. Therefore, we thought that this might be helpful in the deep palmar abscess cases, which requires understanding the three-dimensional anatomy of the hand. This letter aims to report the use of AR with the help of a third-party app on smartphones in a case with hand deep palmar space infection.

A 55 year-old-female applied to outpatient clinic with pus drainage from the dorsal and the palmar side of the right hand for 15 days. She had medical history of diabetes mellitus, chronic renal failure, closed arteriovenous fistula in the same extremity. In her psychical examination, palmar tenderness, erythema, edema, loss of palmar concavity in her right hand were detected. The range of motion in the 2nd, 3rd, and 4th metacarpophalangeal joint were limited. MRI images of the right hand showed deep palmar abscess in the thenar space and compartment and flexor tendon sheaths of the 2nd, 3rd, and 4th fingers. Abscess drainage and drain placement for continuous irrigation were scheduled for the patient. MRI images were imported to a smartphone preoperatively. AR application (Tracing Projector App, for IOS) was used to superimpose MRI image and the surgical field [Figure 1]. Metacarpal heads were taken as landmarks for proper adaptation of MRI image and real-time camera image. After the determination of the depth perception of the anatomical structures and the abscesses that spread to the compartments with AR, abscess locations were marked and appropriate Brunner incision lines were drawn on the hand at the operation table [Video 1]. Surgery was performed respected to preoperative plan and all the infected deep palmar compartments were opened and irrigated without complication. The patient was discharged at postoperative 7th day, without erythema, swelling, pus drainage, and with increased range of motion of the 2nd, 3rd, and 4th fingers.
Figure 1: (Left) Superimposed images of magnetic resonance imaging and the patients' hand in smartphone augmented reality application (tracing projector App.) (Right) The image shows augmented reality-assisted marked abscess location and incision line

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Midpalmar space, the thenar space and compartment, the hypothenar space, and the compartment and the subaponeurotic space constitute the deep space of the hand. The infection of this space occurs via direct bacteria inoculation or secondary infection through adjacent tendon synovium/bursae or fascial space. In the treatment, close observation, drainage, debridement, and intraoperative and postoperative irrigation are essential.[4] Surgical incisions should be planned according to certain compartment involvement. Superimposed images of MRI and the patients' hand might help choosing appropriate Brunner incisions and adequate drainage and drain placement.

While the high cost of Google Glass and Microsoft HoloLens is an obstacle for the common use of AR, smartphones are available worldwide. The AR by a third-party smartphone app is an easy, portable, and noninvasive method that gives depth perception of the relevant anatomy. Since the third-party applications were not designed for medical purposes, safely usage of them for two-dimensional image superimposing was described in the literature.[3] AR with smartphone application helps choose appropriate surgical incisions and techniques. It reduces excessive incisions, dissections, and thereby operating time. AR with a smartphone might be useful in the management of the deep palmar infections. As a result, AR technology is a promising innovation, which can be used in various clinical and scenarios.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Davis CR, Rosenfield LK. Looking at plastic surgery through Google Glass: Part 1. Systematic review of Google Glass evidence and the first plastic surgical procedures. Plast Reconstr Surg 2015;135:918-28.  Back to cited text no. 1
Tepper OM, Rudy HL, Lefkowitz A, Weimer KA, Marks SM, Stern CS, et al. Mixed reality with HoloLens: Where virtual reality meets augmented reality in the operating room. Plast Reconstr Surg 2017;140:1066-70.  Back to cited text no. 2
Pereira N, Kufeke M, Parada L, Troncoso E, Bahamondes J, Sanchez L, et al. Augmented reality microsurgical planning with a smartphone (ARM-PS): A dissection route map in your pocket. J Plast Reconstr Aesthet Surg 2019;72:759-62.  Back to cited text no. 3
Rigopoulos N, Dailiana ZH, Varitimidis S, Malizos KN. Closed-space hand infections: Diagnostic and treatment considerations. Orthop Rev (Pavia) 2012;4:e19.  Back to cited text no. 4


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