Intraoperative Holographic Navigation Using Augmented Reality for Facial Artery and Peroneal Perforator Identification in Microsurgical Mandibular Reconstruction

Mandibular reconstruction with the fibula free flap is the gold standard for large defects, with virtual surgical planning becoming integral to the process. The localization and dissection of critical vessels, such as the recipient vessels in the neck and the perforating vessels of the fibula flap, are demanding steps that directly impact surgical success. Augmented reality offers a solution by overlaying three-dimensional virtual models directly onto the surgeon's view of the operative field. We report the first case in Latin America utilizing a low-cost, commercially available holographic navigation system for complex microsurgical mandibular reconstruction. A 26-year-old female presented with a large, destructive osteoblastoma of the left mandible, requiring wide resection and reconstruction. Preoperative surgical planning was conducted using DICOM data from the patient's CT scans to generate 3D holographic models. Intraoperatively, the primary surgeon used the AR system to superimpose the holographic models onto the patient. The system provided real-time, immersive guidance for identifying the facial artery, which was anatomically displaced by the tumor mass, as well as for localizing the pe-roneal artery perforators for donor flap harvest. An osteo-fascial fibula free flap was harvested and successfully transferred. This case demonstrates the successful applica-tion and feasibility of using a low-cost, consumer-grade holographic navigation system.