Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Combining Preoperative CTA Mapping of the Peroneal Artery and Its Perforators with Computer-Generated Patient-Specific Surgical Guides for Free Fibula Flap Reconstruction of Complex Head and Neck Defects
Noopur Gangopadhyay, MD, Mark W. Villa, MD, Edward I. Chang, MD, Jesse C. Selber, MD, Elizabeth S. Craig, MD, Jessie Liu, PhD, Patrick B. Garvey, MD.
UT MD Anderson Cancer Center, Houston, TX, USA.

PURPOSE:
Computer-aided design and modeling (CAD/CAM) have been applied to fibula flap reconstruction preoperatively to aid in surgical planning and execution. Our surgeons have also developed a protocol to combine CAD/CAM modeling with computed tomography angiography (CTA) to map perforators of the peroneal artery for optimized placement of the skin island. We hypothesized that the use of CAD/CAM+CTA decreased operative times and improved patient outcomes with respect to fewer surgical site occurrences and lesser need for revisional surgeries.
METHODS:
We retrospectively compared consecutive patients (N=148) at a single major US cancer center who underwent mandibulectomy reconstruction with free fibula flaps for whom CAD/CAM and CTA were (N=28) or
were not (N=120) employed preoperatively over a six-year period (2008-2014). To minimize selection bias, we only included patients of surgeons who selectively employed both CAD/CAM+CTA as well as conventional fibula flap harvest in the study. We employed logistic regression analysis to identify potential associations between patient and reconstructive factors and postoperative outcomes.
RESULTS:
The patient characteristics were similar between the two groups. Flap ischemia time was significantly shorter in the CAD/CAM+CTA group (82 vs. 103 minutes; p<0.01), while total operative time was similar between the two groups (612 vs. 641 minutes; p=0.28). Surgical complication rates, including failure rates, were similar between the two groups (p=0.39). There was a trend towards less need for surgical revision for contour deformity and asymmetry in the CAD/CAM+CTA group (7.1%) than in those without preoperative planning (20.8%), although this difference did not reach statistical significance (p=0.09).
CONCLUSION:
There appear to be advantages for preoperative planning combining the use of CAD/CAM and CTA for mandibular reconstruction with free fibula flaps. Specifically this technology appears to facilitate shorter ischemia times and improved postoperative outcomes. Future studies are needed to more specifically define the patients who will most benefit from this technology.


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