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

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Operative Outcomes with CT-Guided Virtual Surgical Modeling for Mandibular Reconstruction with Osteocutaneous Free Flaps?
Eric I. Chang, M.D., Neal S. Topham, M.D..
Fox Chase Cancer Center, Rockledge, PA, USA.

PURPOSE: The osteocutaneous free fibula flap has become the primary reconstructive modality for segmental mandibulectomy defects. The advent of preoperative virtual surgical planning (VSP) with models and templates has led to significant refinements in operative technique. Here, we examine the value of CT-guided preoperative VSP on outcomes and operative efficiency after mandibular reconstruction with free fibula flaps.
METHODS: A retrospective review was performed from 2002 - 2013 of all patients undergoing free fibula mandible reconstruction at a single cancer center. Surgical technique and operative time were assessed and cost analysis was performed. Patient demographics, complications, and overall outcomes were also examined. A review of postoperative CT scans was also performed to assess accuracy of the osteotomies and bone healing.
RESULTS: Ninety-one patients underwent free fibula osteocutaneous flap reconstruction of the mandible during the study period. In 10 patients, the shaping of the neo-mandible was performed without VSP while 27 patients underwent shaping of the fibula based upon the prefabricated stereolithic models. The remaining 54 patients underwent preoperative CT-imaging to design patient-specific, cutting templates for the native mandible as well as the fibula. The use of preoperative CT-guided planning resulted in less osteotomies, burring, and bone grafting. VSP also significantly decreased operative time (707 min vs. 534 min, p<0.0003) which translated into considerable cost savings. Review of postoperative CT scans demonstrated no differences in rates of boney nonunion, and there were no significant differences in overall outcomes or complications between the groups.
CONCLUSION: Preoperative VSP has refined mandible reconstruction with free fibula flaps. The use of patient-specific, CT-guided modeling with fabrication of osteotomy guides outweigh the costs associated with this adjunctive technology. Patient-specific, computer-guided surgical planning improves operative efficiency without jeopardizing overall outcomes or increasing complications.


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