Utilization of Three-Dimensional Computer-Aided Preoperative Virtual Planning and Manufacturing in Maxillary and Mandibular Reconstruction with a Microvascular Fibula Flap

Minna Kääriäinen; Marika Kuuskeri; Georgios Gremoutis; Hannu Kuokkanen; Aimo Miettinen; Jussi Laranne

doi:10.1055/s-0035-1563396

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2016; 32(02): 137-141
DOI: 10.1055/s-0035-1563396

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Utilization of Three-Dimensional Computer-Aided Preoperative Virtual Planning and Manufacturing in Maxillary and Mandibular Reconstruction with a Microvascular Fibula Flap

Minna Kääriäinen

¹Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland

,

Marika Kuuskeri

¹Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland

,

Georgios Gremoutis

¹Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland

,

Hannu Kuokkanen

¹Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland

,

Aimo Miettinen

²Oral and Maxillofacial Unit, Tampere University Hospital, Tampere, Finland

,

Jussi Laranne

³Department of Otolaryngology, Tampere University Hospital, Tampere, Finland

› Institutsangaben

Abstract

Background The aim of this study was to analyze the effects of computer-aided three-dimensional virtual planning and the use of customized cutting guides in maxillary and mandibular reconstruction with a microvascular fibula flap.

Methods Patients (n = 17) undergoing free fibula flap (n = 18) reconstruction of the maxilla (n = 2) or mandible (n = 15) from January 2012 through March 2014 were enrolled in the study. Preoperatively, patients underwent high-resolution computed tomography of the maxillofacial and lower leg regions. Three-dimensional virtual planning of the resection and reconstruction was performed. Customized cutting guides for maxillary/mandibular resections and fibular osteotomies, and prebend plates were manufactured. Demographic data, surgical factors, and perioperative and postoperative results were evaluated.

Results Sixteen patients had malignant disease and one had benign disease. Sixteen of the flaps were osteomuscular and two were osteomusculocutaneous. Mean ischemia time was 99 minutes and mean operative time was 542 minutes. The flaps fitted into the defects precisely and no bone grafts were needed. Mean length of the fibula flap was 74 mm and the mean number of segments in the flap was 2.1.

Conclusion Three-dimensional computer-aided preoperative virtual planning allowed for precise planning of the tumor resection and size of the fibula flap, the number and placement of the osteotomies needed, and the manufacture of customized cutting guides. Fibular shaping is easier and faster, which may decrease the ischemia time and total operative time. Exact placement of the flap in the defect may facilitate restoration of the anatomic shape and ossification.

Keywords

maxilla - mandible - reconstruction - fibula flap - virtual planning

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Referenzen

References
1 Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84 (1) 71-79
2 Wong C-H, Wei F-C. Microsurgical free flap in head and neck reconstruction. Head Neck 2010; 32 (9) 1236-1245
3 Wallace CG, Chang YM, Tsai CY, Wei FC. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction. Plast Reconstr Surg 2010; 125 (1) 305-314
4 Gennaro P, Della Monaca M, Aboh IV, Priore P, Facchini A, Valentini V. “Naked microvascular bone flap” in oral reconstruction. Ann Plast Surg 2014; 73 (2) 164-169
5 Eckardt A, Swennen GRJ. Virtual planning of composite mandibular reconstruction with free fibula bone graft. J Craniofac Surg 2005; 16 (6) 1137-1140
6 Modabber A, Legros C, Rana M, Gerressen M, Riediger D, Ghassemi A. Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study. Int J Med Robot 2012; 8 (2) 215-220
7 Seruya M, Fisher M, Rodriguez ED. Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: an outcomes comparison. Plast Reconstr Surg 2013; 132 (5) 1219-1228
8 Mazzoni S, Marchetti C, Sgarzani R, Cipriani R, Scotti R, Ciocca L. Prosthetically guided maxillofacial surgery: evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction. Plast Reconstr Surg 2013; 131 (6) 1376-1385
9 Avraham T, Franco P, Brecht LE , et al. Functional outcomes of virtually planned free fibula flap reconstruction of the mandible. Plast Reconstr Surg 2014; 134 (4) 628e-634e
10 Succo G, Berrone M, Battiston B , et al. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning. Eur Arch Otorhinolaryngol 2015; 272 (6) 1491-1501
11 Tan H, Yang K, Wei P , et al. A novel preoperative planning technique using a combination of CT angiography and three-dimensional printing for complex toe-to-hand reconstruction. J Reconstr Microsurg 2015; 31 (5) 369-377
12 Matros E, Santamaria E, Cordeiro PG. Standardized templates for shaping the fibula free flap in mandible reconstruction. J Reconstr Microsurg 2013; 29 (9) 619-622
13 Matros E, Albornoz CR, Rensberger M, Weimer K, Garfein ES. Computer-assisted design and computer-assisted modeling technique optimization and advantages over traditional methods of osseous flap reconstruction. J Reconstr Microsurg 2014; 30 (5) 289-296
14 Foley BD, Thayer WP, Honeybrook A, McKenna S, Press S. Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results. J Oral Maxillofac Surg 2013; 71 (2) e111-e119
15 Zheng G-S, Su Y-X, Liao G-Q , et al. Mandible reconstruction assisted by preoperative simulation and transferring templates: cadaveric study of accuracy. J Oral Maxillofac Surg 2012; 70 (6) 1480-1485
16 Broer PN, Tanna N, Franco PB , et al. Ten-year evolution utilizing computer-assisted reconstruction for giant ameloblastoma. J Reconstr Microsurg 2013; 29 (3) 173-180
17 Levine JP, Bae JS, Soares M , et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg 2013; 131 (6) 1386-1391
18 Chang EI, Chang EI, Soto-Miranda MA , et al. Comprehensive evaluation of risk factors and management of impending flap loss in 2138 breast free flaps. Ann Plast Surg 2014; ; PMID: 25003429
19 Dragu A, Schnürer S, Surmann-Schmitt C, Unglaub F, Kneser U, Horch RE. Expression of HIF-1α in ischemia and reperfusion in human microsurgical free muscle tissue transfer. Plast Reconstr Surg 2011; 127 (6) 2293-2300
20 Deutsch M, Kroll SS, Ainsle N, Wang B. Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction. Ann Plast Surg 1999; 42 (6) 662-664
21 Daley BJ, Cecil W, Clarke PC, Cofer JB, Guillamondegui OD. How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee Surgical Quality Collaborative. J Am Coll Surg 2015; 220 (4) 550-558