Evaluation of virtual surgical planning and three‐dimensional configurations for reconstruction of maxillary defects using the fibula free flap

Abstract

Background: Maxillary reconstructive surgery with fibula free flaps (FFFs) is a challenging procedure for head and neck surgeons. However, virtual surgical planning (VSP) and three-dimensional (3D) printing technologies have contributed to improved functional and aesthetic outcomes. The objective of this report is to demonstrate VSP/3D application in reconstruction of maxillary defects using the FFF by describing the different configurations available. We reviewed a series of consecutive cases operated at our institution and considered the management strategy of in-house planning in VSP/3D application.Methods: In total, 11 cases were included from November 2016 to December 2021.Eight male and three female were included, with a mean age of 55.4 years old (range: 34-74 years old). Maxillary defects were classified according to Brown's Classification: two cases with IIB, one case with IIC, four cases with IID, three cases with III, and one case with IV. Preoperatively, facial computed tomography (CT) and lower extremity computed tomography angiogram (CTA) were performed in all patients.Osteocutaneous FFFs were planned, harvested, and customized according to the VSP/3D guide configuration. VSP and 3D printed cutting guides were performed by an external company in nine cases and were self-planned in three of them. Titanium 3D-printed fixation plates were used in four cases.Results: All flaps survived, and the main reconstructive goals were achieved in 9 cases out of 11. Mean FFF length before osteotomy was 20.0 cm (17.5-22.5 cm). None of the cases experienced flap ischemia or venous congestion. At least one complication occurred in four cases: Prefabricated titanium plate exposure (two cases), loss of donor site skin grafts (one case), and ectropion (one case). One patient underwent a second FFF reconstruction. Two titanium printed plates became exposed after radiotherapy and needed to be removed. Mean follow-up time was 23.5 months (range 6-63 months). Dental rehabilitation was completed in eight of the 11 cases. Regarding functional recovery, five cases underwent delayed osseo-integrated dental implants

Multiple Flap Transfer for Multiple Local Recurrence of Soft Tissue Sarcoma

“…It’s worth noting here that in order to ensure the safety of subsequent reconstructive surgeries that employ a flap for local recurrence, a meticulous and thorough preoperative assessment is paramount. This assessment should take into account the state of arteries and veins in close proximity to the defect, leveraging tools such as CT angiography or ultrasonography [ 20 , 21 , 22 ].…”

The Use of the Deep Brachial Artery as the Recipient Artery for Free Perforator Flap Transfer: An Anatomic Study and Clinical Applications

“…After the introduction of free flaps with less morbidity such as the scapular flap and the parascapular flap, more than 20 years have passed since the first report of the perforator flap; the refinements of perforator flap harvesting have been well described [ 14 , 15 , 16 , 17 , 18 ]. The donor site morbidity is minimized when the flap is harvested with its pedicle artery at the perforator level, which often results in a small pedicle artery of around 1.0 mm.…”