Techniques on Modeling the Vascularized Free Fibula Flap in Mandibular Reconstruction

Abstract

In mandibular reconstruction with bone grafts, the functional and aesthetic outcomes are clearly influenced by reconstructive techniques. Vascularized free fibular flaps are considered the most suitable choice for mandible reconstruction because of their good aesthetic and functional outcomes. Several techniques have been described in literature. According to various authors, shaping of the fibular graft can be performed by means of computer-aided design/computer-aided modeling procedures for the evaluation of the presurgery anatomy and three-dimensional models of fibula graft. However, these models are expensive, require a strict realization of the programmed intervention, and are not easily adaptable to a surgical treatment different from the planned one. We report our experience on a technique for mandibular reconstruction using a free fibular flap, obtained by modeling a template on the resected mandible. Our operative technique consists of 5 steps: preplating, resection, template modeling, contouring of the fibula, and fixing the flap on the mandible.Template modeling is performed to record the length of the resected bone, the mandibular curvature on the 3 space planes, and the width of the basal bone. On the basis of the template, the fibula flap was modeled while still attached to the pedicle. The plates, positioned at the level of the fibular osteotomies, were preformed to make the fibula precisely fit in the template. Once the fibula was shaped, mandibular reconstruction was completed by positioning the fibula graft on the mandibular stumps. Bone graft modeling by means of template is a rapid, safe, and flexible method to reconstruct the mandible.

Additive manufacturing for microvascular reconstruction of the mandible in 20 patients

“…Notably, 3D models may be used for any form of reconstruction after trauma or tumour, as well as in patients with complex syndromic disorders (Aung et al, 1999;Bill and Reuther, 2004;Cohen et al, 2009;Eckardt and Swennen, 2005;Liu et al, 2009;Moro et al, 2009;Singare et al, 2004;Sinn et al, 2006). Good accuracy of 3D models is of great importance when using them as planning tools.…”

Mandibular reconstruction with microvascular re-anastomosed fibular free flaps – Two complementary methods of postoperative transplant monitoring

“…The risk rises when multiple osteotomies for adapting the fibular bone to the shape of the mandible are required because this procedure may impair the periosteal vascular supply of the bone [8,14,31].…”

Mandibular alveolar reconstruction using three-dimensional planning

“…Some authors still favor utilizing operative plating or external fixation and intraoperative templating of the defect or resected specimen to plan the reconstruction [14]. For instance, if planning and cutting guides are utilized, but the surgeon decides intraoperatively that a larger mandibular resection is necessary, then all of the preoperative models may not be effective to design an appropriately sized and shaped fibular graft.…”