To Computer-Aided Design and Manufacturing or Not to Computer-Aided Design and Manufacturing? Free Fibula Flap With Computer-Aided Technique for Mandibular Reconstruction

Aim: The purpose of this study was to analyze the accuracy of computer-assisted free fibula flap for reconstruction of large mandibular defects for benign tumors. Materials and Methods: Between December 2012 and January 2014, a total of 4 free osteocutaneous computer-assisted fibula flaps have been used in an equal number of patients for reconstruction of the mandible at the Division of Maxillofacial Surgery, Citta' della Scienza e della Salute Hospital, University of Turin. Inclusion criteria were large mandibular defects due to benign tumors. The computer-assisted fibula flap was chosen when 2 or more osteotomies were requested. Intraoperative complication, mean ischemia time, operative time, and morphologic outcomes were analyzed in all cases. After surgery, a postoperative computed tomography compared the virtual plan with the surgical results. Results: All 3 flaps were harvested and transplanted successfully. For the free flaps examined in this work, no intraoperative complications were noted. Postoperative computed tomography showed high correspondence in terms of bone contour according to the virtual plan. The immediate and long-term morphologic results were satisfactory. Conclusions: Microsurgical mandible reconstruction using a computer-assisted fibula flap technique is the best available method to manage complex defects.