Chang Eric I, Jenkins Matthew P, Patel Sameer A, Topham Neal S
Philadelphia, Pa. From the Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center.
Plast Reconstr Surg. 2016 Feb;137(2):619-623. doi: 10.1097/01.prs.0000475796.61855.a7.
Osteocutaneous free flaps have become the primary reconstructive modality for segmental mandibulectomy defects. The advent of preoperative virtual surgical planning with stereolithic models and cutting templates has led to significant refinements in operative technique. In this article, the authors examine the value of computed tomography-guided preoperative virtual surgical planning on operative outcomes and efficiency after mandibular reconstruction with osteocutaneous free flaps.
A retrospective review was performed of all patients undergoing free flap mandible reconstruction at a single cancer center from 2002 to 2013. Surgical technique and operative time were assessed, as were overall complications and outcomes. Postoperative computed tomographic scans were also examined to determine the accuracy of osteotomies with and without virtual surgical planning.
Ninety-two patients underwent osteocutaneous free flap reconstruction of the mandible during the study period. In 43 patients, the shaping of the neomandible was performed based on the prefabricated stereolithic models. The remaining 49 patients underwent preoperative computed tomographic imaging to design patient-specific cutting guides for the native mandible and the osteocutaneous flap. The use of preoperative computed tomography-guided planning resulted in less burring, fewer osteotomy revisions, and less bone grafting. Virtual surgical planning also significantly decreased operative time (666 minutes versus 545 minutes; p < 0.005). Review of postoperative computed tomographic scans demonstrated decreased rates of bony nonunion with virtual surgical planning, and there were no significant differences in overall outcomes or complications between the groups.
Preoperative virtual surgical planning has refined mandible reconstruction with osteocutaneous free flaps through the introduction of patient-specific models, prebent plates, and osteotomy guides. Virtual surgical planning decreases operative time and improves the accuracy of free flap mandibular reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
骨皮瓣已成为节段性下颌骨切除术后缺损的主要重建方式。术前利用立体光刻模型和切割模板进行虚拟手术规划的出现，使手术技术有了显著改进。在本文中，作者探讨了计算机断层扫描引导下的术前虚拟手术规划对骨皮瓣下颌骨重建术后手术效果和效率的价值。
对2002年至2013年在某单一癌症中心接受游离皮瓣下颌骨重建的所有患者进行回顾性研究。评估手术技术和手术时间，以及总体并发症和手术效果。还对术后计算机断层扫描进行检查，以确定有无虚拟手术规划时截骨的准确性。
在研究期间，92例患者接受了骨皮瓣游离重建下颌骨。43例患者根据预制的立体光刻模型进行新下颌骨塑形。其余49例患者术前进行计算机断层扫描成像，以设计针对天然下颌骨和骨皮瓣的个体化切割导板。术前计算机断层扫描引导规划的使用减少了打磨、截骨修正和骨移植。虚拟手术规划还显著缩短了手术时间（666分钟对545分钟；p<0.005）。术后计算机断层扫描复查显示，虚拟手术规划使骨不连发生率降低，两组间总体手术效果或并发症无显著差异。
术前虚拟手术规划通过引入个体化模型、预弯钢板和截骨导板，改进了骨皮瓣游离重建下颌骨的技术。虚拟手术规划减少了手术时间，提高了游离皮瓣下颌骨重建的准确性。
临床问题/证据水平：治疗性，III级。
