Lindhardt Joakim L, Kiil Birgitte J, Jakobsen Anders M, Buhl Jytte, Krag Andreas E
From the 3D Innovation, Aarhus University Hospital, Aarhus, Denmark.
Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
Plast Reconstr Surg Glob Open. 2024 Aug 27;12(8):e6108. doi: 10.1097/GOX.0000000000006108. eCollection 2024 Aug.
Computer-aided design and manufacturing (CAD/CAM) is widely adopted for optimizing microsurgical reconstruction of mandibular defects. However, commercial solutions are hampered by costs and lengthy lead times, with the latter being problematic in cancer surgery. This study aimed to investigate the efficiency of an in-house CAD/CAM service for expeditious planning and execution of free fibula mandibular reconstruction in head and neck cancer patients.
This retrospective cohort study compared cancer patients undergoing segmental mandibulectomy and immediate free fibula flap reconstruction treated before and after implementation of in-house CAD/CAM. The primary endpoint was treatment delay from preoperative consultation to surgery. Cases in the two groups were matched on the number of fibula segments required for mandibular reconstruction. The control group underwent segmental mandibulectomy and fibula flap reconstruction by "freehand." The CAD/CAM group underwent preoperative virtual surgical planning and CAD/CAM of intraoperative cutting guides for the mandibulectomy and fibula osteotomies. Outcomes were compared with the unpaired test or Wilcoxon rank-sum test.
Sixteen patients were included in both groups. Treatment delay did not increase after implementation of in-house CAD/CAM with a median 6 (range 6-20) days wait in the CAD/CAM group and 8 (6-20) days wait in the control group ( = 0.48). Utilization of CAD/CAM significantly reduced fibula flap ischemia time with a mean of 18.4 [95% confidence interval 2.8; 33.9] minutes ( = 0.022).
In-house CAD/CAM was implemented for free fibula flap mandibular reconstruction in head and neck cancer patients without causing treatment delay. Furthermore, CAD/CAM reduced fibula flap ischemia time.
计算机辅助设计与制造（CAD/CAM）被广泛应用于优化下颌骨缺损的显微外科重建。然而，商业解决方案受到成本和较长交付周期的限制，后者在癌症手术中是个问题。本研究旨在探讨内部CAD/CAM服务对头颈部癌症患者游离腓骨下颌骨重建进行快速规划和实施的效率。
这项回顾性队列研究比较了在实施内部CAD/CAM之前和之后接受节段性下颌骨切除术并立即进行游离腓骨瓣重建的癌症患者。主要终点是从术前咨询到手术的治疗延迟。两组病例在下颌骨重建所需腓骨段数上进行匹配。对照组通过“徒手”进行节段性下颌骨切除术和腓骨瓣重建。CAD/CAM组进行术前虚拟手术规划以及下颌骨切除术和腓骨截骨术中的术中切割导板的CAD/CAM制作。结果采用非配对t检验或Wilcoxon秩和检验进行比较。
两组均纳入16例患者。实施内部CAD/CAM后治疗延迟并未增加，CAD/CAM组中位等待时间为6天（范围6 - 20天），对照组为8天（6 - 20天）（P = 0.48）。CAD/CAM的使用显著缩短了腓骨瓣缺血时间，平均为18.4分钟[95%置信区间2.8；33.9]（P = 0.022）。
在头颈部癌症患者游离腓骨瓣下颌骨重建中实施内部CAD/CAM并未导致治疗延迟。此外，CAD/CAM缩短了腓骨瓣缺血时间。
