Khajehalichalehshtari Manuel, Khromov Tatjana, Panahi Babak, Schminke Boris, Schliephake Henning, Brockmeyer Phillipp
Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany.
Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany.
Oral Maxillofac Surg. 2025 Mar 25;29(1):73. doi: 10.1007/s10006-025-01366-y.
To investigate whether deviations in the localization of the main septo-cutaneous perforator (SCP) in maxillofacial reconstruction with free fibula flaps (FFF) lead to inaccuracies in the reconstruction result with respect to virtual surgical planning (VSP) procedures.
The consecutive VSP planning data of a total of 24 patients who either underwent resection of a bone-destructive malignancy or underwent maxillofacial reconstruction with FFF due to another osteodestructive lesion were retrospectively analyzed together with the postoperative computed tomography (CT) control data set and the preoperative computed tomographic angiograms (CTA). The deviations of the VSP from the actual position of the main SCP were quantified morphometrically to evaluate the impact on the reconstruction accuracy.
Significant differences in bone segment surfaces (p = 0.0006) and bone segment volumes (p = 0.0001) were observed between VSP and postoperative reconstruction results. A significant positive linear relationship was found between the distance of the SCP from the inferior margin of the lateral malleolus (p = 0.0362, R = 0.1844) and the deviation of the SCP from the center of the VSP (p = 0.0016, R = 0.3700), with increasing root mean square (RMS) values indicating a less accurate reconstruction result. The multimodal regression model showed that the deviation of the SCP from the center of the VSP significantly affected the accuracy of the reconstruction result (p = 0.0046, R = 0.3345).
The data provide evidence that the integration of the main SCP into the VSP procedures improves the predictability and accuracy of postoperative reconstruction outcomes.
探讨在游离腓骨瓣（FFF）进行颌面重建时，主要的鼻中隔-皮肤穿支血管（SCP）定位偏差是否会导致相对于虚拟手术规划（VSP）程序而言的重建结果不准确。
回顾性分析了总共24例患者的连续VSP规划数据，这些患者要么接受了骨破坏性恶性肿瘤切除术，要么因其他骨破坏性病变接受了FFF颌面重建，并结合术后计算机断层扫描（CT）对照数据集和术前计算机断层血管造影（CTA）进行分析。通过形态计量学方法对VSP与主要SCP实际位置之间的偏差进行量化，以评估其对重建准确性的影响。
观察到VSP与术后重建结果之间在骨段表面（p = 0.0006）和骨段体积（p = 0.0001）方面存在显著差异。发现SCP距外踝下缘的距离（p = 0.0362，R = 0.1844）与SCP偏离VSP中心的偏差（p = 0.0016，R = 0.3700）之间存在显著的正线性关系，均方根（RMS）值增加表明重建结果准确性降低。多模态回归模型显示，SCP偏离VSP中心对重建结果的准确性有显著影响（p = 0.0046，R = 0.3345）。
数据表明，将主要SCP纳入VSP程序可提高术后重建结果的可预测性和准确性。
