Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: An outcomes comparison

Mitchel Seruya, Mark Fisher, Eduardo D. Rodriguez

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: There has been rising interest in computer-aided design/computer-aided manufacturing for preoperative planning and execution of osseous free flap reconstruction. The purpose of this study was to compare outcomes between computer-assisted and conventional fibula free flap techniques for craniofacial reconstruction. METHODS:: A two-center, retrospective review was carried out on patients who underwent fibula free flap surgery for craniofacial reconstruction from 2003 to 2012. Patients were categorized by the type of reconstructive technique: conventional (between 2003 and 2009) or computer-aided design/computer-aided manufacturing (from 2010 to 2012). Demographics, surgical factors, and perioperative and long-term outcomes were compared. RESULTS:: A total of 68 patients underwent microsurgical craniofacial reconstruction: 58 conventional and 10 computer-aided design and manufacturing fibula free flaps. By demographics, patients undergoing the computer-aided design/computer-aided manufacturing method were significantly older and had a higher rate of radiotherapy exposure compared with conventional patients. Intraoperatively, the median number of osteotomies was significantly higher (2.0 versus 1.0, p = 0.002) and the median ischemia time was significantly shorter (120 minutes versus 170 minutes, p = 0.004) for the computer-aided design/computer-aided manufacturing technique compared with conventional techniques; operative times were shorter for patients undergoing the computer-aided design/computer-aided manufacturing technique, although this did not reach statistical significance. Perioperative and long-term outcomes were equivalent for the two groups, notably, hospital length of stay, recipient-site infection, partial and total flap loss, and rate of soft-tissue and bony tissue revisions. CONCLUSION:: Microsurgical craniofacial reconstruction using a computer-assisted fibula flap technique yielded significantly shorter ischemia times amidst a higher number of osteotomies compared with conventional techniques.

Original languageEnglish (US)
Pages (from-to)1219-1228
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume132
Issue number5
DOIs
StatePublished - Nov 2013
Externally publishedYes

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Computer-Aided Design
Fibula
Free Tissue Flaps
Osteotomy
Length of Stay
Ischemia
Demography
Operative Time
Radiotherapy

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction : An outcomes comparison. / Seruya, Mitchel; Fisher, Mark; Rodriguez, Eduardo D.

In: Plastic and Reconstructive Surgery, Vol. 132, No. 5, 11.2013, p. 1219-1228.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND:: There has been rising interest in computer-aided design/computer-aided manufacturing for preoperative planning and execution of osseous free flap reconstruction. The purpose of this study was to compare outcomes between computer-assisted and conventional fibula free flap techniques for craniofacial reconstruction. METHODS:: A two-center, retrospective review was carried out on patients who underwent fibula free flap surgery for craniofacial reconstruction from 2003 to 2012. Patients were categorized by the type of reconstructive technique: conventional (between 2003 and 2009) or computer-aided design/computer-aided manufacturing (from 2010 to 2012). Demographics, surgical factors, and perioperative and long-term outcomes were compared. RESULTS:: A total of 68 patients underwent microsurgical craniofacial reconstruction: 58 conventional and 10 computer-aided design and manufacturing fibula free flaps. By demographics, patients undergoing the computer-aided design/computer-aided manufacturing method were significantly older and had a higher rate of radiotherapy exposure compared with conventional patients. Intraoperatively, the median number of osteotomies was significantly higher (2.0 versus 1.0, p = 0.002) and the median ischemia time was significantly shorter (120 minutes versus 170 minutes, p = 0.004) for the computer-aided design/computer-aided manufacturing technique compared with conventional techniques; operative times were shorter for patients undergoing the computer-aided design/computer-aided manufacturing technique, although this did not reach statistical significance. Perioperative and long-term outcomes were equivalent for the two groups, notably, hospital length of stay, recipient-site infection, partial and total flap loss, and rate of soft-tissue and bony tissue revisions. CONCLUSION:: Microsurgical craniofacial reconstruction using a computer-assisted fibula flap technique yielded significantly shorter ischemia times amidst a higher number of osteotomies compared with conventional techniques.",
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