title: Use of a titanium cutting guide to assist with raising and inset of a DCIA free flap.
abstract: Reconstructing maxillary defects can be challenging. In particular, Class 3 and 4 defects require careful planning. Bone for reconstruction must be placed in the correct three dimensional (3D) position in order to achieve a good cosmetic and functional result. Correct size and positioning of the harvested bone also enables placement of dental implants and allows rehabilitation. We describe the use of a Deep Circumflex Iliac Artery Flap (DCIA) cutting guide to aid safe harvest and positioning of the correct quality and quantity of bone. We illustrate the benefits of using a guide based upon stereolithographic planning models of the pelvis by presenting 4 cases where planning to this level has been used. Our experiences clearly demonstrate the potential benefits that preformed cutting guides may have on outcomes when reconstructing complex maxillary defects. In particular, we note a reduction in operative time and improved functional and aesthetic results. The use of such a guide has not previously been described.
authors.affiliation: University Hospitals Birmingham, United Kingdom. Electronic address: cellanthomas@hotmail.com.
authors.forename: Cellan V
authors.initials: CV
authors.lastname: Thomas
authors.forename: Kevin G
authors.initials: KG
authors.lastname: McMillan
authors.forename: Pete
authors.initials: P
authors.lastname: Jeynes
authors.forename: Tim
authors.initials: T
authors.lastname: Martin
authors.forename: Sat
authors.initials: S
authors.lastname: Parmar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000737:chemistry*; D001860:Bone Plates; D016025:Bone Transplantation / Q000295:instrumentation*; D017076:Computer-Aided Design; D004867:Equipment Design; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D010347:Patient Care Planning; D066330:Printing, Three-Dimensional; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation*; D014025:Titanium / Q000737:chemistry*; D014057:Tomography, X-Ray Computed / Q000379:methods; D060053:Transplant Donor Site / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D014025:Titanium
keywords: Cutting guides; DCIA free flap; Maxillary reconstruction; Stereolithographic models