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


CONCLUSIONS
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.


METHODS
Therapeutic, III.
Melbourne, Victoria, Australia; and Baltimore, Md. From the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital; The Johns Hopkins University School of Medicine; and the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland.
Mitchel
M
Seruya
Mark
M
Fisher
Eduardo D
ED
Rodriguez
D000328:Adult; D017076:Computer-Aided Design; D005145:Face / Q000601:surgery*; D005151:Facial Injuries / Q000601:surgery; D005260:Female; D005360:Fibula / Q000601:surgery / Q000637:transplantation*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010027:Osteotomy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000293:injuries / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*