title: Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning.
abstract: BACKGROUND
  Free fibula osteocutaneous flaps are the primary option for reconstruction after segmental mandibulectomies. This study evaluates the impact of CT-guided preoperative planning on operative outcomes after free fibula mandible reconstruction.
  
  
  METHODS
  We conducted a retrospective review of all patients undergoing free fibula reconstruction of the mandible from 2002 to 2011.
  
  
  RESULTS
  Fifty-seven patients underwent free fibula osteocutaneous flap reconstruction for head and neck cancers involving the mandible. Twelve patients had shaping of the neomandible performed on the back table while 20 patients underwent shaping in situ without the use of any adjunctive technology. The remaining 25 patients underwent preoperative CT imaging, which significantly decreased operative time (707 minutes vs 534 minutes; p < .0003) as well as overall costs ($24,532.50 vs $20,950.48). There were no significant differences in outcomes or complications.
  
  
  CONCLUSIONS
  Preoperative, patient-specific CT modeling, and cutting guide fabrication outweigh the costs associated with the additional technology without jeopardizing overall outcomes or increasing complication rates.
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Julia M
authors: JM
authors: Toto
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Eric I
authors: EI
authors: Chang
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Richard
authors: R
authors: Agag
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Karthik
authors: K
authors: Devarajan
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Sameer A
authors: SA
authors: Patel
authors: Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Neal S
authors: NS
authors: Topham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: free fibula osteocutaneous flap; mandible reconstruction; preoperative planning