title: Functional outcomes of virtually planned free fibula flap reconstruction of the mandible.
abstract: BACKGROUND
  The free fibula osteocutaneous flap has become the criterion standard for reconstruction of complex mandibular defects. The authors present their institutional experience with optimization of flap contouring and inset using virtual planning and prefabricated cutting jigs.
  
  
  METHODS
  All free fibula-based mandible reconstructions performed at the authors' institution using virtual planning technology between 2009 and 2012 were retrospectively analyzed. The authors evaluated a variety of patient and procedural variables and outcomes. A series of cases performed before virtual planning was reviewed for comparison purposes.
  
  
  RESULTS
  Fifty-four reconstructions were performed in 52 patients. Patients were divided evenly between a private university-affiliated medical center and a large county hospital. The most common indications were malignancy (43 percent), ameloblastoma (26 percent), and osteonecrosis/osteomyelitis (23 percent). Thirty percent of patients had irradiation of the recipient site and 38 percent had previous surgery. Sixty-three percent of patients received dental implants, with 47 percent achieving functional dentition. Twenty-five percent of patients had immediate dental implant placement, and 9 percent had immediate dental restoration. Postoperative imaging demonstrated excellent precision and accuracy of flap positioning. Comparison with cases performed before virtual planning demonstrated increased complexity of flap design along with reduced operative time in the virtually planned group.
  
  
  CONCLUSIONS
  Preoperative virtual planning along with use of prefabricated cutting jigs allows for precise contouring and positioning of microvascular fibula free flaps in mandibular reconstruction. Using this technique, the authors have achieved unprecedented rates of dental rehabilitation along with reduced operative times. The authors believe that virtual planning technologies are an emerging criterion standard in mandible reconstruction.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: New York, N.Y. From the Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center.
authors.forename: Tomer
authors.initials: T
authors.lastname: Avraham
authors.forename: Peter
authors.initials: P
authors.lastname: Franco
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Brecht
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ceradini
authors.forename: Pierre B
authors.initials: PB
authors.lastname: Saadeh
authors.forename: David L
authors.initials: DL
authors.lastname: Hirsch
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005360:Fibula / Q000637:transplantation*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D010347:Patient Care Planning; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D055815:Young Adult