title: Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border--Evolution of a biplanar plug-on cutting guide.
abstract: BACKGROUND
  Computer-assisted planning and intraoperative implementation using templates have become appreciated modalities in craniofacial reconstruction with fibula and DCIA flaps due to saving in operation time, improved accuracy of osteotomies and easy insetting. Up to now, a similar development for flaps from the subscapular vascular system, namely the lateral scapular border and tip, has not been addressed in the literature.
  
  
  METHODS
  A cohort of 12 patients who underwent mandibular (n = 10) or maxillary (n = 2) reconstruction with free flaps containing the lateral scapular border and tip using computer-assisted planning, stereolithography (STL) models and selective laser sintered (SLS) templates for bone contouring and sub-segmentation osteotomies was reviewed focussing on iterations in the design of computer generated tools and templates.
  
  
  RESULTS
  The technical evolution migrated from hybrid STL models over SLS templates for cut out as well as sub-segmentation with a uniplanar framework to plug-on tandem template assemblies providing a biplanar access for the in toto cut out from the posterior aspect in succession with contouring into sub-segments from the medial side.
  
  
  CONCLUSIONS
  The latest design version is the proof of concept that virtual planning of bone flaps from the lateral scapular border can be successfully transferred into surgery by appropriate templates.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany. Electronic address: Peter.Cornelius@med.uni-muenchen.de.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Cornelius
authors.affiliation: Department of Plastic, Reconstructive, Esthetic and Hand Surgery, Klinikum Kassel, Kassel, Germany.
authors.forename: Goetz Andreas
authors.initials: GA
authors.lastname: Giessler
authors.affiliation: Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, German Armed Forces Hospital Ulm and Academic Hospital of Ulm University, Ulm, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wilde
authors.affiliation: Department of Oral and Maxillofacial Surgery, Albert-Ludwig-University, Freiburg i. Brsg., Germany.
authors.forename: Marc Christian
authors.initials: MC
authors.lastname: Metzger
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Gerson
authors.initials: G
authors.lastname: Mast
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Florian Andreas
authors.initials: FA
authors.lastname: Probst
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D005260:Female; D005360:Fibula; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D063175:Mandibular Reconstruction; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged
keywords: Bone flaps; Computer-assisted surgery; Cutting guide design; Lateral scapular border; Mandibular reconstruction; Maxillary reconstruction