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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182a3c0b1
Pediatric/Craniofacial: Original Articles

Computer-Assisted versus Conventional Free Fibula Flap Technique for Craniofacial Reconstruction: An Outcomes Comparison

Seruya, Mitchel M.D.; Fisher, Mark B.A.; Rodriguez, Eduardo D. M.D., D.D.S.

Discussion
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Abstract

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.

Conclusion: 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.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

©2013American Society of Plastic Surgeons

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