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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.

Plastic and Reconstructive Surgery: November 2013 - Volume 132 - Issue 5 - p 1219–1228
doi: 10.1097/PRS.0b013e3182a3c0b1
Pediatric/Craniofacial: Original Articles

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.


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.

Received for publication January 1, 2013; accepted May 29, 2013.

Presented at the 92nd Annual Meeting of the American Association of Plastic Surgeons, in New Orleans, Louisiana, April 20 through 23, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Eduardo D. Rodriguez, M.D., D.D.S., Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, Md. 21201,

©2013American Society of Plastic Surgeons