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Virtual Surgical Planning in Free Fibula Reconstruction of the Mandible: Comparison of Long-Term Outcomes with the Conventional Technique
Fuat Baris Bengur, MD; Pooja Humar, BS; Rakan Saadoun, MD; Nayel Khan, MD; Erin Anstadt, MD; Sophia Dang, MD; Neil Fadia, BS; Elizabeth A. Moroni, MD, MHA; Matthew T. Bottegal, BS; Tahsin Oguz Acarturk, MD; Shaum Sridharan, MD; Mark Kubik, MD; Mario G. Solari, MD
University of Pittsburgh
2024-02-01
Presenter: Fuat Baris Bengur, MD
Affidavit:
I certify.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Pre-operative virtual surgical planning (VSP) revolutionized head and neck reconstruction after extirpative surgery. However, studies performing head-to-head comparison to the conventional technique are limited with long-term outcomes. We aimed to compare free fibula reconstructions of mandible with and without VSP for early surgical and long-term reconstructive outcomes.
Methods: Patients undergoing free flap reconstruction from 2012 to 2021 were included. Data regarding patient demographics, past medical history, surgical details, 30-day surgical and long-term reconstructive outcomes were collected. Patients who had VSP were compared with the patients who underwent reconstruction with the conventional technique. The cumulative incidence of hardware removal was displayed using the Kaplan-Meier method.
Results: For 30-day outcomes, 219 patients (n=79 non-VSP, n=140 VSP) were included. Both cohorts had similar demographics except the VSP cohort was younger (p=0.029). The mean operative duration was 53 minutes shorter with the use of VSP (p=0.016), while the ischemia time was 18 minutes shorter in the non-VSP cohort (p=0.008). Total and partial flap loss rates were similar. Patients with VSP had significantly lower rates of early wound dehiscence (p=0.050). Median follow up of patients included in the long-term outcomes were similar (931 [1854] for non-VSP vs 719 [868] for VSP days, p=0.060). VSP cohort had a lower hardware removal rate (29.2% vs 13.6%, p=0.008). The significance persisted after excluding patients with less than 2 years of follow up.
Conclusion: Our results show that the use of VSP reduces operative duration and significantly lowers early wound dehiscence and late hardware removal rates.
