Impact of Virtual Surgical Planning on Margin Status in Cases of Mandibular Reconstruction
University of Pittsburgh Medical Center
Presenter: Elizabeth Bailey
Dr. Bailey has reviewed this abstract, is actively working to incorporate 2 additional years of data, and is spearheading writing and submitting the manuscript for this study.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
The osteocutaneous fibula free flap (OCFFF) is the gold standard for mandibular reconstruction after oncologic resection. Virtual surgical planning (VSP) has been shown to decrease ischemia time, operative time, and hospital stay while improving bony consolidation, symmetry, and occlusion. However, a significant concern remains regarding the potential impact of VSP on surgical margin status.
A retrospective review of patients who underwent mandibular reconstruction with OCFFF for oral cavity squamous cell carcinoma between 2012 and 2018 was performed. The primary outcome was the incidence of positive bony margins (PBM). Secondary outcomes included time from cross-sectional imaging to surgery and deviation from VSP.
101 patients were identified (VSP, n=57; non-VSP, n=55). PBM were present in 1.7% (n=1) and 6.8% (n=3) of the VSP and non-VSP groups, respectively (p-value=0.20). The average time from imaging to surgery was 20 and 23 days in the VSP and non-VSP group, respectively (p-value=0.25). Time from imaging to surgery was 27 days in the 1 patient with PBM in the VSP group and averaged 33 days in the 3 patients with PBM in the non-VSP group. VSP was altered intra-operatively in 5% (n=3) of the cases.
We have shown that the rate of positive bony margins is not compromised with VSP. Furthermore, the rate of deviation from VSP is low at our institution. Our data suggests that surgeons may anticipate a higher risk of either deviation from the VSP or positive bony margins as the time from imaging to surgery is delayed.
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