Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning

Background Free fibula osteocutaneous flaps are the primary option for reconstruction after segmental mandibulectomies. This study evaluates the impact of CT-guided preoperative planning on operative outcomes after free fibula mandible reconstruction. Methods We conducted a retrospective review of all patients undergoing free fibula reconstruction of the mandible from 2002 to 2011. Results Fifty-seven patients underwent free fibula osteocutaneous flap reconstruction for head and neck cancers involving the mandible. Twelve patients had shaping of the neomandible performed on the back table while 20 patients underwent shaping in situ without the use of any adjunctive technology. The remaining 25 patients underwent preoperative CT imaging, which significantly decreased operative time (707 minutes vs 534 minutes; p<.0003) as well as overall costs (24,532.50 vs 20,950.48). There were no significant differences in outcomes or complications. Conclusion Preoperative, patient-specific CT modeling, and cutting guide fabrication outweigh the costs associated with the additional technology without jeopardizing overall outcomes or increasing complication rates.