The Latest Evolution in Virtual Surgical Planning: Customized Reconstruction Plates in Free Fibula Flap Mandibular Reconstruction.

BACKGROUND Virtual surgical planning (VSP) has contributed to technical advancements in free fibula flap mandible reconstruction. We present the largest comparative study on the latest modification of this technology: the use of patient-specific, preoperatively customized reconstruction plates for fixation. METHODS A retrospective chart review was performed on all patients undergoing mandibular reconstruction with virtually planned free fibula flaps at a single institution between 2008 and 2018. Patient demographics, perioperative characteristics and postoperative outcomes were reviewed. Reconstructions utilizing traditional fixation methods were compared to those utilizing pre-fabricated, patient-specific reconstruction plates. RESULTS A total of 126 patients (mean age 48.5 ± 20.3 years; 61.1% male) underwent mandibular reconstruction with free fibula flap. Mean follow-up time was 23.5 months. A customized plate was used in 43.7% of cases. Reconstructions with patient-specific plates had significantly shorter total operative times compared to non-customized fixation methods (643.0 vs. 741.7 minutes, p=0.001). Hardware complications occurred in 11.1% of patients, with a trend towards a lower rate in the customized plate group (5.5% vs. 15.5%, p=0.091). Multivariate regression showed that the use of customized plates was a significant independent predictor of less overall complications (p=0.03), shorter operative time (p=0.014), and shorter length of stay (p=0.001). CONCLUSION Compared to traditional fixation methods, patient-specific plates are associated with less complications, shorter operative times, and reduced length of stay. The use of customized reconstruction plates increases efficiency and represents the latest technological innovation in mandibular reconstruction.