الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 288 |  |  |
| | | from | 288 | | |
Abstract
The reconstruction of discontinuity defects of the bone specially the mandible due to benign or malignant lesions is a very challenging procedure for the reconstructive surgeon. Many different approaches have been used to try to reconstruct these defects.
Many reconstructive options exist due to the development of new techniques and the variety of flap donor sites. However, the most common donor site remains to be the fibula.
The bony reconstruction of the mandible by microvascular fibula free flaps after segmental mandibulectomy is an established standard procedure in reconstructive head and neck surgery. As first described in the maxillofacial region by Hidalgo 1989. It was proved to be well suited for mandible reconstruction due to a long vascular pedicle, a wide vessel diameter, and the possibility to harvest a skin island and a muscle cuff.
The fibula is the only bone transplant which allows reconstruction of the whole mandible with one single flap. Nevertheless, surgeons are challenged by reconstructions of complex defects with one or more osteotomies in order to achieve a harmonic and functional neomandibular arch.
The exact adaption, segmentation, and forming of the fibula are essential to address the vital roles of the mandible regarding facial harmony, speech, mastication, and airway maintenance and to mimic it in the most accurate way possible. Therefore, the simulation of the mandibular contour correspondingly assumes the exact angles of the osteotomy and the bent plates. VSP is increasingly applied for complex defect reconstructions, especially in two or more segmented mandible reconstruction cases to facilitate osteotomy and enhance accuracy.
The skin paddle is supplied by perforator vessels arising from the posterior border of the fibula with sustenance through the peroneal artery. Unfortunately, the surgeon regularly faces a high variability in the anatomical course of these perforator vessels, which may lead to difficulties in planning.
Doppler sonography, computerized tomographic angiography (CTA) or magnetic resonance Angiography (MRA) are widely used for preoperative evaluation, but the obtained information is typically not linked to CAD/CAM planning procedures. The bony aspect of the fibula is a reliable structure. Therefore, its integration into CAD/CAM logarithms for surgical planning is a generally accepted and widely used tool.
This study aimed to evaluate the effectiveness and benefits of computer aided planning as tool in improving free fibula flap results in bone defects reconstruction.
The VSP process begins with the appropriate preoperative imaging. High-resolution CT scans of the mandible and fibula with 1 mm interval cuts are obtained. The ablative surgeon is then given control of the virtual scalpel to demonstrate the location of the osteotomies. Next, the fibula is positioned onscreen to replace the removed areas of the mandible/maxilla. The same location and number of osteotomies are performed as with the traditional templates described above. Once the virtual fibula reconstruction is complete, dental implants can also be placed into the fibula. The location and depth of implant placement are determined at this time.
After completion of the virtual planning, acrylic cutting guides for the tumor resection and the fibula are made through the process of additive printing.