Geometric Study and Clinical Case Series for Mandible Reconstruction With a Single-Piece Scapular Free Flap.

Abstract

Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations. Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions. Virtually, the vertical placement outperformed the horizontal placement in dice score (DSC) and Hausdorff-95 for all but one defect. Clinically, the VSP cohort had shorter operative time (386.6 ± 111.6 min vs. 268.9 ± 50.6 min, p = 0.002), fewer tracheostomies (73% vs. 15%, p = 0.002), lower length of hospital stay (16.6 ± 13.5 days vs. 12.2 ± 8.1 days, p = 0.319), and higher complete/partial union to a non-significant degree (78% vs. 100%, p = 0.471). A single-piece scapula free flap is a versatile option for mandibular reconstruction. VSP has time and cost savings potential and quality of life impact that should be further investigated.