The Deep Circumflex Iliac Artery Flap for Mandibular Reconstruction and Donor Site Reconstruction with a Patient-Specific Implant: A Case Report

Long-Term Follow-Up of a Novel Surgical Option Combining Fibula Free Flap and 3D-Bioprinted, Patient-Specific Polycaprolactone (PCL) Implant for Mandible Reconstruction

As the fibula free flap became the gold standard in mandibular reconstruction that required both hard tissue and soft tissue, various methods have been sought to solve the height discrepancy between the mandible and fibula. The purpose of this paper was to propose a surgical option that combined the microvascular fibula free flap with a 3D-bioprinted, patient-specific polycaprolactone (PCL) implant as a safe and simple novel method that achieved the best functional and aesthetic results in mandibular reconstruction surgery for young patients with malignant tumors. The patient's reconstructed mandible maintained volume symmetry without any deformation or complications for over 6 years. Computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing technology enabled accurate and safe surgical results.

Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model

BACKGROUND

This study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed.

RESULTS

The output of implants was accurately implemented within the error range (- 0.03-0.03 mm), and the surgical accuracy varied depending on the measured area (range - 0.4-1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery.

CONCLUSION

To reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.

The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis

BACKGROUND

 Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction.

METHODS

 A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap.

RESULTS

 A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1-8%). No significant heterogeneity was present across studies (Q statistic 22.12, p = 0.14; I ² = 27.68%, p = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm², respectively. The area of the skin paddles was 117 cm².

CONCLUSION

 The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.