How Is a Cutting Guide With Additional Anatomical References Better in Fibular-Free Flap Mandibular Reconstruction? A Technical Strategy

BACKGROUND

Computer-assisted surgery is used to design and manufacture cutting guides in mandibular reconstructions with fibula-free flaps. To improve the outcomes of the procedure, the aim of this research was to investigate and compare the accuracy of mandibular reconstruction following the use of 2 versus 3 anatomical reference cutting guides.

METHODS

Eighteen sets of prototype bone models retrieved from an ameloblastoma patient were used for mock operations. The mandibular segmental osteotomies and fibular reconstructions were performed using 2 and 3 anatomical reference cutting guides in vivo surgeries. After reconstruction, the accuracy of the placed reference points was measured by superimposition of computed tomography images.

RESULTS

The error in cutting guides when using 2 or 3 anatomical references showed no significant difference. The fibular and condylar errors of the cutting guide between 2 and 3 anatomical references showed no significant difference in every plate type. The difference in screw hole position errors between 2 and 3 anatomical reference cutting guides was not statistically significant.

CONCLUSIONS

Two anatomical reference cutting guides are sufficient and reasonable enough for mandible resection. However, there were some limitations and errors in our study.

Radiological landmark of syndesmotic ligament complex by magnetic resonance imaging correlate with fibula free flap harvesting procedure

Preservation of syndesmotic ligaments is crucial for preventing adverse sequelae at the donor site following free fibula osteocutaneous flap harvesting. This study sought to determine the relationship between distal tibiofibular ligaments and the fibular segment to identify radiological landmarks that facilitate safe and precise flap. The distances between the distal tibiofibular ligaments (anterior inferior tibiofibular ligament [AITFL], posterior inferior tibiofibular ligament [PITFL]) and the fibular segment, as well as the lower border of the interosseous membrane, were measured on magnetic resonance imaging (MRI) scans of 296 patients without any perceivable ankle abnormalities. The mean distances (± SD) between the distal end of the fibula and the AITFL, PITFL, and lower interosseous membrane border were 3.0 ± 0.4 cm, 2.6 ± 0.4 cm, and 3.9 ± 0.6 cm, respectively. The distance between the talar dome and the PITFL exhibited a range of 0.0-0.5 cm. Our findings support preserving a distal fibular remnant of at least 4 cm to avoid injury to the syndesmotic ligament throughout fibula osteocutaneous flap harvesting. The talar dome could serve as a useful radiological landmark for identifying the upper border of PITFL during preoperative evaluation, and thus facilitating precise and safe flap procurement.

A Successful Outcome after Lymphaticovenular Anastomosis Using a Contralateral Augmented Reality Mapping Technique in a Lymphedema Patient Secondary to a Mycobacterium abscessus Infection

We report a case of extremity lymphedema after a Mycobacterium abscessus infection in a 43-year-old man with anti-interferon-γ autoantibody syndrome. Lymphaticovenular anastomosis was performed using the contralateral healthy or less severe limb as a mirror image to map the lymph vessels in the edematous limb. A satisfying outcome was provided after the surgery. No report of lymphedema caused by this condition has been previously reported in the literature.