Dental Silicone-based Surgical Guides to Harvest the Chimeric Scapular Flap: Preventing Iatrogenic Vascular Injury

Abstract

Summary: The angular branch of the thoracodorsal artery and the periosteal branches of the circumflex scapular artery can be easily injured while harvesting a chimeric scapular flap. Thus, we reported the use of 3D printed scapular models using CT angiography to prepare inexpensive surgical guides from autoclavable dental silicone impressions for scapular flap harvest. Mandibular and scapular models were prepared using a 3D printer for 11 patients undergoing chimeric scapular flap transfer following mandibular resection. During preoperative simulation surgery, we molded dental silicone accordingly with scapular models to produce surgical cutting guides. Six men (54.5%) and five women (45.5%) were included. The average age of patients was 65.4 years. Fourteen bone units were reconstructed as three patients needed two bone segments (27.3%) whereas eight patients required reconstruction of one bone segment (72.7%). The mean flap harvest time and total surgical time were 52.1 min and 633.8 min, respectively. The mean duration for osteotomies and bone plate fixation was 26.2 min. The difference between the length of the preoperative surgical model (64.92 mm) and the postoperative 3D-CT measurements (64.48 mm) was not statistically significant (0.95 mm, P = 0.397). No injuries were caused to the angular and periosteal vessels. Four patients exhibited donor-site seroma (36.4%). The cost of the dental silicone for surgical guide was only $5 per patient. Dental silicone-based surgical guides help minimize the risk of vascular injury while harvesting chimeric scapular flaps. The osteotomies were performed with precision and in a time-efficient manner.

Management of Through-and-Through Oromandibular Defects after Segmental Mandibulectomy with Fibula Osteocutaneous Flap

“…29 Of note, the incorporation of three-dimensional printing and VSP, together with the learning curve of the surgical team, will tend to improve postoperative results. 29 30…”

“…29 Of note, the incorporation of three-dimensional printing and VSP, together with the learning curve of the surgical team, will tend to improve postoperative results. 29,30 The proximal musculocutaneous perforator may not arise from the main peroneal pedicle but from the posterior tibial, anterior tibial, popliteal artery, or as a trifurcation. 25 In these cases, the muscular perforator can be used to harvest a freestyle free flap (with or without muscle) with a larger skin paddle to cover larger external defects or reconstruct other structures requiring mucosal lining (e.g., tongue, palate, sinus) (►Supplementary Data S2, available in the online version).…”

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

“…For instance, the use of virtual surgical planning and computed tomography angiography to identify adequate perforators has caused a reduction in surgical time and shorter length of stay. [4][5][6] Furthermore, the enhanced recovery after surgery protocol has been increasingly implemented across the United States, demonstrating reduced use of opioid analgesia and length of stay without negatively altering patient-reported outcomes or the rate of complications. [7][8][9] Other strategies to optimize perioperative outcomes include running simultaneous operating rooms by a single surgeon.…”