Effectiveness of computer-assisted virtual planning, cutting guides and pre-engineered plates on outcomes in mandible fibular free flap reconstructions: a systematic review protocol

Abstract

Objective: The objective of this review is to synthesize the best available evidence on the outcomes of mandibular fibular free flap (MFFF) reconstructions using computer-assisted techniques versus traditional freehand techniques. Introduction: Fibular free flaps are the most commonly used free flap for mandible reconstruction and are considered best practice for mandible reconstructions following resection of head and neck cancers. There are several reported advantages of computer-assisted MFFF reconstructions, including increased accuracy, decreased operation time, decreased ischemia time, decreased overall cost and improved patient outcomes. It is important to assess the advantages and potential harms of these techniques in a systematic review. Inclusion criteria: Eligible studies will consider patients of all ages undergoing MFFF reconstruction. Studies will compare computer-assisted techniques to traditional freehand techniques for the primary outcomes of flap failure, patient-reported outcomes and bony resection margin status. Studies published in English from 2008 will be included. Experimental, quasi-experimental, prospective and retrospective cohort, case-control and analytical cross-sectional studies will be considered. Methods: MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials will be searched. Gray literature sources will include Google Scholar and the World Health Organization International Clinical Trials Registry Platform. Two independent reviewers will screen titles and abstracts, assess full-text papers against the inclusion criteria, evaluate methodological quality using standardized critical appraisal instruments and extract data using a customized form. If possible, data will be pooled for statistical meta-analysis, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings will be presented.

Subtotal Mandible Reconstruction with a Free Fibula Flap and No Skin Incisions

“…The advent of virtual surgical planning (VSP) has resulted in greater efficiency and improved outcomes. 3 Compared to “freehand” mandibular reconstruction, VSP results in shorter ischemic time, total operative time, and length of hospital stay, with no difference in postoperative complication rates. 4 These techniques are important in the total transoral approach where mandibular exposure is comparatively limited.…”

Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes

“…Optimizing surgical management to a minimal amount of total procedures, operative time, and the least invasive options should be integral in the surgeon’s and patient’s decision-making process 8 . Reconstruction with microvascular free tissue transfers has increased in popularity with the advent of virtual surgical planning (VSP) and the possibility of dental prosthetic rehabilitation 9–12 . Despite this evolution, free osteocutaneous flap reconstruction can be a complex operation requiring extensive preoperative planning, specialized surgical teams, and the potential for higher financial burden, 9,10,13 with varying rates of patients undergoing dental rehabilitation 10,14–18 …”

“…Virtual surgical planning use in fibula free flap (FFF) reconstruction has become common due to its demonstration of safety, decreased operative time, and increased accuracy when compared with conventional intraoperative shaping and osteotomies without preplanned guidance 13,19 . While there are numerous benefits, VSP use can be associated with a possible increased length of time from diagnosis to surgical treatment due to increased planning time, lead time, and cost 9,13 . Dental prosthetic rehabilitation has become more prevalent in current literature, especially with the introduction of the concept of “jaw-in-a-day.” This describes the technique of free fibula flap use for a complete reconstruction of bone and teeth during the same operation as resection and is offered at specialized centers 20–22 .…”

New Technologies for Personalized Medicine in Head and Neck Oncologic and Reconstructive Surgery

“…These technologies have gained significant acceptance in oncologic applications. In the area of reconstructive surgery, it provides many benefits, since the surgical precision required to restore facial symmetry, appearance, and function is a complex challenge and the three-dimensional (3D) position is difficult to control, especially in extensive bony defects [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“… It simplifies the osteotomies during tumor ablation in oncologic patients [ 9 ]. It improves reconstructive accuracy [ 5 , 7 , 8 , 9 ]. It improves the osteosynthesis of the bone segments for reconstruction [ 8 ].…”