Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning

Toto, Julia M.; Chang, Eric I.; Agag, Richard L.; Devarajan, Karthik; Patel, Sameer A.; Topham, Neal S.

doi:10.1002/hed.23815

Cited by 156 publications

(132 citation statements)

References 20 publications

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“…[7][8][9][10][11][12][13] Initially, the preoperative planning generated a stereolithic model that only served as a guide for the reconstructive surgeon. With further innovations and refinements, virtual surgical planning now provides a prebent mandibular plate and osteotomy guides for both the mandible and the osteocutaneous flap.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the use of this new technology does not increase the rate of complications associated with mandibular reconstruction with free fibula flaps. 8 Clearly, the use of virtual surgical planning optimizes surgical outcomes and minimizes operative time. Avraham et al recently reported a series of 52 patients where virtual surgical planning not only improved operative outcomes but also increased rates of dental rehabilitation.…”

Section: Plastic and Reconstructive Surgery • February 2016mentioning

confidence: 99%

“…Virtual surgical planning was found to decrease the overall costs associated with mandibular reconstruction by decreasing operative time. 8 However, the accuracy and utility of this new technology and the longterm benefits remain largely unknown.…”

mentioning

confidence: 99%

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Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction

Chang

Jenkins

Patel

et al. 2016

Plastic and Reconstructive Surgery

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127

102

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Section: Discussionmentioning

confidence: 99%

Section: Plastic and Reconstructive Surgery • February 2016mentioning

confidence: 99%

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Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction

Chang

Jenkins

Patel

et al. 2016

Plastic and Reconstructive Surgery

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127

102

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“…Some authors have argued that it is difficult to justify the costs associated with the added expense of SDS for procedures such as ART . The available literature was not found to provide definitive information on the costs of adding SDS through its effect on potential reduction in the operative time, the overall treatment time, and osseointegrated implant waste.…”

Section: Discussionmentioning

confidence: 99%

“…SDS and additive manufacturing approaches hold the potential to reduce surgical time and inaccuracies compared to intuitive intraoperative surgical design or analog planning. Studies suggest that the rates of surgical complications, flap survival, morbidity, and aesthetic outcomes in patients treated with SDS‐guided reconstructive surgery are similar to those treated with conventional intuitive intraoperative reconstruction design.…”

Section: Introductionmentioning

confidence: 99%

The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

et al. 2019

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Objectives/Hypothesis The free flap reconstructive protocols of the jaws have been refined over the years and presently are based on bone‐driven approaches that generally use the lower border of the mandible or the anterior surface of the maxilla as the templates for reconstruction because these contours are deemed important to the eventual cosmetic outcomes of patients. The ultimate goal of functional jaw reconstruction, however, is the reconstruction of the dental occlusion and oral rehabilitation. The purpose of the present study was to evaluate the Alberta reconstructive technique (ART), which is a new approach of occlusion‐driven jaw reconstruction with digitally planned immediate osseointegrated implant installation. Study Design Prospective cohort study. Methods This research study considers the ART's safety, effectiveness, accuracy, timeliness of reconstruction, aesthetic appeal, and cost‐effectiveness in comparison with the standard bone‐driven and delayed osseointegrated implant installation (BDD) protocol. Results The ART procedures were as safe and more effective at achieving full occlusal reconstruction and oral rehabilitation. The ART cohort of patients achieved oral rehabilitation in 21.4 month as compared to 73.1 months for the BDD cohort. There were no differences in the aesthetic appeal the two groups. The ART cost an average of $22,004 less than BDD and we calculated the quality adjusted life years gain to be between 2.14 and 4.04 in favour of ART. Conclusions The ART is a good option for patients with jaw defects. It provides a safe, effective, accurate, aesthetic, and cost‐effective reconstruction that restores form and function in a timely manner. Level of Evidence 2b Laryngoscope, 129:S1–S14, 2019

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Identifying Factors of Operative Efficiency in Head and Neck Free Flap Reconstruction

Alhefzi

Redwood

Hatchell

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck oncological resection and reconstruction is a complex process that requires multidisciplinary collaboration and prolonged operative time. Numerous factors are associated with operative time, including a surgeon’s experience, team familiarity, and the use of new technologies. It is paramount to evaluate the contribution of these factors and modalities on operative time to facilitate broad adoption of the most effective modalities and reduce complications associated with prolonged operative time.ObjectiveTo examine the association of head and neck cancer resection and reconstruction interventions with operative time.Design, Setting, and ParticipantsThis large cohort study included all patients who underwent head and neck oncologic resection and free flap–based reconstruction in Calgary (Alberta, Canada) between January 1, 2007, and March 31, 2020. Data were analyzed between November 2021 and May2022.InterventionsThe interventions that were implemented in the program were classified into team-based strategies and the introduction of new technology. Team-based strategies included introducing a standardized operative team, treatment centralization in a single institution, and introducing a microsurgery fellowship program. New technologies included use of venous coupler anastomosis and virtual surgical planning.Main Outcomes and MeasuresThe primary outcome was mean operative time difference before and after the implementation of each modality. Secondary outcomes included returns to the operating room within 30 days, reasons for reoperation, returns to the emergency department or readmissions to hospital within 30 days, and 2-year and 5-year disease-specific survival. Multivariate regression analyses were performed to examine the association of each modality with operative time.ResultsA total of 578 patients (179 women [30.9%]; mean [SD] age, 60.8 [12.9] years) undergoing 590 procedures met inclusion criteria. During the study period, operative time progressively decreased and reached a 32% reduction during the final years of the study. A significant reduction was observed in mean operative time following the introduction of each intervention. However, a multivariate analysis revealed that team-based strategies, including the use of a standardized nursing team, treatment centralization, and a fellowship program, were significantly associated with a reduction in operative time.ConclusionsThe results of this cohort study suggest that among patients with head and neck cancer, use of team-based strategies was associated with significant decreases in operative time without an increase in complications.

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Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning

Abstract: Preoperative, patient-specific CT modeling, and cutting guide fabrication outweigh the costs associated with the additional technology without jeopardizing overall outcomes or increasing complication rates.

Cited by 156 publications

References 20 publications

Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction

Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction

The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction

Identifying Factors of Operative Efficiency in Head and Neck Free Flap Reconstruction

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