A Modified Approach to Extensive Oromandibular Reconstruction Using Free Fibula Flaps

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic and Reconstructive Surgery
• Biomedical Engineering

Background:

• Large composite tissue defects often require multiple flap reconstructions.
• Single flap reconstructions may be limited by soft tissue availability.

Purpose of the Study:

• To evaluate the impact of virtual surgical planning on soft tissue requirements for single fibula free flap reconstructions.
• To determine if reducing projection can maximize soft tissue coverage in complex cases.

Main Methods:

• Utilized 3D virtual surgery to simulate angle-to-angle reconstructions with free fibula flaps.
• Compared standard symphyseal projection to recessed projections (0.5-2 cm posterior to the anterior nasal spine plane).
• Calculated changes in floor of mouth surface area and volume using program analytics.

Main Results:

• Recessing projection by 1 cm decreased surface area by 22% (to 14 cm²).
• Recessing projection by 2 cm decreased surface area by 44% (to 10 cm²).
• Converting a 3-segment to a 2-segment construct reduced surface area by 22% (to 14 cm²).

Conclusions:

• Virtual surgical planning can optimize single fibula free flap use in extensive reconstructions.
• Modest sacrifice in projection significantly reduces soft tissue volume and surface area needs.
• This technique increases confidence in using a single compound flap for complex reconstructions.