Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective...

In this study, selective laser melted patient specific functional implants (PSFI) were utilised in combination with a fibula free flap, for mandible reconstruction. The shape and length of the PSFI, the shaping of fibula graft, its angulation and the length of the screws, were virtually planned before the surgery. Information, such as resection margin and screw lengths, were coded on the implant. 22 patients were reconstructed with PSFI and fibula transplantation. Data collected related to the size of the defect, pre- and postoperative intercondylar distance, ischemia time, time consumed to shape the fibula graft and complications. All patients were reconstructed as planned. Depending on the extension of the defect, the fibula grafts were shaped into different shapes, within 41.6 ± 4.9 min. The mean difference of pre- and post-operational condyle distances was 1.2 ± 1.4 mm. Postoperative complications such as wound healing disturbance and plate exposure occurred in 8 patients. All PSFIs remained within reconstruction sites during the follow up period. 8 out of the 22 patients had full dental rehabilitation with implants. Based on our results, the use of PSFIs in the reconstruction of mandibular segmental defects may contribute to a better clinical outcome. Further work will be required in order to evaluate their mechanical properties in detail.