Guide design in virtual planning for scapular tip free flap reconstruction

Area of Science:

• Head and Neck Surgery
• Plastic and Reconstructive Surgery
• Biomedical Engineering

Background:

• Virtual surgical planning (VSP) offers advanced tools for head and neck reconstruction.
• While VSP is used for fibular reconstruction, its application to scapular tip reconstruction is less documented.

Purpose of the Study:

• To evaluate the application of VSP and patient-specific guides for scapular tip osseous free flap reconstruction.
• To address the challenges of intraoperative osteotomies in scapular tip harvesting.

Main Methods:

• Four cases of mandibular or maxillary reconstruction utilized scapular tip osseous free flaps between 2013-2014.
• All cases involved preoperative VSP with the design of patient-specific cutting guides for scapular tip harvest.

Main Results:

• Patient-specific guides were successfully generated for scapular tip harvesting.
• A novel stabilizing flange and bracket design improved guide placement accuracy.
• Precise wedge osteotomies were achieved with minimal periosteal disruption in one case.

Conclusions:

• Scapular tip reconstruction presents unique challenges due to overlying muscle attachments, unlike fibula or iliac crest donor sites.
• Effective guide design requires careful consideration of scapular anatomy, including the fibrous tip and muscle insertions.
• VSP and custom guides can facilitate complex scapular tip osteotomies in head and neck reconstruction.