Virtual surgical planning in microsurgical head and neck reconstruction: The Newcastle experience

Head and neck microvascular reconstruction is a complex but powerful tool following immediate cancer ablation or delayed sequalae after cancer treatment. Virtual surgical planning (VSP), using computer-aided design or computer-aided manufacturing has emerged as a potentially beneficial adjunct to head and neck reconstruction. The aim of this study was to assess the outcomes of VSP technology using the KLS Martin custom-made cutting guides and low-profile plates in head and neck microvascular reconstruction in our centre. A retrospective study was conducted at the regional head and neck centre in the UK from March 2017 until June 2023. A total of 127 patients were included. Among them, 77.8% of the patients underwent immediate reconstruction following cancer ablative procedure, with 22.2% being treated for osteoradionecrosis. Median flap ischaemia time was 130 min (45-360 min). Median number of osteotomies was 1 (0-3). Median operative time was 622 min (302-962 min). Procedural complications occurred in 16.2% of the patients. Total flap failure rate was 6.35%. This study found that patients who were operated on with palliative intent had significantly worse flap survival rates (p < 0.033). The length of hospital stay was significantly impacted by longer operative time (p < 0.002) and overall length of intensive therapy unit stay was significantly increased in diabetic and palliative patients. Three-dimensional planning software has become a standard of care within our centre, leading to shorter operative time, reliable and accurate reconstruction and a short learning curve for skill acquisition. Extensive surgery in palliative patients requires a robust consenting process in the context of a multi-disciplinary team discussion.