Fibula free flap reconstruction: improving the accuracy of virtual surgical planning using titanium inserts

Although advancements in three-dimensional (3D) modelling techniques have significantly reduced deviations between planned and actual clinical outcomes in fibula free flap reconstructions, discrepancies between the virtual surgical plan (VSP) and postoperative results persist. In this study, three head and neck surgeons performed 10 fibula osteotomies using conventional cutting templates and 10 osteotomies using more rigid cutting templates with titanium inserts. Differences in 3D angles and segment lengths between the planned and achieved osteotomy planes were calculated. The use of the titanium inserts resulted in a decrease in 3D angular deviation by 0.5° and a reduction in fibula segment length deviation by 0.2 mm for both the short and long sides. The use of the inserts enhanced guidance of the saw and diminished the risk of creating a false route, resulting in a better alignment with the VSP. This may lead to better reconstructive results, decreased operation times, and a potential reduction in complications in a cost-effective manner.