Conformational Reconstruction in Head and Neck Bone Cancer: Could Fibula Free Flap Become the Gold Standard Flap?

Background/Objectives: The aim of this study is to present our conformational approach to CAD/CAM planning and reconstruction of head and neck cancer defects using a single-barrel fibula free flap, where the right oral rehabilitation position and the best aesthetic recontouring are achieved through 3D conformational miniplates (3D-CMP). Methods: We retrospectively enrolled patients between 2024 and 2019 who underwent maxillo-mandibular cancer resection, reconstructed with single-barrel fibula free flap and 3D-CMP. All the suitable patients had a deferred procedure for implant rehabilitation. Microvascular and implant-related complications were recorded over a medium follow-up of 29 months. Results: Twenty-two patients were treated by demolitive and reconstructive microsurgery with 3D-CMP. Minor complications were reported in five patients. Successful flap positioning for dental rehabilitation was observed in all 16 patients. An analysis of 3D planning models and 3D post-surgery models reported a high level of accuracy. Conclusions: Our conformational approach, which matches a single-barrel fibula free flap with 3D-CMP, has proven to be effective in restoring aesthetics and function in our patient cohort. This approach could lead the FFF to become the gold standard for head and neck bone reconstruction compared to other bone flaps, overcoming all the limitations noted to date.