Enhanced bone graft contouring for mandibular reconstruction using intraoperatively fashioned templates

Among the challenges created by reconstruction of mandibular defects using free vascularized bone flaps is sizing and contouring of the bone graft in accordance with the dimensions of the defect. We have developed a rapid and reliable method for constructing a postablative template of the defect using a rapid-setting splint material called Aquaplast. The template can then be used at a site remote from the head and neck as a precise model of the defect for optimal size and shape estimation during bone graft sculpting and fixation. The material also has postablative utility for estimation of internal lining requirements and soft-tissue replacements during osteomusculocutaneous or fasciocutaneous flap planning. We feel that the use of Aquaplast has greatly enhanced our three-dimensional appreciation of mandibular bone defects and enhanced the final aesthetic and functional results in our patients undergoing mandibular reconstruction.