Virtual surgical planning can help surgeons ace challenging facial reconstructions, including complex maxillofacial reconstruction, with multiple simultaneous free flaps, finds a new report in the September issue of Plastic and Reconstructive Surgery.
According to lead author Adam Saad, MD, of Louisiana State University Health Sciences Center in New Orleans, and colleagues, such virtual surgical planning begins with a high-resolution 3D CT scan of the skull and facial defect and the donor site where the surgeon will obtain bone and tissue flaps for use in reconstruction. The CT data are then used to “virtually restore” the patient’s preinjury anatomy—including a computer simulation showing how multiple bone-containing flaps would be placed to restore the defect.
The virtual reconstruction is used to create a “stereolithic” model of the patient’s skull, including the pieces needed to perform the reconstruction. Surgeons can use the model to create custom jigs for use in performing the necessary bone cuts, as well as pre-bent surgical plates.
In the study, 10 patients had severe destruction and distortion of the facial structure. Reconstructions based on the virtual surgical planning system went smoothly with no surgical complications. Follow-up CT scans showed “excellent contour” of the bone flaps used for reconstruction of the facial skeleton. All bone and tissue flaps were viable at 3 months’ follow-up. Where reconstruction of the mandible was performed, functional jaw motion was restored—in some cases, allowing the patient to resume oral feeding, the study showed.
“Usage of this technology should allow for more precise estimates on required bony components for reconstruction, as well as enhancing our ability to make exact osteotomies to better match the contour of the facial skeleton,” the study authors write. Although virtual surgical planning carries some additional costs, the researchers think this may be offset by the ability to simplify complex reconstructions. “We do feel that no price tag can be assigned to predictability and streamlining.”