Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates

Head Neck. 2021 Aug;43(8):2342-2352. doi: 10.1002/hed.26688. Epub 2021 Mar 31.


Background: To determine whether virtual surgical planning and three-dimensional printed cutting guides (3D/VSP) improved radiographic bone union compared to conventional methods (CM) in fibula free flap (FFF) reconstruction of the mandibles.

Methods: Retrospective study from the years 2000-2018 at a tertiary hospital. Osseous union was evaluated by a radiologist blinded to each patient's treatment.

Results: Two hundred sixty patients who underwent FFF tissue transfer, 28 with VSP and 3D cutting guides. Bony union was not achieved in 46 (20%) patients who underwent CM compared to 1 (4%) of patients with VSP and guides (p = 0.036). FFF complication was significantly higher in CM with 87 patients (38%) compared to three patients (11%) in 3D/VSP (p = 0.005). Median time to bony union for patients who underwent CM was 1.4 years compared to 0.8 years in 3D/VSP.

Conclusions: 3D/VSP reduced the rate of radiographic nonunion and flap-related complications in FFF reconstruction for mandibular defects.

Keywords: 3D printing; fibula free flap; head and neck cancer; mandible reconstruction; virtual surgical planning.

MeSH terms

  • Fibula / surgery
  • Free Tissue Flaps*
  • Humans
  • Mandible / diagnostic imaging
  • Mandible / surgery
  • Mandibular Reconstruction*
  • Plastic Surgery Procedures*
  • Retrospective Studies
  • Surgery, Computer-Assisted*