Reconstruction of mandibular defects using free fibula flaps with a spliced surgical template system

BACKGROUND: Mandibular defect reconstruction after tumor resection poses significant challenges in oral and maxillofacial surgery. The free fibula flap is widely used and effective for reconstructing such defects. Traditional manual segmentation and stabilization can lead to inaccuracies; while 3D-printed guides improve cutting precision, they often overlook the stabilization of bone segments. The conventional surgical template system consists of three separate guides: a tumor removal guide, a fibula cutting guide, and a reconstruction guide, which requires manual detachment and reshaping of fibula segments before reconstruction. In contrast, the spliced surgical template system integrates an additional fibula cutting frame and reconstruction frame. This allows the fibula cutting guides to transform directly into the reconstruction guide without detaching the segments, thereby simplifying the workflow and improving stabilization accuracy. This study evaluates a spliced surgical template system and compares its accuracy in stabilizing bone segments with that of conventional systems. PATIENT AND METHOD: A retrospective cohort study was conducted for patients who underwent mandibular tumor resection and free fibula flap reconstruction at Shanghai Ninth People's Hospital from 01/01/2022 to 31/03/2025. Patients were divided into two groups based on whether they used conventional or spliced surgical template systems. Preoperative virtual surgical planning was adapted to create 3D models, cutting guides, and reconstructing guides. Postoperative CT scans were also analyzed to assess reconstruction accuracy by measuring deviations in three dimensions. RESULT: 20 patients were included; 10 used the spliced surgical template system, and the rest used the conventional ones. The spliced system showed significantly more minor errors in reconstruction accuracy than the other. The offset was X-axis 0.31 [0.13, 0.97] mm, Y-axis 0.32 [0.11, 0.78] mm, and Z-axis 0.37 [0.06, 0.47] mm for the spliced system, versus 4.03 [0.61, 18.49] mm, 3.50 [0.66, 13.94] mm, and 3.14 [0.85, 7.25] mm for the conventional system, which were all statistically significant (p < 0.05). CONCLUSION: The spliced surgical template system provides higher accuracy and stability in mandibular reconstruction with the free fibula flap. It reduces errors in the positioning of fibula segments, resulting in improved reconstruction precision and potentially contributing to better functional outcomes compared with conventional methods.

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A retrospective cohort of 20 patients undergoing mandibular reconstruction with free fibula flaps compared a spliced surgical template system (n=10) to conventional guides; the spliced system yielded significantly smaller positioning errors on all three axes (p<0.05).

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