The localization of septo-cutaneous perforators of free fibular flaps determines the postoperative accuracy of maxillofacial reconstructions and should therefore be included in virtual surgical planning procedures

Abstract

Purpose To investigate whether deviations in the localization of the main septo-cutaneous perforator (SCP) in maxillofacial reconstruction with free fibula flaps (FFF) lead to inaccuracies in the reconstruction result with respect to virtual surgical planning (VSP) procedures. Methods The consecutive VSP planning data of a total of 24 patients who either underwent resection of a bone-destructive malignancy or underwent maxillofacial reconstruction with FFF due to another osteodestructive lesion were retrospectively analyzed together with the postoperative computed tomography (CT) control data set and the preoperative computed tomographic angiograms (CTA). The deviations of the VSP from the actual position of the main SCP were quantified morphometrically to evaluate the impact on the reconstruction accuracy. Results Significant differences in bone segment surfaces (p = 0.0006) and bone segment volumes (p = 0.0001) were observed between VSP and postoperative reconstruction results. A significant positive linear relationship was found between the distance of the SCP from the inferior margin of the lateral malleolus (p = 0.0362, R² = 0.1844) and the deviation of the SCP from the center of the VSP (p = 0.0016, R² = 0.3700), with increasing root mean square (RMS) values indicating a less accurate reconstruction result. The multimodal regression model showed that the deviation of the SCP from the center of the VSP significantly affected the accuracy of the reconstruction result (p = 0.005). Conclusions The data provide evidence that the integration of the main SCP into the VSP procedures improves the predictability and accuracy of postoperative reconstruction outcomes.