Piotr Pietruski1, Marcin Majak2, Ewelina Światek-Najwer2, Magdalena Żuk2, Michał Popek2, Maciej Mazurek3, Marta Świecka3, Janusz Jaworowski3. 1. Department of Applied Pharmacy and Bioengineering, Medical University of Warsaw, Banacha 1 Street, 02-097 Warsaw, Poland; Department of Plastic Surgery, Prof. W. Orlowski Memorial Hospital, Medical Centre of Postgraduate Education, Czerniakowska 231 Street, 00-416 Warsaw, Poland. Electronic address: pietruski.piotr@gmail.com. 2. Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Lukasiewicza 7/9 Street, 50-370 Wroclaw, Poland. 3. Department of Applied Pharmacy and Bioengineering, Medical University of Warsaw, Banacha 1 Street, 02-097 Warsaw, Poland.
Abstract
OBJECTIVE: To analyze a novel technique of supporting fibula free flap harvest and fabrication with intraoperative navigation technology. MATERIALS AND METHODS: In the first phase of the study, navigation accuracy achieved with two registration methods, namely, point-pair and hybrid technique utilizing point-pair with surface matching, were evaluated in the form of the fiducial (FRE) and target registration error (TRE). Next, a series of 42 simulated navigated fibular osteotomies were conducted on specially manufactured lower leg phantom. Postoperative results were analyzed in the form of the angular and position deviations between the virtually planned and the obtained osteotomies. RESULTS: Mean FRE values obtained with point-pair and hybrid registration methods were 1.82 ± 0.96 mm and 1.41 ± 0.44 mm, respectively. Mean TRE value in the fibula region was 2.00 ± 0.67 mm for the first method and 1.51 ± 0.72 mm for the second. For all performed surgeries, the total mean angular deviation between the planned and actual osteotomy trajectory equaled 3.66° ± 3.60°. The total mean position disparity of osteotomy control points was 1.85 ± 0.99 mm. CONCLUSIONS: Navigation-guided free fibula flap harvest and fabrication, due to encouraging study results and its superiority over currently popular cutting guides in many clinical aspects, may become a routine operative procedure for the reconstruction of complex mandibular defects. The presented method is especially well suited for plastic and maxillofacial surgery.
OBJECTIVE: To analyze a novel technique of supporting fibula free flap harvest and fabrication with intraoperative navigation technology. MATERIALS AND METHODS: In the first phase of the study, navigation accuracy achieved with two registration methods, namely, point-pair and hybrid technique utilizing point-pair with surface matching, were evaluated in the form of the fiducial (FRE) and target registration error (TRE). Next, a series of 42 simulated navigated fibular osteotomies were conducted on specially manufactured lower leg phantom. Postoperative results were analyzed in the form of the angular and position deviations between the virtually planned and the obtained osteotomies. RESULTS: Mean FRE values obtained with point-pair and hybrid registration methods were 1.82 ± 0.96 mm and 1.41 ± 0.44 mm, respectively. Mean TRE value in the fibula region was 2.00 ± 0.67 mm for the first method and 1.51 ± 0.72 mm for the second. For all performed surgeries, the total mean angular deviation between the planned and actual osteotomy trajectory equaled 3.66° ± 3.60°. The total mean position disparity of osteotomy control points was 1.85 ± 0.99 mm. CONCLUSIONS: Navigation-guided free fibula flap harvest and fabrication, due to encouraging study results and its superiority over currently popular cutting guides in many clinical aspects, may become a routine operative procedure for the reconstruction of complex mandibular defects. The presented method is especially well suited for plastic and maxillofacial surgery.
Authors: Raúl Antúnez-Conde; José Ignacio Salmerón; Alberto Díez-Montiel; Marc Agea; Dafne Gascón; Ángela Sada; Ignacio Navarro Cuéllar; Manuel Tousidonis; Santiago Ochandiano; Gema Arenas; Carlos Navarro Cuéllar Journal: Front Oncol Date: 2021-10-05 Impact factor: 6.244