Optimized design for using of double-barrel vascularized fibular flap in various types of mandibular defects

Background/purpose The functional and aesthetic reconstruction of the mandible can be achieved by using the double-barrel vascularized free fibula flap. The purpose of this study was to use multiple integrated techniques to more effectively reconstruct the mandible, some contains of our unique ideas. Materials and methods 21 patients were included in this study. Computed tomography (CT) data of the patient's mandible and fibula were acquired preoperatively. Individualized surgical simulation was performed by using computer-aided surgical simulation (CASS) technology, about 6 kinds of integrated 3D design ideas were simultaneously perfectly transferred to real surgery. The accuracy of reconstruction was evaluated by superimposing the postoperative and preoperative image of mandible, measuring the linear and angular deviation of landmarks between the planned and actual outcomes. Results The mandibular reconstruction was effectively performed on all patients, and the result analysis showed that the surgical plan was precisely performed. The facial contours of the postoperative patients were harmonized and the largest mean linear and angular differences were 1.47 ± 0.31 mm and 3.97 ± 0.63°, respectively. Conclusion This study system illustrates how to select and position the fibula for reconstruction of various types of segmental mandibular defects by using double-barrel vascularized free fibula flap. It will provide valuable guidance and enhance the accessibility and efficiency of mandibular defects treatment.