Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology. Issue 9 (November 2017)

• Record Type: Journal Article
• Authors: Modabber, A.; Ayoub, N.; Bock, A.; Möhlhenrich, S.C.; Lethaus, B.; Ghassemi, A.; Mitchell, D.A.; Hölzle, F.
• Is Part Of: British journal of oral and maxillofacial surgery. Volume 55:Issue 9(2017)
• Page Start: 946
• Page End: 951
• Publication Date: 2017-11
• Subjects: DCIA flap -- medial approach -- computer-assisted surgery -- virtual surgical planning -- surgical guide -- jaw reconstruction; Mouth -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; Dentistry, Operative -- Periodicals; Face -- surgery -- Periodicals; Mouth -- surgery -- Periodicals; Maxilla -- surgery -- Periodicals; Surgery, Oral -- Periodicals; Oral Surgical Procedures -- Periodicals; Dentistry, Operative -- Periodicals; Bouche -- Chirurgie -- Périodiques; Maxillaire supérieur -- Chirurgie -- Périodiques; Face -- Chirurgie -- Périodiques; Chirurgie dentaire -- Périodiques; Dentistry, Operative; Face -- Surgery; Maxilla -- Surgery; Mouth -- Surgery; Surgery, Plastic; Electronic journals; Periodicals; 617.52059
• DOI: 10.1016/j.bjoms.2017.09.005
• Languages: English
• ISSNs: 0266-4356

Abstract

Abstract: Donor site morbidity is the most common limitation of the deep circumflex iliac artery (DCIA) flap, so the purpose of this paper is to describe a new, minimally-invasive, approach to its harvest using virtual surgical planning and CAD/CAM technology to reduce functional and aesthetic morbidity at the donor site. Virtual surgical planning was based on preoperative computed tomographic data. A newly-designed surgical guide made using CAD/CAM technology was used to transfer the virtual surgical plan to the site of operation. This enabled us to raise a bicortical flap from the pelvis with preservation of the anterior superior iliac crest from the medial side with minimal muscular stripping. The guide, designed at slightly less than 90° to the lateral cortex, allowed the cut segment of bone to be raised medially. The new virtual surgical planning guide allowed a medial approach with reduced stripping of muscle and lower morbidity. No complications were encountered during the operation or the healing phase. Patients treated in this way had a shorter recovery period, with minimal complaints about walking or loss of profile of the hip. We conclude that virtual surgical planning can aid a minimally-invasive approach with predictable results. This allows a medial approach to the harvest of DCIA with preservation of important anatomical structures, and a reduction in donor site morbidity.