TY  - JOUR
A1  - Vollmer, Andreas
A1  - Saravi, Babak
A1  - Breitenbuecher, Niko
A1  - Mueller-Richter, Urs
A1  - Straub, Anton
A1  - Šimić, Luka
A1  - Kübler, Alexander
A1  - Vollmer, Michael
A1  - Gubik, Sebastian
A1  - Volland, Julian
A1  - Hartmann, Stefan
A1  - Brands, Roman C.
T1  - Realizing in-house algorithm-driven free fibula flap set up within 24 hours
BT  - a pilot study evaluating accuracy with open-source tools
JF  - Frontiers in Surgery
N2  - Objective: This study aims to critically evaluate the effectiveness and accuracy of a time safing and cost-efficient open-source algorithm for in-house planning of mandibular reconstructions using the free osteocutaneous fibula graft. The evaluation focuses on quantifying anatomical accuracy and assessing the impact on ischemia time.

Methods: A pilot study was conducted, including patients who underwent in-house planned computer-aided design and manufacturing (CAD/CAM) of free fibula flaps between 2021 and 2023. Out of all patient cases, we included all with postoperative 3D imaging in the study. The study utilized open-source software tools for the planning step, and three-dimensional (3D) printing techniques. The Hausdorff distance and Dice coefficient metrics were used to evaluate the accuracy of the planning procedure.

Results: The study assessed eight patients (five males and three females, mean age 61.75 ± 3.69 years) with different diagnoses such as osteoradionecrosis and oral squamous cell carcinoma. The average ischemia time was 68.38 ± 27.95 min. For the evaluation of preoperative planning vs. the postoperative outcome, the mean Hausdorff Distance was 1.22 ± 0.40. The Dice Coefficients yielded a mean of 0.77 ± 0.07, suggesting a satisfactory concordance between the planned and postoperative states. Dice Coefficient and Hausdorff Distance revealed significant correlations with ischemia time (Spearman's rho = −0.810, p = 0.015 and Spearman's rho = 0.762, p = 0.028, respectively). Linear regression models adjusting for disease type further substantiated these findings.

Conclusions: The in-house planning algorithm not only achieved high anatomical accuracy, as reflected by the Dice Coefficients and Hausdorff Distance metrics, but this accuracy also exhibited a significant correlation with reduced ischemia time. This underlines the critical role of meticulous planning in surgical outcomes. Additionally, the algorithm's open-source nature renders it cost-efficient, easy to learn, and broadly applicable, offering promising avenues for enhancing both healthcare affordability and accessibility.
KW  - mandibular
KW  - reconstruction
KW  - preoperative
KW  - planning
KW  - ischemia
KW  - osteocutaneous
KW  - fibula
KW  - graft
KW  - computer-aided
KW  - design
KW  - manufacturing (CAD/CAM)
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-353945
N1  - Funding
The author(s) declare that no financial support was received for
the research, authorship, and/or publication of this article.
VL  - 10
ER  -