Application of temporary patient-specific plate in head and neck osteocutaneous free flap reconstruction: a prospective pilot study.

Background: During autologous osteocutaneous free flap transfer, the traditional process of manually contouring harvested bone segments to match the virtually planned jaw morphology is often imprecise and time-consuming. Consequently, the use of virtual surgical planning (VSP) and patient-specific surgical plates (PSPs) has gained substantial popularity in overcoming such challenges. However, the high costs and complex equipment required for manufacturing PSPs may render this technology inaccessible. Purpose: This study aimed to investigate the feasibility of developing a resin-made temporary patient-specific plate (TPSP) as an adjunct to improve the surgical efficiency and accuracy of reconstructive surgeries. Study design setting and sample: A prospective, single-centre study was performed. Patients indicated for computer-assisted free osteocutaneous flap reconstruction were recruited between December 2020 and October 2021. Outcome variables: Patient demographics, intraoperative characteristics, and postoperative outcomes were reviewed. Reconstruction accuracy was evaluated by comparing preoperative plans and postoperative models; the deviations and angulations of the reconstructed jaw, bone segments, and dental implants were measured. Analyses: Descriptive analysis was carried out. Results: Ten patients (seven men, three women) with a mean age of 52.9 ± 18.8 years were included in the study. In terms of surgical efficiency, the mean operative time was 492 ± 84.2 min, while the mean plating and reconstructive times were 58.7 ± 19.4 and 131.7 ± 26.4 min, respectively. A total of 26 simultaneous dental implants were placed in eight patients. One (3.8%) implant was abandoned due to intra-operative fenestration of the fibula bone, and one implant was explanted 12 months postoperatively. In terms of accuracy, the mean absolute distance deviation was 0.621 ± 0.548 (range: 0.0047-1.6277). The mean distance and deviation of the reconstructed segments were 5.16 ± 2.25 mm and 9.67° ± 6.84°, respectively. The mean distance deviations at the implant platform and apex were 3.94 ± 2.20 and 3.95 ± 2.97 mm, respectively, with a mean implant deviation of 12.8° ± 9.94°. Conclusions and relevance: The use of TPSP proved to be a more affordable intraoperative alternative to PSP for aligning and stabilizing bony segments during flap inset while achieving surgical efficiency and accuracy comparable to those of PSP.