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Surgical design and simulation in fibula free flap reconstruction:
Benchtop study to current practice
Heather Logan, MSc
Surgical Design Simulationist
Disclosure
I have no relationship that could be perceived as placing me in a real or apparent conflict of interest in
the context of this presentation.
Acknowledgments
I wish to acknowledge:
1) Covenant Health Research Centre for the funding
to support this research project.
2) Synthes (Canada) Ltd for the donation of the
surgical instruments.
3) Diagnostic Imaging (MCH) for the medical
imaging support.
4) Institute for Reconstructive Sciences in Medicine
for their financial support.
5) Supervisory Committee: Dr. Johan Wolfaardt, Dr.
Hadi Seikaly, Dr. Pierre Boulanger, Dr. Bill Hodgetts
Surgical design and simulation in fibula free flap reconstruction:
Benchtop study to current practice
Heather Logan, MSc
Surgical Design Simulationist
Medical Modeling Research Laboratory Institute for Reconstructive Sciences in Medicine Misericordia Community Hospital
Surgical Design and Simulation
3D Printing
•Cancer
•Congenital
•Trauma
Our Patients
Our Patients
Background
• In the past and even still today, patients are being reconstructed without preoperative virtual surgical planning and simulation.
• Without surgical planning patients can be left with problems in oral functions such as deglutition, speech, mandibular movements, mastication and control
of saliva.
• Patients can be left with major negative changes in their quality of life which can lead to low self-confidence and negative self perception.
Exploratory Benchtop Study Evaluating the Use of Surgical Design and Simulation in
Fibula Free Flap Mandibular Reconstruction
Purpose:
To examine whether there is a difference, in the context of surgical simulation, between free hand surgery completed without virtual surgical planning software and preoperatively planned surgery completed with the use of
virtual surgical planning software.
Free hand (no planning)
SESSION A
Preoperative digital planning
SESSION B VS
OUTCOME MEASURES
1. Digital registration computer software 2. Hard tissue measures 3. Duration of the task
Methods – repeated measures
Free hand (no planning)
SESSION A
• Mandible to reconstruct • Fibula
Methods
Preoperative digital planning
SESSION B • Mandible to reconstruct
• Fibula • Reference mandible
• Reference of the planned reconstruction model • Mandible fixator • Fibula cutting guide
+
On screen review of the digital planning
Methods
Surgical planning was completed in
collaboration with a prosthodontist and a head and neck surgeon
-Optimal implant location -Optimal placement of the fibula
-Optimal height of the fibula in relation to the occlusal plane
Methods
A B A B
A B A B A B
#1 #2
#3 #4 #5
CONTROL
Results
Session A
Participant #1
Session B
Participant #1
Results – digital registration
13 hard tissue
manual measures
Left Gonial Angle Right Gonial Angle Inter-Corononoid
Process Length Fibula Crest Length
Results
Time to complete each session
Participant Session A Session B
01 76 minutes 81 minutes
02 79 minutes 81 minutes
03 81 minutes 80 minutes
04 82 minutes 175 minutes
05 83 minutes 55 minutes
Min Max Median Range Skewness Kurtosis
Session A 76 83 80.00 7.00 -0.423 -0.416
Session B 55 81 80.50 26.00 -1.992 3.972
Descriptive statistics
Results
How did…
• Improved our surgical planning & design process
No cutting guide Titanium welded cutting guide Digitally designed and 3d printed cutting guide
Fibula Cutting Guide
How did…
• Improved our surgical planning & design process
Fibula Holder
How did…
• Improved our surgical planning & design process
How did…
• Improved our surgical planning & design process
How did…
• Improved our surgical planning & design process
How did…
• Improved our surgical planning & design process
How did…
• Improved our surgical planning & design process
Planned
How has…
Actual
How has…
How has…
Planned
Actual
How has…
POST OP
POST OP
PLANNED
PLANNED
129.38mm 137.82mm
132.35mm 136.11mm
Planned Actual Difference
Left 137.82 129.38 5.08
Right 132.35 136.11 -3.76
How has…
POST OP PLANNED
114.99mm
90.34mm 92.06mm
119.67mm
Planned Actual Difference
1 119.67 114.99 4.68
2 90.34 92.06 -1.72
How has…
POST OP PLANNED
89.57mm 94.65mm
Planned Actual Difference
94.65 89.57 5.08
How has…
POST OP PLANNED
104.59mm 97.25mm
Planned Actual Difference
104.59 97.25 7.34
How has…
• improve accuracy
• improve surgeon confidence • limit time needed for the reconstruction process • innovative design of surgical guides
• improve patient reconstructions • improve patient rehabilitation
• improve patient outcomes • better quality of life for the patient
How will… this research impact best practices, clinician`s practices and/or
patient outcomes?
Surgical design and simulation in fibula free flap reconstruction:
Benchtop study to current practice
Heather Logan, MSc
Surgical Design Simulationist
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