Background: The traditional approach to head and neck reconstruction is considered challenging, requiring a subjective assessment of an often-complex defect followed by careful modelling of a bony flap to match this. The introduction of Virtual Surgical Planning (VSP) has provided the surgeon with a means to increase efficiency, precision and overall patient outcomes. This study aims to compare VSP and traditional head and neck reconstructions utilising fibula free flaps with regards surgical efficiency and patient outcomes.
Methods: A systematic search of the PubMed and Medline databases was performed from the date of their inception through to August 2018 to evaluate and compare VSP and non-VSP cohorts in the context of fibula free flap head and neck reconstruction. Key comparative outcomes included operative and ischaemic time, complication rates and measures of accuracy.
Results: One hundred and fifty-three articles were identified. Twenty-three articles were included in the review, comprising a total of 713 patients. VSP was associated with significantly decreased intraoperative time (Standardised Mean Difference -1.01; 95% CI -1.23 to 0.80; p = 0.000) and ischaemic time (Standardised Mean Difference -1.55; 95% CI -1.87 to -1.23, p=0.002). VSP was also associated with reduced orthognathic deviation from an ideal outcome when compared with conventional techniques. No statistically significant differences in complication rates between conventional and VSP techniques were identified.
Conclusion: The results of this meta-analysis suggests thatVSP confers significant benefits with respect to improved orthognathic accuracy, ischaemic times and intraoperative times without any significant increase in complications. Recommendations for ongoing research are suggested.