BACKGROUND: Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation.
METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap\'s suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured.
RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar.
CONCLUSIONS: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.

BACKGROUND: Microsurgical bone reconstruction is challenging in cases of anterior maxillary defects because of the presence of residual teeth. The study analyzed the method and feasibility of using vascularized bone flaps to reconstruct anterior maxillary defects.
METHODS: We retrospectively analyzed 15 patients treated at the Department of Oral and Maxillofacial Surgery, Peking University School, and Hospital of Stomatology between November 2017 and January 2023.
RESULTS: A total of 14 patients were successfully reconstructed using the digital technique: 6 deep circumflex iliac artery (DCIA) flaps and 8 fibular free flaps. Palatal and buccal pedicle paths were used in 4 and 10 cases, respectively, for vascular anastomosis. The implant coverage rates of the DCIA and fibular free flaps were 87.2% and 92.6%, respectively (p > 0.05).
CONCLUSIONS: Anterior maxillary defects reconstructed with the DCIA and fibular free flaps are reliable methods. Furthermore, the palatal and buccal paths are recommended for vascular anastomosis.

As maxillofacial surgical techniques have advanced, vascularized bone free flap transplantation has become the standard treatment for repairing maxillofacial defects. In this meta-analysis, we summarize the survival rates of implants after VBFF surgery for maxillary and mandibular reconstructions and investigate the factors affecting patient outcomes.
The PubMed, Embase, and Wanfang databases were searched up to May 31, 2022. The results of the treatment effect are presented as the risk ratio or odds ratio, using 95% confidence intervals. Statistical significance was calculated at α = 0.05 (two-tailed z tests).
35 studies were included in our analysis. The results revealed a 3-year and 5-year implant survival rate of 95.2% and 85.4% in VBFFs, respectively. The location of jaw defects (maxilla or mandible) or timing of implantation was not found to have a statistically significant influence on the survival rate. However, statistically significant differences were observed in the failure of implants placed in irradiated bone tissue.
Statistically significant differences were not found in the implant survival rate between simultaneous and delayed implantation, or between maxillary and mandibular defects. However, dental implants placed in irradiated flaps tended to have a lower survival rate than those surgically placed in non-irradiated flaps.

This study evaluated the accuracy of computer-assisted surgery (CAS)-driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM).
Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation.
High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts.
CAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context.

UNASSIGNED: Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors.
UNASSIGNED: We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case.
UNASSIGNED: The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either.
UNASSIGNED: Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes.
UNASSIGNED: Level IV, case series.

Microsurgical reconstruction for anterior maxillary defects presents a surgical challenge. The objective of this study was to ascertain the feasibility of a new series of intraoral surgical approach using deep circumflex iliac artery (DCIA) flap to achieve functional reconstruction for anterior maxillary defects. Two male patients with anterior maxillary defects (Brown Class IC) were treated in this study. Both patients underwent computer-assisted maxillary reconstruction with a DCIA flap (with pedicle positioning laterally to the bony flap) using intraoral anastomosis techniques. The overall DCIA flap survival rate was 100% and mucosa was all healed uneventfully. One patient received dental implantation and loaded with prosthetic superstructures. Both patients were satisfied with their postoperative oral function and appearance. This study illustrated a new and feasible series of surgical design for anterior maxillary bone defect reconstruction with DCIA flaps and intraoral anastomosis assisted by digital techniques.

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005-2010. The patients\' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n=86, 45%) and the anterolateral thigh free flap (ALTFF) (n=48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n=25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41-50 years (p=0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p=0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.

A 39-year-old male patient presented with an extensive putrescent ulceration of abdominoperineal region infiltrated by advanced penile squamous cell carcinoma. To our knowledge, it is the largest defect after aggressive palliative resection of penile squamous cell carcinoma (pSCC) in the literature, which was 36×23 cm. The defect was divided into three sub-defects, and was repaired by bilateral anteromedial thigh (AMT) and left deep circumflex iliac artery (DCIA) flaps. The postoperative course was uneventful and no flap necrosis occurred. The symptom relief was excellent.

OBJECTIVE: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results.
METHODS: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes.
RESULTS: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour.
CONCLUSIONS: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap.