Deep Circumflex Iliac Artery (DCIA) Free-Flap Mandibular Reconstruction Using Patient-Specific Surgical Guides and Customized Plates: A Preliminary Study

Background: Mandibular reconstruction remains challenging in oral and maxillofacial surgery due to its complex anatomy and functional requirements. While Deep Circumflex Iliac Artery (DCIA) flaps offer advantages in bone height and natural contour, their application with computer-aided surgical planning remains limited. Aim: This preliminary study aimed to evaluate the accuracy and clinical outcomes of mandibular reconstruction using DCIA free flaps with patient-specific surgical guides and customized plates. Materials and Methods: A pilot study of five patients who underwent mandibular reconstruction using DCIA free flaps was conducted. Virtual surgical planning was performed using Cone-Beam Computed Tomography (CBCT) and pelvic Computed Tomography (CT) data to design patient-specific cutting guides and reconstruction plates. All surgeries were performed by a single experienced surgeon using standardized techniques. Results: The mean deviation between the virtual planning and actual surgical outcomes was 0.73 +/- 0.23 mm, with maximum deviations ranging from 3.87 to 7.83 mm. All flaps achieved 100% survival, with one case (20%) experiencing screw loosening that required plate removal. This complication led to the modification of the plate design to include six or more holes in subsequent cases. Conclusions: Despite limitations including the small sample size and short follow-up period, our preliminary results demonstrate that computer-aided surgical planning with patient-specific devices can significantly improve the accuracy and predictability of DCIA flap mandibular reconstruction, even in challenging revision cases. Further studies with larger patient cohorts are needed to validate these findings.