Mandible reconstruction using the calcium-sulphate three-dimensional model and rubber stick: A new method, 'mould technique', for more accurate, efficient and simplified fabrication

Background: Osteocutaneous flaps are one of the best options for one-stage mandible reconstruction. However, the challenge remains to achieve optimal functional and cosmetic results. A new novel approach involving the preoperative prefabrication of a reconstructive plate through a calcium-sulphate three-dimensional (3D) model facilitates the contouring of vascularised bone grafts. We herein report our preparations and results using this technique. Methods: A total of 17 mandibular defects were reconstructed by this novel approach. A calcium-sulphate 3D model was constructed from computed tomography (CT) data. After the oncologist designed the cut line on the model, the mandibular arc was ground to the neomandible shape, which consisted of several linear planes according to the osteotomy of the bone graft. The reconstruction plate was shaped to fit this. After tumour resection, the prefabricated plate was placed to the remaining mandible and revealed the defect to be reconstructed, just as a mould. Rubber sticks were used as a template to shape the bone graft. The preoperative information, and functional and aesthetic results were retrospectively analysed. Results: As many as 12 fibular and 5 scapular flaps were applied. Postoperative complications included two salivary fistulae, one abscess and one partial skin loss, all of which were resolved after conservative treatment. Postoperatively, all patients could speak clearly, 12 had a normal diet and 12 had excellent cosmetic results. Conclusions: This is the first report using models made by calcium-sulphate. The largest advantage of this model is that the neo-mandible shape can be demonstrated preoperatively. The refinement of mandible reconstruction after tumour ablative surgery can be achieved with a prefabricated plate through the use of a calcium-sulphate 3D model. It enables more accurate, faster and simplified fabrication of reconstruction plates, thus leading to satisfactory functional and cosmetic results. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.