Unleashing the potency of multi-segmental DCIA flap in mandibular reconstruction with the aid of virtual surgery- A retrospective cohort study.

Abstract

Although the deep circumflex iliac artery (DCIA) flap is a mainstay in mandibular reconstruction, its multi-segmental utilization is infrequently reported, primarily due to concerns regarding the variable cutaneous component and potentially inadequate vascular supply to multi-block segments. This retrospective study analyzed the outcomes of 86 patients undergoing mandibular reconstruction with multi-segmental DCIA flaps, compared to 167 patients who received conventional single-segmental flaps. The survival rate for multi-segmental flaps was comparable to that of single-segmental flaps (100% vs. 98.2%, p = 0.553). Multi-segmental flaps were used to reconstruct longer bony defects (median: 9 cm vs. 6.5 cm, p < 0.001). Despite the longer operation times in the multi-segmental group (368.8 vs. 326.8 min, p < 0.001), there was no significant increase in the incidence of surgical complications. Furthermore, postoperative QoL and Harris Hip scores did not show significant differences, despite the increased graft lengths and segmentation in the multi-segmental group. The study underscores the underrecognized efficacy of multi-segmental DCIA flaps in complex mandibular reconstructions, particularly for specific types of defects such as Brown III, Brown I (Ic), and Brown II (IIc), which can be effectively and reliably reconstructed with the aid of virtual surgical techniques. This research also confirms that concerns regarding soft tissue management with multi-segmental DCIA flaps can be effectively addressed.