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Computer-assisted surgical planning in orthognathic surgery: A practical workflow

Introduction Orthognathic surgery outcomes depend not only on surgical technique, but also on appropriate diagnosis and treatment planning. The adoption of computer-assisted design/computed-assisted manufacturing (CAD/CAM) technology, computer-assisted surgical planning (CaSP), and three-dimensional (3D) printing has created a paradigm shift for patients with maxillofacial deformities and for the surgeons treating them. The advent of noninvasive 3D visualization of the maxillofacial skeleton has allowed for the conversion of…

Computer-assisted maxillofacial reconstruction

Introduction A comprehensive maxillofacial computer-assisted surgical workflow can be divided into three areas: 1) presurgical planning, 2) surgical execution, and 3) anatomic verification. Historically, presurgical planning has been a function of the surgeon’s spatial cognition abilities, surgical execution was heavily dependent on surgeon experience, and intraoperative verification tools to confirm the surgical reconstruction were nonexistent. Advances in computer-assisted surgery (CAS) have resulted in a paradigm shift…

Creating traumatic occlusal splints using computer-assisted design and computer-assisted manufacturing technology

Introduction Complex maxillomandibular fractures can have devastating functional and aesthetic outcomes for patients. Traumatic occlusal splints can act as surgical guides for fracture reduction which can then serve as the foundation upon which the remainder of the face may be reconstructed. The occlusal splint may be uniquely helpful in patients with extensive comminuted fractures and in those who are partially edentulous. The use of these splints…

Computer-assisted design and computer-assisted manufacturing

Introduction Computer-assisted design (CAD) and computer-assisted manufacturing (CAM) can play a unique role in craniofacial surgery because of the intricate three-dimensional (3D) anatomic considerations inherent to this field. Through the use of CAD/CAM techniques, surgeons can uniquely plan for each patient’s procedure by analyzing an unlimited number of iterations and options. By doing so, surgeons can optimize the surgical approach and create patient-specific, customized cutting guides,…

The history of the computed tomography scan: How computer-assisted tomography changed craniofacial surgery, and use of computerized digital planning in patients with severe craniofacial congenital anomalies

History and introduction Innovation in three-dimensional (3D)-scanning technology has now enabled all plastic surgeons to have a 3D scanner at their disposal for use in surgical planning. These developments began with innovation in the aviation industry, which translated to innovation in 3D imaging in surgical subspecialties such as craniofacial surgery. The father of craniofacial surgery, Dr. Paul Tessier, and Dr. David Hemmy, a neurosurgeon from Milwaukee,…

Complex Foot Reconstruction

Clinical Presentation A 35-year-old White male sustained an accidental gunshot wound (GSW) to his left foot. The GSW (12 × 6 × 4 cm) was through-and-through to the medial aspect of the left midfoot with significant soft tissue loss. He also had a comminuted fracture of the first metatarsal with a 5-cm bony defect and complete destruction of the first metatarsophalangeal joint. The extensor hallucis longus tendon was completely…

Foot Reconstruction

Case 1 Clinical Presentation A 54-year-old White male had a long history of complex congenital deformity of his right foot. He had several previous orthopedic procedures but unfortunately the hardware became infected. He underwent hardware removal by the orthopedic foot and ankle service, which left an open wound with scar tissue in the lateral foot, measuring 7 × 3.5 cm. The plastic surgery service was asked to provide…

Heel Reconstruction

Case 1 Clinical Presentation A 36-year-old White male developed a wound dehiscence following an open reduction and internal fixation of his calcaneus fracture by the orthopedic foot and ankle service ( Fig. 50.1 ). He had sustained a right foot calcaneus fracture from a fall. He underwent soft tissue debridement by the orthopedic foot and ankle service, which left a complex heel wound with the exposed fracture…

Complex Ankle Reconstruction

Case 1 Clinical Presentation A 28-year-old White male had a complex left foot open fracture wound as a result of a motor vehicle accident. He suffered an avulsion injury of the left medial ankle with underlying comminuted fractures. There was significate bone loss and lack of continuity of bony structures with an open wound measuring 15 × 8 cm ( Fig. 49.1 ). The plastic surgery service was consulted…

Ankle Reconstruction

Case 1 Clinical Presentation A 68-year-old Asian male sustained left ankle open fracture and dislocation as a result of a motorcycle collision. He had a complex open wound over the medial malleolus with an exposed flexor digitorum longus tendon. He was managed initially by the orthopedic trauma service for wound debridement and placement of an external fixator. The critical part of the wound measured 7 × 4 cm…

Complex Leg Reconstruction

Case 1 Clinical Presentation A 21-year-old White male had an extensive middle tibia wound of his right leg associated with an open fracture as a result of a motor vehicle accident. He had a 13 × 6 cm middle tibia wound of the right leg with exposed tibial fracture site. A rigid fixation of the tibia fracture was performed with an intramedullary rod by the orthopedic trauma service…

Leg Reconstruction: Distal Third (Free Flaps)

Case 1 Clinical Presentation A 54-year-old White male unfortunately developed a wound dehiscence in the left distal third of his leg after an open reduction and internal fixation for a distal tibial fracture. The distal tibial wound measured 12 × 6 cm with the exposed fracture site, reconstruction plate, and antibiotic beads. The wound was located quite distally and extended to the ankle ( Fig. 46.1 ). Clearly, there…

Leg Reconstruction: Distal Third (Local Flaps)

Case 1 Clinical Presentation A 57-year-old White female sustained an open tibial fracture of her left leg as a result of a motor vehicle accident. She had a 5 × 4 cm open fracture wound in the distal third of the leg with an exposed tibial fracture site. She initially had debridement of the open tibial fracture site and placement of an external fixator by the orthopedic trauma…

Leg Reconstruction: Middle Third

Case 1 Clinical Presentation A 40-year-old White male sustained chronic osteomyelitis secondary to an open middle tibial fracture 1 year ago from a motor vehicle accident. He had a longstanding smoking history. He had chronic drainage from the old fracture site about 2 months previously ( Figs. 44.1 and 44.2 ). He had undergone debridement of the middle tibial wound, removal of hardware, and placement of an external…

Leg Reconstruction: Proximal Third

Case 1 Clinical Presentation An 11-year-old White male sustained a significant crush and avulsion injury to his right upper leg as a result of a motor vehicle accident. He had extensive full-thickness skin loss over the proximal third of his leg with the exposed underlying tibia measuring 7 × 2 cm. The soft tissue wound was debrided by the trauma service and his surgical care was then transferred…

Knee Reconstruction

Case 1 Clinical Presentation A 29-year-old white male had significant left proximal tibia bone loss and open knee injury as a result of an explosive injury in a foreign country. The orthopedic injury was stabilized initially after debridement in an overseas military hospital. He was subsequently transferred to the orthopedic trauma service of our hospital for more definitive treatment. After admission, an aggressive orthopedic debridement was…

Lower Thigh Reconstruction

Case 1 Clinical Presentation A 42-year-old White male had a complicated lateral thigh wound following an open distal femur fracture. He underwent an open reduction and internal fixation of the distal femur fracture by the orthopedic trauma service, which left a large open wound, measuring 12 × 8 cm, with the exposed fracture site and reconstructed plate ( Figs. 41.1 and 41.2 ). The plastic surgery service was asked…

Upper Thigh Reconstruction

Case 1 Clinical Presentation A 40-year-old White male had a very complicated injury to his right hip and lateral thigh regions with a pelvic fracture and extensive muscle necrosis over his right hip region as a result of a motor vehicle accident. He unfortunately developed heterotopic ossification requiring resection of the head of the right femur. A definitive treatment plan, proposed by the orthopedic trauma service,…

Scrotal Reconstruction

Clinical Presentation A 76-year-old paraplegic White male with a long-standing history of diabetes developed Fournier’s gangrene and presented to the urology service. The primary service performed emergent radical surgical debridement to control the soft tissue infection. After debridement, a significantly large soft tissue wound involving the entire right ischial, gluteal, and posterior thigh regions as well as bilateral scrotal areas remained ( Fig. 39.1 ). The plastic…

Penile Reconstruction

Clinical Presentation A 14-year-old intersex White person had been born with ambiguous genitalia. The patient decided to be a male but unfortunately all male genital organs had been removed at a young age. The patient now strongly desired a transformation from female to male and was seen by the pediatric urology service for a total penile reconstruction ( Fig. 38.1 ). The plastic surgery service was asked…