Bony contouring in head and neck microvascular reconstruction

Head and neck reconstruction has evolved substantially in the last three decades to rely heavily on microvascular free tissue transfer, including bony composite flaps that improve form and functional outcomes. The technologies available for planning and executing bony reconstruction have undergone concurrent innovation, leaving the modern surgeons with a host of options to consider. In this review, the techniques of external fixation, virtual surgical planning and rapid prototyping are discussed with the aim of familiarizing surgeons and comparing these approaches. External fixation, though not new to head and neck surgery, has seen a revival and has considerable utility in vascularized bony reconstruction with the potential for improved efficiency and cost control. We explore the clinical situations in which virtual surgical planning is best employed, and the varying levels to which it can be applied throughout the reconstructive process. The ever-expanding realm of rapid prototyping, or 3D printing, is also examined to explore potential applications for surgical modeling, tissue engineering and even clinical training. Finally, we present a discussion of the cost-effectiveness of the technologies and future directions for research in the field.