Use of stock DICOM data of fibular bone for CAD-CAM design in facial reconstruction by free fibula flap

Abstract Background: The free fibula flap (FFF) is a cornerstone in facial skeletal reconstruction, but its harvest may be challenging in 5–10% of cases due to concerns over vascularization. While lower limb CT angiography is widely used to assess vascular patency, it involves ionizing radiation and iodinated contrast, posing risks, especially for patients with renal insufficiency or allergies. This study investigates the use of stock fibula models, derived from average anatomical measurements, as a reliable alternative to patient-specific fibulae for surgical planning, thereby eliminating the need for CT angiography. The safeness off fibula harvesting is guaranteed by US color Doppler. Methods: A total of 40 fibulas (20 male, 20 female) were analyzed using DICOM data obtained from standard CT scans. Data segmentation and measurement were performed by an open source softwere (3Dslicer). Results: Statistical analysis showed significant differences in fibular dimensions between genders (p < 0.00001), with minimal variability (CV Width M: 8.66%, CV Thickness M: 10.43%, CV Width F: 10.88%, CV Thickness F: 14.43%), confirming the suitability of stock models for accurate reconstructive plans. Importantly, bypassing CT angiography eliminates radiation exposure and the administration of iodinated contrast, reducing patient risks. Conclusion: The results suggest that stock fibula models, based on population averages, provide an effective and safe solution for facial reconstruction, ensuring high surgical precision without the need for CT angiography or contrast agents.