# Development of a universal cutting guide for raising deep circumflex iliac artery flaps

## TL;DR

This paper presents a universal cutting guide for deep circumflex iliac artery flaps, which can save time and resources in surgical planning.

## Contribution

The development of a ready-made cutting guide that maintains the benefits of CAD planning while reducing the need for CT scans.

## Key findings

- The mean thickness of the space between the iliac crest and cutting guide was 2.137 mm.
- The overall averaged group did not show the highest volume or thickness of the space.
- Cutting guides fit sufficiently to the iliac crest and can save radiation dose and resources.

## Abstract

The deep circumflex iliac crest flap (DCIA) is used for the reconstruction of the jaw. For fitting of the transplant by computer-aided planning (CAD), a computerized tomography (CT) of the jaw and the pelvis is necessary. Ready-made cutting guides save a pelvic CT and healthcare resources while maintaining the advantages of the CAD planning.

A total of 2000 CTs of the pelvis were divided into groups of 500 by sex and age (≤ 45 and > 45 years). Three-dimensional (3D) pelvis models were aligned and averaged. Cutting guides were designed on the averaged pelvis for each group and an overall averaged pelvis. The cutting guides and 50 randomly selected iliac crests (10 from each group and 10 from the whole collective) were 3D printed. The appropriate cutting guide was mounted to the iliac crest and a cone beam CT was performed. The thickness of the space between the iliac crest and the cutting guide was evaluated.

Overall the mean thickness of the space was 2.137 mm and the mean volume of the space was 4513 mm3. The measured values were significantly different between the different groups. The overall averaged group had not the greatest volume, maximum thickness and mean thickness of the space.

Ready-made cutting guides for the DCIA flap fit to the iliac crest and make quick and accurate flap raising possible while radiation dose and resources can be saved. The cutting guides fit sufficient to the iliac crest and should keep the advantages of a standard CAD planning.