Review of fixation techniques in double-barrel fibula flap and introduction of a new technique

Objective. The fibula flap is the preferred choice for mandibular reconstruction, especially with recent technological advancements. This study presents and evaluates a novel EASY-WEAR-OFF CAD/CAM patient-specific implant (PSI) double-barrel double-plate designed to improve stabilisation and outcomes.
Methods. A custom CAD/CAM plate with 2 parts, a long-bar and a short-bar plate, connected by vertical rods, was developed. Implant placement was performed under local anaesthesia alongside the removal of the short-bar plate at 6 months postoperatively. Literature on fixation techniques and CAD/CAM designs was reviewed to contextualise this approach.
Results. The double-barrel technique provides greater vertical bone height than the single-bar, reducing the bone gap and improving implant conditions. This PSI shows potential for better patient satisfaction and functional outcomes, supporting easier implant placement and postoperative management.
Conclusions. This CAD/CAM PSI may enhance mandibular reconstruction using the double-barrel fibula flap. Further studies with larger cohorts are needed to confirm its clinical benefits and longterm outcomes.