Patient-Specific Virtual Surgical Planning and In-House CAD-/CAM-Guided Vascularized Bone Flaps for Salvage Extremity Reconstruction: A Case Series.

The surgical management of extremity bone defects, particularly post-traumatic nonunion wounds, remains a challenge. Vascularized bone flaps (VBFs), widely used for mandibular reconstruction in head and neck oncologic surgery, are less established in extremity reconstruction and are typically performed freehand, which has several limitations. In the past decade, virtual surgical planning (VSP) and computer-aided design and modeling (CAD-CAM) technology have enabled patient-specific 3D-printed models to guide reconstruction. While this technology has been used extensively in head and neck reconstructive surgery, its application to extremity reconstruction is less well-documented. This case series evaluates the feasibility, safety, and surgical utility of VSP and in-house CAD-CAM manufacture of 3D-printed models and cutting guides for post-traumatic non-healing extremity reconstructions using VBFs. Eight patients at a single tertiary academic center underwent VBF reconstruction guided by patient-specific models and cutting guides, with cases grouped into categories (humerus, femur, and tibia). The multi-disciplinary workflow supported preoperative visualization, osteotomy planning, and intraoperative execution. All vascularized flaps survived, and radiographic union was documented in patients with adequate follow-up. These findings suggest that integrating VSP and CAD-CAM into trauma-associated VBF extremity reconstruction is feasible and safe and may improve reconstructive accuracy and enhance multi-disciplinary team workflow, potentially contributing to improved clinical outcomes.