Advances in virtual surgical planning for free tissue transfer.

[PURPOSE OF REVIEW] This review seeks to describe the current state of virtual surgical planning (VSP) for head and neck free flap reconstruction, highlighting recent advancements, future directions, and outstanding limitations.

[RECENT FINDINGS] Three-dimensional (3D)-printed plates have been shown to confer increased accuracy and lower fracture rate compared to hand-bent plates. Efforts are underway to optimize plate design for load bearing and dental rehabilitation. Preclinical work is investigating bioresorbable plate materials and 3D-bioprinting of composite materials using stem cell and tissue engineering technology. Advances in imaging and artificial intelligence may improve reconstructive planning. Use of robots and augmented reality may increase precision and intraoperative flexibility in the future. Cost of VSP remains a concern, but has shown to be offset by decreased operative time and in-house VSP, and will likely continue to fall as use of VSP increases. While numerous advantages have been shown for VSP, few studies have investigated correlation of VSP to patient-reported outcomes, which is an increasingly important metric.

[SUMMARY] In addition to increasing accuracy, decreasing operative time, and facilitating complex reconstructions, VSP has the potential to harness advancements in reconstructive materials, imaging, and artificial intelligence to advance free flap reconstruction and improve patient outcomes.