Utilization of a pre-bent plate-positioning surgical guide system in precise mandibular reconstruction with a free fibula flap

•The position of the prebent plate was designated by using the guides.•The shaping guide assisted the contouring of the fibula segments.•The ischemia time was reduced and the accuracy was increased. We evaluated the effects of three-dimensional virtual planning and the use of a plate-embedded surgical guide in mandibular reconstruction with microvascular fibula flaps. We retrospectively reviewed 35 patients who underwent primary mandibular reconstruction with a free fibula flap. They were divided into three groups according to the therapy they received. In group A, 12 patients underwent reconstruction using the modified surgical guide system, including virtual surgeries, pre-bent titanium plates, screw-predesignated cutting guides for mandibular and fibular osteotomies, and plate-embedded shaping guides. In group B, 14 patients underwent reconstruction using the common surgical guide system, including virtual surgeries, cutting guides and pre-bent plates. In group C, 9 patients underwent reconstruction based on the surgeon’s experience. All cases were reviewed for the total operative time, ischemia time of the fibula flaps, accuracy of surgery, and postoperative complications. All of the fibula flaps survived. In group A, the ischemia time was shorter than that of groups B and C (P