{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:35:16Z","timestamp":1791855316755,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,4]],"date-time":"2023-06-04T00:00:00Z","timestamp":1685836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Institute for Advancement of Technology (KIAT)","award":["P0008811"],"award-info":[{"award-number":["P0008811"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>As the fibula free flap became the gold standard in mandibular reconstruction that required both hard tissue and soft tissue, various methods have been sought to solve the height discrepancy between the mandible and fibula. The purpose of this paper was to propose a surgical option that combined the microvascular fibula free flap with a 3D-bioprinted, patient-specific polycaprolactone (PCL) implant as a safe and simple novel method that achieved the best functional and aesthetic results in mandibular reconstruction surgery for young patients with malignant tumors. The patient\u2019s reconstructed mandible maintained volume symmetry without any deformation or complications for over 6 years. Computer-aided design\/computer-aided manufacturing (CAD\/CAM) and 3D printing technology enabled accurate and safe surgical results.<\/jats:p>","DOI":"10.3390\/bioengineering10060684","type":"journal-article","created":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T02:57:47Z","timestamp":1685933867000},"page":"684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Long-Term Follow-Up of a Novel Surgical Option Combining Fibula Free Flap and 3D-Bioprinted, Patient-Specific Polycaprolactone (PCL) Implant for Mandible Reconstruction"],"prefix":"10.3390","volume":"10","author":[{"given":"Bo-Yeon","family":"Hwang","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwantae","family":"Noh","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9902-347X","authenticated-orcid":false,"given":"Jung-Woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1097\/00006534-199910000-00011","article-title":"Reconstruction of the mandible with osseous free flaps: A 10-year experience with 150 consecutive patients","volume":"104","author":"Cordeiro","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/00006534-198907000-00014","article-title":"Fibula free flap: A new method of mandible reconstruction","volume":"84","author":"Hidalgo","year":"1989","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1016\/j.joms.2009.02.007","article-title":"Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: A paradigm shift in head and neck reconstruction","volume":"67","author":"Hirsch","year":"2009","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.maxilo.2012.06.002","article-title":"Microvascular reconstruction of the mandible: An argument for the fibula osteocutaneous free flap","volume":"36","author":"Su","year":"2014","journal-title":"Rev. Espa\u00f1ola De Cirug\u00eda Oral Y Maxilofac."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0278-2391(98)90914-4","article-title":"Use of the \u201cdouble barrel\u201d free vascularized fibula in mandibular reconstruction","volume":"56","author":"Stoll","year":"1998","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/micr.1920160704","article-title":"Mandibular reconstruction using the double barrel fibular graft","volume":"16","author":"Horiuchi","year":"1995","journal-title":"Microsurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1054\/ijom.2003.0487","article-title":"Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap","volume":"33","author":"Lee","year":"2004","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijom.2019.05.005","article-title":"A novel \u2018surgeon-dominated\u2019 approach to the design of 3D-printed patient-specific surgical plates in mandibular reconstruction: A proof-of-concept study","volume":"49","author":"Yang","year":"2020","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/PRS.0b013e3181c2bb9d","article-title":"Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction","volume":"125","author":"Wallace","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1054\/jcms.2000.0106","article-title":"Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: Case report","volume":"28","author":"Nocini","year":"2000","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/01.prs.0000233211.54505.9a","article-title":"Oromandibular reconstruction using a fibula osteocutaneous free flap: Four different \u201cpreplating\u201d techniques","volume":"118","author":"Marchetti","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12938-016-0236-4","article-title":"3D-printing techniques in a medical setting: A systematic literature review","volume":"15","author":"Tack","year":"2016","journal-title":"Biomed. Eng. Online"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.bjoms.2014.09.015","article-title":"Surgical planning and microvascular reconstruction of the mandible with a fibular flap using computer-aided design, rapid prototype modelling, and precontoured titanium reconstruction plates: A prospective study","volume":"53","author":"Gil","year":"2015","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.ijom.2019.12.006","article-title":"\u201cOne-piece\u201d patient-specific reconstruction plate for double-barrel fibula-based mandibular reconstruction","volume":"49","author":"Yang","year":"2020","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1097\/SCS.0000000000005842","article-title":"Virtual surgical planning for mandible reconstruction with a double barrel fibula flap and immediate implant placement","volume":"31","author":"Berrone","year":"2020","journal-title":"J. Craniofacial Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.bjoms.2015.10.012","article-title":"Double-barrelled vascularised fibular free flap using computer-assisted preoperative planning and a surgical template for accurate reconstruction of a segmental mandibular defect","volume":"54","author":"Lee","year":"2016","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e365","DOI":"10.1097\/SCS.0000000000005379","article-title":"Vascularized combined with nonvascularized fibula flap for mandibular reconstruction: Preliminary results of a novel technique","volume":"30","author":"Lin","year":"2019","journal-title":"J. Craniofacial Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/S0278-2391(97)90165-8","article-title":"A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects","volume":"55","author":"Pogrel","year":"1997","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/j.progpolymsci.2010.04.002","article-title":"The return of a forgotten polymer\u2014Polycaprolactone in the 21st century","volume":"35","author":"Woodruff","year":"2010","journal-title":"Prog. Polym. Sci."},{"key":"ref_20","first-page":"208","article-title":"The degradation profile of novel, bioresorbable PCL\u2013TCP scaffolds: An in vitro and in vivo study","volume":"84","author":"Yeo","year":"2008","journal-title":"J. Biomed. Mater. Res. Part A Off. J. Soc. Biomater. Jpn. Soc. Biomater. Aust. Soc. Biomater. Korean Soc. Biomater."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1975","DOI":"10.1097\/GOX.0000000000001975","article-title":"Reconstruction of complex maxillary defects using patient-specific 3D-printed biodegradable scaffolds","volume":"6","author":"Han","year":"2018","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jeong, W.-S., Kim, Y.-C., Min, J.-C., Park, H.-J., Lee, E.-J., Shim, J.-H., and Choi, J.-W. (2022). Clinical application of 3D-printed patient-specific polycaprolactone\/beta tricalcium phosphate scaffold for complex zygomatico-maxillary defects. Polymers, 14.","DOI":"10.3390\/polym14040740"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"ra264","DOI":"10.1126\/scitranslmed.3010825","article-title":"Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients","volume":"7","author":"Morrison","year":"2015","journal-title":"Sci. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103548","DOI":"10.1016\/j.jmbbm.2019.103548","article-title":"Biomechanics of alloplastic mandible reconstruction using biomaterials: The effect of implant design on stress concentration influences choice of material","volume":"103","author":"Prasadh","year":"2020","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4979","DOI":"10.1038\/s41598-020-61944-w","article-title":"Efficacy of three-dimensionally printed polycaprolactone\/beta tricalcium phosphate scaffold on mandibular reconstruction","volume":"10","author":"Lee","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.biomaterials.2005.09.019","article-title":"The in vivo degradation, absorption and excretion of PCL-based implant","volume":"27","author":"Sun","year":"2006","journal-title":"Biomaterials"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/MOO.0000000000000175","article-title":"Update of patient-specific maxillofacial implant","volume":"23","author":"Owusu","year":"2015","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e426","DOI":"10.1097\/SCS.0000000000006559","article-title":"Facial reconstruction based on combined three-dimensional printing and microsurgical free transfer","volume":"31","author":"Horta","year":"2020","journal-title":"J. Craniofacial Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1016\/j.bjps.2007.12.020","article-title":"Correction of a mandibular asymmetry using a custom-made titanium onlay","volume":"62","author":"Yates","year":"2009","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.ijom.2017.06.001","article-title":"Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction","volume":"46","author":"Qassemyar","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1501.e1","DOI":"10.1016\/j.joms.2016.02.031","article-title":"Simultaneous bimaxillary surgery and mandibular reconstruction with a 3-dimensional printed titanium implant fabricated by electron beam melting: A preliminary mechanical testing of the printed mandible","volume":"74","author":"Lee","year":"2016","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1097\/SCS.0000000000000659","article-title":"Correction of facial and mandibular asymmetry using a computer aided design\/computer aided manufacturing prefabricated titanium implant","volume":"25","author":"Watson","year":"2014","journal-title":"J. Craniofacial Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kim, H.J., and Moon, S.Y. (2020). The deep circumflex iliac artery flap for mandibular reconstruction and donor site reconstruction with a patient-specific implant: A case report. Appl. Sci., 10.","DOI":"10.3390\/app10051587"},{"key":"ref_34","first-page":"e37","article-title":"Three-dimensional printing surgical applications","volume":"15","author":"AlAli","year":"2015","journal-title":"Eplasty"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/6\/684\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:47:59Z","timestamp":1760125679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/6\/684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,4]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["bioengineering10060684"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10060684","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,4]]}}}