title: Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction.
abstract: BACKGROUND
  Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection.
  
  
  METHODS
  This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters.
  
  
  RESULTS
  Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m(2)) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply.
  
  
  CONCLUSIONS
  Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Yang Hoi
authors.initials: YH
authors.lastname: Heo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Shunjiro
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Toriyama
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Takanari
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishio
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Fujii
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Plastic and Reconstructive Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan; Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan; Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan; and Department of Otorhinolaryngology, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kamei