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/m2) 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.Conclusion: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.

Free flap transfer, a safe and efficient method for reconstruction of composite skull base defects after salvage resection of advanced intra- and extracranial communicating tumors

“…Thompson et al [28] supposed that there was a higher wound complication rate in those with a history of smoking and diabetes. Postoperative facial stula and recipient-site infection occurred mainly in low-BMI patients, reported by Heo et al [29]. Flap crisis included infection, arterial and venous thrombosis, and vascular thrombosis remains the primary reason of ap failure [30].…”

Risk Factors for Delayed Surgical Recovery and Massive Bleeding in Skull Base Surgery

“…Wound infection and neuropsychiatric disorders were the direct reason for long-term hospitalization. Postoperative recipient-site infection and facial fistula were reported to occur mainly in patients with a low BMI [25]. Optimal reconstruction without having a dead space and immediate assessment for fluid retention are necessary to decrease postoperative complications.…”

Novel Use of the Buccal Fat Pad for Sinocutaneous Fistulae Closure and a Review of Reconstructive Options

“…Variable rates of SCF formation following free flap reconstruction of the primary defect have been reported with rates of ranging from 5.8% to 16%. [25][26][27][28] The ALT provides good bulk and is ideal for obliterating dead space in the medial canthal and sinonasal region while the RFFF is thin and allows for good contouring. The serratus anterior free flap has also been described in successful SCF closure.…”