Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction

Craniofacial reconstruction has undergone significant advancement during the past 2 decades, after technical improvements in microsurgery that have increased the options available regarding the type of flap used, such as rectus abdominis, latissimus, radial forearm, fibular, and anterolateral thigh flaps, for closure of complex skull-base defects.1–6 Although the use of a free flap has become standard for head and neck reconstruction, surgeons are still challenged to achieve better surgical outcomes without complications. Wide en bloc resection and craniofacial reconstruction using a free flap is the mainstay of maxillary sinus carcinoma treatment.7 Maxillary sinus carcinoma often invades the surrounding tissue including the orbit, nasal cavity, hard palate, and cranial base.8 It is necessary to reconstruct the barrier between the cranial base and nasal and/or oral cavity to protect the central nervous system and to restore the facial contour aesthetically, which requires a large amount of soft tissue. Rectus abdominis musculocutaneous flap is preferred to reconstruct the oncologic resected defect because it has well-vascularized tissue and makes voluminous tissue transfer possible.9,10 And also, rectus abdominis musculocutaneous free flap does not require intraoperative position change, which can shorten the operative time to reduce postoperative complication rate. However, it is difficult to harvest enough tissue volume from the patient’s abdomen to fill up the oncologic resected region. This may account for the dead space on the recipient site causing postoperative complications. Here, we describe the relationship between postoperative complications and body mass index (BMI) in patients who underwent craniofacial reconstruction with a rectus abdominis musculocutaneous free flap after the anterolateral craniofacial tumor resection.