# BMI, Sex as Predictors of Anterolateral Thigh Free Flap Thickness for Oropharyngeal Reconstructions

## TL;DR

This study shows that BMI and sex are strong predictors of thigh flap thickness used in head and neck reconstructions, helping surgeons choose the best flap type for better outcomes.

## Contribution

The study identifies BMI and sex as reliable predictors for ALTFF thickness, influencing flap selection in oropharyngeal reconstruction.

## Key findings

- BMI strongly correlates with flap thickness at all measured points (r > 0.62).
- Females had significantly thicker flaps than males at all points despite similar BMI.
- Incorporating BMI and sex into preoperative planning improves flap selection and reduces intraoperative adjustments.

## Abstract

To evaluate the relationship between body mass index (BMI), sex, and anterolateral thigh free flap (ALTFF) thickness, and to determine their impact on the use of ALT and super‐thin ALT (STALFF) flaps for oral and oropharyngeal reconstruction.

Ninety‐four patients who underwent ALTFF, super thin‐ALTFF (ST‐ALTFF), or radial forearm free flap (RFFF) reconstruction following resection of oral cavity and oropharyngeal squamous cell carcinoma were included. Preoperative PET/CT scans were analyzed to measure ALTFF thickness at three points along the thigh: the proximal fourth (Point A), midpoint (Point B), and distal fourth (Point C) of the line extending from the anterior superior iliac spine to the superior lateral surface of the patella. Statistical analyses included chi‐squared, t‐tests, ANOVA, and Pearson's correlation to assess associations between BMI, sex, and flap thickness.

Forty patients (42.5%) underwent ALTFF reconstruction, 18 had ST‐ALTFF (19.1%), and 36 (38.3%) received RFFF. Pearson's correlation confirmed a strong positive relationship between BMI and flap thickness at all points (r > 0.62). Although BMI did not differ significantly between sexes (p = 0.066), females had significantly thicker flaps at all measured points (p < 0.0001).

BMI and sex are reliable predictors of ALTFF thickness and influence flap selection. Integrating these factors into preoperative planning optimizes patient selection for free flap type choice, minimizing intraoperative modifications and improving reconstructive outcomes.

4.

This study evaluated BMI, sex, and their influence on anterolateral thigh free flap (ALTFF) thickness for oral/oropharyngeal reconstruction. Our results showed that BMI strongly correlated with flap thickness, and women had significantly thicker flaps, despite similar BMI. These findings suggest BMI and sex have an important role in guiding flap selection to optimize outcomes and reduce perioperative adjustments.