{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:02:31Z","timestamp":1784332951695,"version":"3.55.0"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The impact of body mass index (BMI) extremes on the outcomes after head and neck cancer (HNC) reconstruction remains uncertain. Herein, we investigate the influence of low and high BMI on the intraoperative and postoperative outcomes of oncologic head and neck microvascular reconstruction.<\/jats:p>\n                  <jats:p>We analyzed a prospective institutional database (September 2019\u2013December 2024). Patients were stratified into underweight, normal weight, overweight, and obesity I, II, and III. Flaps were categorized by donor site (thigh, back, fibula, or forearm). Demographics, intraoperative events, and donor, recipient, and systemic postoperative complications were assessed.<\/jats:p>\n                  <jats:p>Among 542 patients, BMI distribution was: 9.6% underweight (&lt;18.5\u2009kg\/m2), 34.7% normal weight (\u226518.5 and &lt;25\u2009kg\/m2), 29.5% overweight (\u226525 and &lt;30\u2009kg\/m2), and 15.5, 7.0, and 3.7% within obesity I (\u226530 and &lt;35\u2009kg\/m2), II (\u226535 and &lt;40\u2009kg\/m2), and III (\u226540\u2009kg\/m2), respectively. Flaps employed significantly differed between low and high BMI groups (p\u2009&lt;\u20090.001). Underweight patients demonstrated increased odds of donor-site (odds ratio [OR]: 4.60; p\u2009=\u20090.011) and recipient-site (OR: 2.49; p\u2009=\u20090.007) complications, notably salivary leaks (24.0% vs. \u226411.2%; p\u2009=\u20090.0322). In subgroup analyses, obesity II patients undergoing thigh-based reconstructions saw increased flap loss (16.7% vs. \u22642.4%, p\u2009=\u20090.0002); obesity II and III patients trended toward increased recipient-site hematoma (16.7% vs. \u22643.6%, p\u2009=\u20090.1376) and dehiscence (20.0% vs. \u22647.1%, p\u2009=\u20090.0824), respectively.<\/jats:p>\n                  <jats:p>BMI extremes relate to perioperative risk in HNC microvascular reconstruction. Underweight status is associated with higher perioperative complications across flaps, while obesity-related risk concentrates in class II\/III patients undergoing thigh-based flaps. Findings support BMI-informed preoperative optimization and flap selection strategies.<\/jats:p>","DOI":"10.1055\/a-2903-1493","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T22:57:33Z","timestamp":1782773853000},"source":"Crossref","is-referenced-by-count":0,"title":["Influence of Body Mass Index on Perioperative Outcomes of Oncologic Head and Neck Free Flaps: Comprehensive Analysis Using a Prospective Institutional Database"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0742-3618","authenticated-orcid":false,"given":"Honghao","family":"Xu","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth D.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Mroueh","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana M.","family":"Duncan","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Bottegal","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungwon","family":"Kim","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Otolaryngology\u2013Head and Neck Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario G.","family":"Solari","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pennsylvania, United States","place":["Pittsburgh"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"issue":"03","key":"ref1","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J 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