Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer
Takaya Makiguchi MD, PhD  Takahiro Yamaguchi DDS  Hideharu Nakamura MD  Keisuke Suzuki DDS Norifumi Harimoto MD, PhD  Ken Shirabe MD, PhD  Satoshi Yokoo DMD, DMSc
First published: 22 July 2019 https://doi.org/10.1002/micr.30494
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Abstract
Background
Sarcopenia is a disease in which skeletal muscle mass (SMM) and function are progressively lost. Here, we investigate surgical site infection (SSI) as a function of SMM in patients who underwent free flap reconstruction for a defect caused by oral cancer resection.

Methods
A nonrandomized, retrospective group of 122 patients treated with free flap reconstruction after oral cancer resection was enrolled in the study. All subjects also underwent preoperative abdominal‐lumbar computed tomography (CT). Cross‐sectional areas (cm2) of skeletal muscles in the L3 region were measured by manual outline on CT images. The obtained areas were normalized for height (cm2/m2), and the resulting value is referred to as the skeletal muscle index (SMI).

Results
Recipient site SSI occurred in 30 patients (24.6%). Underweight status (body mass index [BMI] < 18.5 kg/m2), anemia and lower SMI were significantly related to recipient site SSI in univariate analysis (p < . 05). In multiple logistic regression analysis, lower SMI was an independent significant risk factor for recipient site SSI (p = .015, adjusted odds ratio = 1.41 per 5 cm2/m2 decrease).

Conclusions
These findings suggest that a decrease in SMM might have more impact than a decrease in BMI on SSI in free flap reconstruction after resection of oral cancer.