<scp>BMI</scp> , Sex as Predictors of Anterolateral Thigh Free Flap Thickness for Oropharyngeal Reconstructions

ABSTRACT Objective 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. Methods 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. Results 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 &gt; 0.62). Although BMI did not differ significantly between sexes ( p = 0.066), females had significantly thicker flaps at all measured points ( p &lt; 0.0001). Conclusion 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. Level of Evidence 4.