151751-Najiba-Chargi

95 Surgery: skeletal muscle mass and free fibula flap reconstruction INTRODUCTION Fibula free flaps (FFF) have become one of the main preferred choices for reconstruction of major segmental defects of the mandible, e.g., after resection of benign or malignant tumors, osteomyelitis or osteoradionecrosis. The FFF, due to increasing refinement of surgical tech - niques, has a high success rate and relatively low risk of complications. 1,2 However, flap complications and loss do occur and can have severe consequences. Various risk factors for flap complications and flap loss have been identified in the literature. These include, patient characteristics and prior medical history, such as age, smoking, history of irradiation, and history of surgery in the area of the anastomosis. 3–6 Another set of risk factors are related to intra-operative and postoperative variables such as, microsurgical technique, ischemia time, intraoperative hypotension, operative time, choice of recipient vessels and anticoagulant administration. 5,7,8 In the last year’s loss of skeletal muscle mass (SMM), also known as sarcopenia, has been identified as an increasingly important independent risk factor of both survival and surgical outcomes in cancer patients. 9–12 Sarcopenia has been defined by consensus statements as a syndrome of progressive and generalized loss of skeletal muscle mass and function. 13,14 In cancer patients, sarcopenia has been associated with a higher incidence of postoperative complications, chemotherapy related toxicity, longer hospital stays and lower disease-free and overall survival. 11,15–17 The relationship between increased postoperative complications and its negative influence on survival has been demonstrated in various surgical fields such as hepato-biliary, colon and lung surgery. 11,15,18–20 In oncologic head and neck surgery, the predictive value of low SMM for surgical complications and survival has not yet been estab- lished as thoroughly. SMM is rarely assessed as a routine preoperative clinical measure. SMM is usually assessed on computer tomography (CT) scan of the abdomen at the level of the third lumbar vertebra (L3). However abdominal CT scanning is not routinely included in preoperativemanagement proto - cols in patients with head and neck cancer (HNC) and is often only available in a subset patient group with advanced disease and increased risk for distant metastasis. Instead, SMM assess - ment at the level of the third cervical vertebra (C3) has been proven as a viable alternative. 21 In this study SMM is measured using CT or MRI at the level of C3. The association of low SMM with surgical complications of FFF and other postoperative complications in patients under - going FFF reconstruction of the mandible after composite resection for malignant oral cavity tumors is investigated. Additionally, its impact on overall survival in these patients is studied. 6