Analysis of Abdominal Dermal‐Fat Grafting to Repair Parotidectomy Defects: An 18‐Year Cohort Study

Abstract

ObjectivesTo assess the outcomes of abdominal dermal‐fat grafting following superficial and total parotidectomy.MethodsA retrospective chart review of parotidectomy patients was performed. Patients were divided into four groups based on surgical extent and grafting status: superficial parotidectomy (SP), superficial parotidectomy with grafting (SPg), total parotidectomy (TP), and total parotidectomy with grafting (TPg). Complication rates and operative times were then compared between surgically matched groups (SP vs. SPg, TP vs. TPg). Complications included graft necrosis, gustatory sweating, first‐bite syndrome, infection, hematoma, sialocele, and seroma. Data was analyzed via chi‐square and two‐sample t testing, logistic regression, and one‐way analysis of variance.ResultsThe cohort consisted of 330 patients: 106 SP (32.12%), 61 SPg (18.48%), 82 TP (24.85%), and 81 TPg (24.55%). No donor site complications occurred. TPg resulted in seven graft necroses (8.64%), and 22 reported gustatory sweating (27.20% vs. 10 TP patients (12.2%), P = 0.016); SPg resulted in two necroses (3.28%). There were no other statistically significant differences in complication rates. Graft recipients receiving adjuvant radiation were more likely to develop necrosis (odds ratio [OR] 4.60, 95% confidence interval [CI], 1.16–18.27, P = .0194). Patients who developed gustatory sweating were 8.38 years younger (95% CI 2.66–14.10, P = 0.002, follow‐up time > 48 days). Grafting did not increase operative times (TP/TPg: mean = 275.91/263.65 minutes, standard error of the mean = 41.96/33.75, P = 0.822).ConclusionAn abdominal dermal‐fat graft is an excellent reconstructive choice for a parotidectomy defect and is not associated with increased complication rates or prolonged operative time.Level of Evidence4 Laryngoscope, 130:2144–2147, 2020

Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta‐analysis

“…In particular, it is readily available from multiple potential donor sites (e.g., abdominal wall), and it could be easily harvested without prolonging operative time. Donor site complications are uncommon, 47,58 and the scar could be easily hidden. Moreover, no increase in post-operative complication at the level of the parotid bed was demonstrated.…”

“…In particular, graft-related complications (e.g., graft necrosis) are extremely rare, and are significantly related to graft site adjuvant radiotherapy. 58 On the other hand, the main limit of fat allografting is the unpredictable reabsorption rate, which may vary from 20% to 90% of the volume. 84,85 Transplantation with dermis or an overcorrection between 15% and 30% have been used to overcome this issue.…”

“…The majority of included studies were prospective 37,40,43,[45][46][47]50,52,56,59,60,68,69,71,73,76,77,[79][80][81] (n = 1239, 32.3%) or retrospective 13,38,39,41,42,44,48,49,51,[53][54][55]57,58,[61][62][63][64][65][66][67]70,72,74,75,78,82,83 (n = 2301, 60.1%) non-randomized studies. In particular, 12 prospective (n = 349, 9.1%) and seven retrospective (n = 378, 9.9%) single-arm studies were included, while 22 retrospective case-control (n = 1923, 50.2%) and eight prospective non-randomized studies (n = 890, 23.2%) fulfilled the abovementioned eligibility criteria.…”

Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention

“…This is consistent with our clinical practice, where most total parotidectomy patients are offered abdominal dermal fat graft reconstruction. We have found that it is a relatively simple and effective reconstructive option that is not associated with increased operative time or complication rates 44 …”

“…We have found that it is a relatively simple and effective reconstructive option that is not associated with increased operative time or complication rates. 44 Eye tracking has been used previously to investigate multiple facial deformities, including facial paralysis 27 and Mohs defects. 25 We can compare our frontal view results to these studies (also displayed frontal images for 10 seconds) to provide relative effect sizes.…”