Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series

Abstract

Background: Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. Materials and methods: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. Results: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. Conclusion: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.

Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial

“…Concave facial asymmetry, preauricular deformity, and Frey’s syndrome are embarrassing and disturbing post-parotidectomy complications that cause low self-esteem and annoy patients 25 . Using interposition grafts significantly decreases these complications 6 . Allografts or synthetic alloplastic materials are available options that can be used.…”

“…Although they have the advantage of no need for an additional surgical site, they are associated with an increased risk of infection, seroma, sialocele, salivary fistula, or longer drainage duration. Moreover, synthetic grafts are more expensive and are liable to implant extrusion 6 , 26–31 . On the other hand, autologous grafts provide an excellent option for reconstruction with minimal sequelae.…”

“…On the other hand, autologous grafts provide an excellent option for reconstruction with minimal sequelae. Some autologous flaps have their own problems like SCM flap or temporoparietal fascial flap 6 . However, many studies have documented the superiority of using FDFG or SMAS flap and sometimes their combination over simple closure without flaps, with a lower rate of complications 2–6 , 8 , 11 , 12 , 15 , 17–22 , 25 , 26 , 32–37 .…”

“…Free dermal fat graft (FDFG) is a well-known technique for plastic surgical reconstruction of facial and complex head and neck defects 6 , 17 . Many authors have documented that autologous abdominal FDFG preserved facial cosmesis even with total parotidectomy and efficiently prevented Frey’s syndrome 2 , 5 , 6 , 18 , 19 .…”

“…Free dermal fat graft (FDFG) is a well-known technique for plastic surgical reconstruction of facial and complex head and neck defects 6 , 17 . Many authors have documented that autologous abdominal FDFG preserved facial cosmesis even with total parotidectomy and efficiently prevented Frey’s syndrome 2 , 5 , 6 , 18 , 19 . Many other authors have documented a valuable role of using SMAS flap in preventing post-parotidectomy complications and improving aesthetic results 3 , 4 , 20 .…”