Evaluation of Superficial Musculoaponeurotic System Flap and Fat Graft Outcomes for Benign and Malignant Parotid Disease

Abstract

The combined technique of SMAS flap and free fat graft is effective for immediate reconstruction of the parotidectomy defect with minimal morbidity and low complication rates. This study demonstrates long-term viability of the free fat graft even in the setting of postoperative radiation.

Free abdominal fat transfer for partial and total parotidectomy defect reconstruction

“…Similar to other reports, we did not find malignancy a contraindication to the use of fat grafting, although we did consider this a contraindication to the use of a facelift incision when malignancy was suspected on the basis of preoperative fine needle aspiration cytology. The use of FAT did not confound postoperative surveillance in cases of malignancy because FAT has distinct imaging characteristics from normal or pathological tissue that is best appreciated on magnetic resonance imaging . We did not find an increase in complications in patients who underwent concurrent neck dissection, underwent postoperative radiation, or had with a history of prior radiation, although the number of patients in these groups was small.…”

“…We now use an abdominal binder to facilitate apposition of the dead space for the first postoperative week and discharge patients to home with a closed drainage system. Our incidence of short-term donor site complications is higher than others have reported 12,13,25,26 and may be due to differences in the volume of FAT harvested, as well as the size of the incision. The incidence of donor site hematoma has been reported to be lower when a transverse or horizontal incision is utilized as compared with the smaller periumbilical incision.…”

“…Parotidectomy defect reconstruction has been shown in a meta‐analysis to reduce the incidence of Frey's syndrome, although none of the series included utilized fat grafting alone but included temporalis or SMAS fascia as part of reconstruction . We did not specifically test for Frey's syndrome, which has been reported to occur in less than 5% patients after fat grafting with SMAS plication . We suspect that the low self‐reported incidence may be due to the generous size of fat grafts used in this series which, when integrated, serve as an effective soft tissue barrier to the aberrant regeneration of parasympathetic nerves.…”

“…We now perform suture closure of the preauricular and infralobular parotidectomy incision, which appears to allow for more consistent skin‐to‐skin apposition of this area under increased tension from intentional overcorrection of the defect with FAT. Superficial musculoaponeurotic system plication over the fat graft prior to closure may reduce the incidence of visible fat necrosis but may not be possible in many cases …”

“…Superficial musculoaponeurotic system plication over the fat graft prior to closure may reduce the incidence of visible fat necrosis but may not be possible in many cases. 12,26 The most common abdominal donor site complication was hematoma. Fat transfer is harvested through a minimally invasive periumbilical incision that is smaller than the size of the FAT harvested and results in a large dead space.…”