Reconstruction of limited parotidectomy defects using the dermofat graft

Pham, My; Eviston, Timothy J.; Clark, Jonathan

doi:10.1111/ans.13608

Cited by 11 publications

(13 citation statements)

References 35 publications

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“…Wound infection was reported in 94 studies 6,9,12,14,15,17,21–25,27,28,31,35,36,39–44,49,55,57–67,69–72,74,75,79,81,85–90,92,93,95,96,98–103,105–107,111,112,115–122,124,125,128,131–149 reporting on 15,861 patients (Table I and Fig. 2B).…”

Section: Resultsmentioning

confidence: 95%

Minor Parotidectomy Complications: A Systematic Review

et al. 2020

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Objectives To report descriptive statistics for minor parotidectomy complications. Methods A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. Results The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4‐3.5), wound infection 2.3% (95% CI: 1.8‐2.9), sialocele 4.5% (95% CI: 3.5‐5.7), salivary fistula 3.1% (95% CI: 2.6‐3.7), flap necrosis 1.7% (95% CI: 1.1‐2.5), scar issues 3.6% (95% CI: 2.4‐5.4), numbness 33.9% (95% CI: 25.6‐43.4), and deformity 11.8 (95% CI: 6.9‐19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. Conclusions Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571–579, 2021

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Section: Resultsmentioning

confidence: 95%

Minor Parotidectomy Complications: A Systematic Review

et al. 2020

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“…26 Dermofat grafts are increasingly used to reconstruct relatively small defects created following partial parotidectomy and are of value in patients who are concerned with minor aesthetic changes. 8,[15][16][17] Dermofat grafts were used in 17% of our study population; these patients had a 90% reduction in the odds of developing a wound complication compared to no reconstruction. This result is largely attributable to a reduction in salivary fistula and sialocele.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstructive techniques are primarily employed following parotidectomy to restore facial contour 26 . Dermofat grafts are increasingly used to reconstruct relatively small defects created following partial parotidectomy and are of value in patients who are concerned with minor aesthetic changes 8,15–17 . Dermofat grafts were used in 17% of our study population; these patients had a 90% reduction in the odds of developing a wound complication compared to no reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 In 2016, we reported preliminary data suggesting that FTD 8 and simple reconstructive methods such as dermofat grafting 17 may reduce surgical morbidity. Whilst ECD and LP have been reported on extensively, comparisons of FTD with other approaches are lacking 1,[18][19][20][21][22][23] and most studies evaluating dermofat grafting have been focused on Frey's syndrome 16,24,25 and aesthetics, 16,17,25 disregarding wound complications. 14,26 The aim of this study was to determine what techniques the surgeon can employ to reduce postoperative complications in patients undergoing parotidectomy for benign pathology.…”

Section: Introductionmentioning

confidence: 99%

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Reducing the morbidity of parotidectomy for benign pathology

Petrides

Subramaniam

Pham

et al. 2020

ANZ Journal of Surgery

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Background: Conservative surgical approaches, reconstructive techniques and technology are increasingly used in parotid surgery. The aim of this study was to determine the surgeon-modifiable factors which impact the rates of post-operative complications following parotidectomy for benign pathology. Methods: A retrospective cohort study of patients undergoing parotidectomy for benign pathology by or under the supervision of the senior author between 2006 and 2019 was performed. Clinicopathological variables, operative techniques and post-operative complications were recorded using standardized templates. Multivariable logistic regression models were used to obtain odds ratios (ORs) whilst adjusting for the effect of other clinically relevant covariates. Results: In total, 357 parotidectomies were performed. Independent factors associated with post-operative facial paresis were re-operative surgery (OR 3.51, 95% CI 1.19-10.33, P = 0.023), nerve integrity monitoring (OR 0.50, 95% CI 0.26-0.99, P = 0.046) and operation type, with focused tumour dissection (FTD) having the lowest rate of paresis (OR 0.19, 95% CI 0.040-0.92, P = 0.038) compared to limited parotidectomy. Factors associated with reduced wound complications on adjusted analysis were dermofat grafting (OR 0.10, 95% CI 0.01-0.72, P = 0.023), lesion size (OR 0.68, 95% CI 0.50-0.92, P = 0.01) and FTD (OR 0.16, 95% CI 0.05-0.59, P = 0.005) compared to limited parotidectomy. Conclusion: FTD, nerve integrity monitoring and dermofat grafting are surgeon-modifiable variables associated with lower rates of post-operative complications following parotidectomy for benign pathology. However, the benefit of these operative techniques relies on their appropriate utilization by performing surgeons.

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“…There is a debate about the ideal barrier and contour material, and surgeons use a wide array of reconstructive interposition methods including though not limited to SMAS flap, acellular dermal matrix, vicryl mesh, sternocleidomastoid muscle flap, temporoparietal fascia flap, and dermal-fat grafting. 10 In addition to improving contour deformities and possibly reducing Frey syndrome, this material may act as a protective covering to the facial nerve if later facelift surgery is planned. Of note, in smaller parotidectomies, we reapproximate the remaining parotid tissue.…”

Section: Discussionmentioning

confidence: 99%

Rhytidectomy After Parotidectomy

2017

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A history of prior parotidectomy is typically thought to substantially increase the risk of facial nerve injury for patients undergoing subsequent facelift surgery. For this reason, surgeons are often hesitant and may even elect not to perform facelift surgery on such patients. However, we have developed a safe and predictable operation for performing the postparotidectomy rhytidectomy. Here, we present our rationale, approach, and results for performing this operation. This review is a retrospective case series. In total, 1200 facelifts from 2012 to 2016 performed by a single surgeon (D.B.R.) were reviewed. From these, 9 patients were identified as having had parotid surgery prior to rhytidectomy. Rhytidectomy was performed in 8 of 9 cases with a deep-plane, bilaminar approach. There were no intraoperative complications. One patient had a direct neck lift. There were no cases of revision. There were no cases of facial nerve damage including paresis or paralysis; 100% patient satisfaction was noted. Rhytidectomy with a deep-plane approach may be performed safely in patients who have undergone prior parotidectomy. Although there were no complications, revisions, postoperative asymmetry, or dissatisfaction in the patients in this study, it must be stressed that there is no substitute for a thorough appreciation of the surgical anatomy in combination with consideration of the changes to the surgical field that occur with parotid surgery.

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Reconstruction of limited parotidectomy defects using the dermofat graft

Abstract: Dermofat graft is associated with high rates of patient satisfaction and a low incidence of complications.

Cited by 11 publications

References 35 publications

Minor Parotidectomy Complications: A Systematic Review

Minor Parotidectomy Complications: A Systematic Review

Reducing the morbidity of parotidectomy for benign pathology

Rhytidectomy After Parotidectomy

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