Reconstruction of complex total parotidectomy defects using the free anterolateral thigh flap: a classification...

Area of Science:

• Plastic Surgery
• Head and Neck Surgery
• Reconstructive Surgery

Background:

• Total parotidectomy leads to complex defects requiring specialized reconstruction.
• The anterolateral thigh (ALT) flap is explored for its utility in these challenging cases.

Purpose of the Study:

• To review the use of the ALT flap with adjacent fascia and nerve grafts for parotidectomy defect reconstruction.
• To establish a classification system and treatment algorithm for these reconstructions.

Main Methods:

• A retrospective review of 22 patients undergoing total parotidectomy and immediate ALT flap reconstruction.
• Defects were classified into four types based on soft-tissue loss, nerve excision, and bone resection.
• Reconstruction techniques varied, including free ALT flaps, with fascia lata slings, and nerve grafting.

Main Results:

• One flap loss occurred; donor site complications were minor (numbness, seroma).
• Recipient site morbidity included Frey syndrome, delayed healing, facial numbness, and mild oral incompetence.
• Despite some functional deficits like smile asymmetry (50%), 71% of patients reported high satisfaction.

Conclusions:

• The ALT flap, combined with nerve and fascia, is a versatile reconstructive option for complex parotidectomy defects.
• The procedure demonstrates minimal donor site morbidity and yields favorable functional outcomes and patient satisfaction.