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Published on: March 1, 2015
Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following
Shaheen Hasmat1, Tsu-Hui Low1, Aparna Krishnan1
1From the Faculty of Medicine and the Central Clinical School, University of Sydney; Department of Head and Neck Surgery and Sydney Facial Nerve Service, The Chris O'Brien Lifehouse; the Illawarra Health and Medical Research Institute; and the Centre for Oncology Education and Research Translation.
This study shows a chimeric vastus lateralis and anterolateral thigh flap effectively reconstructs defects and restores dynamic facial function after parotid surgery. Young age and pre-existing facial nerve integrity improve outcomes.
Area of Science:
- Plastic Surgery
- Head and Neck Oncology
- Facial Nerve Reconstruction
Background:
- Radical parotidectomy for malignant tumors often results in complex facial defects and facial nerve palsy.
- Reconstruction of these defects requires addressing both soft-tissue loss and functional deficits, particularly facial nerve function.
Purpose of the Study:
- To evaluate the efficacy of a chimeric vastus lateralis muscle flap combined with an anterolateral thigh flap for soft-tissue reconstruction and dynamic facial reanimation after radical parotidectomy.
- To identify factors influencing the return of dynamic midface movement post-reconstruction.
Main Methods:
- A retrospective review of 27 patients undergoing radical parotidectomy and reconstruction with a chimeric vastus lateralis and anterolateral thigh flap (March 2013 - May 2017).
- Primary outcome was the return of dynamic midface movement, assessed using clinician-graded facial function scales.
- Factors such as age, sex, pre-operative facial nerve status, and neurotization technique were analyzed.
Main Results:
- 48% of patients (13 out of 27) achieved dynamic midface movement.
- Younger age, being female, and having an intact facial nerve pre-operatively were associated with improved dynamic function.
- Neurotization using midface facial nerve branches, rather than nerve-to-masseter alone, correlated with superior midface dynamic function.
Conclusions:
- The chimeric vastus lateralis and anterolateral thigh flap is a viable option for complex defects following radical parotidectomy.
- This flap technique allows for simultaneous soft-tissue reconstruction and dynamic facial reanimation.
- Patient-specific factors and surgical technique influence the success of functional recovery.
