Microvascular free dermis-fat flaps for reconstruction after ablative head and neck surgery

Reconstruction of the head and neck region following radical parotidectomy with or without mandibulectomy may be a difficult procedure. Facial skin is usually preserved, but the underlying soft-tissue structures and bone are deficient. The challenge is to augment the facial defect while the overlying skin is preserved with a high success rate, minimal time, one operative stage, and reduced secondary deformity to the patient. In certain instances, a microvascular free flap is ideal. We have used a de-epithelialized microvascular free groin flap successfully to reconstruct large parotid-mandibular defects in nine patients. A small bridge of epithelium is left to relieve tension from edema and to monitor the flap postoperatively. The high success rate, minimal complications, and acceptable donor site defect make the microvascular free dermis-fat flap an ideal choice for this type of reconstruction.