Introduction : Following parotidectomy patients develop progressive significant facial defect. Such defects have traditionally been corrected by sternocleidomastoid, temperoparietal fascial, SMAS flaps and fascia lata flaps. These flaps are not without their limitations, i.e. donor site defect and necrosis once transferred. The paraumbilical fat graft has been previously described in the literature and we present a case series of where this graft can be used at the time of surgery for immediate reconstruction of the parotid bed defect.
Methods : The graft is harvested through a supra/sub umbilical or suprapubic incision if there is adequate fat. Over correction of approximately 50% is required due to atrophy and resorption with time. The graft is harvested with the overlying dermis and the graft should not be filleted as this can cause necrosis. An antibiotic membrane is placed between the graft and the underlying bed and the graft is secured with vicryl sutures. A redivac drain is used for 72 h to reduce the risk of seroma and haematoma formation.
Results : Since 1997, 71 patients have been treated successfully with this method. Regarding complications nine patients developed seromas, four patients developed a haematoma, two patients had graft liquefaction and one patient suffered infection with frank suppuration and loss of the graft. The incidence of Frey’s syndrome also appeared to be reduced and if it did occur, it only occurred anterior to the graft.
Conclusion : Although parotid surgery is becoming more conservative with extracapsular dissection for benign disease, the paraumbilical fat graft appears to be a successful and reliable method of correcting facial defects after a superficial or total parotidectomy. The graft can also be used to correct temporal defects following temporalis muscle transfer. It also has the added benefit of reducing the incidence of post-operative Frey’s syndrome.
Key words : parotidectomy; paraumbilical fat graft