Free abdominal fat transfer for reconstruction of the total parotidectomy defect

Objectives: Free abdominal fat transfer (FAT) grafts have been used after superficial parotidectomy to restore facial contour. We reviewed our experience with the use of FAT reconstruction of total parotidectomy defects to determine the safety and efficacy of this procedure. Study Design: Non-randomized retrospective analysis. Materials and Methods: The medical records of all patients who underwent total parotidectomy with the harmonic scalpel at the Medical College of Georgia from September 2004 to June 2007 were retrospectively reviewed. Patients with a prior bleeding disorder, facial nerve weakness, or who had undergone concurrent neck dissection were excluded. Results: Twenty-two patients met the study criteria; nine patients underwent FAT reconstruction. There was a greater percentage of malignancy in the FAT group (44%) compared with controls (15%), and a larger tumor size in the FAT group (3.8 ± 2.1 cm) compared with controls (2.6 ± 1.2 cm), but these differences did not achieve significance. FAT reconstruction was associated with increased length of surgery (324.6 ± 86.9 minutes vs. 206.6 ± 61.8 minutes for controls, P =.0013) and intraoperative blood loss (138.9 ± 95.3 mL vs. 50.1 ± 30.9 mL, P =.0052). There were no significant differences between FAT and control groups with respect to postoperative drain output (42.0 ± 35.0 mL vs. 52.5 ± 41.3, P >.05), duration of drainage (32.0 ± 12.0 h vs. 34.8 ± 15.1 h, P >.05), or facial nerve function. All patients who underwent FAT reconstruction were satisfied with their postoperative appearance, compared to 70% of control patients who reported some degree of dissatisfaction postoperatively. Conclusions: FAT reconstruction of the total parotidectomy defect is associated with greater blood loss from the FAT donor site and increased surgical time, but is safe and highly effective. These data suggest that the benefits of FAT reconstruction outweigh the additional increment in operative time and blood loss observed.