Analysis of Abdominal Dermal‐Fat Grafting to Repair Parotidectomy Defects: An 18‐Year Cohort Study

• Published in: The Laryngoscope Vol. 130; no. 9; pp. 2144 - 2147
• Main Authors: Gruszczynski, Nelson R., Anderies, Barrett J., Dey, Jacob K., Price, Daniel L., Moore, Eric J., Janus, Jeffrey R.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-09-2020; Wiley Subscription Services, Inc
• Subjects: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort analysis; Dermal‐fat; Female; Frey's; graft; gustatory sweating; Humans; Male; Middle Aged; Parotid Gland - surgery; parotidectomy; Postoperative Complications - etiology; Postoperative Complications - surgery; Reconstructive Surgical Procedures - methods; Retrospective Studies; Subcutaneous Fat, Abdominal - transplantation; Treatment Outcome; Young Adult; graft; Frey's; Dermal-fat; parotidectomy; gustatory sweating
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28466

Objectives
To assess the outcomes of abdominal dermal‐fat grafting following superficial and total parotidectomy.
Methods
A retrospective chart review of parotidectomy patients was performed. Patients were divided into four groups based on surgical extent and grafting status: superficial parotidectomy (SP), superficial parotidectomy with grafting (SPg), total parotidectomy (TP), and total parotidectomy with grafting (TPg). Complication rates and operative times were then compared between surgically matched groups (SP vs. SPg, TP vs. TPg). Complications included graft necrosis, gustatory sweating, first‐bite syndrome, infection, hematoma, sialocele, and seroma. Data was analyzed via chi‐square and two‐sample t testing, logistic regression, and one‐way analysis of variance.
Results
The cohort consisted of 330 patients: 106 SP (32.12%), 61 SPg (18.48%), 82 TP (24.85%), and 81 TPg (24.55%). No donor site complications occurred. TPg resulted in seven graft necroses (8.64%), and 22 reported gustatory sweating (27.20% vs. 10 TP patients (12.2%), P = 0.016); SPg resulted in two necroses (3.28%). There were no other statistically significant differences in complication rates. Graft recipients receiving adjuvant radiation were more likely to develop necrosis (odds ratio [OR] 4.60, 95% confidence interval [CI], 1.16–18.27, P = .0194). Patients who developed gustatory sweating were 8.38 years younger (95% CI 2.66–14.10, P = 0.002, follow‐up time > 48 days). Grafting did not increase operative times (TP/TPg: mean = 275.91/263.65 minutes, standard error of the mean = 41.96/33.75, P = 0.822).
Conclusion
An abdominal dermal‐fat graft is an excellent reconstructive choice for a parotidectomy defect and is not associated with increased complication rates or prolonged operative time.
Level of Evidence
4 Laryngoscope, 130:2144–2147, 2020