(0504) Adipofascial Profunda Artery Perforator Flap for Reconstruction of Contour Defect After Parotidectomy

Introduction: Contour defects following parotidectomy can be unsightly due to the unnatural concavity of the defect. Multiple techniques utilizing free flaps to reconstruct the contour deformity after parotidectomy have been described; however these may carry the risk of additional donor site morbidity and often have unsightly donor site scars. The profunda artery perforator (PAP) free flap is a reliable option which can be harvested concurrently with resection with a well-hidden incision in the medial thigh. Here, we describe the novel application of the adipofascial PAP free flap after recontouring after parotidectomy.

Methods: Retrospective cohort study of all patients who underwent adipofascial PAP free flap reconstruction following parotidectomy between October 2019 and October 2023 at a tertiary center. Clinical data including patient demographics, operative details, and postoperative complications were collected from the electronic medical record.

Results: In total, 14 patients met criteria for inclusion. The mean age was 42.2 ± 14 years. Of the total, 11 (79%) of patients were female. The most common indication for parotidectomy was pleomorphic adenoma (10/14, 71%). The median cut-to-close time was 338 minutes. The most common recipient artery was the occipital artery (10/14, 71%) and the most common recipient vein was the ranine vein (6/14, 43%). The median coupler size was 2.5mm (range 1.5-3.5mm). The median length of stay was 1 day. There were no flap failures and no wound complications at either the donor or recipient site other than distal skin necrosis of the facial skin flap in one patient which was managed conservatively. A single patient underwent revision 5 months postoperatively for excessive bulk.

Conclusions: The adipofascial PAP free flap is an excellent option for recontouring after parotidectomy. This flap can be harvested concurrently with the resection with minimal donor site morbidity via an incision that is well-hidden, leading to minimal cosmetic impact from the donor site.