(0626) Contemporary Management of Free Tissue Reconstruction for Complex Parotidectomy Defects

Introduction: Parotidectomy defects after oncologic surgery often lead to significant volume loss and unfavorable facial contours for patients. Reconstruction requires accounting for the oncologic defect, facial contour, auricle position, and facial nerve reconstruction. The optimal reconstructive paradigm for patients with salivary gland malignancies is yet to be elucidated. To address this practice gap, we propose a free flap reconstructive treatment algorithm for patients requiring parotidectomy, incorporating skin excision and facial nerve sacrifice.

Methods: A treatment algorithm is proposed from a retrospective review of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November 2012 and November 2020. Variables of interest included color match, availability of a donor nerve, and BMI. Patients with documented pictures of their reconstruction and external skin paddles were considered. Patient demographics and surgery-specific factors were recorded. Objective differences in the color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score.

Results: The two major decision branches to consider in our proposed algorithm are facial nerve sacrifice and the need for skin resurfacing. Our data demonstrate the lateral arm free flap is optimal in cases where skin resurfacing and facial nerve reconstruction are required, with a separate thigh incision. The ALT free flap is best suited for cases needing facial nerve reconstruction and volume for facial contour but no skin resurfacing. The lateral arm or parascapular free flap are ideal for cases needing skin resurfacing, given a better skin color match.

Conclusions: Parotid reconstruction is complex and involves the interdependence between aesthetics and function. We propose that ALT free flaps are optimal for patients with facial nerve sacrifice but without skin excision. For patients who require facial skin resurfacing, lateral arm or parascapular free flaps provide better skin color match.