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Thigh tissue effectively transplanted after radical parotidectomy

Patients who undergo radical parotidectomy or removal of cutaneous squamous cell carcinoma can be successfully treated by using anterolateral thigh tissue to repair postsurgical facial defects, according to study results.

Researchers conducted their study with five male patients aged 48 to 82 years who had been diagnosed with three diseases: high-grade adenocarcinoma (two patients), cutaneous squamous cell carcinoma (two patients), and recurrent dermatofibrosarcoma protuberans (one patient). All the patients had T4 tumors that were extirpated, resulting in damage to the patients’ facial nerves and defects to their skin.

Each patient underwent orthodromic temporalis tendon transfer (OTTT), a facial reconstruction technique used after parotidectomy and/or tumor removal to restore the affected areas. Four of the five patients also underwent nerve anastomosis, or cable grafting.

Anterolateral thigh (ALT) free fat and fascia flaps were used in all patients to augment the facial tissue lost during tumor removal. Two of the grafts were buried de-epithelialized fat/fascia flaps and three were fasciocutaneous flaps. The researchers reported no complications at the patients’ tissue donor sites.

One patient experienced postsurgical complications and was hospitalized with urinary retention and cardiac irregularity.

Researchers said they recreated as much of each patient’s original face shape and function as possible to minimize surgical defects and the stigma many patients have after undergoing parotidectomy or removal of cutaneous facial tumors.

“Oncologically sound resection, restoration of facial symmetry, and immediate … facial rehabilitation were accomplished in a single-stage procedure using our method of simultaneous reconstruction with ALT free flap, OTTT, and cable grafting when indicated,” researchers said.

They also noted that all patients underwent at least three additional procedures for facial nerve rehabilitation.