Reconstruction of complex total parotidectomy defects using the free XXXX flap: a classification system and algorithm.

@entity1 @entity154 @entity1183 @entity1697 @entity8810 @entity2080 @entity425 @entity2103 @entity281 @entity446 @entity18564
BACKGROUND: Composite defects resulting from total parotidectomy present unique reconstructive challenges. This study reviews our experience using the @entity18564 ( @entity18564 ) flap with adjacent fascia and nerve grafts to reconstruct these defects, and establishes a classification system and treatment algorithm that simplifies reconstruction. METHODS: Between July 2005 and November 2009, 22 @entity1 underwent total parotidectomy and immediate reconstruction with the extended @entity18564 flap. Of total, 21 @entity1 had concomitant neck dissection. Defects were classified as follows: Type I, significant soft-tissue loss (n = 4); Type II, significant soft-tissue loss with @entity2103 (n = 2); Type III, significant soft-tissue loss with resection of surrounding bone(s) (n = 5); and Type IV, significant soft-tissue loss, bone resection, and @entity2103 (n = 11). Reconstruction procedures included free @entity18564 (n = 9); @entity18564 with fascia lata sling (n = 4); @entity18564 with nerve grafting (n = 5); and @entity18564 , fascia lata sling, and nerve grafting (n = 4). Complications, functional outcome, and @entity1 satisfaction were assessed by chart review and prospective surveys. RESULTS: Fourteen of 22 @entity1 participated in surveys. There was 1 flap loss. Donor site complications included the following: 4 @entity1 (29%) with minor numbness of the lateral thigh skin, and 1 (7%) @entity2080 . There was no leg @entity425 or @entity281 . Recipient site morbidity included 2 @entity1 (14%) with @entity8810 , 3 (21%) with delayed wound @entity446 , 5 (36%) with @entity1183 , and 5 with mild @entity1697 . Smile asymmetry was present in 7 @entity1 (50%). Ten @entity1 (71%) reported being "very happy" with their appearance. CONCLUSIONS: The @entity18564 flap, used with adjacent nerve and fascia, offers a versatile option for reconstructing @entity154 . The procedure involves minimal donor site morbidity, and results in sound functional outcomes and high degrees of @entity1 satisfaction.
