Long‐Term Cosmetic Outcomes of Parotidectomy Reconstruction: AlloDerm versus Free Dermal Fat Graft

Abstract

Objective: Parotid neoplasms generally require surgical resection with adequate margins. Cosmetic contour deformities resulting from parotidectomy can cause significant postoperative dissatisfaction. Therefore, we seek to compare the functional and cosmetic success of 2 postparotidectomy reconstructive modalities: autologous free dermal fat grafting (FDFG) and AlloDerm implantation. Method: We conducted a retrospective review of all patients who underwent a parotidectomy with either AlloDerm or autologous FDFG reconstruction by a single surgeon since January 1997. Complications were identified and patients from both cohorts were contacted by telephone to assess cosmetic satisfaction using a novel analogue scale. Results: Sixty-five patients who received AlloDerm reconstruction and 35 patients who received FDFG reconstruction were analyzed. The incidence of complications following FDFG was 3% (n = 1) compared with 5% (n = 3) after AlloDerm implantation ( P = 1.000). Both cohorts rated their reconstruction on symmetry (1-worst to 5-best), degree of change (1-least to 5-most), and overall satisfaction (1-worst to 5-best). Patients with FDFG reconstruction reported favorable cosmesis with respect to symmetry (4.5 ± 0.7) and overall appearance (4.8 ± 0.4), while indicating mild changes in their appearance over time (2.0 ± 1.2). At the time of this writing, cosmetic assessment of AlloDerm patients was underway but incomplete. Conclusion: FDFG and AlloDerm are cosmetically and functionally viable options to reconstruct the post-ablative parotid bed. Both modalities demonstrated similarly low complication rates ( P = 1.000), and an assessment of long-term patient satisfaction with AlloDerm will determine how it compares to the cosmetically efficacious FDFG.