Reconstruction of extensive defects of the parotid region: experience with the pectoralis major and free latissimus dorsi flaps

Abstract

Large defects of the parotid region resulting from excision of malignant tumours, or necrotic tissue due to radiotherapy, should not always be closed with local tissue, for several reasons. Occasionally, myocutaneous flaps are indicated, giving better results. We describe the problems of such tissue defects and our experience over a 10-year period using 2 different flap reconstruction techniques. A total of 28 cases, 25 with malignant tumours of the parotid or the external ear, 2 with extensive radionecrosis of the parotid region and 1 with a burn, were evaluated. The defects were restored with a pectoralis major flap in 21 cases and with a free latissimus dorsi flap in 7 cases. The follow-up ranged from 18 to 60 months. The flaps were successful in achieving stable wound healing, restoration of tissue volume and in helping patients to return to normal life activities. There were complications in 28.5% of the cases. There were 2 early deaths due to encephalitis. Two pectoralis major flaps (9.5%) failed partially. All latissimus dorsi flaps survived. The pectoralis major proved to be useful, especially in older and medically compromised patients, whereas the latissimus dorsi fared well in younger female patients and in cases of a hemifacial resection defect. Numerous technical points in both methods are emphasized.