Repair of Parotidectomy Defects Using Layered Meshed Allogenic Grafts

Abstract

Objectives: Cervicofacial deformities following parotidectomy are commonly repaired using autologous tissue and allogenic grafts. Using two layers of allogenic material, oriented perpendicularly after meshing, and accented by eccentric spindle-shaped gaps, affords a more favorable outcome with respect to appearance and healing. Methods: Following parotidectomy, the defect is measured and the allogenic tissue cut to size, using sterile paper as a template, if desired. A duplicate graft is prepared using either the first graft or the template. Each graft is oriented with ink, then meshed 1.5:1. The critical step is to orient the second graft on the mesher platform by 90 degrees. This maneuver creates spindle-shaped holes oriented perpendicularly once each graft is placed. The meshed grafts are thinner and more pliable than the original material, facilitating in-setting. The deep and superficial grafts are placed, taking into account the orientation of the spindles. Both grafts are trimmed in situ. The spindle sizes are altered by varying the tension, achieved by peripheral trimming. The superficial graft is tacked down beyond the deeper graft to provide a smoother transition zone. A suction drain is placed superficial to the grafts. Results: The integrity of each graft protects the facial nerve, affords precise contouring, and avoids donor site morbidity. Graft porosity facilitates drainage, expediting healing. Fibrinous in-growth exceeds that of non-porous tissue. The overlapping spindles inhibit neural in-growth, reducing the likelihood of gustatory sweating. Conclusions: Allogenic grafts with eccentrically-overlapping spindles provide an optimal setting for healing following parotidectomy.