Use of SMAS Flap and Fat Graft: Viability and Effectiveness

Abstract

Objective: 1) Evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. 2) Evaluate the long-term viability of the free fat graft, including in the setting of postoperative radiation. Method: A prospective, consecutive analysis of patients undergoing parotidectomy for benign and malignant disease from 2006-2011 was performed at an academic university setting. The main outcome measures were the effectiveness of achieving symmetric volume of the ipsilateral parotid defect, long-term viability of the free fat graft, and presence of Frey’s syndrome. Results: Twenty-four consecutive patients received parotidectomy with SMAS flap and free fat graft from 2006-2011. The average age was 56 (range 16-84). Nineteen patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. Five procedures were done for malignant disease, and, in each instance, postoperative radiation was administered. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. MRI imaging confirmed graft viability even in the setting of postoperative radiation. There was 1 case of Frey’s syndrome and no instances of long-term facial weakness among the patients. Conclusion: The SMAS flap and free fat graft are an effective approach to reconstructing the parotidectomy defect with minimal morbidity and complication. This study demonstrates long-term viability of the free fat graft in the setting of postoperative radiation. Reconstruction reduces the rate of Frey’s syndrome compared to historic rates following surgery.