Reconstruction after total parotidectomy using a de-epithelialized free flap

Introduction: Total parotidectomy has aesthetic and functional sequelae, including Frey' syndrome and soft tissue depression of the region. The aim of repair is to reduce these problems, importing tissue into the surgical field to fill the region and to avoid Frey's syndrome. The soft tissues to use are those which are not resorbed in order to have a stable aesthetic result. Objective: To propose a new method for avoiding negative functional and aesthetic sequelae of total parotidectomy. Patients: Two patients underwent total parotidectomy because of recurrent sialoadenolithiasis in one case and for adenocarcinoma in the other. Immediate repair was obtained with a de-epithelialized parascapular free flap: both cases required thinning of the flap secondarily under local anaesthesia. Results: Aesthetic results were good in both cases. No patient developed Frey's syndrome. Conclusion: Among the many techniques that have been proposed for this purpose, the de-epthelialized parascapular free flap guarantees an adequate amount of tissue with good vascularization and leads to a pleasing and stable result. (c) 2007 European Association for Cranio-Maxillofacial Surgery.