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Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy

Hasmat, Shaheen M.D., B.Med.; Low, Tsu-Hui M.B.B.S., B.Sc. Med.; Krishnan, Aparna Ph.D.; Coulson, Susan Ph.D.(Physio.), M.App.Sc.(Ex. & Sport Sc.), B.App.Sc.(Physio.); Ch’ng, Sydney M.B.B.S., Ph.D.; Ashford, Bruce G. M.D., B.D., M.B.B.S.; Croxson, Glen M.B.B.S.(Hons.); Clark, Jonathan R. M.B.B.S., B.Sc.(Med.), M.Biostat.

Plastic and Reconstructive Surgery: November 2019 - Volume 144 - Issue 5 - p 853e-863e
doi: 10.1097/PRS.0000000000006183
Reconstructive: Head and Neck: Original Articles
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Discussion

Background: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors’ experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy.

Methods: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes.

Results: A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05).

Conclusion: The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Camperdown, Wollongong, and Liverpool, New South Wales, Australia

From the Faculty of Medicine and the Central Clinical School, University of Sydney; Department of Head and Neck Surgery and Sydney Facial Nerve Service, The Chris O’Brien Lifehouse; the Illawarra Health and Medical Research Institute; and the Centre for Oncology Education and Research Translation.

Received for publication April 27, 2018; accepted February 28, 2019.

Presented at the 19th Annual Scientific Meeting of the Australian and New Zealand Head and Neck Cancer Society, in Brisbane, Queensland, Australia, October 12 through 14, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Shaheen Hasmat, M.D., B.Med., The Chris O’Brien Lifehouse, 119-143 Missenden Road, Camperdown, New South Wales 2050, Australia, shas9044@uni.sydney.edu.au

Copyright © 2019 by the American Society of Plastic Surgeons