One primary complaint about using standard fat grafts for parotidectomy defect reconstruction has been fat reabsorption and liquefaction. Although this may be a concern for fat harvested through liposuction methods, as well as for AlloDerm, which does not work well for filling substantial gaps, Dr. Gourin said that the connective tissue acts as an anchor to keep the transplanted fat in place. “Generally, the surgeon would take 30% more abdominal fat than what’s needed to repair the defect because despite the connecting tissue acting as an anchor, some reabsorption will happen, but with a large piece there is a better chance of the tissue surviving in its new location,” she added.
Only perhaps half of parotid surgeons perform [the FAT procedure], and I think its use depends to some extent on the age of the surgeon and where he or she trained. It wasn’t something I learned to do in my training; many of us just weren’t exposed to techniques for parotid defect reconstruction. —Christine Gourin, MD
Advantages, Disadvantages, and Complications
Although FAT grafts are a viable option for parotidectomy defect reconstruction, Dr. Gourin was surprised at the abdominal complication rate, with hematoma in eight patients and seroma in three patients. “The abdominal complication rate of 10% was a little higher than I thought it would be, but it really is the result of taking a large fat graft through a small incision,” she said. “But it’s a pretty realistic rate of donor site complications, and it’s important to report those honest data.”