Parascapular adipofascial free flap for post-parotidectomy reconstruction

Background: Facial contour defects after parotidectomy are an important aesthetic consideration. While free fat grafts are frequently utilized to restore facial volume, their long-term durability can be variable and volume under-correction due to fat necrosis is a recognized disadvantage, particularly in patients requiring adjuvant radiation.¹ Parascapular vascularized free fat flaps offer an attractive alternative reconstructive approach; in our institutional experience, they can confer more predictable and stable volume of fat transferred with minimal donor site morbidity.² Herein, we present our approach to adipofascial parascapular free flap harvest for post-parotidectomy facial defects. Methods: This video demonstrates vascularized free parascapular fat flap harvest for reconstruction of a parotidectomy defect. Approaches and techniques are reviewed. Results: We highlight the technical aspects of parascapular free flap reconstruction after resection of a 3.5 cm pleomorphic adenoma in a 32-year-old male. Total parotidectomy with preservation of facial nerve was performed. The cumulative cut-to-close time for ablation and microvascular reconstruction was 210 min. Conclusion: Adipofascial parascapular free flap is an attractive reconstructive option for parotidectomy defects with facial contour distortion.