What should be interposed between skin and facial nerve to prevent Frey's syndrome?

Frey's syndrome, also known as gustatory sweating, can occur following parotid gland surgery or trauma when the auriculotemporal nerve is inadvertently cut or damaged. This results in aberrant regeneration where nerve fibers intended for the parotid gland end up innervating the sweat glands of the skin, leading to sweating during meals.

The use of a fat graft serves as an effective barrier between the skin and the facial nerve during surgical procedures. Fat tissue has a high degree of vascularity and a low level of innervation, which helps to provide a buffer that can prevent the errant connections of the nerve fibers associated with Frey's syndrome. Additionally, fat grafts will integrate with the surrounding tissue, promoting healing while simultaneously providing volume and a protective layer.

Other options, such as muscle flaps, collagen matrices, or bone grafts, do not provide the same level of effective neurophysiological isolation that fat grafts do. Muscle flaps may have their own nerve supply and could potentially contribute to unwanted outcomes. Collagen matrices are less effective due to their lack of tissue integration and vascularization. Bone grafts would not provide any protective layer relevant to nerve or sweat gland interaction, as they are not soft tissue and would not