RECONSTRUCTIVE UROLOGY

doi: 10.1590/S1677-553820100003000023

Morbidity of oral mucosa graft harvesting from a single cheek
Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, Lazzeri M
The Centre for Reconstructive Urethral Surgery, Arezzo, Italy.
Eur Urol. 2010 Jan 19 [Epub ahead of print]

• Background: The oral mucosa (OM) is a popular substitute for urethroplasty.
  Objective: The aim of this study was to investigate oral morbidity and patient satisfaction in a homogeneous group of patients who underwent OM harvesting.
  Design, Setting, and Participants: This study is a prospective analysis of 350 patients who underwent OM harvesting from a single cheek.
  Intervention: The graft was harvested in an ovoid shape with closure of the wound. Standard graft size was 4cm in length and 2.5cm in width.
  Measurements: Self-administered, nonvalidated semiquantitative (0, absence of complications or symptoms; 3, the worst complication or symptom) questionnaire consisting of six questions was used to investigate early complications, with 13 questions designed to investigate late complications and patient satisfaction.
  Results and Limitations: Early complications included bleeding, which occurred in 15 patients (4.3%); two patients required immediate surgical revision of the harvesting site. The majority of patients (85.2%) showed no pain, and only 3.7% of patients required use of anti-inflammatory drugs. The majority of patients (65.8%) showed slight or moderate swelling. With respect to late complications, most of the patients (73.4%) reported oral numbness for 1 wk, 22.9% for 1 mo, and 3.77% for 3 mo. Numbness resulting from scarring was absent or slight in most of patients. Changes in oral sensitivity occurred in 2.3% of patients. No difficulties opening the mouth or smiling was found in 98.3% and 99.7% of patients, respectively. Slight or moderate dry mouth was found in 97.1% of patients. In response to the question, “Would you undergo oral mucosa graft harvesting using this technique again,” 343 patients (98%) replied “yes,” and 7 patients (2%) replied “no.”
  Conclusions: The harvesting of an OM ovoid graft from a cheek with closure of the wound is a safe procedure with a high patient satisfaction rate.

• Editorial Comment
  Success rates of substitution urethroplasty with buccal mucosa graft are similar to those using genital skin as the graft material. The principal reason buccal mucosa has been embraced as the graft material of choice is because the graft harvest is believed to cause less morbidity than harvest from other donor areas. Thus, this article represents an important study documenting the low morbidity of oral graft harvest. The questions asked by the authors cover a broad spectrum of possible symptoms. This confirms most surgeons’ observations that oral mucosa harvest is well-tolerated. Still, in the absence of a study that directly compares the morbidity of oral mucosa harvest with that of genital skin harvest it is unclear whether oral mucosa harvest is safer than genital skin harvest.

Dr. Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu