Comparison of donor site intraoral morbidity after mucosal graft harvensting for urethral reconstruction. Urology

Northwestern University, Evanston, Illinois, United States
Urology (Impact Factor: 2.19). 11/2005; 66(4):716-20. DOI: 10.1016/j.urology.2005.04.045
Source: PubMed


To compare postoperative intraoral morbidity after mucosal graft harvesting from the lower lip and inner cheek in men undergoing substitution urethroplasty.
From 2000 to 2004, 40 patients underwent oral mucosal graft harvesting for urethral reconstruction. Of the 40 patients, 17 underwent harvest from the lower lip (group 1), 19 from the inner cheek (group 2), and 4 from both sites (group 3). We analyzed the postoperative differences in discomfort levels, neurosensory deficits, salivary flow, complications, and overall quality of life according to harvest site. Outcomes were assessed using analog scales and a questionnaire.
At longer term follow-up, the proportion of men with persistent postoperative discomfort, neurosensory deficits, and changes in salivary flow was greater in men whose grafts were harvested from the lower lip than in those whose grafts were harvested from the cheek. Contractures were noted in 1 (5.9%) of 17 and 5 (26.3%) of 19 men in groups 1 and 2, respectively. At the last follow-up visit, overall quality of life (measured by an analog scale of 0 [delighted] to 6 [terrible]) was not significantly different in patients with lower lip versus inner cheek harvest (1.35 versus 0.66, respectively, P = 0.079).
Persistent postoperative discomfort, neurosensory deficits, and salivary flow changes were more common in men whose grafts were harvested from the lower lip. However, the overall quality of life in this group was not significantly different compared with men whose grafts were harvested from the inner cheek. From a morbidity standpoint, the inner cheek appears to be the preferable site of graft harvest.

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    • "In our study BMG and LMG were used as ventral onlay grafts in cases of complex hypospadias after failed previous repair. Mean graft harvesting time in BMG was 24 min, and this is not far from that of 21.6 min reported by Jang et al. [8]. Compared to BMG, LMG showed a statistically significantly shorter harvesting time, an advantage which, together with Table 1 Preoperative and operative data in the two groups. "
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    ABSTRACT: Objectives: To compare surgical outcomes and donor site complications of buccal and lingual mucosa used as ventral onlay graft for complex hypospadias cases. Patients & methods: Forty four cases with complex hypospadias after failed previous surgery were prospectively included. All had severely scarred penile skin with reasonable residual urethral plate. Cases were categorized into two groups: Group I (23) where buccal mucosal graft [BMG] was used and group II (21) where lingual mucosal graft [LMG] was used. Donor site complications as well as functional and esthetic outcomes were recorded for each group. Results: Mean follow up was 20.8 months (range 12-24). Average graft harvesting time was 24 min for BMG and 19 min for LMG. Donor site pain was reported with both techniques but recovery was earlier with LMG. Slurred speech and difficult tongue protrusion were reported with lingual but not buccal grafts; however mouth tightness, peri-oral numbness and persistent oral discomfort were reported only with buccal grafts. Successful urethroplasty was obtained in 78.2% of BMG compared to 76.1% of LMG. Conclusion: Surgical outcomes of LMG urethroplasty were comparable to those of BMG in complex hypospadias cases. Compared to buccal mucosa, LMG is easy to harvest, with minimal donor site complications.
    Journal of pediatric urology 09/2012; 9(6). DOI:10.1016/j.jpurol.2012.08.013 · 0.90 Impact Factor
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    • "Morey et al (Morey and McAninch, 1996) 1996 18 no complications Tolstunov et al (Tolstunov et al., 1997) 1997 3 0 0 0 0 Eppley et al (Eppley, 1997) 1997 0 0 0 Dublin et al (Dublin and Stewart, 2004) 2004 13.6 64 0 16 32 0 Wood et al (Wood et al., 2004) 2004 83 26 9 11 Kamp et al (Kamp et al., 2005) 2005 12.5 100 0 25 16 Fabbroni et al(Fabbroni et al., 2005) 2005 3 4.3 4 Jang et al (Jang et al., 2005) "

    Current Concepts of Urethroplasty, 07/2011; , ISBN: 978-953-307-392-7
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    • "Some authors reported graft harvesting longer than 5 cm [5] [12] [13]. Some studies compared the oral outcome in patients who had undergone OM graft harvesting from the lip or cheek and concluded that OM harvested from the cheek was associated with less postoperative discomfort and fewer complications [6] [7] [13]. The difference in morbidities can be explained by the different anatomic location of each harvest site [7]. "
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    ABSTRACT: The oral mucosa (OM) is a popular substitute for urethroplasty. The aim of this study was to investigate oral morbidity and patient satisfaction in a homogeneous group of patients who underwent OM harvesting. This study is a prospective analysis of 350 patients who underwent OM harvesting from a single cheek. The graft was harvested in an ovoid shape with closure of the wound. Standard graft size was 4 cm in length and 2.5 cm in width. 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. 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." 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.
    European Urology 07/2010; 58(1):33-41. DOI:10.1016/j.eururo.2010.01.012 · 13.94 Impact Factor
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