381 ALTERNATIVE ORAL MUCOSA GRAFTS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (III)1 Apr 2013381 ALTERNATIVE ORAL MUCOSA GRAFTS Paul Bradley and Raul Ordorica Paul BradleyPaul Bradley Tampa, FL More articles by this author and Raul OrdoricaRaul Ordorica Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1769AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Oral mucosa grafts are a proven source of extragenital tissue for urethroplasty, with buccal mucosa being the predominate choice. Labial and lingual mucosa are less commonly used, with concern regarding cosmetic and functional complications. We have evaluated these alternatives, presenting a retrospective review of lingual and labial mucosa grafts with attention to technique measuring outcome in regard to stricture recurrence and donor site complications. METHODS 59 patients (56 men, 3 women) underwent urethroplasty between 2000 and 2012, mean age of 50 (18 ± 77), with a total of 62 grafts harvested. 36 of these procedures were a single stage dorsal onlay urethroplasty with 26 being repaired in a staged fashion for distal urethral plate replacement for either balanitis xerotica obliterans (16), hypospadias (8), or epispadias (2). Labial grafts were harvested from the lower lip excluding the frenulum, and at least 1 cm from the vermillion border. Hydrodissection was performed using ¼ marcaine with epinephrine. Care was taken to maintain the plane of dissection just beneath the mucosa and avoid the labial fat and mental nerve. Lingual grafts were harvested lateral to the frenulum excluding the lateral border. While labial donor sites were left open to re-epithelialize secondarily, lingual donor sites were closed primarily. 48 labial grafts were harvested with dimensions ranging from widths of 1.5 to 2 cm, with lengths ranging from 4 to 12 cm, while 14 lingual grafts were harvested with dimensions ranging from widths of 1.5 to 2 cm, with lengths ranging from 3.5 to 7 cm. RESULTS 54/62 (87%) of these procedures were considered successful in regard to stricture recurrence as measured by AUA symptom score and complex uroflowmetry at mean last follow up of 20 months (6 to 99). For those 8 patients who developed recurrent symptoms or reduction in flow, 5 were found to have stricture recurrence involving the grafted portion of the repair (labial). No patient reported long-term morbidity involving the graft harvest site (e.g. numbness, alteration in phonation, change in external cosmetic appearance). CONCLUSIONS Labial and lingual oral mucosa grafts are suitable alternatives to buccal mucosa grafts resulting in similar outcomes with minimal morbidity. Procurement of labial or lingual tissue requires careful dissection with avoidance of underlying structures given the potential for cosmetic and functional sequelae. Use of these tissues allows for repair of longer strictures utilizing additional oral mucosa, or for patients in which the buccal mucosa has already been harvested, or as the initial graft site. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e154 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Bradley Tampa, FL More articles by this author Raul Ordorica Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...