Healing of donor-site buccal mucosa urethroplasty

Healing of donor-site buccal mucosa urethroplasty

Healing of donor-site buccal mucosa urethroplasty

Abstract

Buccal mucosal graft represents the gold standard graft material for urethroplasty due to its thick epithelium and a thin lamina propria. There is an ongoing debate whether to close the buccal graft donor site or not. We show a unique buccal donor site video and pictures taken daily by the patient after buccal urethroplasty, demonstrating the healing process over time for the first month post-operatively where only the anterior half of the wound was closed, allowing real-time observation of wound healing; both when the cheek is closed and when it is left open.

Manuscript

A 25-year-old man with a history of complex urethral stricture disease, who underwent dorsal-onlay urethroplasty utilizing buccal mucosal graft from the left cheek, for 1.3 cm proximal bulbar urethral stricture. The buccal wound is closed as typically done in our institution(1), closing the anterior half of the wound with interrupted 4-0 chromic sutures, and leaving the posterior half of the wound to heal by secondary intention in order to drain any potential hematoma. The operation was uneventful, and the urethral catheter was removed at 3 weeks post-operatively. He is voiding well, and the graft donor site healed well with no issues. Interestingly, during the first month of the post-operative period, the patient took daily pictures for the healing process of the graft donor site. Figures 1-3 represent 3 selected chronological pictures for the healing process. An accompanying video combines the all the pictures together in a chronological order. There is controversy as to whether to close the donor site wound or not, with a prospective study(2) and 2 randomized controlled trials (RCTs)(3, 4) showing benefit for non-closure in terms of less pain and earlier return to diet, while 1 RCT(5) showed no difference between the 2 groups. These pictures and the accompanying video provide a unique opportunity for up-close examination of the donor site healing process.

References

1.  Morey AF MJ. TECHNIQUE OF HARVESTING BUCCAL MUCOSA FOR URETHRAL RECONSTRUCTION. J Urol. 1995;155:1696-7.

2.  Wood DN AS, Andrich DE, et al. The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. 2004;172:580-3.

3.  Rourke K MS, St Martin B. Effect of wound closure on buccal mucosal graft harvest site morbidity: results of a randomized prospective trial. Urology. 2012;79:443-7.

4.  Muruganandam K DD, Gulia AK, et al. Closure versus nonclosure of buccal mucosal graft harvest site: a prospective randomized study on post operative morbidity. Indian j Urol. 2009;25:72-5.

5.  Wong E FA, Alhasso A, et al. Does Closure of the Buccal Mucosal Graft Bed Matter? Results From a Randomized Controlled Trial. Urology. 2014;84(5):1223-7.

 

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