IN-SITU SKIN-GRAFTING OF FREE MUSCLE FLAPS PRIOR TO MICROVASCULAR TRANSFER TO PROVIDE INTRAORAL LINING FOR FULL-THICKNESS DEFECTS

Background. Previously, the importance of providing skin for intraoral lining for full-thickness mucocutaneous defects has been emphasized. More recently, simple skin grafting of the intraoral portion of muscle flaps has been described. Methods. Six patients were evaluated who ha d full-thickness mucocutaneous defects reconstructed by means of free muscle flaps with skin grafting of the intraoral muscle surface. An il lustrative case is provided. A technique of preplacing the skin graft on the muscle prior to microvascular transfer is described. Mucosal bi opsies were performed at the reconstruction site. Results. All patient s had complete take of the skin grafts. No fistulas occurred. Function al and esthetic results were satisfactory. Conclusions. The ideal cand idate for this form of reconstruction is one in whom there is a large, full-thickness mucocutaneous defect. Preplacement of the skin graft r educes ischemia time, allows suturing of the skin graft to the muscle surface outside the narrow confines of the oral cavity, and enables pl acement of multiple quilting sutures that secure the graft against she ar forces and so obviate the need for a stent dressing. (C) 1995 John Wiley & Sons, Inc.