RECONSTRUCTION OF THE FLOOR OF THE MOUTH WITH A FASCIAL RADIAL FOREARM FLAP, PRELAMINATED WITH AUTOLOGOUS MUCOSA

To circumvent the disadvantages of extraoral skin within the oral cavi ty and to cover mucosal defects by mucosa, we successfully prelaminate d the radial forearm flap by insertion of buccal mucosa in ten patient s. In a first-step operation, free grafts of buccal mucosa were fixed to the forearm fascia and covered with an alloplastic sheet, separatin g the mucosa grafts and the dissected fascia between and around the gr afts from the overlaying subcutaneous tissue. The dimension of the all oplastic sheet in the subcutaneous pocket was chosen according to the size of the desired flap. Underneath the alloplastic sheet, the mucosa l grafts merged and the mucosal surface increased by advancing of epit helial cells under in vivo culture conditions. After two months, mucos al prelamination of the distal radial forearm fascia had led to thin, pliable and resistant fasciomucosal flaps with a mucosal surface up to 7x4 cm, allowing physiological intraoral reconstruction. The preserva tion of skin and subcutaneous tissue of the forearm also enabled prima ry wound closure, reducing donor-site morbidity.