Comparison of two techniques of dermal graft harvest for temporomandibularjoint reconstruction

Purpose: The purpose of our study was to compare the healing characteristic s of two common techniques of obtaining a dermal graft and the patient's pe rception of the aesthetics of the donor site scar. Materials and Methods: Fifty-two female patients (60 sites) were evaluated by means of questionnaire, interview, and chart review. The mean follow-up time was 4.08 years after temporomandibular joint reconstructive surgery. C omparisons were made between the two primary harvest techniques: the dermat ome (trapdoor) and the elliptical excision methods. Of the 60 sites, 32 inv olved the elliptical method and 28 the trapdoor method. Results: Common findings in both groups included prolonged discomfort (6.6% ), altered contour (50%), color change (58.3%), prolonged numbness (10%), a nd itching (21.6%). There were few healing complications (5.0%). Aesthetica lly 45% of patients thought their scars were noticeable, and 8.3% thought t hat they were bothersome. The elliptical method showed significantly less d iscomfort, texture change, numbness, and itching. The scars were concealed better and less noticeable. Although 60.7% of the patients with the trapdoo r method considered the wounds to be noticeable, only four patients reporte d that the scars were bothersome. Conclusions: Both techniques were used successfully with minimal complicati ons. Although the elliptical technique appeared to have cosmetic advantages , larger grafts produced longer wounds, which may be more difficult to conc eal. The trapdoor method is a simple technique that is used effectively wit h good patient acceptance. The results of this study are useful in properly informing patients about what to expect after having a dermal graft.