G. Lauer et al., Intraoral wound closure with tissue-engineered mucosa: New perspectives for urethra reconstruction with buccal mucosa grafts, PLAS R SURG, 107(1), 2001, pp. 25-33
In urethra reconstruction, the creation of a new urethra from a free oral m
ucosa graft is an established surgical technique. The oral mucosa is remove
d at the same time that the urethra reconstruction procedure is performed.
Depending on the size of graft required, the intraoral wound is closed prim
arily or left to heal secondarily. The latter method limits this technique
by leading to scars or strictures, which have a negative impact on the cond
ition of the intraoral soft tissue. Therefore, in this study, a pilot study
involving 12 patients, tissue-engineered mucosa was tested for covering in
traoral defects to avoid the drawbacks mentioned above. For mucosa tissue-g
raft engineering, a biopsy; sample 2 to 4 mm in diameter was removed from t
he hard palate approximately 4 weeks before the urethra reconstruction proc
edure was to be performed. In addition, 30 mi of autogenous serum was extra
cted from a venous whole-blood sample. The primary cultures were incubated
in Dulbecco modified Eagle's medium and nutrient factor F 12 (Gibco Co., Eg
genstein, Germany), containing the usual additives and autogenous serum. Af
ter a period of 3 weeks, subcultivation was performed to engineer mucosa tr
ansplants consisting of several layers of keratinocytes on a support foil.
After thorough intraoperative blood coagulation had occurred, the cultured
mucosa graft on the carrier foil was applied on the wound surface and fixed
by single sutures. Additionally, the cultured mucosa graft was covered for
8 to 10 days by an intraoral dressing, which was also fixed onto the wound
surface by single suture loops. It is possible to perform primary intraora
l wound closure with tissue-engineered mucosa to col er defect sizes as lar
ge as 11.0 x 4.0 cm. This new method provides a better prospect for both ur
ethra reconstruction and the reconstruction of intraoral tissue defects. Th
e number and size of intraoral scars and strictures are diminished. This is
of special interest for the reconstruction of the functional unit oral cav
ity, including soft tissue and cosmetic conditions (e.g., in case of prosth
etic rehabilitation). In comparison to primary wound closure with local tis
sue, the technique presented in this study reduces the severity of postoper
ative pain and allows faster rehabilitation in patients because of a better
wound-healing process. Furthermore, better mobility of intraoral soft tiss
ue structures is achieved.