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An Alternative to Split-Thickness Skin Grafts

Paul H. Rhee, MD; Craig D. Friedman, MD; John A. Ridge, MD, PhD; Joseph Kusiak, MD

Arch Otolaryngol Head Neck Surg. 1998;124:1201-1204.

Background  The standard reconstruction of significant mucosal defects in head and neck surgery has been split-thickness skin grafting (STSG).

Objective  To examine the use of a commercially available acellular dermal matrix as an alternative to STSG to reduce the scarring and contracture inherent to meshed split-thickness autografting and avoid the additional donor site morbidity.

Patients and Methods  Twenty-nine patients with full-thickness defects of the oral cavity were included in this retrospective chart review. Candidate patients had their operative procedure performed at a tertiary care center during a 24-month period. Allograft dermal matrix, an acellular tissue-processed biomaterial, was applied to these intraoral defects. The defects were reconstructed with an acellular dermal graft matrix in the same technical fashion as with an autologous skin graft. Patients were evaluated for rate of "take," functional return time to reepithelialization, average surface area of graft, associated pain and discomfort, evidence of restrictive graft contracture, patient diagnosis, and graft location within the oral cavity. Any evidence of incomplete graft reepithelialization was considered grounds for graft failure, either complete or incomplete. Epithelialization and contracture were assessed during outpatient clinical examinations. Patient complaints with regard to discomfort at the graft bed were considered evidence of pain.

Results  Graft locations included 9 in the tongue (32%), 5 in the maxillary oral vestibule (17%), 4 in the mandible (14%), 4 in the floor of mouth (14%), 3 in the hard and/or soft palate (10%), 3 in the tonsil (10%), and 1 in the lip (3%). The overall rate of take was 90% with complete epithelialization noted on clinical evaluation within 4 weeks. Patients were followed up for an average of 8.6 months. The average grafted surface area was 25 cm². Pain or discomfort was noted in 3 patients (12%). One patient (4%) was noted to have clinical evidence of graft contracture.

Conclusions  Allograft dermal matrix was successful as a substitute to autologous STSG for resurfacing of intraoral defects. Allograft dermal matrix may be considered a useful reconstructive option for patients with oral mucosal defects.

From Craniofacial Tissue Engineering , Fox Chase Cancer Center, Philadelphia, Pa. Dr Rhee is now with the Division of Plastic and Reconstructive Surgery, University of Colorado Health Sciences Center, Denver.

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