Simple technique of securing intraoral skin grafts

Small defects following intraoral resection are often resurfaced by skin grafts. Skin grafting has the advantage of ease of harvest with minimal additional operating time and post-operative hospital stay, an acceptable functional cosmetic result, and the ability to survive post-operative radiation [1]. In addition to adequate vascularity of the recipient area, the most important aspect for graft survival is immobilization and adherence of the graft to the defect. However, in the oral cavity due to the uneven wound bed and constant mobility of the cheek, the graft is not completely immobilized. In addition, the salivary secretions tend to accumulate beneath the graft, separating the graft from the bed. Graft-failure can be prevented by immobilizing the graft and closing up any potential dead space that might lead to separation [2]. A variety of methods have been described for immobilization and bolstering the graft to the wound. Many types of stents have been used varying from the simple cotton balls, resin molds, and foam pads, to complex stents like metal, plastic, and dental liner [3,4]. The traditional tie over bolster technique described by Schramm and Myers involves fixation of the skin graft to the raw area, followed by placement of non-absorbable silk sutures from the adjacent mucosa, which are then tied over the bolster [1]. However, the placement of this tie over sutures requires adjacent normal mucosa for anchorage, which may not be sufficient especially in the gingivo-buccal sulcus. Although external fixation of the stents to the cheek has been described, this results in ugly scarring of the cheek [2]. We describe a simple technique of fixation of the skin graft in the oral cavity, which avoids the placement of additional tie over sutures and in our opinion results in better anchorage. (C) 2005 Wiley-Liss, Inc.