Morbidity of Closure versus Non-Closure of Oral Mucosal Graft Harvest Site during Urethroplasty

Abstract

Background: Technique of harvesting oral mucosa is straightforward and its efficacy in urethroplasty is beyond question. But the optimal method for managing the intraoral defect is yet to be determined. Regarding closure versus non-closure of the oral mucosal graft harvest site, there are various published articles worldwide. In Bangladesh, there are limited study regarding the issue though now a day’s buccal mucosal graft urethroplasty has become one of the routine operation of the urologist of Bangladesh. Objective: The objective of the study is to determine the effect of closure versus non-closure of the oral mucosal graft harvest site in men undergoing urethroplasty for urethral stricture disease. In this hospital based Quasi experimental study, a total of 37 patients were allocated into two groups by purposive sampling technique where the donor site was either closed or left open. Baseline demographic and clinical data were recorded. Postoperatively, questionnaires assessing pain, resumption of diet, perioral sensation, mouth opening, salivary disturbance and facial deformity were completed at postoperative Day 1, 5 at 3 and 6 months. All the collected data were compiled. Further Statistical analyses of the results were obtained by using Microsoft Xcel, 2010 and web based computer software -Graph Pad Software, 2017. The baseline characteristics like age, stricture length and site of graft harvesting of the study subjects were potentially comparable. The early postoperative pain scores demonstrated a trend favoring the non-closure group until day 5. Regarding difficulty in mouth opening, the result also favored the non-closure group (44.44%, 11.11% vs 78.94%, 63.15%, p<0.05 in Day1 and Day5) as did the appearance of postoperative facial deformity (5.56%, 0% vs 21.05%, 15.78%, p<0.05 in Day1 and Day5). Non-closure resulted in early return to regular diet (88.88% vs 78.94% in Day1 and 94.44% vs 73.68% in Day5). More perioral numbness was in non-closure group. (61.11% vs 52.63% in Day1 and 50.00% vs 42.10% in Day5), but these differences were not statistically significant (p>0.05). Dry mouth was higher in closure group than non-closure group patients (day 1 21% vs 16%, day 5 15.78% vs 11%, 3 months 10% vs 5%). The difference was not statistically significant (p>0.05). However, at 6 months, no difference was found in the above mentioned parameters between the two groups. The results of the present study suggest that closure of the oral mucosa graft harvest site may lead to a significantly increased early postoperative pain perception, difficulty in mouth opening and facial deformity although long term results are the same. So keeping the donor area unsutured may be a better option of dealing the graft harvest site in terms of early postoperative recovery.