Modified bolster dressing with continuous suction improves skin graft survival for an oral cavity wound

Abstract

BackgroundSkin engraftment of intraoral defects is known to be inconsistent due to mobility of the oral structure, uneven wounds, and accumulation of saliva under the skin graft. To improve the success rate of oral skin graft, we proposed a novel and simple dressing technique for intraoral skin graft to control saliva accumulation, in comparison with the conventional bolster dressing.MethodsWe retrospectively reviewed 31 patients reconstructed with skin graft in their intraoral defect. The patients were divided into two groups; conventional bolster group (n = 21) and modified bolster group (n = 10). In the modified bolster group, a polyvinyl alcohol sponge was designed to fit the skin graft and a suction drain was inserted with tagging suture to apply continuous suction. We analyzed the success rate, the size of the skin grafts and clinical variables of each method.ResultsThe overall success rate of oral skin graft was not different between the two groups (90.0 and 90.5%). However, partial necrosis in the engrafted skin was observed frequently in the control group (57.1% versus 20.0%). The relative engrafted area was significantly higher in the modified bolster group (55.0 ± 11.6% versus 23.0 ± 18.7%, p = 0.015). The duration of bolster dressing and the time to start an oral diet were shorter in the modified bolster group.ConclusionsOur modified method could be easily applied for removing saliva accumulation under a skin graft and for enhancing skin engraftment of an oral cavity wound.Electronic supplementary materialThe online version of this article (10.1186/s40463-018-0314-7) contains supplementary material, which is available to authorized users.

A simple sandwich technique using buttons combined with a tie-over technique for an intraoral split-thickness skin graft

“…Other studies have reported total graft failure rates of 9.5-10% for intraoral STSGs [9]. Furthermore, the partial necrosis rate has been reported to be 12.3-57.1% [9,10]. In this series, the button sandwich technique combined with a tie-over technique demonstrated an excellent engraftment rate (90.5%) and no cases of total graft failure were encountered.…”

“…The success rate of STSG in the oral cavity has been reported to be 33-75% [8]. Other studies have reported total graft failure rates of 9.5-10% for intraoral STSGs [9]. Furthermore, the partial necrosis rate has been reported to be 12.3-57.1% [9,10].…”

Evaluation of skin natural change function in split-thickness skin graft

“…Gentle pressure from a layered dressing is applied, or small sutures are used to hold the graft in place. A non-adherent sterile dressing is then applied to the raw donor area for about three to five days to protect it from infection (Lee et al, 2018).…”

Inferiorly Based Nasolabial Flap: A Reliable Option for Oral and Maxillofacial Reconstruction.

“…7 Skin grafting is a simple procedure and can be an option for reconstructing these defects; however it has certain drawbacks like contraction, abnormal pigmentations and high risk of graft failure especially when used in intraoral reconstruction because of possibility of saliva collection underneath. 8,9 The pedicled temporalis muscle flap has its role for craniofacial and intraoral reconstruction especially retromolar area and cheek resection defects., The commonest problem with this flap is postoperative trismus which can be prevented by performing coronoidectomy that increase the operative time and adds morbidity at the operative site. 10 We do believe that trismus is caused by fibrosis, especially after radiotherapy, in comparison with nasolabial flaps no trismus were encountered in any of our patients including those who received postoperative radiotherapy and this stands on for the rich blood supply of the nasolabial flap.…”