Mungadi I A, Ugboko V I
Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Ann Afr Med. 2009 Oct-Dec;8(4):203-9. doi: 10.4103/1596-3519.59572.
Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts.
A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome.
The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity.
Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution.
尿道重建一直给泌尿外科、儿科和整形外科医生带来巨大挑战，因为对于理想替代材料的质量和类型存在多种不同观点。本综述旨在引起外科医生对口腔黏膜移植物多功能性的关注。
对口腔黏膜在尿道重建中的应用进行综述。通过结构化的医学文献数据库检索，研究口腔黏膜应用的各个方面，包括黏膜获取、供体部位并发症及手术效果。
尿道的特殊需求对自体移植物替代物设定了高标准；因此文献报道显示，阴囊、阴茎、生殖器外部位（输尿管、大隐静脉、阑尾、结肠、上臂内侧、颈部、侧胸部、腹部、膀胱黏膜）的中厚皮片和全厚皮片，以及最近的口腔黏膜都被用于尿道重建。与其他组织不同，口腔黏膜移植物柔韧性好，易于获取和修剪，且具有有利于移植存活的优良微血管系统。此外，口腔黏膜在口腔环境中的天然湿润位置有利于其在尿道通道中轻松适应，从而取得良好的长期效果。然而，有报道称供体部位会出现并发症，最常见的是脸颊或嘴唇的感觉减退或感觉异常。口腔黏膜的区域差异、所需移植物的长度、决定关闭或开放供体部位以及获取技术等，是一些被认为可解释供体部位并发症差异的因素。
口腔黏膜移植物是一种多功能的尿道替代物，效果良好。它正成为尿道替代的金标准。
