Professor of urology. Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti Medical Science University, Iran.
Resident of urology. Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Urol J. 2020 May 16;17(3):289-293. doi: 10.22037/uj.v0i0.5534.
Currently, three methods are implicated in cases of long urethral stricture including harvesting buccal mucosa of inner cheeks, harvesting lip mucosa and finally lingual mucosal graft. This study evaluated the feasibility, safety and morbidity of our "Boomerang shape" technique used for graft retrieval from the inner cheeks to repair long urethral defect cases which are usually 12-15 cm in length and 2.5 cm in width.
The Kilner-Doughty mouth retractor is inserted to give access to the donor site. Initially, the internal surface of the right/left cheek is cleaned with a solution containing 10% povidone-iodine. Then, Stensen's duct, located at the level of the second molar is identified and the desired size of the graft is measured and marked in a boomerang shape, 1.5 cm from the Stensen's duct and 1.5 cm from the edge of the cheek. To decrease submucosal bleeding from the harvest site, 1% lidocaine combined with a 1:100,000 epinephrine solution is injected using a 25-gauge long needle. The outlines of the graft are drawn by using a scalpel through the mucosa. Then, the outlined graft is sharply dissected and removed, leaving the muscle intact. A 5-0 polyglactin continuous suture is used for the closure of the harvest site. The standard graft harvested from the cheek should be 12-15 cm in length and 2.5 cm in width.
Between 2017-2019, five adults have had their mucosal grafts harvested by the "Boomerang shape" technique in our center. No donor site complications were observed. Moreover, no urethral strictures or diverticulum occurred and the functional outcomes were satisfactory in all patients.
Our routine technique of harvesting the buccal mucosa from the cheek is secure and easily performable by any surgeon. It has minimal incidence of intra and post-operative complications.
目前，治疗长段尿道狭窄的方法有三种，包括颊黏膜内取、唇黏膜取和舌黏膜取。本研究评估了我们的“Boomerang 形”技术从内颊取黏膜移植物修复长段尿道缺损的可行性、安全性和发病率，这些缺损通常长 12-15cm、宽 2.5cm。
插入 Kilner-Doughty 口牵开器以进入供体部位。首先，用含 10%聚维酮碘的溶液清洁右侧/左侧颊的内表面。然后，找到位于第二磨牙水平的 Stensen 管，并测量并标记所需大小的移植物，呈 Boomerang 形，距离 Stensen 管 1.5cm，距离颊缘 1.5cm。为了减少取供体部位的黏膜下出血，使用 25 号长针将 1%利多卡因和 1:100000 肾上腺素溶液混合注射。通过黏膜用手术刀绘制移植物的轮廓。然后，锐性分离并切除划出的移植物，使肌肉完整。使用 5-0 聚甘醇酸连续缝合关闭取供体部位。颊部取的标准移植物应长 12-15cm、宽 2.5cm。
2017-2019 年间，我们中心有 5 例成人采用“Boomerang 形”技术取颊黏膜移植物，供体部位无并发症。而且，所有患者均未发生尿道狭窄或憩室，功能结果满意。
我们从颊部取颊黏膜的常规技术安全，易于任何外科医生操作。其术中及术后并发症发生率低。
