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Atlanta-Surgeons from Italy have developed a technique to take tissue from the underside of the tongue and transplant it to repair strictures in the urethra, giving surgeons an alternative to buccal mucosa for the procedure.
"It is another place to take a graft, not a substitution for the buccal mucosa," said Alchiede Simonato, MD, professor of urology at Ospedale S. Martino, University of Genoa, in explaining his pilot study during a moderated poster presentation at the 2006 AUA annual meeting here.
He said that in the eight patients in his study, he had successful outcomes in all but one of the cases. The unsuccessful case required other manipulations to improve urine flow. Dr. Simonato and his colleagues have gone on to perform another 10 of the procedures since September 2004, when the pilot study closed.
Some of those problems include changes in the patients' salivary function, scarring, aesthetic changes in the lip and sometimes some retraction in the cheeks.
With those considerations, Dr. Simonato and colleagues began investigating the idea of using the lingual mucosa as a possible site for the grafts in January 2001.
"The mucosa covering the lateral and under surface of the tongue is identical in structure with that lining the rest of the oral cavity," Dr. Simonato said. "It is easily accessible and has similar immunological properties."
In the open-surgery procedure, surgeons first investigate the urethra to measure the length of tissue that will be necessary to repair the blockage in the urethra. Then they turn their attention to the mouth. When the donor graft is removed from the tongue, graft defatting is performed until all underlying fibrovascular tissue is completely removed. The donor site is closed with polyglactin sutures, which dissolve a few days after the procedure is completed, Dr. Simonato explained.
The graft is then transplanted to the urethra to replace the unhealthy tissue re-moved there at the start of the procedure, completing the urethroplasty.
'No major complications'
Median follow-up for these first eight patients was 18 months. The lingual mucosal graft ranged in length from 3 to 7 cm with a width of 1.5 cm.
"No major perioperative complications occurred," he said.