Oral mucosa harvest: an overview of anatomic and biologic considerations

EAU-EBU UPDATE SERIES 2007; 5:179-187.

Objectives: The authors review the biologic characteristics of the oral mucosa. In addition, the authors report a contemporary harvesting technique of the oral mucosa for urethral transplantation, using biologically sound principles, modified by current literature.

Methods: We reviewed pertinent English literature from January 1966 through January 1, 2007 regarding the biologic properties of the oral mucosa.

Results: The oral mucosa is made up of a thick, nonkeratinized, squamous cell epithelium, overlying a thin lamina propia. It hosts a number of microorganisms, yet, the tissue’s inflammatory response to these organisms is minimal. There are multiple immunologic processes intrinsic to the oral mucosa that makes it impervious to native oral flora colonization. Histologic studies have demonstrated that the oral mucosa is highly compatible with the urethral recipient site, at times being indistinguishable from the surrounding tissue. The harvesting surgeon should closely inspect the oral mucosa for any abnormalities prior to considering harvest. Wound healing in the oral mucosa is ameliorated by sound surgical principles, yet is mediated by biologic processes beyond the surgeon’s control. When harvesting oral mucosa, the surgeon is advised to stay well away from pertinent anatomic landmarks to defer any aesthetic or functional defect to the donor site.

Conclusions: Success of the oral mucosa graft for urethral surgery can be partially attributed to the tissue’s biologic properties. When harvesting the tissue, anatomic landmarks should be considered to provide the best possible treatment for the patient while minimizing morbidity to the donor site.