Careful measurement to avoid excess length or diameter may prevent graft prolapse and stricture formation. Large diameters may cause folding of the graft, which may inhibit vascularization. 10 Bladders previously augmented with bowel, those exposed to recurrent infections and vesicostomy, exstrophy bladders, and noncompliant neurogenic bladders with significant trabeculations may not be ideal donors of bladder mucosa. Recently, a pedicle flap of distal ureter has been used to reconstruct the proximal male urethra and total female urethra. A random pedicle flap of tunica vaginalis has been used to repair complicated hypospadias, but meatal stenosis occurred in all three patients, including subsequent fistula formation in one.
Buccal mucosa has several properties that make it an ideal free graft in reconstructive surgery.
Benefits of buccal mucosal graft over bladder mucosal graft include easy access for harvesting through a minor procedure with minimal donor-site morbidity. Physical characteristics of the buccal mucosal graft that facilitate its use in urethral reconstruction include its thickness and elasticity, which prevent contraction of the graft but promote graft acceptance. 3,6 Harvest sites have included the upper lip, lower lip, and cheek. 1-4 Buccal mucosa may be used as a tubularized, folded tube, or onlay graft. 1-4 Difficulties with meatal encrustation and prolapse as seen with bladder mucosal grafts have not been reported with buccal mucosal grafts.