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Comparison of two techniques of dermal graft harvest for temporomandibular joint reconstruction
B W Beck1, D Nagy, J S Goldberg
1Department of Oral and Maxillofacial Surgery, Case Western Reserve University, University Hospitals and Mt. Sinai Medical Center of Cleveland, OH, USA.
Purpose:
The purpose of our study was to compare the healing characteristics of two common techniques of obtaining a dermal graft and the patient's perception of the aesthetics of the donor site scar.
Materials And Methods:
Fifty-two female patients (60 sites) were evaluated by means of questionnaire, interview, and chart review. The mean follow-up time was 4.08 years after temporomandibular joint reconstructive surgery. Comparisons were made between the two primary harvest techniques: the dermatome (trapdoor) and the elliptical excision methods. Of the 60 sites, 32 involved the elliptical method and 28 the trapdoor method.
Results:
Common findings in both groups included prolonged discomfort (6.6%), altered contour (50%), color change (58.3%), prolonged numbness (10%), and itching (21.6%). There were few healing complications (5.0%). Aesthetically, 45% of patients thought their scars were noticeable, and 8.3% thought that they were bothersome. The elliptical method showed significantly less discomfort, texture change, numbness, and itching. The scars were concealed better and less noticeable. Although 60.7% of the patients with the trapdoor method considered the wounds to be noticeable, only four patients reported that the scars were bothersome.
Conclusions:
Both techniques were used successfully with minimal complications. Although the elliptical technique appeared to have cosmetic advantages, larger grafts produced longer wounds, which may be more difficult to conceal. The trapdoor method is a simple technique that is used effectively with good patient acceptance. The results of this study are useful in properly informing patients about what to expect after having a dermal graft.