Skin grafts used in combination with free flaps for intraoral oncological reconstruction

Surgeons have relied less on skin grafts for intraoral reconstruction by extending free flap tissue onto adjacent areas that could be potentially skin grafted. Split-thickness skin grafts provide thin, reliable epithelial coverage to tissue beds that can be grafted without requiring additional flap tissue. The combined use of split-thickness skin grafts with free tissue transfer may be advantageous in select situations. Four patients underwent intraoral tumor resection with immediate reconstruction using free tissue transfer and split-thickness skin grafts. Skin grafting the tongue component of combined hemiglossectomy and floor-of-mouth (FOM) defects rather than spanning the tongue-FOM junction with flap tissue may prevent excessive bulk, improve tongue mobility, and reduce the size requirement of the flap. A split-thickness skin graft can be applied to the intraoral surface of free flaps used to reconstruct through-and-through orocutaneous defects, reducing the complexity of flap design and inset. Maxillectomy defects reconstructed with muscle flaps can be epithelialized immediately with the application of a split-thickness skin graft to provide a stable obturator cavity. In select cases, the combination of split-thickness skin grafts and free tissue transfer may have advantages over the use of flap tissue alone to cover the adjacent areas of a complex defect capable of being grafted.