Factors Associated With Intraoral Skin Graft Take Following Oral Cavity Surgery

To evaluate factors associated with graft success, tongue tethering, and dysphagia following intraoral skin grafting.

In this retrospective case series, we evaluated adult patients from 2018 to 2024 who underwent intraoral split-thickness skin graft (STSG) for oral cavity defects. Our primary outcome was complete skin graft take, with a secondary outcome of tongue tethering and dysphagia. Fisher's exact test was used for the comparison of categorical variables, and Mann-Whitney U tests were used for continuous variables.

Thirty-nine patients were included. The mean age (SD) was 63.9 (13.2), and 59% were male. Mean follow-up (SD) was 1.66 years (1.54). The average defect area (SD) was 11.13 cm² (4.24). Seven (17.9%) had successful skin graft take. Bolster placement (p = 0.059) and pie-crusting (p = 0.057) both trended toward association with successful graft take. Smoking history, defect area, T-stage, tumor location, postoperative antibiotics, radiation, and chemotherapy were not significantly associated with skin graft success. Tongue tethering occurred in seven patients (17.9%), and dysphagia occurred in six patients (15.4%). None of the above-reported variables were significantly associated with tongue tethering, but radiation (p = 0.011) and chemotherapy (p = 0.006) were both significantly associated with dysphagia.

Bolster placement and pie-crusting trended toward improved graft survival, whereas demographic and clinical factors, including age, sex, smoking status, comorbidities, tumor stage, and tumor location, were not predictive. Dysphagia was significantly associated with radiation and/or chemotherapy. Larger, prospective studies are needed to better define predictors of STSG success.