Sandwich silicone technique for securing intra-oral skin grafts to the buccal mucosa defects

Introduction: The stabilization of skin graft on intra oral surgical defects remains a challenge to many experienced surgeons. Various methods have been tried in past to secure the skin graft intra orally and still there is a constant search for an ideal biocompatible material which can be placed amicably to cover the grafted skin, induce proper stabilization and avoid failure of graft uptake.
Objectives: The chief objective of this pilot study was to evaluate the efficacy of silicone sheets as biocompatible stent to secure intra oral skin grafts to the buccal mucosa surgical defects.
Material and Methods: 9 patients (6 Males & 3 Females) between 20-60 years (mean age of 40.5 years), having benign lesion on their buccal mucosa were included in the study, and were planned for surgical excision of the lesion and reconstruction with split thickness skin graft. A non-reinforced, transparent silicone sheet of size 150x200 mm and thickness of 0.005 inch was used to secure skin graft in a sandwich technique, with one sheet placed intra orally over the skin graft and the other placed extra orally on the cheek, tied together with trans buccal sutures. Post operative findings were assessed based on graft size, capillary test, mouth opening and healing of the graft and surgical defect.
Results: The silicone sheet got displaced from the skin graft and thus gave an uneven capillary test. The skin graft size reduced remarkably due to sloughing and very less graft uptake was seen. The mouth opening improved with every post operative day, and healing of the surgical defect was satisfactory as assessed by Landry Turnbull and Howley index.
Conclusion: The recommendation to use non-reinforced (.005 inch), 150x200mm silicone sheet as an stent for intra oral skin graft in a sandwich technique stands doubtful, but a further study can be done with thicker silicone sheet and proper adaptation of same intra-orally by quilting the sheet properly to the skin graft and cheek mucosa and keeping the cheek immobilized.