# Impact of Coverage with an Acellular Dermal Matrix and Suturing Versus Primary Closure on Tongue Pain and Oral Morbidity After Lingual Mucosa Harvesting for Urethroplasty: A Retrospective Cohort Study

## TL;DR

Using a special material during tongue surgery for urethra repair reduces early pain and swelling without affecting long-term recovery.

## Contribution

ADM use during lingual mucosa graft suturing reduces early pain and swelling compared to primary closure.

## Key findings

- ADM significantly reduced early pain (60.94% vs 92.80%) and swelling (64.06% vs 88.80%).
- No significant differences in 3-mo oral morbidity between ADM and primary closure groups.
- ADM may offer faster early recovery without compromising long-term outcomes.

## Abstract

In comparison to primary closure of the donor site, coverage with an acellular dermal matrix and suturing reduces early pain and swelling after urethroplasty with a lingual mucosa graft, with comparable 3-mo oral morbidity. Artificial acellular dermal matrix use may improve early-stage recovery in this setting.

Surgical management of the harvest site for lingual mucosal graft (LMG) urethroplasty remains controversial. Our aim was to compare pain intensity and oral morbidity at the donor site between primary closure (PC) and use of an artificial acellular dermal matrix (ADM) for coverage during suturing.

We conducted a retrospective study of patients who underwent LMG urethroplasty between October 15, 2015, and December 18, 2022. Follow-up was conducted prospectively in the early postoperative period (7 d after surgery) and retrospectively for the 3-mo time point. Patients completed a postoperative questionnaire regarding LMG harvesting, including questions on pain intensity and oral morbidity. Propensity score matching was used to balance the PC and ADM groups, and generalized linear mixed models were used to evaluate factors influencing lingual pain (primary endpoint) and oral morbidity (secondary endpoint).

A total of 250/448 patients (55.8%) completed the postoperative tongue health questionnaire, including 174 in the PC group and 76 in the ADM group. ADM use for coverage during suturing significantly reduced early-stage pain (60.94% vs 92.80%; p < 0.001) and swelling (64.06% vs 88.80%; p < 0.001). The 3-mo data showed no significant between-group differences in oral morbidity, including pain, bleeding, swelling, numbness, salivary secretion, taste changes, and dietary and speech impairments. The retrospective design is the main study limitation.

ADM use for coverage during suturing reduces early pain and swelling after LMG harvesting for urethroplasty in comparison to PC, with comparable long-term oral morbidity. Patients may benefit from ADM use in terms of faster early recovery.

We compared two methods for suturing the tongue after taking tissue to repair a defect in the urethra. Our results show that use of product called an artificial acellular dermal matrix (ADM) significantly reduces early pain and swelling after surgery in comparison to the traditional method. Long-term results are comparable for the two methods. Patients may benefit from ADM use in terms of faster early recovery.