A reproducible single-surgeon technique for buccal mucosa graft harvest in urethroplasty using circumferential oral retraction: technique description and case series

Abstract Background Buccal mucosal graft (BMG) urethroplasty is widely considered the standard technique for urethral reconstruction using a graft. Although graft placement techniques have been extensively described, less attention has been given to optimizing graft harvesting. Conventional harvesting methods typically rely on manual retraction by surgical assistants, which may limit surgical autonomy and procedural efficiency. Objective To describe a reproducible technique for buccal mucosal graft harvesting that allows a single surgeon to perform the procedure using a circumferential oral retraction system and topical tranexamic acid for donor-site hemostasis and to report donor-site outcomes in a retrospective case series. Methods We describe a step-by-step surgical technique for harvesting buccal mucosa using a circumferential retraction configuration based on the Scott retractor system. This setup provides stable, hands-free exposure of the oral cavity. We harvested the graft through a sharp mucosal incision, followed by submucosal dissection over the buccinator muscle. We achieved donor-site hemostasis with electrocautery and topical tranexamic acid applied with gauze packing, allowing healing by secondary intention. We additionally performed a retrospective review of 33 patients who underwent this technique, assessing donor-site complications at early (< 3 months) and 3-month follow-up, classified using the Clavien–Dindo system. Results The circumferential retraction system provides stable exposure of the oral vestibule, facilitating the identification of anatomical landmarks such as the Stensen duct and enabling a single surgeon to perform graft dissection. Donor-site management includes electrocautery followed by temporary application of tranexamic acid-soaked gauze, with the donor site left to heal by secondary intention. In the retrospective series of 33 patients, donor-site complications occurred in 7 (21.2%) during the early postoperative period, most commonly oral pain (12.1%); donor-site bleeding requiring intervention occurred in one patient (3.0%), managed without surgical revision. At 3 months, only one patient (3.0%) had a persistent complication (perioral sensory loss). No Stensen duct injuries occurred. Conclusions This technique provides a practical, reproducible method for harvesting buccal mucosal grafts in single-surgeon practice. Stable circumferential retraction combined with topical tranexamic acid may simplify the procedure, improve surgical ergonomics, and facilitate the donor-site management without compromising established principles of buccal graft preparation. In this cohort, donor-site morbidity was low and comparable to or lower than previously reported series.