Mucoperiosteal Flaps and Wound Closure Flashcards
What are the important aspects/qualities of a mucoperiosteal flap? (5) Essentially, why is it used?
- Outlined by a surgical incision
- Carries its own blood supply*
- Allows access to underlying tissues
- Can be placed back in original position
- Maintained with sutures to heal
What is the main indication to use a muco flap?
To gain surgical access to bone or roots
Name specific reasons that indicate when a mucoperiosteal flap should be utilized? (12)
(Simply put, things are complicated) Fractured off root Surgical extraction used because -Impacted -Gross decay -Curved roots -Widely Divergent Roots -Close to sinus -Hypercementosis Multiple Teeth Removal Alveoloplasty is required PD Surgery Endo Surgery
General mistake general dentists make with muco flaps?
They underutilize them. Use them at the slightest indication that they can be helpful.
Basic design concept of a muco flap?
It should have a broader (wider) base. This will prevent necrosis.
What problems can occur if the muco flap is too small? (2)
- Won’t be able to see properly or use instrument.
2. Skin can tear if under too much tension.
If your only options are to make the flap too small or too big, which should you choose?
Too big is always the safe route.
What heals faster, a small or large muco flap?
They both heal at the same rate.
How far anterior and posterior do you extend an envelope flap?
2 teeth anterior
1 tooth posterior to area of surgery
How far anterior and posterior do you extend an envelope with releasing incision?
One tooth anterior
One tooth posterior
What is a releasing incision?
It is a cut made 6-8mm from bone removal sight
Releasing incision position relative to bone?
It should be made over bone. IF NOT supported by bone, more likely to delay wound, cause defects or dehiscence.
Full thickness flaps include what layers?
Surface Mucosa
Submucosa
Periostem
Partial Thickness flaps include what layers? and when is this procedure useful?
Surface Mucosa and Submucosa only
*periosteum still attached to the bone makes it useful for grafting attached gingiva.
How do you avoid the lingual nerve?
avoid lingual incisions around the 3rd mandibular molars
How do you minimize mental nerve damage?
And what type of incision should be used.
You can place releasing incisions well ANTERIOR and POSTERIOR of the foramen. Use and envelope incision if possible?
How do you avoid severing the facial artery in the mandible?
Avoid accidental slipping or cutting into the depth of the vestibule around the 2nd molar.
What two arteries may be injured on the maxilla? (although they rarely are) And which is a more serious problem if injured?
Greater Palatine Artery (very posterior), will bleed alot. Nasopalatine Artery (at incisive foramen and won't bleed much)
Why should you avoid incising over bony prominences?
The skin gets thin over these areas and is more likely to undergo dehiscence.
Name another soft tissue attachment that should not be incised?
Major Frenum
What is our go to flap?
The envelope flap
When do you add a releasing incision to an envelope flap?
Add it when you need additional access.
In what directionality should a vertical releasing incision be made?
In an oblique direction so a broad base is formed/maintained.
Where should the incision be made when going over the free gingival margin?
At the line angle, NOT FACIAL aspect. Facial incisions can cause defects.
Can papillas be cut thru?
Not recommended, damaged papillas can increase periodontal problems.
How often is an envelope flap with two releasing incisions utilized?
Pretty much never
Semilunar (Curved flap)
- Describe its general qualities
- When it is useful?
- Flap does not involve the gingival sulcus of teeth, it’s more apical incision (avoids trauma of papilla and gingival margin)
- Useful for periapical endo surgery or retrieval of root tips.
4 Basic steps in a flap technique
- Grasp scalpel
- Make incision
- Reflect flap
- Retraction of flap
During the incision, how many cuts/strokes should be made?
One smooth continuous cut
- 90 degrees to the tissue
- contacting bone
Procedure to reflect the flap?
- Sharp end of molt #9 used under papilla and pushed to bone
- Turned laterally to being to pry papilla from bone
- continue this along free gingiva
- use broad, flat end in same manner afterwards
What 3 ways can the tissue flap be retracted?
Austin (90 degree one)
Minnesota (funny curved one)
Broad end of periosteal elevator
After closing the surgical wound, how can a subperiosteal abscess form commonly? (what was done incorrectly?)
Debris was left under the flap.
*Irrigate extensively with a sterile saline.
What is the function of sutures?
They ONLY hold tissue in place
*NOT FOR stretching or pulling tissues into place
Blanching occurs after sutures have been tied, what does this indicate?
Tissue was tied too tightly.
Continued bleeding after suturing causes what? (2)
Delayed Healing
Greater Risk for Infection
How ling should intraoral sutures be left in place for?
4-7 days.
How far away from the flap margin should sutures be placed?
3mm away
Where should the suture needle be placed first? Attached to unattached or unattached to attached?
Unattached flap to Attached.
FUN FACT: To make room for the needle, use broad end of Molt #9 under attached skin to make a slight amount of space for needle
What type of needle is used to suture?
a circle reverse cutting needle.
Where is the cutting edge located on the suture needles?
On the outer side of the curve.
How long are suture needles typically?
3/8 inch reverse cutting needle (1/2 inch also pretty commonly used he stated)
Two major types of suture material?
Non-resorbable and resorbable
Non-resorbable sutures:
-Specific Material used (2) Pros and Cons of each too
- Braided Silk
- Easy to tie
- Intense inflammation in the mouth however - Monofilament NYLON
- stiffer/harder to tie
Types of Resorbable sutures?(3) and how long is each last in the skin
Gut- 3-5 days
Catgut
Vicryl—>super expensive
Kept calling something Chromic Gut…idk if that is vicryl or not, but Chromic last 7-9 days
What breaks down resorbable sutures?
Proteolytic activity.
Down sides of resorbable sutures?
- Little bit harder to tie
- Untie early as they are degraded
- CANNOT be used on skin
Patient has a laceration full thickness of cheek, which sutures used and where?
Gut used intraorally
Nylon used on skin since gut bad for skin.
Interrupted suture technique, pros and cons
- Most popular
- If one becomes untied, others will still be in place
- Time consuming to tie multiple sutures
Horizontal Mattress: when useful?
For sharing two papilla with a single stitch
Vertical Mattress: when useful?
- When more tension is needed.
- Rarely used intraorally.
Figure 8 Suture is useful when?
It helps keep gel foam in place to hold a clot in place better
Continuous sutures: Pros and Cons
- Useful for long span incision
- Fast
- CON: If one end unties, entire thing will come out.
How are the diameters of sutures noted?
The O system
3 O > 4 O > 5 O
