INCISION AND FLAP DESIGN

INCISION – a cut or wound of the body tissue

- allow complete access to the lesion or part to be operated on or excise.

TYPES OF INCISION :

1.Partial thickness - is made through mucosa and submucosa

2. Full thickness - is made through mucosa, tissue and Periosteum.

TYPES OF SCALPEL GRASP

1. Pen Grasp – used for mucosal and other intra oral incision.

2. Table Knife Grasp – best used for skin incision for extra oral surgery.

TYPES OF BLADE HOLDER

TYPES OF BLADES COMMONLY USED IN THE CLINIC

CARDINAL RULES OF INCISION :

1.Must be made with a firm continuous stroke.2. Should not cross on underlying bony defects that is existed prior to surgery.3. Vertical incision should be made in the concavities between bony tissues.

4. Base of the flap must be wider than the free edge or width of the free edge.

5. Vertical incision should not extend into thaa fold.

6. Termination of the vertical incision at the gingival crest must be at the line angle of a tooth.

7. Periosteum must be reflected as an integral part of the flap.

BASIC PRINCIPLES TO REMEMBER WHEN PERFORMING TISSUE INCISION:

1. A sharp blade of the proper size should be used.2. A firm continuous stroke should be

done when doing an incision.3. Surgeons should carefully avoid

cutting vital structures when incising to avoid unintentionally cutting large vessels or nerves.

4.Incision should be made with the held perpendicular to the epithelial surface.5. Incision in the oral cavity should be properly placed.

SURGICAL FLAP – IS A SOFT

TISSUE FLAP THAT IS INCISED AND RETRACTED SO THAT THE UNDERLYING BONE CAN BE REMOVED TO EXPOSE TEETH, ROOTS, AND PATHOLOGICAL TISSUE.

- To obtain adequate visualization and access in order to removed structure or tissue without traumatizing the surrounding tissues.

TYPES OF FLAP DESIGN :

1. SEMILUNAR2. TRAPEZOIDAL / ENVELOPE

TYPE3. MODIFIED TRAPIZOIDAL /

LUEBKE OCHSENBEIN 4. TRIANGULAR5. GINGIVAL

1. SEMILUNAR FLAP

2. TRAPEZOIDAL FLAP

3. MODIFIED TRAPIZOIDAL / LUEBKE OCHSEN BEIN

4. TRIANGULAR FLAP

WOUND – a break or injury involving the skin surface or mucosa in which such break is in communication with the environment.

TYPES OF WOUND : 1.Incised wound – results from sharp

instruments, most common in facial injuries, leaving a clean cut wound with sharp margins.

2. Contused wound – cause by blunt instruments.3. Lacerated wound – a tear in the sub epithelial tissues usually caused by a sharp object such as a piece of broken glass .

4. Abrasssion – wound caused by friction between an object and the surface of the soft tissue. Produce by rubbing or scraping off of the surface.5. Punctured wound – cause by pointed instruments such as needle or ice pick.

6. Gunshot Wound – caused by ammunition or bullet coming from the gun.7. Burns – caused by contact with flames, hot liquids, metal acids electricity , sunlight, and irritant gasses.

TYPES OF WOUND HEALING :

1. Primary wound Healing – known as healing by first intention,in which there is no soft tissue loss and and are held together by suturing and allow to heal.

CONDITIONS NECESSARY FOR PRIMARY WOUND HEALING :

1. Smooth Clean cut edges.2. Absence of tissue necrosis.3. Avoidance of infection.4. Avoidance of post operative

bleeding, thus , formation of hematoma is prevented between wound edges.

2. SECONDARY WOUND HEALING Known as healing by secondary intention.

- occurs as a result of wound whose edges are not held together due to the development of excessive fibrin and granulation tissue in between the wound edges.

3. TERTIARY INTENTION – refers to the healing of the wound through the use of tissue grafts to lessen the amount of wound repair.

THREE PHASES OF WOUND HEALING

1.Exudative Phase – shows the picture of exudative inflammation with plasma exudation, fibrin formation, migration of leukocytes and wound edema.

2 . PROLIFERATIVE PHASE – marked by the formation granulation tissue and new connective tissue, rapid and increased production of cells.

Begins to establish contact with their counter parts.

3. SCAR FORMATION – Characterized by an increase production of collagen fibers at the wound site.

THREE STAGES OF WOUND HEALING :

I.INFLAMMATORY STAGE – Begins,the moment the tissue injury occurred and in the absence of factors that prolonged inflammation and last for 3 to 5 days.

II. FIBROBLASTIC STAGE - increase growth of fibrous tissue,connective tissue begin to establish contact.

III. REMODELING STAGE stage of wound repair or wound maturation.

TWO PHASES OF INFLAMMATORY STAGE

1. Vascular – set in motion during inflammation begins.

2. Cellular – is triggered by the activation of the serum compliment by tissue trauma.

Factors That Impair Wound Healing :

1. Foreign Materials2. Necrotic Tissues3. Ischemia4. Tension

CLASSIFICATION OF BURNS :

1. Partial Thickness or First Degree.

2. Deep Partial Thickness or Second Degree Burn.

3. Full Thickness or Third Degree Burn

MAJOR MANIFESTATION IN THE TREATMENT OF WOUND:

1. Blood Is Lost2. Tissue Is Damage3. Defense Against Bacteria4. Mechanical Defect May

Develop

MEANS OF PROMOTING WOUND HEMOSTASIS :

1. Assisting natural hemostatic mechanism –using cotton sponge to place on bleeding.2. Thermal coagulation – use of heat to caused the ends of cut vessels to close.

3. Surgical hemostasis – Suture/ ligation.4. Placement of pressure dressing over closed wound.5. Placing vasoconstrictive substances – applying procoagulants (commercial thrombin or collagen.)

THE BASIC PRINCIPLES OF FLAP DESIGN IS TO PREVENT COMPLICATIONS OF FLAP SURGERY:

1.Flap Necrosis can be prevented. Basic Principles: - apex of a flap should never be wider than the base. - an axial blood supply should be included in the base of the flap. - base of flap should not be excessively twisted or stretched

2. Flap Dehiscence – under tension

3. Flap Tearing – Insufficient access

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