Soft Tissue Flaps and Sutures in Oral Surgery: BS. Phan Bá L C

SOFT TISSUE FLAPS AND SUTURES
IN ORAL SURGERY
BS. Phan Bá Lộc

PRINCIPLES OF FLAP DESIGN,
DEVELOPMENT AND MANAGEMENT
PRINCIPLES OF
FLAP
DESIGN
(*)
TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

CAN THO UNIVERSITY OF MEDICINE AND PHARMACY (*) Flap Design - Learning Pathways - Home - ITI
FLAP
Section of soft tissue:
• Outlined by a surgical incision
• Carries its own blood supply
• Allows surgical access to underlying tissues
• Maintained with sutures
(*)
(*) Classifications of Flaps | Keanu Manalo - Academia.edu

DEFINITION OF FLAP 3
CAN THO UNIVERSITY OF MEDICINE AND PHARMACY
Incision
A sharp cut on skin or mucosa made by a skilled

operator using surgical blade, cautery to
expose the underlying structures and pathology
for a therapeutic or diagnostic purpose.
(*)
(*) Incisions and flap Design - Oral and Maxillofacial Surgery PPT Download - YouTube

Incision 4
Incision
● Pen grapsp / table knife grasp
● Sharp blade
● Proper size blade/handle
● Continuous stroke
● Avoid cutting vital structures
● Perpendicular to the epithelium
(*)
● Over healthy bone
(*) Incisions and flap Design - Oral and Maxillofacial Surgery PPT Download - YouTube

Incision 5
Incision
(*)
(*) Jame R. Hupp et al (2014) Contemporary Oral and Maxillofacial Surgery 6th

Incision 6
Incision
(*)

Incision 7
Elevation
(*)

Elevation 8
Retraction
(*)

Retraction 9
Retraction
(*)

Retraction 10
Design parameter
1 Size 2 Base
Broader than the free margin
Adequate size => adequate access
Base > Height x 2
3 The incision 4 Releasing incision

Only when necessary
Over intact bone/ avoid injury to Do not cross bony prominences
vital structure directly on facial aspect of the
tooth, papilla
Cross the free gingiva margin at
the line angle of the tooth

Design parameter 11
Design parameter
1 Size
Adequate size => adequate access
(*)

Design parameter 12
Design parameter
2 Base
• Broader than the free margin (*)
• Base > Length x 2 (x > 2y)
(*)

Design parameter 13
Design parameter
3 The incision
Over intact bone/ avoid injury

to vital structure
(*)

Design parameter 14
Design parameter
4 Releasing incision
• Only when necessary

• Do not cross bony prominences, directly on
facial aspect of the tooth, papilla
• Cross the free gingiva margin at the line angle
of the tooth
(*)

Design parameter 15
Intraoral Soft tissue Flap
Classification
(*)
(*) Flap Techniques in Dentoalveolar Surgery |

IntechOpen

CLASSIFICATION OF FLAPS 16
THICKNESS
FULL
Including the periosteum
(*)
PARTIAL
Do not include the periosteum
(*) Classifications of Flaps | Keanu Manalo - Academia.edu

PLACEMENT AFTER SURGERY
NON-DISPLACED
Original position
Displaced
(*)
Apically/coronally/laterally to their original position

(*) (PDF) Flap Techniques in Dentoalveolar Surgery (researchgate.net)

Management of papilla
Conventional flap
(*)
Preservation flap
(*) Dr. Uma Sudhakar et al (2020)

Shape
3-cornered flap
Envelope flap
(Triangular flap)
Not combined with a releasing incision 1 vertical-releasing incision
4-cornered flap
Semi-lunar flap
(Trapezoidal flap)
To avoid marginal attached gingiva 2 vertical-releasing incision
TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

20
CAN THO UNIVERSITY OF MEDICINE AND PHARMACY Development and Management
Shape
Envelope flap HOW TO MAKE INDICATIONS
Not combined with a releasing incision

• Extended Horizontal incision
• In gingival sulcus Surgical procedures involving
• Along cervical lines of 4-5 the cervical lines of the teeth.
teeth

21
Shape
Envelope flap ADVANTAGES DISADVANTAGES

• Difficult reflection
Not combined with a releasing incision
• Avoidance of vertical incision • Great tension
• Easy to replace • Risk of the ends tearing
(approximately) to the • Limited visualization,
original position access (Apicoectomies)
• Defect of attached gingiva
• Risk of palatal vessels and
nerves injuries
22
Shape
3-cornered flap
HOW TO MAKE INDICATIONS
(Triangular flap)
1 vertical-releasing incision
Labial/buccal both jaws
• Horizontal incision In
Surgical procedures
gingival sulcus
removing root tips, small
• 1 Vertical incision
cysts, apicoectomies…

23
Shape
3-cornered flap
ADVANTAGES DISADVANTAGES
(Triangular flap)
1 vertical-releasing incision • Adequate blood supply
• Satisfactory visualization
• Good stability • Limited access to long roots
• Easy to modify and replace • Tension (retractor)
(approximately) to the • Defect of attached gingiva
original position

24
Shape
4-cornered flap
HOW TO MAKE INDICATIONS
(Trapezoidal flap)
• Horizontal incision In When an extensive surgical
gingival sulcus field exposure is required
• 2 Vertical incision (Triangle flap is inadequate)

25
Shape
4-cornered flap
ADVANTAGES DISADVANTAGES
(Trapezoidal flap)
• Excellent access and
• Can not be modified or
visualization
lengthened (once reflected)
• Minimal tension
• Defect of attached gingiva
• Easy to replace (approximately)
to the original position

26
Shape
Semi-lunar flap HOW TO MAKE INDICATIONS

• Curved incision Begins
To avoid marginal attached gingiva
beneath the vestibular fold
• Bow shape course, the Apicoectomies, removing
convex part toward the small cyst, root tips
attached gingiva
• Lowest point: 0.5mm above
Gingiva margin

27
Shape
Semi-lunar flap ADVANTAGES DISADVANTAGES
To avoid marginal attached gingiva

• Small incision • Limited access and
• Easy reflection visualization
• No recession of gingiva (margin) • Tear
• Easier oral hygiene • Scar
• Incision over bone lesion

28
Shape
Y-Shape flap Y HOW TO MAKE INDICATIONS
• 1 incision along midline of

the palate Removal of small exostosis
• 2 anterolateral incisions (->

canines)

29
Shape
Double Y-Shape flap Y

Y HOW TO MAKE INDICATIONS
• 1 incision along midline of

the palate Removal of larger exostosis
• 2 anterolateral incisions (->
canines)
• 2 posterolateral incisions
(*)
(*) Oral Surgery | Quizlet

30
Pedicle flap
Buccal – Palatal - Bridge INDICATIONS
Closure of an oroantral
communication.
(*)
(*) Surgical Incisions and Flaps – Dentowesome

31
Principles of suturing in oral surgery
Principles of
SUTURING
In oral surgery
TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

32
CAN THO UNIVERSITY OF MEDICINE AND PHARMACY in oral surgery
1. Provide an adequate tension of wound closure without dead space but
loose enough to obviate tissue ischemia and necrosis
2. Maintain hemostasis.
3. Permit primary intention healing
4. Provide support for tissue margins until they have healed and the support is
no longer needed
5. Reduce postoperative pain
6. Prevent bone exposure resulting in delayed healing and unnecessary
resorption
GOALS

33
Needle holder

34
Needles
Dental Suturing Materials and Techniques (juniperpublishers.com)
35
SUTURES
36
SUTURES
Suture Materials – Core EM
37
Suturing

38
Suturing

39
Suturing

40
Suturing

41
Suturing

42
Suturing

43
Advantages
1. Strong
2. Tension is shared.
3. Each is independent and loosening one
will not produce loosening of the other
4. In infection or hematoma, removal of
few sutures.
5. Free of interferences between each
stitch and easy to clean
Interupted

44
Advantages
1. Avoid multiple knots
2. Distributes tension uniformly
3. Watertight closure
4. Prevents excessive tightening
Continuous

45
Advantages
1. Better adaptation and maximum tissue
approximation.
2. Get eversion of wound margins slightly.
3. Control soft tissue hemorrhage.
Vertical mattress

46
Advantages
1. Close bony deficiencies such as
oroantral fistula or cystic cavities,
extraction socket wounds
2. Prevent the flap from being inverted
into the cavity.
3. Control post-operative hemorrhage
from gingiva around the tooth socket to
tense the mucoperiosteum over the
underlying bone.
Horizontal mattress

47
Figure 8 and Cross

48
1. Jame R. Hupp et al (2014) Contemporary Oral
and Maxillofacial Surgery 6th
2. Hassan H Koshak (2017), Dental Suturing
Materials and Techniques, Global Journal of
Otolaryngology.

Soft Tissue Flaps and Sutures in Oral Surgery: BS. Phan Bá L C

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SOFT TISSUE FLAPS AND SUTURES

BS. Phan Bá Lộc

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

(*) Classifications of Flaps | Keanu Manalo - Academia.edu

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

A sharp cut on skin or mucosa made by a skilled

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

3 The incision 4 Releasing incision

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

Adequate size => adequate access

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

Over intact bone/ avoid injury

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

• Only when necessary

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

Intraoral Soft tissue Flap

(*) Flap Techniques in Dentoalveolar Surgery |

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

PLACEMENT AFTER SURGERY

Apically/coronally/laterally to their original position

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Envelope flap HOW TO MAKE INDICATIONS

Not combined with a releasing incision

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Envelope flap ADVANTAGES DISADVANTAGES

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Semi-lunar flap HOW TO MAKE INDICATIONS

convex part toward the small cyst, root tips

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Semi-lunar flap ADVANTAGES DISADVANTAGES

To avoid marginal attached gingiva

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Y-Shape flap Y HOW TO MAKE INDICATIONS

• 1 incision along midline of

• 2 anterolateral incisions (->

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Flap

Double Y-Shape flap Y

• 1 incision along midline of

(*) Oral Surgery | Quizlet

Buccal – Palatal - Bridge INDICATIONS

(*) Surgical Incisions and Flaps – Dentowesome

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing

TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ Principles of suturing