常見口腔皮瓣種類
Envelop flap Triangular flap
– Horizontal and single vertical incision
Quadrangular flap– Horizontal and 2
vertical incisions
處進傷口止血的方法
自然止血的機制– Fabric sponge or gauze or hemostat
Gelfoam, surgicel Small vessels: 20~30 seconds Large vessels: 5~10 minutes
– 輕敷而非擦拭
用熱來封閉( Thermal coagulation)– Hold the vessels by hemostat– Removal of any blood or fluid around the vessel
用縫線來結紮( Suture ligation) 直接加壓( Pressure dressing)
– Most bleeding from dentoalveolar surgery can be controlled by this method.
使用血管收縮素( Vasocontrictive substance)– epinephrine – Lidocaine with epinephrine
去污及清創
Normal saline irrigation– Decrease the bacterial count– Lessen the chance of wound infection
Wound debridement– Necrotic tissue– Foreign body– Severely ischemic tissue
縫線材料 Resorbable sutures
– Gut Proteolytic enzymes by inflammatory cells Plain gut : 5-7 days, but 2~4 days in oral cavity Chromic gut : 9~14 days, but 3~5 days in oral cavity
– Polyglycolic acid (PGA) Hydrolysis Dexon
– Polyglactin 910 (PLGA) Hydrolysis Vicryl
Not used in the skin wound– Inflammatory reaction
縫線材料 Nonresorbable sutures
– Silk Multifilamentous Inflammatory response
– Nylon Monofilamentous: Ethilon, Dermalon Multifilamentous
– Polyester Monofilamentous: Polysorb
– Polypropylene Monofilamentous: Prolene
Nylon is suitable for facial laceration wound
Suture sizes
7 ~ 11-0 Most oral and maxillofacial surgical
procedures require the use of a 3-0 or 4-0 suture
縫線操作
Multifilamentous sutures handle better than monofilamentous sutures
Silk – 3 knotting throws
Polyester, gut, PGA, PLGA– 4 knotting throws
Nylon– 5 knotting throws
縫針
Preattached vs. nonattached (French-eyed needles)
Needle points– Cutting or tapered
Degrees of needle curvature
基本縫合技術
Needle holder– ½ to ¾ needle
Perpendicular to the surface Following the curvature of needle From free tissue to fixed tissue Tie only tightly enough to gently approximate
the wound edges
縫合傷口的術後照護
Keep free of dried blood and other debris Sutures in oral cavity
– Removal of sutures in 5~7days
Sutures in face– Removal of sutures in 5 days– Adhesive strips (Steri-strips)
水腫的控制
Degree of edema– The greater the amount of tissue injury, the greater the amo
unt of edema– The more loose connective tissue, the more edema is prese
nted Attached gingiva vs. lip or mouth floor
Control method– Minimize tissue damage– Ice packing– Corticosteroid
Adminstered before tissue is damaged