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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.
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.
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Base of the flap must be wider than the free edge or width of the free edge. Vertical incision should not extend into thaa fold. Termination of the vertical incision at the gingival crest must be at the line angle of a tooth. 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.
- To obtain adequate visualization and access in order to removed structure or tissue without traumatizing the surrounding tissues.
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SEMILUNAR TRAPEZOIDAL / ENVELOPE TYPE 3. MODIFIED TRAPIZOIDAL / LUEBKE OCHSENBEIN 4. TRIANGULAR 5. GINGIVAL
1. SEMILUNAR FLAP
2. TRAPEZOIDAL FLAP
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.
CONDITIONS NECESSARY FOR PRIMARY WOUND HEALING : 1. 2. 3. 4. Smooth Clean cut edges. Absence of tissue necrosis. Avoidance of infection. Avoidance of post operative bleeding, thus , formation of hematoma is prevented between 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.
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.
Factors That Impair Wound Healing : 1. 2. 3. 4. Foreign Materials Necrotic Tissues Ischemia Tension
CLASSIFICATION OF BURNS : 1. 2. Partial Thickness or First Degree. Deep Partial Thickness or Second Degree Burn. Full Thickness or Third Degree Burn
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MAJOR MANIFESTATION IN THE TREATMENT OF WOUND: 1. 2. 3. 4. Blood Is Lost Tissue Is Damage Defense Against Bacteria Mechanical Defect May Develop
3. Surgical hemostasis Suture/ ligation. 4. Placement of pressure dressing over closed wound. 5. Placing vasoconstrictive substances applying procoagulants (commercial thrombin or collagen.)
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
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