During complicated dental procedures where surgical access is limited, it may be necessary to create a flap. When making a flap for tooth removal, the flap should be ‘full-thickness’ mucoperiosteal flaps. This means that the mucosa, submucosa, and periosteum should be included in the flap. There are various criteria that must be taken into consideration in order to create a successful flap. These three criteria are –

• Necrosis
• Dehiscence
• Tearing

Necrosis

In order to prevent necrosis of the flap, there are a few principles we can abide by. Firstly, the tip or apex of the flap should always be narrower than the base (unless there is a major artery at the base). The apex and the base of the flap should also be parallel to one another. Often, the width of the base should be greater than the length of the flap. Along with these principles, it’s important to know that the base of the flaps should never be twisted or stretched in a way that might cause harm to vessels in the area.

Dehiscence and Tearing

Dehiscence of separation can cause pain, bone loss, and scarring, and should be avoided during creation of a flap (avoid placing the flap under tension and handle it with care). The difference between a good flap and a bad flap can be based on how well of access the flap provides for the surgeon. When making a flap, it’s important to understand that a long incision heals as well as a short incision. Therefore, to avoid tearing (which can produce adverse effects of the tissue), you should make a flap that has the proper length in order to ensure proper access to the area.

Other flap considerations

When choosing how large the flap should be, you should anticipate the extent of the surgery. For instance, 6-8 mm of flap should be extended away from the bone that is anticipated to be removed during surgery.

It’s also important to take into account the various structures that may be found around the flap, such as the lingual and mental nerve. Endangering vital structures in the maxilla is much less of a risk.

To summarize:

• Flaps are used when surgical access is limited
• Full-thickness flaps should be utilized
• The base should be wider than the apex
• Handle the flap with care
• Do NOT make the flap smaller than it should be
• Allow 6-8 mm of extension of the flap and the bony defect
• Take into consideration various vital structures

References:

Hupp, James R., et al. Contemporary Oral and Maxillofacial Surgery. Elsevier, 2019.

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.