This document provides an overview of principles of suture and flap design for oral surgery. It discusses the basic principles of incision and flap design, including types of incisions and flaps for different procedures. It also covers different types of sutures and needles that can be used, including absorbable and non-absorbable sutures. Basic suturing techniques like simple interrupted, continuous, and mattress sutures are also outlined. The document is intended as a guide for surgical skills and procedures in oral surgery.

1. principles of suture and flap
design
Dr.Mohammed rhael
Tikrit dentistry college

2. Tips for Surgical skill
 Knowledge of the basic principles of surgery
 Knowledge of anatomy
 training

3. Incision vs flap

4. Basic principles of incision in oral
surgery
 Use new sterilized blade ( number 15 )
 Scalpel grasped in a pen grasp for maximum
control and tectile sensetivity
 The incision should be made at right angle to the
undelying bone
 The scalpel should moved in single constant firm
movement

8. Basic principle of flap design
Avoid anatomical structures
The base wider than the apex
Adequate width for maximum
visualization
The flap should be wider than
anticipitaed bony defect
Delicate handling of flap without
tension
Vertical releasing incision should
start at buccal vestibule and end
at the interdental papilla not at
the buccal or labial surface .

9. Sites where vertical releasing incision
contraindicated
Transveres incision in palate
Lingual incision of the mandible
Canine eminence
Between lower premolars

17. Three sided flap (trapezoidal flap)

20. Semilunar flap

22. Flap for palatal tori removal

23. Flap for oro-antral fistula closure

25. suturing

26. • Monofilament , multifilament
• Absorbable , non absorbale
• Natural ,synthetic

28. Absorbable sutures
• Plain cutgut
• Chromic cutgut
• Polyglactin (vicryl)
• Polydioxanone (PDS)

29. Non –absorbable sutures
• Silk
• Nylone
• Polypylene (prolene )

30. Needles
• Needle of 18 -26 mm in length are the suitable
for oral surgery
• According to suture side of the needle
• Eyed , eyeless
• According to the tip of the needle
¼ circle , ½ circle , 3/8 circle , 5/8 circle

37. • According to the cross section of needles
• Needle with round or oval cross section
• Needles with triangular cross section 9
cutting or reverse cutting )

38. Needle holder , tissue forcepse

39. Needle holder vs mosqueto

40. Basic principles of suturing
• Non touch technique
• Fewer number of suture as possible
• From mobile to fixed tissue
• 3-5 mm from margin and needle should enter at right
angle to the mucosa
• Avoid over tightening , overlapping of the wound
• Undermine the incision to facilitate insertion of the
needle and decrease tension
• Suture removed after 5-7 days

43. Suture techniques
• Simple interrupted suture
• Continous suture ( locking or non locking)
• Mattress suture
• Figure of eight suturing

50. Video

51. Thank you for listening