Triangular Flap Design Research Articles

Comparing Flap Advancement and Wound Coverage of Anterograde Homodigital Neurovascular Island Flap Designs: A Cadaveric Model

Anterograde homodigital neurovascular island flaps are a reconstructive option for volar fingertip injuries and confer the advantage of preserving fingertip sensation after surgery. However, the amount of flap advancement and wound coverage provided by stepwise and triangular flap designs remains unknown. This study sought to investigate how incremental proximal dissection of the pedicle influences flap advancement and whether advancement and/or coverage differ between the triangular and stepwise flap designs using 22 paired cadaveric digits. Flap advancement and wound coverage were evaluated in a pairwise design such that each pair of digits received 1 stepwise flap and 1 triangular flap. After creating a standardized injury to the volar fingertip, pedicled flaps were dissected from the middle phalanx and advanced distally under consistent tension. Advancement was measured for each 5 mm of proximal mobilization of the pedicle to a maximum of 30 mm. On average, 2.6 ± 0.2 mm of flap advancement could be achieved for every 10 mm of pedicle mobilization. With 30 mm of proximal mobilization of the pedicle, 11.8 ± 2.8 mm of advancement and 57.2% ± 16.1% of wound coverage could be expected. There were no significant differences between the flap designs. The stepwise and triangular anterograde homodigital neurovascular island flaps offer comparable and consistent reconstructive outcomes for volar fingertip injuries. The findings in this study suggest that the choice of flap design need not be influenced by the considerations of advancement or coverage; rather, surgeon preference or technical differences between the 2 flap designs may be of more importance.

COMPARISON BETWEEN THE LINGUALLY BASED AND THE BUCCALLY BASED TRIANGULAR FLAP DESIGN IN THE SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLARS (CLINICAL TRIAL)

INTRODUCTION: Removal of wisdom teeth could be challenging owning to limited accessibility, the tooth’s structural location and probable nerve damage especially to the inferior alveolar nerve and the lingual nerve.OBJECTIVES: The primary goal of this study is to make a comparison between the lingually based triangular flap and the buccally based triangular flap in terms of post-operative healing and complications.METHODS: 20 patients between the age of 21 and 30 years were randomly selected for mandibular third molar removal from clinic of the Oral and Maxillofacial Department, Faculty of Dentistry, Alexandria University. They were divided into two groups the study group (n=10) was operated using the lingually based triangular flap design and the control group (n=10) was operated using the buccally based triangular flap design. The patients were recalled on the 2nd, 7th and 14th days postoperatively in order to evaluate postoperative pain ,swelling ,wound dehiscence , the incidence of dry socket formation and lingual nerve injury.RESULTS: The lingually based triangular flap showed inferior levels of pain and was statistically significant in the 3rd and 7th day postoperatively . The lingually based triangular flap design showed less amount of facial swelling and lower incidence of wound dehiscence, dry socket formation and lingual nerve injury but the difference between the groups was all statistically insignificant.CONCLUSION: Lingually based triangular flap design revealed better postoperative healing than buccally based triangular flap design.

Surgical techniques for the removal of mandibular wisdom teeth.

Surgical techniques for the removal of mandibular wisdom teeth.

Efficacy of Lingually Based Triangular Flap vs Routinely Used Triangular Flap Design in Third Molar Surgery

Efficacy of Lingually Based Triangular Flap vs Routinely Used Triangular Flap Design in Third Molar Surgery

Comparison of the Effect of Modified Ward’s and Triangular Flap Design on Periodontium of the Second Molar after Surgical Removal of Mandibular Impacted Third Molar

Background and Objectives: Impacted lower third molar is found in 90% of the general population. Impacted lower third molar surgery may result in complication like pain, swelling, trismus and periodontal health on the distal surface of the adjacent second molar. The aim of this study was to evaluate the effect of flap design on the pain, swelling, trismus, and periodontal health status adjacent to second molar after lower third molar surgery. Materials and Methods: Sixty patients, with an age range of 18-25 years, participated in the present study. They were divided in two groups, each group comprised of 30 patients. In group one triangular flap was used and in group two modified Ward’s flap was used. Post-operatively pain, swelling, trismus was measured on 1st day, 3rd day, and 7th day and periodontal status at 15th days, 1st month, 3rd month and 6th month. Results: No statistically significant differences were found in comparing of pain, swelling, trismus and periodontal status for the between both type of flap design used. Conclusion: It was concluded that the design of mucoperiosteal flap used in surgical removal of impacted mandibular third molar have no effect on the degree of pain, swelling, trismus and periodontal health of adjacent second molar.

The Influence of the Suture-less Anterior Releasing Incision in a Triangular Flap Design on Postoperative Healing Following Surgical Removal of Impacted Mandibular Third Molars.

ABSTRACTObjectives:The objective of this study was to determine the effect of suture-less anterior releasing incisions on postoperative wound healing following surgical removal of impacted mandibular third molars.Materials and Methods:A total of 112 patients were included in the study. Group 1 had 56 patients in which the anterior releasing incision was not sutured postoperatively, and group 2 had 56 patients, in whom the anterior releasing incision was sutured. The two groups were compared in terms of pain, swelling, and trismus at 1 day, 3 days, and 7 days postoperatively. The Univariate Type III Repeated-Measures ANOVA Assuming Sphericity was used to compare the two modes of treatments at different time points. The periodontal healing distal to the second molar was assessed on the first day and at 2 months following the surgical intervention. The independent t test was used to compare the periodontal healing between the two groups at two time points.Results:No significant difference was observed between the two groups for pain and trismus (P > 0.05). However, the swelling was significantly greater in group 2 as compared to group 1 (P < 0.001). Periodontal healing was better in group 2, which showed lower periodontal probing depth distal to the mandibular second molar, compared to group 1 (P < 0.05).Conclusion:Suture-less anterior releasing incision decreases the postoperative swelling and edema, but the periodontal healing was poor when compared to the sutured anterior releasing incision cases. The type of closure technique did not have any significant influence on pain and trismus.

Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis.

Background To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. Material and Methods An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. Results From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. Conclusions Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs. Key words:Impacted third molar, triangular flap, envelope flap, surgical flap, pain perception, trismus.

The effect of triangular and reversed triangular flap designs to post third molar odontectomy complications (a pilot study).

BackgroundOdontectomy is one of the most common surgical procedures in oral and maxillofacial surgery. Flap design influences the post operative complications. Triangular flap is the most widely used flap design but it has many shortages such as dehiscence, alveolar osteitis, reactionary bleeding, and periodontal disruption distal of second molar. The aim of this study is to introduce an alternative flap design in the surgical removal of impacted mandibular third molars – reversed triangular flap – and to compare this flap design with the triangular flap in case of dehiscence, reactionary bleeding, and clinical attachment loss. Material and MethodsThis prospective, split-mouth study involved 15 patients with bilateral partially impacted mandibular third molars with similar impaction classification. One impacted tooth was removed using a triangular flap and the other using a reversed triangular flap. Post operative complications such as dehiscence, reactionary bleeding, and clinical attachment loss were recorded 1, 3, 7, 14, and 30 days post odontectomy. ResultsChi square test result shows that there were fewer incidences of dehiscence seven days post surgery using the reversed triangular flap (p=0.032). Mann Whitney-U test result shows that the reversed triangular flap exhibited less bleeding score on day 1 (p=0.002) and day 2 (p=0.035) post surgery. There were no statistically significant differences according to Mann Whitney-U test between the flap designs for the clinical attachment loss on distal of second molar on day 14 (p=0.512) and day 30 (p=0.902) post surgery. ConclusionsThe reversed triangular flap design is preferable to triangular flap for impacted third molar surgery, escpecially in terms of wound dehisence and reactionary bleeding. Key words:Flap design, third molar impaction, odontectomy, post odontectomy complications.

Comparison Between the Lingually Based and the Buccally Based Triangular Flap Design in the Surgical Removal of Impacted Mandibular Third Molars

Comparison Between the Lingually Based and the Buccally Based Triangular Flap Design in the Surgical Removal of Impacted Mandibular Third Molars

Effect of triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars

OBJECTIVE To evaluate the effect of different triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars. METHODS In this prospective, split-mouth study, 60 healthy patients with bilateral, symmetrically fully impacted lower third molars (LM3) were included, of whom 30 patients with totally bony impacted LM3 were allocated into group A, while the other patients with partially bony impacted LM3 were allocated into group B. All the teeth were extracted by the same surgeon. Triangular flap was used on one side, and the wound was primarily closed with two sutures (TF-P). On the other side, modified triangular flap was used with a triangular region of mucosa posterior to LM2 removed during operation, and a triangular soft tissue defect was left for drainage after suture (MTF-S). The patients were followed up on postoperative days 1, 3 and 7. Clinical parameters included postoperative pain, swelling, and trismus. Distal probing depth of adjacent second molar was assessed 6 months after extraction. Doctors responsible for the evaluation did not know the group and flap design. Paired sample t test was used to analyze the differences of postoperative sequelae between the two strategies. RESULTS In group A, MTF-S strategy could reduce postoperative pain, ibuprofen consumption, and swelling significantly compared with TF-P strategy on the postoperative 1st and 3rd days (P<0.05). Besides, the trismus in the patients with TF-P strategy was more serious than that with MTF-S strategy on the postoperative 1st, 3rd and 7th days (P<0.05). However, statistic difference between the two strategies in pain, swelling and trismus was not detected in group B. Additionally, the VAS score in the patients with MTF-S strategy in group B increased slightly on the postoperative 4th day. The probing depth of the adjacent second molar was evaluated 6 months after extraction. Statistic difference was not detected between MTF-S strategy and TF-P strategy in the both groups. CONCLUSION Modified triangular flap with secondary healing procedure could effectively reduce the postoperative complications of totally bony impacted LM3. However, the difference between the two strategies in the probing depth of the adjacent second molar was not statically significant 6 months after extraction.

Lateral Sinus Floor Elevation Performed with Trapezoidal and Modified Triangular Flap Designs: A Randomized Pilot Study of Post-Operative Pain Using Thermal Infrared Imaging.

Purpose: Post-operative pain and swelling are frequently observed after sinus lift procedures. The aim of the present study was the clinical evaluation of swelling and pain of two different sinus flap lift techniques using a visual analogue scale (VAS), verbal rating scale (VRS), and infrared thermal imaging (i.e., thermography). Materials Methods: A randomized controlled trial was conducted with 15 patients (30 sinuses in total) randomly allocated into two groups. For the sinuses of Group I a trapezoidal flap was used, while for Group II a modified triangular flap without anterior release was utilized. Postoperative pain was scored by means of a 100-mm VAS ranging from 0 (no pain) to 100 (worst pain imaginable), and was recorded at 2, 4, 6 and 14 days after surgery. Swelling was recorded by a verbal rating scale (VRS) and was classified into four categories: a score of 1 referred the absence of swelling, patients with intra-oral swelling in the surgical zone scored 2, any extra-oral swelling in the surgical zone scored 3, and intense swelling exhibited by extra-oral swelling extending beyond the surgical zone scored 4. The facial temperature was recorded before and after sinus augmentation, and at 2, 4, 6, and 14 days post-surgery to check the course of healing. Results: In Group I pain intensity was recorded at 2 days after surgery with a mean score of 38.67 ± 6.4 mm. Swelling was greater at 2 and 4 days, and was absent at day 6. The facial temperature difference before and after the procedure was 4.737 °C ± 0.37. In Group II the pain score were lower than in Group I (p < 0.05). The score for swelling was 2 on the first and second days, and was reduced on day 4. After the second day the difference in temperature was significantly reduced as compared to the day of surgery (0.77 °C); at 2 and 4 days no difference was registered. Conclusions: The results of this clinical study show the significant effectiveness of the modified triangular flap in the sinus lift procedure for reducing pain and swelling.

Evaluation of two flap designs on the mandibular second molar after third molar extractions.

Background:The extraction of third molars is associated with some clinical outcomes and periodontal problems. It is imperative to note that the type of incision used in the surgery for the removal of the impacted third molar is critical. The design of the flap influences the healing of the surgically created defect and damage to the distal periodontal area of the adjacent second molar. However, till date, there have been conflicting reports on the influence of different flap designs used for the surgical removal of impacted third molars.Aim:The present study aimed to comparatively evaluate the clinical outcomes and periodontal status of the adjacent second molar, when two different flap designs, namely, the envelope and the modified triangular flap designs were used.Materials and Methods:Sixty female patients with bilateral impacted third molars completed the study with envelope flap on one side and modified triangular flap design on the other side of the mandible for third molar removal. Clinical parameters including pain, dehiscence and swelling were assessed postoperatively and periodontal probing depth (PPD) on the distal aspect of adjacent second molar were assessed both pre- and post-operatively.Results:The results were assessed on 1, 3 and 8 days for pain using visual analog scale. The subjective perception of swelling was evaluated on 3, 7 and 15 days postoperatively in a similar manner. The results of the periodontal parameters were evaluated both preoperatively and 3 months postoperatively, with cautious exploration using a University of North Carolina (UNC)-15 periodontal probe. The statistically significant results for swelling and PPD were noted for the two flap groups using the Chi-square test (P < 0.05).Conclusion:The study revealed that the modified triangular flap had lesser postoperative PPDs and dehiscence. The envelope flap was better when swelling was analyzed. The pain scores, though slightly higher for the modified triangular flap group, were not statistically significant.

Vaginoplasty in Male-to-Female Transsexual Surgery: A Training Concept Incorporating Dissection Room Experience to Optimize Functional and Cosmetic Results.

Learning a new technique, even for an established surgeon, requires a learning curve; however, in transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results due to a learning curve. In this context, we have tried to build a learning concept for vaginoplasty that includes four steps: (i) formal identification of the surgical steps in order to provide both measure of surgical process and measures of outcomes; (ii) training on cadavers with expert assistance; (iii) performing the live surgery with assistance from expert; and (iv) performing the surgery alone. Herein, we emphasize the second step of our learning concept. Between September 2013 and December 2013, 15 cadavers were operated on by an established surgeon learning vaginoplasty under assistance from two expert practitioners. Mean global time and mean time necessary to perform each step of the operation were recorded by the experts. Intraoperative complications were systematically registered. The final depth and diameter of the neaovaginal cavity were precisely measured. For each cadaver, the aesthetic results were assessed by one of the experts. Mean total operating time was 179 ± 34 minutes and decreased from 262 minutes for the first training attempt to 141 minutes for the last one. Intraoperative expert correction included modification of the scrotal triangular flap design and change of position of the urethra: This happened during the first training. No lesion of the urethra or of the anus occurred. The two experts judged the outcomes as excellent in seven cases, very good in four cases, good in two cases, and fair in two cases. Despite the numerous reports on vaginoplasty in the literature, there is a real lack of published information on the learning curve of this operation. We make the hypothesis that introducing a learning concept with assistance from expert practitioners at the beginning of the surgeon's experience can optimize both the duration of his learning curve and reduce the risk of major complications.

Comparison of a new flap design with the routinely used triangular flap design in third molar surgery

The aim of this study is to introduce a new flap design in the surgical removal of impacted mandibular third molars – a lingually based triangular flap – and to compare this flap design with the routinely used triangular flap. This randomized, prospective, split-mouth study involved 22 patients with impacted bilateral mandibular third molars that were symmetrically positioned, mesially angulated, and retained in bone. The impacted teeth were removed in two sessions, using two different flap designs: the new alternative flap and the traditional triangular flap. Postoperative complications (pain, swelling, trismus, alveolar osteitis, and wound dehiscence) were recorded on days 2, 7, 14, and 21. The data obtained were analysed using the χ2 test, the Mann–Whitney U-test, and Pearson's correlation. In terms of the severity of postoperative facial swelling and trismus, there were no statistically significant differences between the flap designs (P>0.05). The alternative flap exhibited higher pain scores at 12h post-surgery (P<0.05). In addition, the alternative flap group exhibited less wound dehiscence, although this was not statistically significant. Moreover, all wound dehiscence in this group occurred on sound bone. In conclusion, these results show that this new flap design is preferable to the routinely used flap for impacted third molar surgery.

Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery

To investigate the influence of flap design on postoperative trismus, pain, and swelling. Thirty-two patients with bilateral symmetrically impacted mandibular third molars participated in a randomized prospective split mouth study. Two flap designs were used: a buccal envelope flap and a modified triangular flap. Postoperative pain was recorded using a standardized visual analog scale. Postoperative swelling was evaluated using laser scans of models of the patient's cheek taken before and two days after surgery, with the scan area being calculated using MatLab software. There were no statistical differences between the flap designs in terms of severity of postoperative pain or trismus. A statistically significant difference was observed in postoperative swelling at 2 days, with the modified triangular flap design being associated with increased swelling. The envelope flap design was associated with a higher incidence of alveolar osteitis. The flap designs used in this study did not adversely affect patients in terms of postoperative pain and trismus, and although greater extraoral swelling was seen with the modified triangular flap design, the clinical relevance is debatable.