Single-flap technique for fistula repair. Debride the fistula and advance a buccal flap over the defect and create a hard palate rotational flap by debriding the fistula and rotating a mucoperiosteal hard palate flap over the defect.

DENTAL/ORAL CAVITY

GENERAL INFORMATION

• The oral cavity vasculature promotes rapid healing and inhibits infection.
• Infection is common with oral surgery. Perioperative antibiotics should be considered on a case-by-case basis.
• Use atraumatic techniques to minimize tissue swelling and dehiscence, and to promote healing.
  Resect all diseased tissue.
• All oral masses should be submitted for histopathology.
• Use appositional suture patterns.

 

MOST COMMON COMPLICATIONS AND DIFFICULTY

• Expect hemorrhaging and be prepared with direct pressure and ligation. Bleeding may be severe if the palate or bone is cut. Use cautery judiciously to avoid delayed healing.
• Avoid tension on the tissue edges when suturing as this may promote dehiscence (particularly in the palate).

"EXPERTS' ADVICE"

• Plan the closure prior to surgery. Mucosal and mucoperiosteal flaps can be used in the mouth following the same guidelines for flap creation as for the skin.
• Extensive reconstruction typically requires a feeding tube (gastrotomy or esophagotomy) during the healing phase. Consider placing the endotracheal tube through a pharyngostomy approach if the tube is in the way.

 

Use rapidly absorbing suture to minimize discomfort of sutures in the mouth. VICRYL RAPIDE* allows for more rapid absorbtion in sensitive areas. Alternately, use a soft (braided multifilament) suture such as VICRYL* PLUS. VICRYL* PLUS may be preferable to VICRYL* because of triclosan (IRGACARE MP*) in a contaminated environment. MONOCRYL* is also a good substitute for VICRYL* because of its monofilament configuration and rapid absorbtion.


DENTAL/ORAL CAVITY:
SUTURE AND NEEDLE OPTIONS

	Brand		Needle Type	Needle Reference
	Main Choice	Also Possible		Main Choice	Also Possible
MUCOSA	MONOCRYL* VICRYL RAPIDE*	VICRYL* PLUS	Taper Point Reverse Cut	RB-1, CT-2, CT-1 P-3, P-1, P-2	CT-3 FS-2, C-3
SUBCUTANEOUS	MONOCRYL* VICRYL* PLUS	PDS* II VICRYL*	Taper Point	RB-1, SH, CT-2, CT-1
SKIN CLOSURE	ETHILON* PROLENE*	Silk	Reverse Cut	FS-2, FS-1, FS	FSL, CP-2, CP-1, KS

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
MUCOSA	5-0	5-0 or 4-0	4-0 or 3-0	3-0 or 2-0
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

 

Use the suture selection tool for specific product code recommendations.