Wound Healing in the Tissues of the Periodontium following Periradicular Surgery, II. The Dissectional Wound

By Harrison JW, Jurosky KA

Date: 12/1991
Journal: JOE

 Purpose:

To describe the wound-healing responses of the mucoperiosteal tissues and conical bone to dissectional wounding at postsurgical periods of 1 through 4, 14, and 28 days.

Materials and methods:

-n: 4 Rehsus monkeys were included 6 flaps were incorporated in each monkey (sub-marginal flap (Ochsenbein Leubke) and triangular flap) with a total of 26 experimental flaps.

-Each flap was retracted for 15 min with frequent saline irrigation. Flaps were sutured by interrupted plain gut sutures and was allowed to fully absorb.

-The animals were placed on a soft diet supplemented with vit.C and fresh fruit postoperatively for 4 days or until sacrifice. One crushed tablet of Vicodin was added to the food daily for 2 days (or until sacrifice).

-Monkeys were sacrificed and both jaws were sectioned, fixed, and decalcified.  Each flap was divided to 2 blocks (block for vertical incision and a block for a horizontal incision) with a total of 48 blocks. Blocks were embedded, sectioned, and stained with H&E, Masson’s trichrome, and  Snook’s reticulin stain and examined by light microscope.

-Evaluation of the soft tissue wound-healing by 3 aspects: clotting and inflammation, epithelial healing,

and connective tissue healing.

-Summary:

-Healing of dissectional wounds is slower than incisional wounds because it involves wound edges in dissimilar tissues.

Dissectional Wound: Triangular Flap

⁻Day 1: Thin fibrin clot, PMN (predominant cell)

¯Day 2: ↑ MPs,

¯periosteal tissue on the cortical surface of the bone was seen acellular, avascular, and comprised with depolymerized collagen associated with Sharpsey’s fibers. The underlying lamella contained osteocytes unlike the underlying lamella of cortical surface with a periosteal free tissue (necrosis and empty lacunae).

⁻Day 3-4: MP (predominant cell), MP (predominant cell). ↑fibroblasts and fibroblast-like cells, angiogenesis, and granulation tissue.

⁻Day 14: fibrous connective tissue had replaced the depolymerized collagen layer. A new periosteum had formed along the cortical surface.

⁻Day 28: the flapped tissues were completely normal.

⁻Dissectional Wound: Submarginal Rectangular Flap

The same triangular flap with few differences. At the

1- through 4-day intervals, the flapped attached gingiva contained a considerably greater number of inflammatory cells than seen with the triangular flap design.

Clinical significance:

Curettement of bleeding tissue tags from the cortical surface following flap reflection may be counterproductive because it removes cortical-retained periosteal tissues and thus eliminates sites of early reattachment of flapped tissues to cortical bone. ⁻