Principle of Surgery

口腔顎面外科吳崇維

手術基本要件

良好的視野– 適當的途徑– 適當的燈光– 乾淨的手術區

助手– 熟悉– 訓練有素

無菌技術

減少由致病微生物所以起的傷口污染

Flap （皮瓣）

獲得進入手術區域之途徑或將組織由一處移至另一處

常見口腔皮瓣種類

Envelop flap Triangular flap

– Horizontal and single vertical incision

Quadrangular flap– Horizontal and 2

vertical incisions

組織的處理

溫柔地– 避免過度的拉扯或擠壓– Toothed forceps or tissue hooks

切骨時，需大量沖洗，以減少骨頭因熱所受的傷害

開放的傷口需常常加以濕潤或以濕紗布覆蓋

處進傷口止血的方法

自然止血的機制– Fabric sponge or gauze or hemostat

Gelfoam, surgicel Small vessels: 20~30 seconds Large vessels: 5~10 minutes

– 輕敷而非擦拭

用熱來封閉（ Thermal coagulation）– Hold the vessels by hemostat– Removal of any blood or fluid around the vessel

用縫線來結紮（ Suture ligation） 直接加壓（ Pressure dressing）

– Most bleeding from dentoalveolar surgery can be controlled by this method.

使用血管收縮素（ Vasocontrictive substance）– epinephrine – Lidocaine with epinephrine

Suture ligation

去污及清創

Normal saline irrigation– Decrease the bacterial count– Lessen the chance of wound infection

Wound debridement– Necrotic tissue– Foreign body– Severely ischemic tissue

縫線材料 Resorbable sutures

– Gut Proteolytic enzymes by inflammatory cells Plain gut : 5-7 days, but 2~4 days in oral cavity Chromic gut : 9~14 days, but 3~5 days in oral cavity

– Polyglycolic acid (PGA) Hydrolysis Dexon

– Polyglactin 910 (PLGA) Hydrolysis Vicryl

Not used in the skin wound– Inflammatory reaction

縫線材料 Nonresorbable sutures

– Silk Multifilamentous Inflammatory response

– Nylon Monofilamentous: Ethilon, Dermalon Multifilamentous

– Polyester Monofilamentous: Polysorb

– Polypropylene Monofilamentous: Prolene

Nylon is suitable for facial laceration wound

Suture sizes

7 ~ 11-0 Most oral and maxillofacial surgical

procedures require the use of a 3-0 or 4-0 suture

縫線操作

Multifilamentous sutures handle better than monofilamentous sutures

Silk – 3 knotting throws

Polyester, gut, PGA, PLGA– 4 knotting throws

Nylon– 5 knotting throws

縫針

Preattached vs. nonattached (French-eyed needles)

Needle points– Cutting or tapered

Degrees of needle curvature

基本縫合技術

Needle holder– ½ to ¾ needle

Perpendicular to the surface Following the curvature of needle From free tissue to fixed tissue Tie only tightly enough to gently approximate

the wound edges

縫合傷口的術後照護

Keep free of dried blood and other debris Sutures in oral cavity

– Removal of sutures in 5~7days

Sutures in face– Removal of sutures in 5 days– Adhesive strips (Steri-strips)

水腫的控制

Degree of edema– The greater the amount of tissue injury, the greater the amo

unt of edema– The more loose connective tissue, the more edema is prese

nted Attached gingiva vs. lip or mouth floor

Control method– Minimize tissue damage– Ice packing– Corticosteroid

Adminstered before tissue is damaged

The End