Int J Oral Maxillofac Implants. 2022 Jul-Aug;37(4):823-829. doi: 10.11607/jomi.9382.
Since flap advancement is a prerequisite for tension-free primary closure and successful regenerative procedures, the aim of this study was to test the efficacy of six surgical approaches for flap advancement in an ex vivo porcine model.
A total of 60 fresh mandibles from pigs were randomized into one of six groups: (1) trapezoidal full-thickness flap design with two vertical releasing incisions (control), (2) trapezoidal flap with linear periosteal scoring, (3) mucosal detachment technique, (4) mucosal detachment with horizontal extension, (5) mucosal detachment with horizontal and vertical extension, and (6) mucosal detachment with horizontal vertical and cutback extension. Coronal advancement of the flap was recorded as the primary variable; the surface area of exposed mucosa and the tear strength were recorded as secondary variables.
Homogeneity existed among groups for preoperative keratinized tissue width and tissue thickness. Mucosal detachment with horizontal, vertical, and, cutback extensions achieved the highest amount of advancement. All remaining groups achieved a statistically higher advancement compared with the trapezoidal full-thickness flap (control). Pairwise comparison demonstrated statistical significance between any two groups (P < .001). A positive correlation was noted between exposed mucosa and flap advancement; the advancement increased 0.62 mm for each 10 mm of increase in the exposed mucosal surface. Strength at tear stress was the highest in the trapezoidal full-thickness flap (control) and mucosal detachment with horizontal-vertical-cutback incisions (P < .001).
Coronal flap advancement was maximized in the mucosal detachment techniques and positively correlated with the area of exposed mucosa.
由于皮瓣推进是无张力一期闭合和成功再生程序的前提，因此本研究旨在测试六种外科方法在猪离体模型中用于皮瓣推进的效果。
总共 60 个新鲜猪下颌骨随机分为 6 组之一：（1）带有两个垂直松解切口的梯形全厚皮瓣设计（对照组），（2）带线性骨膜划线的梯形皮瓣，（3）黏膜分离技术，（4）带水平延伸的黏膜分离，（5）带水平和垂直延伸的黏膜分离，（6）带水平垂直和回切延伸的黏膜分离。皮瓣的冠状推进被记录为主要变量；暴露的黏膜表面积和撕裂强度被记录为次要变量。
术前角化组织宽度和组织厚度在组间具有同质性。黏膜水平、垂直和回切延伸分离术实现了最高的推进量。所有其余组的推进量均明显高于梯形全厚皮瓣（对照组）。两两比较显示任何两组之间均有统计学意义（P <.001）。暴露的黏膜与皮瓣推进之间存在正相关关系；暴露的黏膜表面每增加 10mm，推进量增加 0.62mm。撕裂强度的最大力在梯形全厚皮瓣（对照组）和黏膜水平垂直回切切口组中最高（P <.001）。
黏膜分离技术可使冠状皮瓣最大程度推进，且与暴露黏膜面积呈正相关。
