The purpose of this paper is to present examples of complications that may arise in association with free soft tissue grafting procedures, and to present suggestions on how to avoid them.
Excessive Hemorrhage at Donor Site-possible bleeding disorders or clotting deficiencies. possible too deep or excessive area for donor site. Take good medical history , the proper donor area is the lateral third of the palate near the teeth, as far as possible from the large artery, the greater palatine foramen. The recipient site is not usually a problem
Bone exposure- graft tissue from the palate area overlying bony exostoses, palpate area, bony area should not prevent utilization of area.
Recurrent herpetic lesions- common site is the palate. it occurs following surgical trauma or administration of local anesthetic when obtaining donor tissue, Predictability or prevention is unknown.
Problem Related to size and thickness of Graft-If the graft is too thin it will fail to produce an adequately increased zone of keratinized gingiva. Grafts too thick will result in an exaggerated tissue profile in the area. Grafts of 1 mm thickness is acceptable.
Color of Grafts-Color discrepancies are encountered with thicker grafts, in individuals with physiologic pigmentation of the attached gingiva
Delayed Healing- (it is rare) excess granulation tissue will persist at the margin of the graft or flap site, possible foreign body reaction. It is easily excised.
Stability of Mature Graft- The present authors have found that meticulous attention to detail removing muscle fibers and preparation of a firm connective tissue base at the recipient site will produce a stable, tightly bound-down graft w/o the additional trauma of fenestration.
Position of Graft in Relation to MGJ- If the incision for the recipient site is entirely within alveolar mucosa the healed graft will appear as an island of keratinized gingiva in the mucosa.
Failure of Graft Union- the accidental inversion of the graft when transferring it to the recipient site so that the oral keratinized surface is placed against the vascular bed. Failure of the graft survival may also occur if the recipient site includes a large area of exposed bone, although grafts will heal well over recipient beds with small areas of bone exposure surrounded by vascular connective tissue.
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