Navigating complications: Management of periodontal flap perforation – A case report with 9-month follow-up

Abstract:

Flap perforations during open-flap debridement usually heal by secondary intention but can lead to necrosis, discomfort, and altered treatment outcomes. This report describes the conservative management of an intraoperative periodontal flap perforation that resulted in localized flap dehiscence. A 55-year-old female with generalized periodontitis, Stage III, Grade A, underwent periodontal debridement surgery, during which an inadvertent flap perforation occurred. Due to its small size and well-vascularized location, the perforation was left to heal by secondary intention. By the 7 ^th postoperative day, localized necrosis was noted on the lingual aspect of tooth #29, with viable tissue underlying the necrotic area. Management included reinforcement of oral hygiene measures, saline and betadine irrigation, and the prescription of antibiotics and analgesics. At 4 weeks, healing was nearly complete. By 9 months, complete tissue recovery was observed, with no evidence of scarring. This case underscores the importance of early recognition, conservative management, and patient compliance in the successful management of surgical complications, thereby ensuring optimal healing outcomes.