Evaluation of the effects of pressure application in the palatal donor area on perioperative hemostasis and postoperative patient discomfort in connective tissue graft applications

Various methods have been described in the literature to manage bleeding in the palatal donor area and to promote healing of the area. These techniques include sutures with or without hemostatic agents, or the use of materials such as acrylic or plastic palatal stents, periodontal seals, and platelet-rich fibrin (PRF) prepared before the operation. The use of an additional hemostatic agent often requires additional surgical time and expense, and most of the techniques described in the literature for the management of palatal hemorrhage are used to control bleeding after it has occurred. Suturing branches of the Great Palatinal Artery or terminal vein is a popular and effective technique to control palatal bleeding. Recently, Kulkarni et al. (Kulkarni, Shettar, Bakshi, & Thakur, 2018) described a detailed protocol for placing a large palatal compression suture (BPKS) and reported that this suture is a predictable method for controlling bleeding when applied preoperatively at the palatal donor site. This protocol is based on the estimated location of the greater palatal foramen and vascular bundle. There is no study that applies the BPKS technique during the connective tissue graft operation. In addition, patient-reported outcome measures such as painkiller intake, number of days of discomfort, satisfaction, quality of life, and willingness to be treated again, as well as the amount of pain and bleeding of the palatal donor site during and after surgery, were not examined. Reduced intraoperative bleeding during the connective tissue graft procedure can help increase the operator's field of view and also help reduce postoperative bleeding and adverse patient-reported outcomes. In our study, it is also aimed to evaluate whether the BPKS technique has any effect on the healing of the half-thickness flap in the donor area when applied in connective tissue graft procedures obtained with the single incision method. It is expected that BPKS, which is applied before the connective tissue graft is taken with the single incision method, will both increase the physician's field of view by reducing intraoperative bleeding, and decrease hemostasis and negative results reported by the patient by keeping it for 1 week in the postoperative period.