What can cause excessive hemorrhaging after initial incisions and flap reflection?

Excessive hemorrhaging after initial incisions and flap reflection is primarily caused by laceration of larger vessels. During surgical procedures, particularly in periodontal surgery, incisions and flap reflections must be made with precision to avoid damaging significant blood vessels in the area. If larger vessels are inadvertently cut, this can lead to a dramatic flow of blood due to their capacity to carry a substantial volume of blood, resulting in significant bleeding that may be difficult to control.

When planning surgical flaps, surgeons take care to account for the vascular anatomy of the area. Understanding the location and size of major blood vessels allows them to design flaps that minimize the risk of hemorrhage. Although improper flap design could contribute to complications, it is the direct laceration of vessels that results in immediate and excessive bleeding.

The choice of sutures, whether resorbable or non-resorbable, primarily affects wound closure and stabilization but does not directly cause initial hemorrhage. Similarly, infection during the procedure could lead to complications post-operatively, such as increased bleeding due to tissue damage or inflammatory response, but it does not directly cause excessive hemorrhage at the time of incision and flap reflection. Thus, laceration of larger vessels is the most critical factor leading to