Periosteal Elevation: Surgical Instruments and Step-by-Step Technique

Instrument

Periosteal elevator (e.g., Freer, Molt, Woodson) – Thin, blunt, slightly curved blade on a handle.

Technique

1. Incise periosteum at the planned elevation margin.
2. Insert elevator blade between periosteum and bone at the incision edge.
3. Use gentle pushing strokes (not tearing) to separate the periosteum subperiosteally.
4. Work circumferentially until the desired exposure is achieved.
5. Retract elevated periosteal flap with a retractor or suture.

Applications

• Orthopedic fracture fixation (plate placement)
• Oral/maxillofacial surgery (mandibular osteotomies, implant placement)
• Spinal surgery (laminectomy, fusion)

Key Principle

Preserve periosteal vascularity (cambium layer) to maintain bone healing capacity. Avoid excessive stripping or thermal injury.