Suture Biomechanics and Static Facial Suspension（1）
JAMA Facial Plastic Surgery
Original Article | May 2007
May 2007, Vol 9, No. 3
Clinton D. Humphrey, MD; Terence E. McIff, PhD; Kevin J. Sykes, MPH; Terance T. Tsue, MD; J. David Kriet, MD
Correspondence: Clinton D. Humphrey, MD, Department of Otolaryngology–Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, KS 66160 (chumphrey@kumc.edu).
Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Humphrey, Tsue, and Kriet and Mr Sykes) and Orthopedic Surgery (Dr McIff), The University of Kansas Medical Center, Kansas City.
Arch Facial Plast Surg. 2007;9(3):188-193.
doi:10.1001/archfaci.9.3.188.
http://archfaci.jamanetwork.com/article.aspx?articleid=481117
ABSTRACT
Background
Static facial suspension (SFS) continues to play a role for rehabilitation in patients with Facial paralysis. We perform SFS almost exclusively with a suture technique in our practice. Monofilament polypropylene suture (Prolene) is commonly used for SFS, but we have witnessed occasional failure and some stretching with this material. The purpose of this study was to establish and compare the biomechanical properties of 3 suture types—polypropylene, polybutilate-coated braided polyester (PBCP) (Ethibond Excel), and braided polyester impregnated with polytetrafluoroethylene (PIP) (Tevdek)—to assess their suitability for SFS.
Methods
Six samples of 0, 2-0, and 3-0 polypropylene, PBCP, and PIP were tested. The mean load to failure was calculated for each suture type. Stiffness and elongation at specific loads were calculated to compare stretch between materials.
Results
The load to failure of PBCP and PIP was significantly greater than that for polypropylene for all suture sizes. In addition, PBCP and PIP had significantly less elongation than did polypropylene at clinically relevant loads.
Conclusions
Both PBCP and PIP had superior load-bearing properties and decreased stretch when compared with polypropylene. These properties suggest that, for SFS with suture, use of PBCP or PIP may reduce the incidence of breakage and elongation, improving outcomes.
Static facial suspension (SFS) continues to play an important role in the rehabilitation of facial paralysis in select patients. The procedure continues to evolve because new materials and simpler, more efficient techniques have been used with improved results. Fascia lata, expanded polytetrafluoroethylene (PTFE) (Gore-Tex; W. L. Gore & Associates, Flagstaff, Ariz), and human acellular dermis (AlloDerm; LifeCell Corporation, Branchburg, NJ) are among the numerous materials that have been used for SFS in the past. Although they are effective for suspension, human acellular dermis and expanded PTFE require extensive dissection for positioning in the midface. The dissection increases operative time and makes revisions or reversal difficult at best. In addition, our experience with expanded PTFE has been marred by frequent wound complications, which have been observed by other authors as well.1-2 To avoid some of these disadvantages, a trend has developed in our own practice toward the use of SFS with suture.
We have adopted a technique similar to that described by Alex and Nguyen.3 Three vectors are marked on the patient that originate at the Lateral orbital rim and insert on the Nasolabial fold at the nasal ala, midfold, and oral commissure regions. The lateral orbital rim is exposed and stab incisions are made at each nasolabial fold site. A long Keith needle is used to pass a suture Subcutaneously from the lateral orbital rim to each stab incision. Each suture is then passed through a small PTFE pledget to prevent suture loop slippage and migration. The sutures are passed back to the lateral rim, and an appropriate amount of tension is placed on each to recreate the nasolabial fold and maintain a horizontal configuration of the oral aperture. A bone tunnel is created in the lateral orbital rim through which the suspension sutures are secured (Figure 1).
Figure 1. Three vectors are marked on the patient, originating at the lateral orbital rim and inserting on the nasolabial fold at the nasal ala, midfold, and oral commissure.
A, The lateral orbital rim is exposed and stab incisions are made at each nasolabial fold site.
B, A long Keith needle is used to pass a suture subcutaneously from the lateral orbital rim to each stab incision.
C, Each suture is then passed through a small polytetrafluoroethylene pledget to prevent suture loop migration.
D, The sutures are passed back to the lateral rim, and an appropriate degree of tension is applied to each.
E, Improved oral commissure position and redefined nasolabial fold are present at completion of the procedure.
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