Suture Biomechanics and Static Facial Suspension（2）
Advantages of this suture technique vs. alternative techniques and materials include minimal dissection, shorter operative time, ease of revision, and a decreased number of complications. The procedure is also easily reversed and can be performed more feasibly as a delayed procedure if necessary. Similar advantages to performing SFS with suture have been cited by other investigators.3 Although many suture options exist, we believe that familiarity has led most reconstructive surgeons to use predominantly polypropylene suture (Prolene; Johnson & Johnson, New Brunswick, NJ) for this procedure. We too initially adopted polypropylene but have observed some disadvantages to the use of that material. Size 3-0 polypropylene sutures have been observed to fail during the early postoperative period.2 Patients report a Snap or Popping sound when the facial suspension fails, suggesting that suture Breakage has occurred. A second disadvantage is the need to anticipate and estimate inevitable suture stretch or relaxation. This necessitates initial surgical Overcorrection with all 3 sutures, but especially at the Oral commissure, to obtain a satisfactory long-term result (Figure 2). Breakage and Elongation are major disadvantages of the suture technique when using polypropylene and, prior to this study, we had no experience using alternative suture materials. Complications due to breakage and elongation are possible but less frequent when using expanded PTFE or human acellular dermis for SFS. Although the biomechanical properties of expanded PTFE and human acellular dermis as used in SFS have been studied, suture materials when used in this capacity have not.4-5 A comparison of the biomechanical properties of different suture types for use in SFS may provide guidance in selecting optimal suspension materials that promote improved patient outcomes. Manufacturers perform biomechanical testing on their suture materials during research and development, but such testing is not performed to emulate the context of SFS and we have found the data difficult to obtain. Our aim in this study was to perform objective biomechanical testing on various suture types to assess their suitability for use in SFS.
Figure 2. This patient underwent static facial suspension following extirpation of a left parotid adenoid cystic carcinoma requiring resection of the facial nerve.
A, In the early postoperative period (1 month after surgery), the overcorrection seems excessive and the patient was initially dissatisfied with his appearance.
B, After suture stretch and elongation, the patient has an acceptable final result at 21 months after surgery.
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