title: Suture biomechanics and static facial suspension.
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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA. chumphrey@kumc.edu
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Humphrey
authors.forename: Terence E
authors.initials: TE
authors.lastname: McIff
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Sykes
authors.forename: Terance T
authors.initials: TT
authors.lastname: Tsue
authors.forename: J David
authors.initials: JD
authors.lastname: Kriet
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D020099:Coated Materials, Biocompatible; D004548:Elasticity; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures
chemical_list: D020099:Coated Materials, Biocompatible; D011091:Polyesters; D011126:Polypropylenes; D011138:Polytetrafluoroethylene