title: Avoiding early revision rhytidectomy: a biomechanical comparison of tissue plication suture techniques.
abstract: BACKGROUND
  Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress.
  
  
  OBJECTIVE
  To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double-layered running locking (DRL) stitch and multiple horizontal mattress stitches.
  
  
  METHODS
  Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points.
  
  
  RESULTS
  There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P-value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P-value of .08.
  
  
  CONCLUSIONS
  The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long-lasting, youthful cosmetic result.
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, The George Washington University, Washington DC 20037, USA. jbw28@columbia.edu
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: White
authors.forename: Mathieu
authors.initials: M
authors.lastname: Barraja
authors.forename: Tewodros
authors.initials: T
authors.lastname: Mengesha
authors.forename: Sumit
authors.initials: S
authors.lastname: Bose
authors.forename: Samaneh
authors.initials: S
authors.lastname: Ashktorab
authors.forename: Ryan
authors.initials: R
authors.lastname: Bahn
authors.forename: Ryan
authors.initials: R
authors.lastname: Vallance
authors.forename: William H
authors.initials: WH
authors.lastname: Lindsey
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D062109:Dermatologic Surgical Procedures; D005152:Facial Muscles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008722:Methods; D008962:Models, Theoretical; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D015361:Rhytidoplasty / Q000379:methods*; D012867:Skin / Q000503:physiopathology; D013536:Suture Techniques; D013552:Swine; D013718:Tensile Strength; D016474:Weight-Bearing / Q000502:physiology; D014945:Wound Healing / Q000502:physiology
chemical_list: D011093:Polyethylene Terephthalates; C025539:Lavsan