title: Analysis of flap tension in surgical rejuvenation of the midface: a cadaver study.
abstract: OBJECTIVE
  To determine the flap tension present for 2 different surgical approaches for midface lifts and whether a gingivobuccal incision for release of the midface periosteum will diminish the resultant load on the midface flap.
  
  
  METHODS
  Cadaver study.
  
  
  METHODS
  Anatomy laboratory at the University of Florida.
  
  
  METHODS
  Twelve fresh-frozen cadaver heads are subjected to a transblepharoplasty (TB) approach on one side of the cadaver head while a transtemporal (TT) approach is performed on the contralateral side. The tension (grams) generated by moving the midface flap a distance of 1.03 cm is recorded by a digital load cell. A gingivobuccal incision is made on each side to allow transoral periosteal release (TOPR) of the midface flap, and the experiment is repeated. Three trials are performed for each operation, and the average load is calculated. A paired t test is applied.
  
  
  RESULTS
  The tension resulting from the TT approach (172 g) was not found to be significantly different from that of the TB approach (179 g; P = .75). Significant differences in the resultant tension were not appreciated when comparing standard techniques to TT with TOPR (141.5 g; P = .27) or for TB with TOPR (164.1 g; P = .45).
  
  
  CONCLUSIONS
  An experimental method is described for determining flap tension in facial rejuvenation surgery. No significant difference is found between flap tensions generated in the TB and TT approaches to the midface.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Herrero
authors.forename: Ethan G
authors.initials: EG
authors.lastname: Sherman
authors.forename: Robert T
authors.initials: RT
authors.lastname: Adelson
mesh_terms: D018592:Cross-Over Studies; D006801:Humans; D010521:Periosteum / Q000637:transplantation*; D011446:Prospective Studies; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D013524:Surgical Flaps / Q000502:physiology*; D013718:Tensile Strength