PHOENIX In the face of myriad short-scar rhytidectomy techniques, suture extrusion rates and efficacy of lift are two variables that can help surgeons identify their preferred approach, Dr. Neil Tanna said at the annual meeting of the American Academy of Cosmetic Surgery.
Although secure suspension of the superficial musculoaponeurotic system (SMAS) is indispensable for effective results, there are numerous SMAS suspension techniques and no consensus on which is superior, said Dr. Tanna, who is a resident in otolaryngology and head and neck surgery at George Washington University in Washington.
"Surgeon preference is usually based on the efficacy of the achieved lift and the rate of suture extrusion," he said in an interview, explaining that suture extrusion disrupts the biomechanical properties of the manipulated tissue.
"With the loss of deep tissue support, there is an increase in wound tension and an increased risk of necrosis, scarring, trophic changes, and contour defect," Dr. Tanna said.
His retrospective study compared 1,850 short-scar rhytidectomies performed by one surgeon between January 2002 and January 2006, with the primary outcome being the rate of suture extrusion. All patients also received cervicofacial liposuction at the time of the surgery and were divided into six groups based on the type of SMAS plication they underwent.
In group A, 100 patients received O-shaped purse-string sutures (20 Ethibond). For the 100 patients in group B, both O-shaped and U-shaped purse-string sutures (20 Ethibond) were used. Interrupted horizontal mattress sutures were used for the 50 patients in group C (20 Ethibond), 50 patients in group D (20 Vicryl), and 50 patients in group E (20 Mersilene). Group F included 1,500 patients in whom a two-layer running locked plication stitch was used with a braided, nonabsorbable suture (20 Mersilene).
After at least 6 months of follow-up, the patients were compared in terms of rate, type, and location of suture extrusion.
Group A had a 5% rate of suture extrusion, compared with 8% for group B, 6% for group C, and 1.2% for group F, reported Dr. Tanna. Although groups D and E had no suture extrusions, he concluded that patients in group F had achieved the best overall outcome in terms of both lift and a low rate of suture extrusion.
Although the study didn't formally "evaluate the efficacy of the achieved lift while looking at suture extrusion … anecdotal experience suggests that the two-layer plication stitch employing a braided nonabsorbable suture allows an effective SMAS suspension with a tolerable rate of suture extrusion," he said.
This patient is undergoing the two-layer running locked superficial musculoaponeurotic system plication with a braided, nonabsorbable suture. Courtesy Dr. Neil Tanna