Suspension sutures in facial reconstruction.

Abstract

Suspension, pexing, or tacking sutures were used in facial cosmetic surgery and have recently been used in facial reconstruction. Suspension sutures are used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction (e.g., ectropion or eclabium), to reform a fold that would be obliterated by the motion of tissue, and to prevent tenting across concavities. Although suspension sutures may help to reduce the spreading of scars in wounds closed under tension, they do not prevent some spreading. The suturing technique requires a stable structure for attachment of the suspension sutures and lax tissue to advance into the wound. On the face, a stable base exists under junctions of cosmetic units along the orbital rim, zygomatic arch, nasal vestibule, and mental crease of the chin. When the deep roll of the needle includes superficial musculoaponeurotic system with the first segment or the pulling arm of the suspension suture, tissue advancement is obtained. The second or anchoring segment is placed with the needle encompassing a very tight arc traveling in a U-shaped pass into the fascia extending to the periosteum. Suspension sutures enable linear closures, prevent distortion of free margins, prevent tenting across concavities, and fix the closure line at the junction of cosmetic units. By redirecting tension, suspension sutures mold surface contours to mimic the natural folds and curves of the face. Judicious use of suspension sutures permits simpler aesthetic reconstructive procedures than might be achieved without their use. Suspension sutures used in this manner help to apply the theoretical concepts of facial reconstruction using facial cosmetic units by performing segmental facial reconstruction.