Angelos Patrick C, Brennan Tara E, Toriumi Dean M
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Illinois at Chicago.
JAMA Facial Plast Surg. 2014 May-Jun;16(3):199-205. doi: 10.1001/jamafacial.2013.2738.
IMPORTANCE It is unknown whether poly-4-hydroxybutyric acid (P4HB)-reinforced superficial musculoaponeurotic system tissue (SMAS) plication techniques will support SMAS imbrication and plication and potentially improve outcomes in rhytidectomy. OBJECTIVES To evaluate the biomechanical properties (tissue breaking strength, suture tearing force, and stress relaxation) of the SMAS with vs without reinforcement with P4HB absorbable mesh and to correlate these results with potential clinical applications. DESIGN, SETTING, AND SAMPLES In a cadaver study at an academic setting, 12 fresh frozen cadaver heads were used. Rhytidectomy incisions were made, and the SMAS was harvested and prepared for strength and stress testing using an Instron device. MAIN OUTCOMES AND MEASURES Tissue breaking strength and suture tearing force were analyzed. Stress relaxation test results were also assessed. The results of the SMAS samples alone were compared with those reinforced with P4HB absorbable mesh. RESULTS Overall, there were significant differences noted in tissue breaking strength and suture tearing force between the 2 groups. When the SMAS was reinforced with absorbable mesh, significant improvements were observed in tissue breaking strength (P < .001) and suture tearing force (P < .003). In addition, less variability was demonstrated in the maximum tensile load-bearing quality of the SMAS when the repair was reinforced with P4HB. CONCLUSIONS AND RELEVANCE Reinforcement with P4HB absorbable mesh improves tissue breaking strength and suture tearing force in cadaveric SMAS. It also reduces the variability in load vs displacement seen among samples tested. These data suggest that P4HB-reinforced SMAS imbrication would support higher loads and provide more consistent, long-lasting SMAS support among patients undergoing rhytidectomy. Further studies are needed to correlate these data with clinical outcomes in rhytidectomy.
重要性 聚-4-羟基丁酸（P4HB）增强的表浅肌肉腱膜系统组织（SMAS）折叠技术是否能支撑SMAS重叠和折叠，并有可能改善除皱术中的效果尚不清楚。目的 评估有无P4HB可吸收网片增强的SMAS的生物力学特性（组织断裂强度、缝线撕裂力和应力松弛），并将这些结果与潜在的临床应用相关联。设计、地点和样本 在一所学术机构进行的尸体研究中，使用了12个新鲜冷冻的尸体头部。制作除皱切口，采集SMAS并使用英斯特朗设备进行强度和应力测试准备。主要结局和测量指标 分析组织断裂强度和缝线撕裂力。还评估应力松弛测试结果。将单独的SMAS样本结果与用P4HB可吸收网片增强的样本结果进行比较。结果 总体而言，两组之间在组织断裂强度和缝线撕裂力方面存在显著差异。当SMAS用可吸收网片增强时，在组织断裂强度（P＜0.001）和缝线撕裂力（P＜0.003）方面观察到显著改善。此外，当用P4HB增强修复时，SMAS的最大拉伸承重质量的变异性较小。结论和相关性 用P4HB可吸收网片增强可提高尸体SMAS的组织断裂强度和缝线撕裂力。它还减少了测试样本中负荷与位移之间的变异性。这些数据表明，P4HB增强的SMAS折叠将支持更高的负荷，并在接受除皱术的患者中提供更一致、持久的SMAS支撑。需要进一步研究将这些数据与除皱术的临床结果相关联。
