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Original Investigation |

Biomechanical Properties of Superficial Musculoaponeurotic System Tissue With vs Without Reinforcement With Poly-4-hydroxybutyric Acid Absorbable Mesh

Patrick C. Angelos, MD1; Tara E. Brennan, MD1; Dean M. Toriumi, MD1
[+] Author Affiliations
1Division 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;16(3):199-205. doi:10.1001/jamafacial.2013.2738.
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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.

Level of Evidence  NA.

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Figures

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Figure 1.
Superficial Musculoaponeurotic System Tissue (SMAS) Flaps

A, Elevated SMAS flap (the medial extent is 1 cm lateral to the melolabial fold). B, Harvested SMAS flaps before processing. C, A 1 × 2-cm SMAS sample with mesh.

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Figure 2.
Instron Device

A, Tissue breaking strength testing using the Instron device. B, Suture tearing force testing using the Instron device.

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Figure 3.
Preparation of Superficial Musculoaponeurotic System Tissue (SMAS)11

A, SMAS only. B, SMAS with mesh.

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Figure 4.
Instron Device for Testing Tensile Properties of Superficial Musculoaponeurotic System Tissue (SMAS) With Mesh

The initial position of the device was approximately 2.5 cm so that the SMAS was under no load at the start of the test.11

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Figure 5.
Tissue Breaking Strength Data

SMAS indicates superficial musculoaponeurotic system tissue.

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Figure 6.
Suture Tearing Force Data

SMAS indicates superficial musculoaponeurotic system tissue.

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Figure 7.
Maximum Tensile Load Data11

SMAS indicates superficial musculoaponeurotic system tissue.

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Figure 8.
Mean Load vs Displacement Curves for SMAS Only and SMAS With Mesh11

SMAS indicates superficial musculoaponeurotic system tissue.

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