Suspension Sutures Aid Facial Reconstruction

Background. Suspension, pexing or tacking sutures, which have a long history of use in facial cosmetic surgery, have only recently begun use in reconstruction. Objective. In this study, the suspension suture was used to fix the closure line at the junction of cosmetic units, to prevent distortion of free margins secondary to wound contraction, eg, ectropion or eclabium, to prevent tenting across concavities, and to prevent scar spreading of wounds closed under tension. The acute complications and long-term effectiveness of this suturing technique in achieving the 4 desired results were evaluated. Methods. During a 10-year period, 136 cases of surgical defects of the face created by the removal of nonmelanoma skin cancer by Mohs micrographic surgery were repaired using absorbable suspension sutures. The wounds were evaluated initially for acute complications of hemorrhage, infection, dehiscence, and necrosis; and later over 3 years for chronic sequela of hypertrophic scar, spread scar, contraction deformities such as distortion of free margins, and pigmentary changes. Results. Suspension sutures were used in 60 cases of primary layered closure and 76 flaps of the face. Suspension sutures allowed primary closure of defects that would have required flaps in 72% of the cases and prevented distortion of free margins. There were more acute and long-term complications related to excess tension with primary closure than with flaps. Suspension sutures fixed the closure line at the junction of cosmetic units, prevented tenting across concavities, and both features were maintained over the duration of the study. Conclusion. Suspension sutures aided in obtaining linear closures, prevented distortion of free margins, prevented tenting across concavities, and fixed the closure line at the junction of cosmetic units; however, they did not prevent spread scars.