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

Abstract

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.

Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review

“…A subset of the identified publications ( n = 12) involved in vitro studies, benchtop testing, cadaver studies, review articles, and ex vivo studies that were broadly categorized as “bench studies” as shown in Figure 2 , and Table 1 ( 5 – 8 , 22 , 36 – 42 ). Several major themes were identified within these studies, namely a correlation between the mechanical strength of P4HB meshes and their remaining molecular weight during degradation studies, as well as the cellular response to P4HB mesh constructs and their degradation products.…”

“…In the last decade, P4HB mesh has been clinically studied in the scientific literature across several surgical specialties ( 7 ). In the area of plastic and reconstructive surgery, P4HB mesh has been used primarily in breast surgery ( 13 – 21 ), with some early work in rhytidectomy ( 16 , 22 ). P4HB mesh has also been evaluated as a potential biomaterial for the repair of pelvic organ prolapse in urogynecological surgery ( 23 – 26 ).…”

Evaluating Pull-Out Strength of Barbed Suture In Vitro by Using Porcine Tissue and Polydimethylsiloxane (PDMS)

“…In another study conducted by Angelos et al, the SMAS tissue was harvested from 12 fresh-frozen cadaver heads and prepared for testing reinforcement with or without poly-4-hydroxybutyric acid (P4HB) absorbable mesh. Though care was taken to minimize the variability, large variations were still observed between the SMAS samples [ 31 ]. Therefore, the initial objective of this study was to replace human tissues with fresh animal tissues, which could be obtained easily with desirable amounts, qualities and sizes.…”

A Review of Midface Aging

“…16 This pattern of attachment is required to allow facial expression. 17 The orbitomalar ligament originates at the inferior orbital rim from the arcus marginalis, with fibers traversing the overlying orbicularis oculi muscle, finally inserting in the dermis, at the eyelid-cheek junction laterally and the nasojugal groove medially. 15,18 The orbitomalar ligament acts as the inferior boundary for orbital fat prolapse and may enhance the appearance of eyelid bags.…”