PLACEMENT OF THE TENSION-BEARING SUTURE IN REPAIRING THE ALAR FACIAL JUNCTION

Background: The cheek advancement flap was used to repair defects of t he concave junctional zone of the nasal base, the medial aspect of the cheek, and the upper lip. Prior description of the sequence of suture placement depended on the concept of the initial suture or key suture . Splitting the functions of the initial suture into its functions of tension bearing or aligning aided the surgeon in determining the seque nce and location of suture placement, Objective: The purpose of the te rminology change was to improve teaching concepts of tissue movement. Methods: A series of 40 cases explored the use of a tension-bearing su ture at the base of the cheek advancement flap, which was anchored to the fascia and periosteum at the nasal notch of the maxilla. Tn placem ent of this suture, the pyramid of the nose was elevated and the flap slid under the nose. Results: Two complications occurred: one case of flap tip necrosis and one infection. There were no cases of bridging o f the nasal cheek junction (sulcus) occurred. In all cases, the proced ure restored the contours of the area. Conclusion: This redefinition o f the key suture into tension-bearing and aligning suture helped the n ovice to place the tension-bearing suture first. In the example of the cheek advancement flap, careful placement of the tension-bearing sutu re promoted the restoration of the nasolabial fold.