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Effects of Skin-Flap Undermining and Superficial Musculoaponeurotic System Suspension

LTC Lawrence P. A. Burgess, MC, USA; MAJ John D. Casler, MC, USA; MAJ Thomas C. Kryzer, MC, USA; J. REGAN THOMAS, MD

Arch Otolaryngol Head Neck Surg. 1993;119(2):173-177.

Abstract
• This study was conducted to determine the effects of skin-flap undermining and superficial musculoaponeurotic system (SMAS) suspension on wound-closing tension. Nine sides from five fresh-frozen cadavers were used, with closing tension measured at the two main anchor points, anteriorly (A) and posteriorly (P), with and without SMAS plication for minimal (MIN), intermediate (INT), and maximal (MAX) skin-flap undermining. Results indicated that closing tension was significantly decreased with SMAS plication, both A and P, for all three levels of skin undermining. The average decrease in closing tension with SMAS plication was: A-MIN 191 g, A-INT 95 g, A-MAX 83 g, P-MIN 235 g, P-INT 68 g, and P-MAX 70 g (P<.001 for all). Considering the effect of skin-flap undermining alone, closing tension decreased with wider skin-flap undermining, both with and without SMAS plication. The tension-reducing effect of SMAS plication was decreased with wider skin-flap undermining. Regression analysis determined a second-order exponential curve relating closing tension to skin excision.

(Arch Otolaryngol Head Neck Surg. 1993;119:173-177)

Author Affiliations
St Louis, Mo

From the Otolaryngology–Head and Neck Surgery Service, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Md.

Footnotes
Accepted for publication August 20, 1992.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.

Reprint requests to Otolaryngology–Head and Neck Surgery Service, Tripler Army Medical Center, ATTN: HSHK-DSH, Tripler, HI 96859-5000 (Dr Burgess).

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