Successfully exploiting two opposing forces: a rational explanation for the "interlocking suture".

Area of Science:

• Plastic Surgery
• Biomechanical Engineering
• Surgical Innovation

Background:

• Periareolar surgery complications include poor scarring, asymmetry, and malposition of the nipple-areola complex (NAC).
• Traditional breast reduction and pexy techniques with extensive circumareolar excision contribute to these issues.
• The interlocking suture was introduced in 2007 to mitigate these common periareolar surgery complications.

Purpose of the Study:

• To evaluate the efficacy of the interlocking suture in managing forces between the NAC and surrounding breast tissue.
• To demonstrate the interlocking suture's ability to reduce common complications in periareolar surgery.

Main Methods:

• Finite Element Method (FEM) software was employed for analysis.
• Skin strain was quantified by comparing traditional interrupted stitches, round-block sutures, and interlocking sutures.
• Biomechanical forces on the nipple-areola complex and surrounding tegument were assessed.

Main Results:

• The interlocking suture demonstrated a more advantageous distribution of forces compared to other methods.
• FEM analysis revealed a 14% reduction in peripheral skin stress with the interlocking suture versus round-block.
• A 15% reduction in peripheral skin stress was observed compared to traditional sutures, and a 9.9% reduction at the areolar edge.

Conclusions:

• The interlocking suture's unique design effectively reduces tension between the NAC and breast tegument edges.
• This tension reduction contributes to improved scar quality and long-lasting results in periareolar surgery.
• The interlocking suture offers a superior method for managing forces in breast reduction and pexy procedures.