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David C. Brodner, MD; J. Crawford Downs, MS,MA; H. Devon Graham III, MD

Arch Facial Plast Surg. 2002;4:248-251.

Objectives  To define the postoperative time interval required for elevated periosteum to readhere to the skull and regain its preoperative strength, and to evaluate whether fixation of the periosteum affects this interval or the strength of postoperative readhesion.

Design  Prospective analysis of variance and covariance with repeated measures.

Subjects  Thirty-six New Zealand white rabbits, each serving as its own control.

Interventions  Subperiosteal elevation was performed on one side of the skull, leaving the contralateral periosteum untouched. The periosteum in half of the subjects was lifted and fixed to a resorbable screw, with the comparison group undergoing subperiosteal elevation only, without lifting and fixation. Several adhesion characteristics were subsequently examined at postoperative weeks 1, 3, 5, 7, 8, 9, 10, 11, and 12. Half of the subjects were assessed histologically to determine attachment of periosteum onto underlying bone. The other half underwent analysis of periosteal readhesion strength.

Results  The 3 independent measures of periosteal adherence to the skull all lacked significant differences between sides after the first postoperative week. Blinded histologic analysis showed no evidence of ongoing periosteal healing and demonstrated no difference between operated-on and nonoperated-on sides. Analysis of periosteal stiffness (P = .76) and energy density (P = .74) also demonstrated no significant differences between sides.

Conclusions  Periosteal readhesion after surgical elevation is virtually complete by the seventh postoperative day. In addition, tension secondary to periosteal elevation with suspension has no influence on postoperative healing. These findings will contribute to the debate regarding the most appropriate brow-lift fixation technique.

From the Departments of Otolaryngology–Head and Neck Surgery (Dr Brodner) and Biomedical Engineering (Mr Downs), Tulane University School of Medicine; and Department of Otolaryngology and Facial Plastic Surgery, Ochsner Clinic (Dr Graham), New Orleans, La. Dr Brodner is now with ENT Associates of South Florida, Boca Raton. No author holds any financial interests in Synthes Maxillofacial, Paoli, Pa.

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