Supplemental Materials for JAAD-D-26-02078R1, Directed Load-Bearing Buried Dermal Sutures as an Alternative to Periosteal Fixation in Cheek Rotation Flap Reconstruction: Outcomes in 79 Patients

Description

This dataset contains the supplementary figures (Supplementary Figures 1–3) supporting the manuscript "Directed Load-Bearing Buried Dermal Sutures as an Alternative to Periosteal Fixation in Cheek Rotation Flap Reconstruction: Outcomes in 79 Patients" by Hengy et al., published in the Journal of the American Academy of Dermatology. Supplementary Figure 1 shows the immediate postoperative result of an inferiorly based rotation-advancement flap. Supplementary Figures 2 and 3 show intraoperative and completed views of a superiorly based cheek rotation (Mustardé) flap, illustrating placement of load-bearing buried dermal sutures used as an alternative to periosteal fixation.

Steps to reproduce

Methods This is a retrospective case series conducted at a single-surgeon, referral-based dermatologic surgery center. All cheek rotation flap reconstructions performed by one Mohs surgeon between 2019 and 2025 were reviewed under an approved IRB protocol (Baylor Scott and White Research Institute IRB #025-420). Case identification: Of 687 total rotational cheek flap reconstructions reviewed, 79 met inclusion criteria: a classic superiorly based cheek rotation (Mustardé) flap or an inferiorly based rotation-advancement flap performed following Mohs micrographic surgery. Cases in which periosteal fixation sutures were used were excluded. Surgical technique: All included flaps were closed using a directed load-bearing buried dermal suture technique in place of periosteal anchoring sutures. Undermining was confined to the subdermal fat plane. One or two load-bearing buried dermal sutures were placed and oriented to redirect wound tension away from the lower eyelid, using 4-0 polyglactin 910 (Vicryl) or 4-0 polydioxanone (PDS). The leading edge at the lid margin was closed with epidermal sutures only. Suture placement and vector direction differed by flap type (temple/apical triangle for Mustardé flaps; sequential oblique sutures for inferiorly based flaps), as illustrated in the accompanying supplementary figures. Data collection and outcome measures: Chart review captured patient demographics (age, sex), anticoagulation status, diagnosis, defect size and location, flap type, follow-up duration, and postoperative outcomes, including rate of ectropion and need for oculoplastic referral. Analysis: Descriptive statistics (means, ranges, percentages) were used to summarize patient and outcome data; no inferential statistical testing or specialized statistical software is described. Instruments/reagents/software: No laboratory instruments or reagents were used. This was a clinical/surgical case series based on retrospective chart review and standard operative technique; no specialized software, imaging platforms, or analytic tools beyond standard clinical documentation were employed. Reproducibility notes: The technique itself (suture type, plane of undermining, suture orientation relative to flap type) is described in full in the manuscript and illustrated in Figure 1 and Supplementary Figures 1–3, which should allow surgeons to replicate the operative approach. Patient-level data beyond what's reported in Table 1 were not included in the supplementary materials to protect patient privacy.

Institutions

• Wayne State University

  Michigan, Detroit

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