Background: The cheek advancement flap was used to repair defects of the 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 sequence and location of suture placement. Objective: The purpose of the terminology change was to improve teaching concepts of tissue movement. Methods: A series of 40 cases explored the use of a tension-bearing suture at the base of the cheek advancement flap, which was anchored to the fascia and periosteum at the nasal notch of the maxilla. In placement 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 of the nasal cheek junction (sulcus) occurred. In all cases, the procedure restored the contours of the area. Conclusion: This redefinition of the key suture into tension-bearing and aligning suture helped the novice to place the tension-bearing suture first. In the example of the cheek advancement flap, careful placement of the tension-bearing suture promoted the restoration of the nasolabial fold.
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