Ritidoplastia y manejo del cuello postbariátrico: técnica con disección cervical extendida / Rithydoplasty and postbariatric neck management: extended cervical disection technique

RESUMEN

Introducción y objetivo: La ritidoplastia ha tenido una evolución constante desde su descripción, sin embargo, siempre ha estado dirigida a pacientes que la solicitan por envejecimiento natural, enfocándose a la región centrofacial.El objetivo de este trabajo es describir una técnica quirúrgica dirigida a pacientes sometidos a cirugía bariátrica que, tras perder masivamente peso, presentan secuelas severas no solo en cara sino también en cuello.Material y método.Técnica de ritidoplastia con disección cervical extendida (hasta borde supraclavicular) para liberar piel y obtener mayor tracción, que junto a plicatura lateral del platisma, corrigen el aspecto de cuello pesado característico de los pacientes con pérdida ponderal importante mediante supracorrección de ángulo mentocervical y surco cervicofacial. Evaluamos la eficacia por los resultados obtenidos y la seguridad por las complicaciones presentadas.Resultados.Recogemos 65 pacientes que cumplieron protocolo perioperatorio postbariátrico y presentaron secuelas severas que ameritaron el procedimiento. El 97.4% mujeres, edad promedio de 44.7 años; 98.7% sometido a bypass gástrico con pérdida promedio de 52.55 kg. En el 67.69% practicamos ritidoplastia como tercer tiempo quirúrgico (tras contorno inferior y superior). Tiempo quirúrgico promedio de 3.7 horas y complicaciones generales del 9.18%. En cuento a la satisfacción en la corrección de secuelas, el 84.6% reportó un resultado satisfactorio alto y el 12.3% moderado.Conclusiones.La técnica de ritidoplastia con disección extendida de cuello en pacientes postbariátricos resulta eficaz, segura y sobre todo, reproducible. (AU)

ABSTRACT

Background and objective: Rithydoplasty had a constant evolution since its description, however, it has always been directed at patients who request it due to the natural aging process, with all techniques focusing on the central facial region.The objective of this paper is to describe a surgical technique aimed at patients who underwent bariatric surgery and who, after losing weight on a massive scale, had severe sequelae not only on the face but also on the neck.Methods.A rithydoplasty technique was performed with extended dissection of the cervical region (up to the supraclavicular edge), to free the skin from the area and achieve greater traction, which, together with a lateral plication of the platysma, correct that aspect of heavy neck characteristic of patients with significant weight losses through over correction of the menthocervical angle and the cervicofacial sulcus. Efficacy was evaluated by the results obtained and safety according to the complications presented.Results.Sixty-five patients who complied with the postbariatric perioperative protocol and with severe sequelae were included; 97.4% were women, average aged 44.7 years; 98.7% underwent gastric bypass, with an average loss of 52.55 kg. The 67.69% underwent rhytidoplasty as the third surgical time (after lower and upper body lifting). The average surgical time was 3.7 hours and the general complications were 9.18%. Regarding satisfaction in the correction of sequelae, 84.6% reported a high satisfactory result and 12.3% moderate.Conclusions.Rhytidoplasty with extended neck dissection in postbariatric patients is an effective technique, safe and, most of all, a reproducible technique. (AU)