A Zone-Specific, Minimally Invasive Approach with a Rotary Cutting System for Moderate-to-Severe Fibrotic Buffalo Hump.

Abstract

Background: The management of moderate-to-severe fibrotic buffalo hump remains challenging, as current treatment options range from minimally invasive but suboptimal techniques to invasive open procedures. This study aimed to evaluate the efficacy and safety of a novel zone-specific surgical strategy using a rotary cutting system for this condition.

Methods: A retrospective cohort study was conducted on 56 patients with fibrotic buffalo hump. A zone-specific strategy was employed: The avascular central zone (Zone I) was resected using a rotary cutting system, while the vascular-rich peripheral zone (Zone II) was managed with blunt dissection and liposuction. Outcomes were assessed using an observer-rated 4-point aesthetic scale and the patient-reported Neck Extension Mobility Score (NEMS).

Results: The mean follow-up duration was 8 months. Most patients (92.9%, 52/56) achieved "Good" or "Excellent" aesthetic outcomes. Functional improvement was significant postoperatively, with the proportion of patients experiencing moderate-to-severe mobility restrictions (NEMS 3-4) dropping from 69.6% preoperatively to 5.4% postoperatively. Complications were minor, primarily transient numbness (25.0%), with a 3.6% seroma rate and no instances of hematoma or infection.

Conclusion: The zone-specific application of a rotary cutting system is a safe and effective advanced minimally invasive option for moderate-to-severe fibrotic buffalo hump, potentially bridging the therapeutic gap between minimally invasive and open procedures.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .