What is the treatment for buffalo hump deformity using TARD (Transverse Axillary Resection and Dissection)?

Treatment of Buffalo Hump Deformity Using TARD (Transverse Axillary Resection and Dissection)

TARD (tumescent anesthesia, release and debulking) is the most effective treatment for buffalo hump deformity, achieving favorable outcomes in 91.1% of cases with minimal complications and no recurrences at 8-month follow-up. 1

Understanding TARD Technique

TARD is a minimally invasive technique specifically designed for reshaping the dorsocervical contour in patients with buffalo hump deformity. The procedure consists of:

1. Tumescent anesthesia - Local infiltration of the treatment area
2. Sharp cannula release - Breaking down fibrous tissue
3. Multi-port liposuction cannula aspiration - For debulking the fat accumulation

This approach is particularly effective for fibrosis-rich dorsocervical humps, which are common in buffalo hump deformities, especially those associated with HIV antiretroviral therapy.

Advantages of TARD Over Other Techniques

• Minimal scarring - Uses small access points rather than large incisions
• Rapid recovery - Less invasive than traditional excisional techniques
• Effective for fibrous tissue - Unlike standard liposuction which often fails with fibrous buffalo humps
• Low complication rate - Only 26.7% experienced transient numbness that resolved within 6 months 1
• Long-term efficacy - No recurrences noted in follow-up studies

Surgical Planning Considerations

When planning TARD for buffalo hump correction:

• Preserve periosteal attachments when possible to maintain stability of the surrounding framework 2
• Use meticulous hemostasis to prevent hematoma formation which can complicate recovery 3
• Consider closed suction drainage if there is concern about fluid accumulation 3
• Avoid excessive undermining of skin to prevent deformities 3

Alternative Approaches

While TARD shows excellent results, other approaches have been documented:

1. Excisional lipectomy - Traditional approach with higher invasiveness but effective for large deformities

   • May be combined with suction-assisted lipoplasty (SAL) for optimal contouring 4
   • Showed no recurrences at 26.6 months follow-up in one study 4

2. Standard liposuction - Less effective for fibrous buffalo humps with variable short-term and long-term results 5

3. Adipocitolitic aqueous micro-gelatinous solution injections - Non-surgical option with promising results in limited studies 6

Post-Procedure Management

• Regular follow-up assessments to monitor for potential recurrence
• Continue monitoring if patient remains on antiretroviral therapy, as this may influence long-term outcomes
• Address any complications promptly (seroma, wound dehiscence, numbness)

Potential Complications and Management

• Transient numbness (26.7% of cases) - Typically resolves within 6 months without intervention 1
• Seroma - May require aspiration if significant
• Wound dehiscence - Usually managed with conservative wound care
• Recurrence - Less common with TARD compared to standard liposuction alone

Special Considerations for HIV-Associated Buffalo Hump

For patients with HIV-associated buffalo hump:

• Surgical treatment has shown favorable long-term effects even in patients continuing antiretroviral therapy 7
• Consider the fibrous nature of the hypertrophied fat when selecting the surgical approach
• TARD is particularly well-suited for these cases due to its effectiveness with fibrous tissue

TARD represents the most advanced and effective approach for buffalo hump deformity, offering excellent aesthetic outcomes with minimal invasiveness and complications.