手術[2]切除＋Z形成術 余剰皮膚切除とZ形成術の併用による頸部の若返り手術

Neck Rejuvenation with Excess Skin Excision and Z-Plasty Combined

はじめに

　顎下部のたるみは加齢性変化や肥満などによって生じ，顔貌の印象を決定する重要な要素の1つである。本稿では，余剰皮膚（たるみ）切除とZ形成術の併用による術式について述べる。

　Neck rejuvenation with excess skin excision and a Z-plasty utilizes the effects of a Z-plasty, the straight-line segmentation effect, and the tetrahedron (turning peaks into valleys) effect. It is also a method for performing a Z-plasty according to the contour line of the transition between the submandibular and the cervical region on the straight suture line from the submandibular region to the cervical region caused by excision of the slack. As a result, by bringing the direction of the wound closer to the relaxation line of the neck, it is possible not only to make postoperative scars inconspicuous but to also reproduce the contour line more clearly from the lower jaw to the neck.

　The main methods for removing the slack in the submandibular area include (i) pulling the superficial musculo-aponeurotic system (SMAS) and the platysma muscle by approaching from around the auricle, using threads, and (ii) liposuction. The advantages of neck rejuvenation with excess skin excision and a Z-plasty method compared to those methods are: (1) There are few important nerves and blood vessels in the sagging submandibular-to-midline portion of the neck, and thus the risk of complications due to surgery is extremely low; (2) the contour line from the lower jaw to the neck can be clarified by the effect of the Z-plasty, (3) it can be easily performed with local anesthesia and is minimally invasive, and (4) excess skin can be used as a local flap. Regarding advantage (1) in particular, there is a risk of damaging the marginal mandibular branch of the facial nerve and the branch of the facial artery during subcutaneous dissection in a facelift approached from the auricle side. With the excess skin excision plus Z-plasty method, the surgical operation site is away from those nerves and blood vessels, and the operation can be performed safely. It is difficult to clarify the contour line from the lower jaw to the neck in many cases by a thread-lift method or liposuction because it is not possible to excise excess skin.

　A disadvantage of the excess skin excision plus Z-plasty method is that scarring is more conspicuous compared to other methods since the surgical wound is in the exposed part of the mandibular midline. However, considering advantage (3), this method would be suitable for middle-aged and elderly individuals. Based on a thorough understanding of the methodʼs merits and demerits and with the selection of suitable cases, the excess skin excision plus Z-plasty surgical procedure can be considered one of the effective options for removing slack in the submandibular region.