Is "Clack" Enough? Rib Remodeling Guided by Ultrasound

Rib remodeling is a surgical technique that allows waist contouring in women and men. This study proposes that the "clack" sound heard in ultrasound-guided scarless rib remodeling (RibXcar technique) is not evidence of the completion of the surgery, but rather, the use of ultrasound is necessary to identify angulations, loss of bone strength, and ultrasound visualization of the loss of bone continuity, and thus consider cosmetic rib surgery to be complete. This study was performed on 100 Peruvian women aged 18-40 years who voluntarily agreed to a rib remodeling procedure. The RibXcar technique was used, and intraoperative ultrasound was performed to obtain objective information during each patient's procedure. Of the total number of patients who underwent surgery with the RibXcar technique, the "clack" sound was detected in 90% of patients, and no "clack" sound was detected in the remaining 10% of patients. However, the use of ultrasound revealed monocortical fractures in 100% of patients. It is observed that of the total number of patients, only in 90% was the "clack" heard; however, in 100% there was a monocortical fracture evaluated in the immediate postoperative period. We suggest not considering the "clack" as the end point of the surgery; instead, define the end point after the use of the ultrasound examination, which provides information on angulations, the loss of bone resistance, and ultrasound visualization of the loss of bone continuity.