Z-plasty is a versatile

plastic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...

technique that is used to improve the functional and cosmetic appearance of

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

s. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central element) is made along the line of the greatest tension or contraction, and triangular flaps are raised on opposite sides of the two ends and then transposed. The length and angle of each flap are usually the same to avoid mismatched flaps that may be difficult to close. Some possible complications of Z-plasty include flap

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

, haematoma (blood clot) formation under the flaps, wound infection, trapdoor effect and sloughing (necrosis) of the flap caused by wound tension and inadequate blood supply.

Classification

Z-plasties can be functional (elongate and relax scars) or cosmetic (realign scars to make them less noticeable). They can be single or multiple. Variations include skew and planimetric Z-plasties.

Technique

The transposition of two triangular flaps The incisions are designed to create a Z shape with the central limb aligned with the part of the scar that needs lengthening or re-aligning. The traditional 60° angle Z-plasty will give a theoretical lengthening of the central limb of 75%. Single or multiple z-plasties can be used. Specific modifications include the double-opposing z-plasty (sometimes called a "jumping man" flap) which can be useful for release of webbing of the medial canthus or release of 1st web space contractures. It is one of the techniques used in scar revision, especially in

burn scar contracture Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar ...

Functional Z-plasty

The lengthening of a scar. Used to help relax or release linear burn scar contractures. The technique is dependent on the availability of mobile adjacent skin.

Cosmetic Z-plasty

The irregularisation of a scar to make it less noticeable. Re-alignment of the central element can place the scar in natural skin tension lines and thereby disguise it. One of a family of similar techniques (such a W plasty).

History

The first Z-plasty was performed by

Horner Horner is an English and German surname that derives from the Middle English word for the occupation ''horner'', meaning horn-worker or horn-maker, or even horn-blower. People *Alison Horner (born 1966), British businesswoman * Arthur Horner (dis ...

in 1837, followed by Denonvilliers in 1854, both for correction of

ectropion Ectropion is a medical condition in which the lower eyelid turns outwards. It is one of the notable aspects of newborns exhibiting congenital Harlequin-type ichthyosis, but ectropion can occur due to any weakening of tissue of the lower eyelid. ...

. The first standard double transposition Z-plasty was reported by Berger in 1904, and McCurdy introduced the term in 1913.

References

External links

eMedicine: Z-plasty

eMedicine: Z-plasty images
{{Skin and subcutaneous tissue procedures Plastic surgery