The Z-plasty is really a technique that can be utilized to help stop scar contracture, or more commonly, as a technique of treating scar contracture. Essentially, two interdigitating triangular flaps are transposed resulting in: (1) a change in the orientation of the common limb of the Z; and (2) a lengthening of the common limb of the Z.
The change in orientation may be used for managing wounds, in which direct closure might result in undue tension and distortion of nearby structures, like in the face. The gain in length can be utilized for treating contracted scars. Both the length of the transverse limbs and their angle with the typical limb can be varied.
First, the greater the angle, the higher the amount of lengthening that will occur. A 45° angle will lengthen the common limb up to 50%, and a 60° angle up to 75%. The angles should generally not exceed 60° since excessive transverse shortening and tension will happen. Second, the limb length is determined by how much tissue is obtainable on either side: the more tissue is obtainable, the longer the limbs may be.
Planning the Z-Plasty
When releasing scar contracture, the Z-plasty is created as follows:
1. The typical limb of the Z is drawn along the length of the scar. The parallel, transverse limbs are drawn at 60° to the common limb.
2. The skin is incised along the Z shape, and any contracted scar is also incised.
3. Vascularity to the suggestions of the triangles must be maintained, since they are at the highest risk of necrosis. This is achieved by maintaining a broad base to the triangles, keeping the flaps as thick as feasible, avoiding undue transverse tension and handling the tissue with care.
4. The triangles are transposed, resulting in a reorientation of the transverse limbs along with a lengthening of the typical limb.
When reorienting the direction of a facial scar, the Z-plasty is created as follows:
1. The typical limb of the Z is drawn along the length of the scar. The new direction of the common limb is planned so that it'll lie in a natural skin crease such as the nasolabial fold.
2. The parallel, transverse limbs ought to extend from the ends of the common limb up to the skin crease in which the new typical limb will lie.
3. The skin is incised along the lines of the Z and also the triangles are transposed. If the blood supply to the suggestions of the flaps is robust, such as in the face, tip necrosis will not happen and angles more acute than 60° can be used.
Patient selection
The ideal candidate is one having a pronounced wrinkle pattern. In such individuals, the scar may be reoriented to lie in a pronounced line of election. Children, with their lack of wrinkles are not good candidates for Z-plasties on the face. If the original scar is markedly hypertrophic, the use of a Z-plasty is questionable. Scars that cross a hollow (bridle scars), such as the angle of the jaw, are also amenable to Z-plasty.
Several Z-Plasties
A single Z-plasty is limited by the transverse shortening resulting from reorientation of the transverse limbs of the Z. This creates lateral tension that is concentrated most heavily at the apices of each triangle. The use of several Z-plasties can offer the same degree of scar lengthening while considerably limiting the amount of transverse shortening.
When a scar is very long and would require enormous transverse limbs, multiple Z-plasties with shorter limbs might be more suitable. In practice, multiple Z-plasties are generally performed with their common limbs as one continuous unit.
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