- Jesse Selber, MD, MPH
Jesse Selber, MD, MPH
- Assistant Professor
- MD Anderson Cancer Center
- Ashley K Christiani, MD
Ashley K Christiani, MD
- Adjunct Clinical Professor
- University of California San Francisco School of Medicine
The basic Z-plasty is composed of a central limb incision and two lateral limb incisions which form a 'Z'. The lengths of the three limbs and the angles formed between the central and lateral limbs are equal. The incisional pattern creates two triangular tissue flaps that are transposed, changing both the length and orientation of a wound or scar.
This topic will review the indications and technique for Z-plasty. Simple wound closure with sutures and staples is discussed elsewhere. (See "Closure of skin wounds with sutures" and "Closure of minor skin wounds with staples".)
The primary reasons to perform a Z-plasty are to improve contour, release scar contracture, relieve skin tension, and mobilize tissue for reconstructive surgery. This technique is rarely needed for the acute management of open wounds.
Z-plasty has four main tissue effects:
●Redirection of scar - The new scar reorients from the axis of the central limb to a line connecting the tips of the lateral limbs. Z-plasty is used to redirect scar into "relaxed skin tension lines" (ie, Langer's lines) (figure 1), natural skin folds, or along the border of an aesthetic unit (ie, nasolabial fold) to improve cosmetic or functional outcome.
- Freiling D, Galla M, Lobenhoffer P. [Arthrolysis for chronic flexion deficits of the knee. An overview of indications and techniques of vastus intermedius muscle resection, transposition of the tibial tuberosity and z-plasty of the patellar tendon]. Unfallchirurg 2006; 109:285.
- Aslan G, Tuncali D, Cigsar B, et al. The propeller flap for postburn elbow contractures. Burns 2006; 32:112.
- Robson MC, Barnett RA, Leitch IO, Hayward PG. Prevention and treatment of postburn scars and contracture. World J Surg 1992; 16:87.
- Ketchum LD. The use of the full thickness skin graft in Dupuytren's contracture. Hand Clin 1991; 7:731.
- Furnas DW, Fischer GW. The Z-plasty: biomechanics and mathematics. Br J Plast Surg 1971; 24:144.
- Olbricht S, Liégeois NJ. Closing surgical defects of the external ear. Semin Cutan Med Surg 2003; 22:273.
- Farroha A, Hanna H. Reconstruction of symptomatic postoperative vaginal shortening using Z-plasty. Int J Gynaecol Obstet 2008; 102:75.
- Pomazkin VI, Mansurov IuV. [Choice of operation for treatment of patients with pilonidal sinus]. Vestn Khir Im I I Grek 2008; 167:85.
- Seyhan T, Kýlýnr H. Median cleft of the lower lip: report of two new cases and review of the literature. Ann Otol Rhinol Laryngol 2002; 111:217.
- Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg 1973; 26:237.
- Hudson DA. Some thoughts on choosing a Z-plasty: the Z made simple. Plast Reconstr Surg 2000; 106:665.
- Roggendorf E. The planimetric Z-plasty. Plast Reconstr Surg 1983; 71:834.
- Suzuki S, Um SC, Kim BM, et al. Versatility of modified planimetric Z-plasties in the treatment of scar with contracture. Br J Plast Surg 1998; 51:363.
- Sillitoe AT, Platt A. The Z-plasty simulator. Ann R Coll Surg Engl 2004; 86:304.
- Hove CR, Williams EF 3rd, Rodgers BJ. Z-plasty: a concise review. Facial Plast Surg 2001; 17:289.
- TYPES OF Z-PLASTY
- Z-plasty variations
- PREOPERATIVE ISSUES
- Wound/scar evaluation
- Antibiotic prophylaxis
- Patient counseling
- Preoperative marking
- General technique
- POSTOPERATIVE CARE
- Special wound considerations
- SUMMARY AND RECOMMENDATIONS