Procedure

Z-Plasty

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Z-Plasty

  • Definition
  1. Plastic surgery technique in scar revision
  • Indications
  • Scar revision (not for primary closure)
  1. Change scar direction
  2. Interrupt scar line to break up tension lines
  3. Lengthen scar to reduce scar traction
  • Prerequisites
  1. Skin must be loose at right angles to scar
  • Step 1
  • Layout incision plan with skin marker
  1. Line 1: Draw along the longitudinal scar axis
    1. Measure the length of line 1
    2. Line 1 runs from Point A to Point B
  2. Line 2: Draw at 60 degrees from Point A
    1. Should be exactly the length of Line 1 and 3
    2. Line 2 runs from Point A to Point C
  3. Line 3: Draw at 60 degrees from Point B
    1. Should be exactly the length of Line 1 and 2
    2. Line 2 runs from Point B to Point D
  4. Completed 3 lines form a Z Shape
    1. Line 1 forms the diagonal middle of the Z
    2. Line 2 and Line 3 form the top and bottom of the Z
    3. Line 2 and Line 3 run parallel to one another
  5. Corners of Z form flap tips of 2 triangles
    1. Flap tip E (top corner of Z at A end of Line 1)
    2. Flap tip F (bottom corner of Z at B end of Line 1)
  • Step 2
  • Prepare and incise Z shape
  1. Betadine or Hibiclens preparation of site
  2. Local Lidocaine anesthesia
  3. Using #15 blade, make vertical incision along Z
    1. Excise scar
    2. Create full thickness skin flaps
  4. Undermine skin at subcutaneous fat
    1. Flaps should be freely mobile
  • Step 3
  • Transpose flap tips
  1. Flap tip E is transposed to point D (bottom end of Z)
    1. Simple interrupted stay Sutures hold sides
    2. Corner Stitches used to hold flap tips in place
  2. Flap tip F is transposed to point C (top end of Z)
    1. Simple interrupted stay Sutures hold sides
    2. Corner Stitches used to hold flap tips in place
  • Step 4
  • Final appearance
  1. Line 1 is now reoriented by 90 degrees
  2. Z shape is a mirror image of incised Z
  • Complications
  1. Flap necrosis or sloughing
  2. Wound hematoma (consider large bore needle aspiration)
  3. Wound Infection
  • References