Surgery Book

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Z-Plasty

Aka: Z-Plasty
  1. Definition
    1. Plastic surgery technique in scar revision
  2. 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
  3. Prerequisites
    1. Skin must be loose at right angles to scar
  4. 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)
  5. 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
  6. 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
  7. Step 4: Final appearance
    1. Line 1 is now reoriented by 90 degrees
    2. Z shape is a mirror image of incised Z
  8. Complications
    1. Flap necrosis or sloughing
    2. Wound hematoma (consider large bore needle aspiration)
    3. Wound Infection
  9. References
    1. Davidson in Cummings (1998) Otolaryngology, p. 440*1
    2. Salam (2003) Am Fam Physician 67(11):2329-32 [PubMed]
      1. http://www.aafp.org/afp/20030601/2329.pdf

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