II. Definition
- Plastic surgery technique in scar revision
III. Indications: Scar revision (not for primary closure)
- Change scar direction
- Interrupt scar line to break up tension lines
- Lengthen scar to reduce scar traction
IV. Prerequisites
- Skin must be loose at right angles to scar
V. Step 1: Layout incision plan with skin marker
- Line 1: Draw along the longitudinal scar axis
- Measure the length of line 1
- Line 1 runs from Point A to Point B
- Line 2: Draw at 60 degrees from Point A
- Should be exactly the length of Line 1 and 3
- Line 2 runs from Point A to Point C
- Line 3: Draw at 60 degrees from Point B
- Should be exactly the length of Line 1 and 2
- Line 2 runs from Point B to Point D
- Completed 3 lines form a Z Shape
- Line 1 forms the diagonal middle of the Z
- Line 2 and Line 3 form the top and bottom of the Z
- Line 2 and Line 3 run parallel to one another
- Corners of Z form flap tips of 2 triangles
- Flap tip E (top corner of Z at A end of Line 1)
- Flap tip F (bottom corner of Z at B end of Line 1)
VI. Step 2: Prepare and incise Z shape
- Betadine or Hibiclens preparation of site
- Local Lidocaine Anesthesia
- Using #15 blade, make vertical incision along Z
- Excise scar
- Create full thickness skin flaps
- Undermine skin at subcutaneous fat
- Flaps should be freely mobile
VII. Step 3: Transpose flap tips
- Flap tip E is transposed to point D (bottom end of Z)
- Simple interrupted stay Sutures hold sides
- Corner Stitches used to hold flap tips in place
- Flap tip F is transposed to point C (top end of Z)
- Simple interrupted stay Sutures hold sides
- Corner Stitches used to hold flap tips in place
VIII. Step 4: Final appearance
- Line 1 is now reoriented by 90 degrees
- Z shape is a mirror image of incised Z
IX. Complications
- Flap necrosis or sloughing
- Wound Hematoma (consider large bore needle aspiration)
- Wound Infection
X. References
- Davidson in Cummings (1998) Otolaryngology, p. 440*1
- Salam (2003) Am Fam Physician 67(11):2329-32 [PubMed]