Z plasty

1. Z-PLASTY: GENERAL SURGICAL PROSPECTIVE By- Dr.Kundan Kharde 1 DPU

2. Conventional technique Post Burn Scars - are managed by release / excision of scar followed by SSG, and post operatively patient requires splinting in corrected position for almost 6-12 months to prevent recurrence of deformity. But compliance of patients for prolonged splinting is very poor, hence come back with recurrence. 2 DPU

3. Conventional technique Pilonidal sinus : Several surgical techniques are available for repair of the defect created after excision of pilonidal sinus including excision and direct closure, marsupalisation , skin grafting or local flaps but each technique has some advantages/ limitations. Recurrence is almost 40% percent after excision and direct closure. DPU 3

4. Z- PLASTY-is it the answer? Scars - Z- plasty serves to reorient and lengthen a scar In Pilonidal disease - Z-plasty eliminates the deep natal cleft by bringing healthy, lateral skin and subcutaneous tissue into the midline This report is based on our experience in managing 10 cases of Post burn contractures and 05 cases of Pilonidal sinus utilising Z-plasty technique. DPU 4

5. What is Z- plasty ? Z- Plasty is a surgical technique that is extensively used in plastic surgery to lengthen the linear scars and thus correct the deformity and improve the function. This technique redirects the forces acting on the scar to improve the appearance. 5 DPU

6. Z- plasty in Scar contracture A total of 10 patients of scar contractures were operated.(linear scars) There were 5 males and 5 females, in the age group of 3 – 30 years. 6 DPU

7. Z- plasty in Scar contractures (cont) DPU 7

8. Z- plasty in Scar contractures (cont) DPU 8

9. Z- plasty in Scar contractures (cont) 9 DPU

10. Z- plasty in Scar contractures (cont) DPU 10

11. Z- plasty in Scar contractures (cont) DPU 11

12. Z- plasty in Scar contractures (cont) Result Scar lengthening was achieved in all the cases and 02 cases had superficial wound infection, which resolved by dressings Complications Number of patients Percentage Flap necrosis 0% Wound infection 2 20% Hematoma formation 0% Dehiscence 0% Trap door effect 0% total 2 20% 12 DPU

13. Z- plasty in Pilonidal sinus A total of five patients of Pilonidal sinus were operated All were males, majority in the age group of 15 – 30 The operating time ranged between 30-45 minutes (mean 35 + 2). 13 DPU

14. Z- plasty in Pilonidal sinus (cont.) 14 DPU

15. Z- plasty in Pilonidal sinus (cont.) DPU 15

16. Z- plasty in Pilonidal sinus (cont.) Result Complications Number of patients Percentage Flap necrosis 0% Wound infection 1 20% Hematoma formation 0% Dehiscence 0% Trap door effect 0% total 1 20% 16 DPU

17. Z- plasty in Pilonidal sinus (cont.) Mean postoperative stay was 3.5 days ( 2-5 days) and return to work was between 7 – 18 days (Mean 12.5 days). There was no recurrence DPU 17

18. What Z- plasty achieves ? 18 DPU

19. Changing the direction favorable scar 19 DPU

20. Basic Z- Plasty 20 DPU

21. Technique 21 DPU

22. Geometric scale 22 DPU

23. Complication Hematoma formation Wound infection Dehiscence Trapdoor Flap necrosis 23 DPU

24. Discussion Multiple reconstructive methods have been used for the treatment of postburn scar contractures including skin grafting, local flaps and free flaps. Similarly, multiple Techniques such as drainage, excision, and marsupilization yield mixed results in the treatment of pilonidal sinuses. Patients are often dissatisfied, because of long post op period and recurrence. 24 DPU

25. Discussion (cont.) Severe contracture lines crossing flexion folds can be released effectively by using Z- plasty technique. In pilonidal disease, the Z- plasty eliminates the deep natal cleft by bringing healthy, lateral skin and subcutaneous tissue into the midline. Excision and Z- plasty together can lead to a low recurrence rate with rapid healing 25 DPU

26. Conclusion In linear scar contracture Z plasty technique helped to increase the length of scars with release of contractures In pilonidal sinus management with Z plasty showed zero recurrence and less hospital stay DPU 26

27. Conclusion Z- plasty is a versatile technique, easy to perform and can be an armamentarium of general surgeon to manage linear scar contractures where scar lengthening is necessary. Once the concept of dual transposition of the triangular flaps is understood, any general surgeon should be able to use to achieve optimal results 27 DPU

28. References Wiliams NS, Christopher JK. Bulstrode P,Ronan O Connell. Pilonidal sinus. In: Bailey and Love’s Short practice of Surgery.25thed.London: Hodder Arnold 2008:1247-8.  I. Iesalnieks , A. Furst , M. Rentsch and K.W. Jauch . Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Chirurg ,   74   (2003), pp. 461–468 The basic Z- plasty . Am Fam Physician. 2003 Jun 1 ;67(11):2329-32 Bernstein L. Z- plasty in head and neck surgery. Arch Otolaryn 89:574-84, 1969 Apr Rohrich RJ, Zbar RI. A simplified algorithm for the use of Z- plasty . Plast Reconstr Surg 1999;103:1513-7. 28 DPU