Z plasty in scar contracture release

Detailed description of Z plasty used for scar contracture release and various types and techniques of it

1. Z Plasty Dr Joe Antony

2. The Z- plasty is a procedure which involves the transposition of two inter- digitating triangular flaps First performed by Horner in 1837 and Denonvilliers in 1854. They used to correct cicatricial ectropion The first published mathematical analysis came from Limberg in 1929.

3. Limberg used pythogorian theory to derive length achieved by each angles

4. Principles 1. There is a gain in length along the direction of the common limb of the Z. 2. The direction of the common limb of the Z is changed.

5. Theoretical basis

6. the length of the contractural diagonal after transposition equals that of the transverse diagonal before transposition. unless there is transverse skin slack available , equal in quantity to the length difference between the axes of the Z, the method will not work.

7. Variables in construction Limb length Angle

8. Multiple Z plasty

9. Can be constructed as Parallel or Skewed Continuous or interrupted

10. Limberg’s four-flap and Mustarde’s “jumping man” five-flap Z- plasties

11. Blood supply of flaps Provision of maximum vascularity designing the flaps broad at the tip by cutting the flaps as thick as possible avoiding scarring across the base Avoidance of undue tension Tip necrosis in single large Z plasty .

12. Classified as Simple Planimetric Skew Multiple

13. Simple Z plasty stereometric Z- plasty two flaps of equal angle and length Raised at 60° as this angle offers the best balance between elongation in the axis of the scar and the creation of tension forces pulling perpendicular to the scar.

14. Planimetric Z plasty By minimizing the amount of rotation and excising redundant tissue, this flap design avoids the contours and depressions

15. May theoretically be designed with lateral limb angles ranging from 60° to 90°, though most often they are planned at 75° angles Planimetric Z- plasty is ideal for scar releases on flat surfaces where lengthening is the primary objective and contour deformities would be suboptimal.

16. Skew Z plasties Skew Z- plasties have lateral limbs departing at different angles from one another. This flap has been suggested when anatomic landmarks mandate asymmetric movement of one flap .

17. Narrow flap form dog ear while suturing Wide flap has more tension over the base , causing restricted blood supply to the flap tip

18. Contracture release Adequate amount of free skin must be available transversly Burns contracture- Usually with surrounding skin scarring

19. Planning of Z plasty Draw equilateral triangle on both sides 1. The flap with the better blood supply is preferable. In particular a potential flap with scarring across the base should be avoided. 2. One flap may result in a scar which will fall into a better line cosmetically. 3. The lie of the flaps and the surrounding skin may permit one set of flaps to transpose more readily into their new position.

20. Thank you