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Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. With this technique, it is possible to redirect a scar into better alignment with a natural skin fold or the lines of least skin tension. Contracted scars may be lengthened with this technique. Z-plasty involves the creation of two triangular flaps of equal dimension that are then transposed. Basic z-plasty flaps are created using an angle of 60 degrees on each side, which can lengthen a scar by 50 to 70 percent and reorient the direction of the central wound by 90 degrees. Keeping the length and angle of each flap precisely the same is key to avoiding mismatched flaps that may be difficult to close. Some possible complications of z-plasty include flap necrosis, hematoma formation under the flaps, wound infection, trapdoor effect, and sloughing of the flap caused by high wound tension. (Am Fam Physician 2003:67:2329-32. Copyright(C) 2003 American Academy of Family Physicians.)
Z-plasty is a plastic surgery technique used to improve the functional and cosmetic appearance of scars. It involves the creation of two triangular flaps of equal dimension that are then transposed.1
For a basic z-plasty, the triangular flaps are created using an angle of 60 degrees (Figures 1a through 1e). Theoretically, this angle can lengthen a contracted scar by about 75 percent and reorient the direction of the central wound by 90 degrees. In practice, the lengthening and reorientation will be less, owing to increased wound tension.
Angles smaller than 60 degrees are easier to transpose but result in less lengthening and realignment of the scar to less than 90 degrees. Angles larger than 60 degrees should be avoided because the force required to transpose the flaps increases markedly, making closure of the wound difficult. The length of each of the lateral limbs of the z-plasty must be precisely equal to the central incision over the original scar, or puckering at the corners will result, and additional undermining and trimming of the flaps will be necessary to obtain proper closure. The multiple variations of the basic z-plasty are beyond the scope of this article.2
In a primary care setting, z-plasty is reserved for improvement of linear, thin scars and is not...