Z-Plasty

Excerpt

Z-plasty is a commonly employed transposition flap utilized in plastic and reconstructive surgery to revise scars. The technique has been applied to numerous areas of the body, from fingers to the nose, the chest to the palate, the face, the eye, the ear, and many others besides.[4] Previously referred to as “converging triangular flaps,” Z-plasty involves the transposition of two or more opposing flaps raised along a shared axis. A benefit of this procedure over other scar revision techniques is that it does not necessarily require skin excision if the quality of the skin overlying the scar is aesthetically acceptable for use in the reconstruction. Z-plasty transposition changes the direction of a scar, so it is more easily hidden within a border between facial regions or relaxed skin tension lines (RSTLs). Additionally, this technique may be employed to release scar contracture after burns. Common variants of the basic Z-plasty include the planimetric Z-plasty, double-opposing Z-plasty, compound Z-plasty, skew Z-plasty, and running/serial Z-plasty.

The earliest records of this technique date back to the early 1800s in a publication at the Philadelphia Hospital Department of Surgery, when Horner described using single transposition flaps. The geometry of what clinicians considered the Z-plasty then was not the same as it is today. At the turn of the century, the “Z-plasty method” became more popular when a publication by Berger in 1904 suggested the use of equal limbs and equal angles. In 1914, Morestin proposed using multiple Z-plasties to address more extensive scarring. However, it was Limberg, in 1929, who delved into the rotational and advancement dynamics of the flaps commonly employed today.