Modeling and concepts of the Malingue plasty compared to Z-plasty

Hand Surg Rehabil. 2023 Jan 7;S2468-1229(23)00002-6. doi: 10.1016/j.hansur.2022.12.005. Online ahead of print.

Abstract

Malingue's diamond-shaped skin plasty is a random skin plasty derived from the Z-plasty. Not widely known, this technique is an alternative to fasciectomy in Dupuytren's disease. The main objective of the present study was to analyze the topographical and anatomical differences between Z-plasty and Malingue plasty in cadaveric and experimental models and the geometrical and mathematical differences in modeling, in order to determine the respective gains in length. The study was carried out in two steps. An anatomical step on a cadaveric model studied vascularization. The second step was based on inert models (latex gloves) and cadaveric models, to study the mechanical behavior of the flaps. Differences in gains in length were analyzed by Euclidean and non-Euclidean geometry. The Malingue plasty flaps showed greater vascular richness than in Z-plasty. The experimental cadaver and inert material models showed 50% length gain with a single Malingue plasty, versus 33.3% with Z-plasty. The gain decreased in multiple plasties: respectively, 25% and 17.5% with double plasty and 20% and 16.7% with triple plasty. The analysis of Euclidean plane geometry did not explain these results, whereas 3D analysis on non-Euclidean geometry can explain a superior elongation effect in the Malingue plasty. The Malingue plasty could be an interesting option when significant lengthening is required, especially when Z-plasty would be insufficient.

Keywords: Dupuytren contracture; Flaps; Lambeaux; Local skin plasty; Maladie de dupuytren; Mathematics; Mathématiques; Mechanics; Mécanique; Plastie cutanée locale.