Z-plasty is particularly useful in treating contracted or webbed scars and scars that distort anatomic facial landmarks. Each segment of the Z contracts in a different direction. This is because of the very nature of the Z-shaped scar that occurs from Z-plasty. As with other methods of scar revision that interrupt a straight scar, the scar resulting from Z-plasty will counter forces of scar contracture. Scars that cause distortion of facial features secondary to contracture may be lengthened with Z-plasty techniques, correcting or improving the distortion. Similarly, with Z-plasty, a long straight scar may be divided into smaller irregular segments to allow better scar camouflage. Z-plasty should be considered when it is optimal to change the direction of a scar so that a portion of it is more easily concealed either within relaxed skin tension lines (RSTLs) or in a border between facial aesthetic regions. It is this flexibility that allows the wide-ranging applications and variations from the classic description.Ī Z-plasty is used to accomplish one or more of three changes in the nature of a scar: change of scar direction, interruption of scar linearity, and release of scar contracture (lengthening of scar). Whereas the classic Z-plasty follows specific geometric guidelines, Limberg demonstrated the flexibility of double transposition flaps that have a Z-plasty design. 8 He also noted that Z-plasties as well as the related Limberg or rhombic flap are best described as having both pivotal and advancement components. In the late 1920s, Limberg elucidated the geometric principles involved with Z-plasty. However, in these case descriptions, the triangular flaps transposed did not have equal angles, nor were they the same size. In the 1800s, Fricke, 4 Horner, 5 Serre, 6 and Denonvilliers 7 described the transposition of cheek and temporal skin to correct eyelid ectropion and regional defects. Although the initial description of transposing equilateral triangular flaps was by Berger 3 in 1904, numerous other descriptions have been recorded. The triangles represent angular flaps that are interchanged with each other by both pivotal and advancement tissue movement. 2 Classically, this technique involves designing a Z with three limbs of equal length that form two triangular flaps of equal angles. The history of Z-plasty has been reviewed by Borges 1 and Davis and Renner. A clear understanding of the underlying principles of Z-plasty will allow the reconstructive surgeon to apply this technique to a wide array of clinical situations. The dynamics of tissue movement that occur with Z-plasty is particularly suited for certain types of scar revision. The principle of Z-plasty is one of the most versatile concepts in reconstructive surgery.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |