Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery by Sharad P. Paul

Author:Sharad P. Paul
Language: eng
Format: epub, pdf
Publisher: Springer International Publishing, Cham

7.2 Z-Plasty

The history of the Z-plasty is rooted in oculoplastic surgery. The first recorded case was when William Horner, a surgeon at the Philadelphia Hospital, Blockley and Professor of Anatomy at the University of Pennsylvania, performed this procedure to repair an eyelid ectropion caused by burn scarring [21]. However, some reports attribute the first Z-plasty to Denonvilliers, who noted the usefulness of breaking up a scar-line into zigs and zags when he first described a Z-plasty–type procedure that he found useful, also for a blepharoplasty [22]. Denonvilliers had written about his plan thus: “I will free the lowered external angle of the eye by two incisions above and below the lid margins meeting at the angle. Then I will form above and a little external to the first triangle, a second triangle opposite to the first. This accomplished, I will raise the triangle involving the external corner of the eye and cause it to take the place of the second triangle that I will then bring down to take the place of the first” [23]. While this complicated description seems apt for a Z-plasty, there were no physical illustrations or images to record the procedure. Stewart McCurdy, an American surgeon, then utilized the same method for the oral commissure. McCurdy, who was Professor of Oral and General Surgery at the University of Pittsburgh, and Orthopaedic and Plastic Surgeon to Columbia and Presbyterian Hospitals is credited as being the first one to use the term “Z-plasty” when he published his article: “Z-plastic surgery: plastic operations to elongate cicatricial contractions of the neck, lips and eyelids and across joints [24].” Limberg, in 1966, famed for his rhombic flaps [25], also wrote extensively on the Z-plasty, although it would seem Limberg considered the term a misnomer—given that in the alphabetical “Z” all the limbs are equal, unlike in surgical versions [26]. Limberg favoured the term “transposed triangular flaps” [27] to describe this technique, and later in his book described a full range of such procedures from equal-angled flaps (where each flap moves equally), to flaps with unequal angles (where the larger angled flap moves less) [28]. However, McCurdy’s term, “Z-plasty” endured the test of time.

Z–plasties can be planned in a single, multiple or serial fashion. When using the multiple Z-plasty in a serial fashion, the planned incisions run parallel to the limbs of the Z-plasty at either end of the scar. In this chapter I am describing the use of zigs and zags to reduce sternal scarring, and indeed scarring at other flexural areas at the jawline, neck or limbs. But using a Z-plasty in this situation can be problematic due to the lengthening it causes. Further, with the serial Z-plasty technique, as would be needed in a location such as the sternum, the flaps become three-sided rhombic flaps, and not two-sided triangles. Now we can begin to understand the wisdom of Limberg’s insistence of calling the procedure as transposed triangular flaps. Also, it must be noted that the limbs in between the two peripheral limbs become approximately twice the length of the limbs before transposition.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.