Detailed description of Z plasty used for scar contracture release and various types and techniques of it

1. Z Plasty
Dr Joe Antony

2. • The Z-plasty is a procedure which involves the
transposition of two inter-digitating triangular
flaps
• First performed by Horner in 1837 and
Denonvilliers in 1854.
– They used to correct cicatricial ectropion
• The first published mathematical analysis
came from Limberg in 1929.

3. • Limberg used pythogorian theory to derive
length achieved by each angles

4. Principles
• 1. There is a gain in length along the direction
of the common limb of the Z.
• 2. The direction of the common limb of the Z
is changed.

5. Theoretical basis

6. • the length of the contractural diagonal after
transposition equals that of the transverse
diagonal before transposition.
– unless there is transverse skin slack available,
equal in quantity to the length difference between
the axes of the Z, the method will not work.

7. Variables in construction
• Limb length
• Angle

8. Multiple Z plasty

9. • Can be constructed as
– Parallel or Skewed
– Continuous or interrupted

10. Limberg’s four-flap and Mustarde’s “jumping
man” five-flap Z-plasties

11. Blood supply of flaps
• Provision of maximum vascularity
– designing the flaps broad at the tip
– by cutting the flaps as thick as possible
– avoiding scarring across the base
• Avoidance of undue tension
– Tip necrosis in single large Z plasty.

12. Classified as
• Simple
• Planimetric
• Skew
• Multiple

13. Simple Z plasty
• stereometric Z-plasty
• two flaps of equal angle and length
• Raised at 60° as this angle offers the best
balance between elongation in the axis of the
scar and the creation of tension forces pulling
perpendicular to the scar.

14. Planimetric Z plasty
• By minimizing the amount of rotation and
excising redundant tissue, this flap design
avoids the contours and depressions

15. • May theoretically be designed with lateral
limb angles ranging from 60° to 90°, though
most often they are planned at 75° angles
• Planimetric Z-plasty is ideal for scar releases
on flat surfaces where lengthening is the
primary objective and contour deformities
would be suboptimal.

16. Skew Z plasties
• Skew Z-plasties have lateral limbs departing at
different angles from one another.
• This flap has been suggested when anatomic
landmarks mandate asymmetric movement of
one flap.

17. • Narrow flap form dog ear while suturing
• Wide flap has more tension over the base ,
causing restricted blood supply to the flap tip

18. Contracture release
• Adequate amount of free skin must be
available transversly
• Burns contracture- Usually with surrounding
skin scarring

21. Planning of Z plasty
• Draw equilateral triangle on both sides
• 1. The flap with the better blood supply is
preferable. In particular a potential flap with
scarring across the base should be avoided.
• 2. One flap may result in a scar which will fall
into a better line cosmetically.
• 3. The lie of the flaps and the surrounding
skin may permit one set of flaps to transpose
more readily into their new position.

23. Thank you