Z-plasty is a surgical and cosmetic treatment first created by Charles-Pierre Denonvilliers, a French surgeon based in Paris. He first performed the operation on a lower lid ectropion on 1856. This operation is commonly done to as a plastic surgery technique to improve the function and appearance of a scar.
How it works
Z-plasty is a useful technique because it lengthens the appearance of a scar. This ‘functional’ technique is most commonly used to heal the wound without any skin loss. Since the tissue is re-positioned, the skin gives the illusion that the area has substantially grown wider, depending on the position.
Coincidentally, since the scar would also be re-positioned, the skin ‘hides’ the former wound. The irregular scar would be partially hidden. This aspect of the procedure makes Z-plasty a useful way of closing a wound without leaving any scars.
A Z-plasty treatment consists of two adjacent triangular flaps. The sides of the triangles are the same size as one another, so as to fit the two flaps completely during the transposition. These flaps are designed to produce a ‘Z’ shape aligned with the part of the scar that needs lengthening or re-positioning. These two flaps are interchanged and sewn into place. This angle, as well as the sutures, also promotes healing for the patient.
A traditional 30° - 60° Z-plasty is done with three incisions along the scar. This can lengthen a scar by almost 75%. However, it shortens the width by 43%. Theoretically, the wider the angle, the greater the length. However, surgeons must remember that if the angle is more than 100°, the incision will be hard to close and might produce some ‘dog ears’. Meanwhile, at an angle under 45° the doctor might hinder the blood supply to the muscles of that area, and has a high chance of causing muscular necrosis.
Other types of Z-plasties are five flap plasties (or the jumping man flap), alternate butterfly flaps, and double and multiple Z’s. These operations are a series of Z-plasties done in succession or in a pattern to cover a wound or for cosmetic services.
Procedure
The process of a Z-plasty operation is fairly simple when compared to other surgeries. Since this operation has predominantly used skin incisions only, infection is just a possibility. In order to counteract this, all practitioners follow their policies to ensure a safe and quick operation.
After sterilizing the area of operation, the nurse or doctor clears any excess hair that might hinder the operation. The scar is examined, and is marked. Marked areas are then slightly lacerated. The cut should not be too deep as to not make the patient uncomfortable. The surgeon uses a skin hook to lift the flap, and cut the excess fat below the skin and to loosen the two flaps. The flaps are interchanged and are then positioned into a 90° angle. The corner stitches are placed, and the doctor begins stitching the wound.