Z-Plasty

Author: Anthony P Sclafani, MD; Chief Editor: Arlen D Meyers, MD, MBA more...

Updated: Mar 11, 2010

What would you like to print?

Background
Indications
Relevant Anatomy
Contraindications
Show All

Background

Z-plasty is one of many techniques for scar revision and camouflage. Z-plasty is a type of transposition flap that incorporates qualities of advancement and rotation flaps into its design. Whether used alone or in conjunction with other scar-camouflage techniques, Z-plasty is a versatile maneuver that, when mastered, provides aesthetically pleasing results.

In 1856, Denonvilliers first described the Z-plasty technique as a surgical treatment for lower lid ectropion. The first reference to this technique in American literature was in 1913, by McCurdy, as treatment for contracture at the oral commissure. Limberg, in 1929, provided a more detailed geometric description. Numerical data showing optimal angles and length relationships of Z-plasty limbs are credited to Davis (1946).

The image below depicts a Z-plasty.

The original scar is A-B. The limbs of the Z-plasty form 2 triangles with 45° angles at apices C and D.

Indications

Z-plasty is an especially useful technique when dealing with a scar that crosses relaxed skin tension lines. Simple redirection of the central limb into these lines can provide adequate camouflage. The redistribution of tension on the wound provided by Z-plasty can be very helpful when dealing with a contracted scar or with a scar near aesthetic units, such as the medial canthus or oral commissure.

Z-plasty is an effective method of wound irregularization. Since straight-line scars draw attention easily, multiple Z-plasties can break up the scar into smaller units, making the scar less noticeable.

Other uses of Z-plasty

Limiting/preventing contracture of linear scars, especially when they cross the border of a facial aesthetic unit (eg, vermillion border) or when scars cross a concave surface (eg, the medial canthus)
Changing scar length (eg, scar contracture of lip, eyelid, or neck)
Changing scar vector (eg, repositioning a scar across the nasolabial fold)
Repositioning malposed tissues (useful for "trapdoor" or "pin-cushion" defects)
Effacing web/release contracture (similar to first listed use)
Closing cutaneous defects (eg, large oval defects, pharyngocutaneous fistulae)
Correcting stenosis (eg, tracheostoma, nares, external auditory canal) using single or multiple Z-plasties^[1]
Transposing healthy tissue to close a fistula (eg, tracheostoma closure after irradiation)

Relevant Anatomy

Z-plasty requires a proper skin thickness. A flap with too much subcutaneous tissue is difficult to position because of limited rotation. A thin flap contracts readily and is unattractive. Ideally, a plane developed between the subdermal plexus and the subcutaneous fatty tissue provides support but is not restrictive in the degree of rotation afforded.

Contraindications

When designing a local flap, consider any factor that may compromise expected results. Attempt to identify health risks that affect vascular supply to the skin (eg, atherosclerotic heart disease, diabetes, smoking, collagen vascular disease, prior irradiation, anticoagulation). A history of poor wound healing, hypertrophic scarring, or keloid formation is a relative contraindication to Z-plasty.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Anthony P Sclafani, MD Director of Facial Plastic Surgery and Surgeon Director, New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College

Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Contura None Board membership; Cascade Medical Enterprises, Inc. Grant/research funds Independent contractor; Cascade Medical Enterprises, Inc. None Board membership; Aesthetic Factors, Inc. Grant/research funds Independent contractor

Specialty Editor Board

Gregory Branham, MD Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine

Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David W Stepnick, MD Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

Kim YH, Kim NH, Seong SY, Hyun DW, Choi HS. Double reversing Z-plasty with inferiorly widening stomaplasty for the management of tracheostomal stenosis. Auris Nasus Larynx. Dec 28 2009;[Medline].
Koc MN, Orbay H, Uysal AC, et al. Z plasty closure of lower lip defects after tumor excision. J Craniofac Surg. Sep 2007;18(5):1120-4. [Medline].
Dutton JM, Neidich MJ. Intranasal Z-plasty for internal nasal valve collapse. Arch Facial Plast Surg. May-Jun 2008;10(3):164-8. [Medline].
Lee PK, Ju HS, Rhie JW, et al. Two flaps and Z-plasty technique for correction of longitudinal ear lobe cleft. Br J Plast Surg. Jun 2005;58(4):573-6. [Medline].
Murakami CS, Nishioka GJ. Essential Concepts in the Design of Local Skin Flaps. Facial Plastic Surgery Clinics of North America. 1996;4:455-464.
Rohrich RJ, Zbar RI. A simplified algorithm for the use of Z-plasty. Plast Reconstr Surg. Apr 1999;103(5):1513-7; quiz 1518. [Medline].
Zins JE, Fardo D. The "anterior-only" approach to neck rejuvenation: an alternative to face lift surgery. Plast Reconstr Surg. May 2005;115(6):1761-8. [Medline].

The original scar is A-B. The limbs of the Z-plasty form 2 triangles with 45° angles at apices C and D.

After transposition of C and D, the scar has reoriented 90° and lengthened. Note the increased distance between hooks, as well as the changed position of asterisks compared with the previous image.

View Table List