eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Z-Plasty

Author: Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Contributor Information and Disclosures

Updated: Nov 4, 2008

Introduction

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).

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
  • 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.

More on Z-Plasty

Overview: Z-Plasty
Treatment: Z-Plasty
Follow-up: Z-Plasty
Multimedia: Z-Plasty
References
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References

  1. 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].

  2. Dutton JM, Neidich MJ. Intranasal Z-plasty for internal nasal valve collapse. Arch Facial Plast Surg. May-Jun 2008;10(3):164-8. [Medline].

  3. 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].

  4. Murakami CS, Nishioka GJ. Essential Concepts in the Design of Local Skin Flaps. Facial Plastic Surgery Clinics of North America. 1996;4:455-464.

  5. 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].

  6. 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].

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Further Reading

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Keywords

z-plasty, scar revision, scar camouflage, transposition flap, advancement flap, rotation flap, multiple Z-plasties, wound irregularization, S-plasty

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Contributor Information and Disclosures

Author

Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The 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: Medicis None Speaking and teaching; Contura None Board membership; Contura Grant/research funds Independent contractor; Cascade Medical Grant/research funds Independent contractor; Cascade Medical None Board membership

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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

 
 
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