The occasional Z-plasty [CJRM

The occasional Z-plasty

Keith MacLellan, MD
Pontiac Community Hospital Inc., Shawville, Que.; Assistant Professor in Family Medicine, McGill University, Montreal, Que.

CJRM 1998;3(2):103

Correspondence to: Dr. Keith MacLellan, PO Box 609, Shawville QC J0X 2Y0

This paper has been peer reviewed.

Here is a simple plastic surgery technique that a rural doctor occasionally can use to save a patient from unsightly scarring. It also eliminates a long trip to visit a plastic surgeon. Once mastered, the technique needs no minimum number of procedures per year to maintain competency.

Lacerations or excisions that cross perpendicular to skin creases (e.g., forehead, wrist, nasolabial fold) scar badly and contract. Z-plasty allows you to lengthen the scar and to angle it away from the perpendicular, hiding some of the scar in the direction of the skin folds.

These illustrations are done on pork hocks and have been exaggerated for clarity. Pork hocks are good for practice but do not easily allow the skin flaps to be pulled over. After practising, you can try cooking the hocks according to the recipe at the end of the article.

Fig. 1 shows the laceration or excision running perpendicular to the skin folds.

Fig. 1

Make an incision as long as the original laceration (Fig. 2), starting from one end of the laceration and angling to the end at a point corresponding to the middle of the laceration. This will create an angle of 60° between the laceration and your new incision. Repeat this procedure at the other end of the laceration to create a parallelogram and 2 equilateral triangular flaps (Fig. 2).

Fig. 2

Undermine the flaps to free the subcutaneous tissue. Transpose the flaps as indicated in the illustration Figs. 3 and 4.

Fig. 3

Fig. 4

Suture the flaps as illustrated (Fig. 5). The scar will be lengthened, much of it will be in the direction of the skin folds and the other parts will be far less than the perpendicular. The results will be cosmetically and functionally much more acceptable.

Fig. 5

Some surgeons will round off the peaks of the triangles to allow for stretching. Most will use an "apical stitch" at the apex of the triangle. Rural doctors with an interest in plastic surgery might have other comments on the procedure. They will be allowed to make them if they promise a "Practitioner" article of their own. What is certain is that very little practise is needed to learn this basic and occasionally very useful technique.

PORK HOCKS,
PONTIAC COUNTY STYLE
3-4 good looking pork hocks
1 onion
Salt and pepper
Recently cooked rice
Flour
Boil the pork hocks for as long as you have something else to do (1 to 3 hours) in water that also contains a chopped onion. Pour off the remainder of the water. Peel off the skin and the fat. Chop the meat into chunks or shreds and discard the bone. Make a gravy and be sure to use flour that has been browned under the broiler. Add the meat. Adjust the seasonings. Serve over rice (although french fries are a good substitute). Goes well with green tea and Gravol.