Zplasty

Z-plasty is a plastic and reconstructive surgical technique used to lengthen contracted tissue and reorient a scar. It works by forming two triangular flaps on opposite sides of a central limb and transposing the flaps to reroute tension, converting a straight scar into a Z-shaped configuration. This rearrangement reduces scar contracture and can improve both function and appearance.

Indications for Z-plasty include scar contractures around joints (notably the hand and neck), webbing, and scar-driven limitations in range of motion. It is particularly useful when tissue laxity and blood supply are adequate to support flap survival. Contraindications include poor vascularity, active infection, significant tissue loss, or situations where there is insufficient tissue to form reliable flaps.

Technique involves marking a central limb along the existing scar and designing two equal triangular flaps at an angle, commonly around 60 degrees. Incisions are made through the skin and subcutaneous tissues, flaps are elevated, and then transposed to opposite sides with layered closure. The central axis lengthens as the flaps are rearranged. For longer scars or greater release, multiple adjacent Z-plasties can be employed, or combination with other scar-modifying techniques such as W-plasty.

Outcomes depend on proper case selection, skin quality, and surgical execution. Benefits include regained range of motion and a less conspicuous scar across a more favorable direction. Risks include flap necrosis at the flap tips, wound infection, hematoma, and scar widening if tension is excessive or healing is compromised.