๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 27 Z-Plasty
Jessica Lori Feig Daniel B. Eisen
SUMMARY
The Z-plasty is a powerful technique utilizing the transposition of triangular
flaps to relieve tension, to lengthen, and to reorient scars parallel to relaxed skin tension lines.
A 60-degree Z-plasty is considered optimal when considering skin laxity, size of
the flaps needed for viability, risk of vascular compromise, location, and theoretical limitations.
The Z-plasty may be used on its own for scar revision or repositioning, or as an
adjunct to other flap closures to mitigate pivotal restraint.
Beginner Tips
Z-plasty is useful for the functional improvement of contractures, web revision, or
free-margin distortions
Two equivalent triangular flaps synchronously interchange into the space previously
occupied by the other. The result of the position swap is a 90-degree reorientation of the common arm of the Z.
Expert Tips
Fundamental goals of the Z-plasty procedure include:
โข Realignment of a scar within relaxed skin tension lines (RSTLs), or parallel to them
โข Lengthening of a scar
โข Release of a contracture by scar lengthening
โข Dispersal of a scar for better camouflage
Donโt Forget!
In one study, survey respondents preferred a simpler and less complex linear scar over
Z-plasty scars, suggesting that the purported benefit of breaking up long scars into smaller ones needs more study before it can be accepted.
Although the surgeon has two choices for the placement of these lateral limbs, only one
combination will allow for optimal cosmesis or reorientation of lines in the direction of, or parallel to, the RSTL.
Pitfalls and Cautions
If a scar already lies along RSTL, a Z-plasty may result in reorientation of the central
incision perpendicular to the RSTLโa less desirable outcome.
Scars within 40 degrees of RSTLs may be better managed with simple excision rather
than with Z-plasty.
Necrosis is more common with angles less than 30 degrees and therefore such acute
angles should be avoided if possible.
Patient Education Points
While a Z-plasty does result in a longer scar line, patients may be reassured that the
net result is generally a less cosmetically obvious scar.
Other scar revision procedures may be needed after Z-plasty, and patients should be
warned of this eventuality prior to surgical intervention.
Billing Pearls
Z-plasty is billed using the adjacent tissue transfer (flap) code series, 140XX.
These codes include a 90-day global period.
If a Z-plasty is performed as part of a larger flap, only a single flap code should be
used.
CHAPTER 27 Z-Plasty
INTRODUCTION
The Z-plasty is a standard technique utilizing the transposition of triangular flaps to relieve tension, lengthen, and reorient scars parallel to relaxed skin tension lines (RSTLs). This technique has been utilized for over a century with only slight modifications, relying on three incisions separated by angles of the surgeonโs choosing. Though a variety of different angles can be used, 60 degrees is considered optimal when considering skin laxity, size of the flaps needed for viability, risk of vascular compromise, location, and theoretical limitations.