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APPLICATIONS
APPLICATIONS
Few comparative studies exist in the literature for Z-plasty versus other methods of repair. A retrospective review of a Japanese plastic surgery departmentโs cases of axillary scar contractures over the last 25 years showed that 31 axillary scar contractures were treated with Z-plasty, all of which showed no flap necrosis, though two cases of scar contracture recurrence were reported.10 Another prospective study of 82 patients undergoing partial selective fasciectomy for Dupuytrenโs contractures compared the Z-plasty to two established models, and the incidence of flap necrosis with the Z-plasty was 7%.11 In 2007, Tatlidede et al. studied resistance to tensile loads of various closures with 4โ0 silk in murine models and concluded that Z-plasty was superior to linear incisions.12 The breaking forces of the Z-plasty were roughly two times higher than that of the linear incisions 4 weeks after surgery, which may be explained by differences in contact surface area of the incision lines and decreased tensile forces which act on oblique lines of transposition flaps, as suggested by the authors.12 Ertas et al. used murine models to study the effective elongation achieved by the Z-plasty or the subcutaneous pedicle rhomboid flap in inguinal skin and found that both techniques were effective in relieving tension over the inguinal areas and in lengthening tension lines, with the Z-plasty producing a greater than 200% gain in length.13
A retrospective study by Fader et al. reviewed the University of Michigan Mohs Database from 1998 to 2000 in an effort to identify cases where flap transposition was used.14 Their analysis revealed that Z-plasty was used in 12 of 614 patients with cheek defects, all with good to excellent cosmetic and functional outcomes as rated by patient and surgeon.14 Of those, a double Z-plasty was performed in a subset of four cases. While no infection occurred, minor superficial tip necrosis occurred at one site.
One of the purported benefits of Z-plasty is that it takes a linear scar and breaks it up into smaller segments that, though longer in combined length than the original scar, are less aesthetically noticeable. This dogma was tested in a prospective national survey that assessed the publicโs aesthetic rating of computer-generated linear facial scars in three different locations in four individuals.15 Survey respondents significantly preferred the 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. Thus, while Z-plasty is clearly useful for functional improvements of contractures, web revision, or free-margin distortions, as well as scar
reorientation, its utility beyond these applications remains unproven.