Z-Plasty: useful uses in dermatologic surgery (2024)

Z-Plasty is a procedure which involves the transposition of two interdigitating triangularflaps. This transposition leads to a gain in length along the direction of the common limbof the Z and the change of its direction.¹ Z-Plasty is an extremely useful procedure in this respect. The techniquewas first introduced in 1856 by Denonvilliers to correct a lower lid ectropion.² Surgeons later proceeded to use it tocorrect contractures of the oral commissure, axillary burn synechiae, and joint mobilityhindered by cicatricial bands.

Symmetry is one of the basic principles.¹The traditional Z-Plasty is designed to ensure that the length of both the lateral andcentral limbs and the angles created by their junction are equal. The length of the limbscan vary depending on circumstances, but it is essential for them to be equal. The flapsare typically designed with angles ranging from 30 to 75 degrees (Figure 1). Angles of less than 30 degrees may incur tip necrosis, andangles of over 75 degrees create flaps that are difficult to rotate, creating dog-ears aswell as increased tension. Variations in the traditional Z-Plasty that involve unequal flapangles may be needed in the reconstruction of certain defects.

This valuable technique can be very helpful in several simple dermatologic procedures. Oneexample is the reconstruction of the infra-orbitary region. Very often the surgical removalof a tumour in this region can potentially lead to an ectropion as a complication. Whilemultiple methods exist to correct this defect, one of the simplest is Z-Plasty. A number offactors need to be taken in consideration: the central limb axis of the Z should bepositioned in the scar; big angles lead to a big gain in length and a big change in thedirection of the scar; Z limbs should never exceed 1cm in the face since this will occasiona poor cosmetic result; big scars should be treated with multiple ZPlasty.³ Another common situation where Z-Plasty canbe helpful is the correction of lip misalignment.^4,5 Normal anatomy can be easilyrestored by realigning tissues produced by the transposition of the two triangular flaps,with an excellent cosmetic outcome (Figure 2).Cicatricial bands can result from several dermatologic procedures. Correction is verysimple using Z-Plasty. Our final example is the treatment of the bifid earlobe.⁶ Lengthening of a pre-existing earlobe holeis a common result of the use of heavy ear jewellery. Simple suture does not work becausethe hole is covered by epithelium. Removing the ephitelium and suturing the defect wasproposed in 1954 by McLaren, but this technique results in a lack of tissue support that isincompatible with the use of earrings.⁷Several repair methods have been described in the literature and Z-Plasty is one of them.Transposition flaps offer good support, and six months after surgery it is possible to useearrings again.

The versatility and simplicity of Z-Plasty is confirmed by its long history of success. Itis a valuable technique that every dermatologist should be able to perform given that itcan resolve common complications of dermatologic surgery. Z-Plasty has been and continuesto be an important tool in a surgeon's armoury.