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Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
There are three main techniques to master: Z-plasty: An operation that involves the transposition of two triangular skin flaps of equal dimension to lengthen a scar or change its direction. There is a risk of necrosis of the flaps if they are poorly designed.Split-thickness skin grafts: If an SSG is used, it is often used as a temporary biological dressing rather than for definitive skin cover.Full-thickness skin grafts (FTGs): These can be used for definitive skin cover anywhere on the hand except the pulps of the fingers and thumb.
Common rhinology and facial plastics viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
A Z-plasty is used to re-orient, lengthen, and irregularise a scar. This may be because the scar is causing webbing/contracture, or because it is running perpendicular to skin lines/RSTLs, making it unsightly. Multiple Z-plasties can be used to lengthen and irregularise longer scars. The amount of lengthening depends on the angles used when constructing the Z-plasty: 30 degrees = 25% longer45 degrees = 50% longer60 degrees = 75% longer75 degrees = 100% longer
Surgical Scar revision, Dermabrasion, and Other Physical Treatments
Published in Alexander Berlin, Mohs and Cutaneous Surgery, 2014
Ian A. Maher, Jeremy S. Bordeaux
Scar Reorientation Z-plasty is the classic example of a surgical revision to reorient scars and redistribute tension. Z-plasty creates two opposing triangular flaps, whose common side is the scar to be reoriented (Figure 5.10). When the flaps are transposed over one another, the central scar is reoriented.24 Due to the length exchange between the shorter central limb and the larger distance between the bases of the triangular flaps, the scar is lengthened (Figure 5.11). Thus, the Z-plasty may be used not only to reorient a malpositioned scar but also to obtain tension release in a contracted scar. Z-plasty may be used to reposition a retracted free margin, correct webbing of a scar over a concavity, or release a contracted joint.
A banner flap with adjacent rotation flap for closure of circular skin defects: a schematic comparison with conventional rotation flap technique
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Tetsushi Aizawa, Takahiro Hirayama, Shota Tojo, Tomoharu Kiyosawa
Several methods using multiple flaps have been reported for closure of comparatively large defects with less tension, less sacrifice of healthy skin, and less resultant scar. One of the best methods meeting these requirements is the ‘reading man procedure’. Mutaf et al. [9] described this method taking the concept of Z-plasty a step further by using two flaps. The reading man procedure is appreciated as aesthetically useful and is becoming an important option for facial reconstruction [10–13]. This method is applicable for other regions; however, it seems to be unsuitable for regions of less elastic skin such as scalp or planta pedis. Z-plasty extends the length of the resultant scar in one direction but also shortens the vertical direction. Therefore, the corners of the rectangular and triangular flaps are subject to strong tensional forces. Z-plasty requires that the mobility of the flaps be restricted in such regions. Flaps are contracted to the vertical direction of the Z-plasty because of the restricted mobility of the flaps. In contrast, the B-R flap is suitable for these regions because the tensional forces on F1 and F2 are considered to be at right angles to each other, and evenly distributed (Figure 1(B)). In addition, F2 relieves the tension at the base of F1, so as not to interfere with perfusion and healing.
Functional reconstruction of a hand that was severely deformed due to Jaccoud’s arthropathy
Published in Modern Rheumatology Case Reports, 2021
Kei Funamura, Hajime Ishikawa, Rika Kakutani, Asami Abe, Hiroshi Otani, Kiyoshi Nakazono, Akira Murasawa
Surgery was performed in two stages. In the first stage, radio-lunate arthrodesis was performed at the radially rotated radiocarpal joint, fusion was performed at the CM and IP joints of the thumb, and finger joint replacement was performed at the MP joint using a silicone implant (Swanson). (Figure 3). In the second stage, finger joint replacement was performed at the MP joint of the index finger, but in the middle, ring, and little fingers, myostatic contracture and shortening of the finger flexor muscles were extremely severe, and sufficient space for the implant could not be made. After cutting the flexor digitorum superficialis (FDS) tendon, the flexor digitorum profundus (FDP) tendon was still tight. Therefore, the metacarpal head was excised about 2 cm in length, and fusion was performed at the MP joint. By reducing the dislocated MP joint, the swan-neck deformity in the index through ring fingers was automatically corrected. The remaining hyperextension at the PIP joint of the little finger was fused in a 30° flexed position. Since the cutaneous contracture was not very severe, Z-plasty with skin grafting was not required.
Reconstruction of postburn contractures due to tandir oven
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Hakan Cinal, Ensar Zafer Barin, Murat Kara, Kerem Yilmaz, Harun Karaduman, İhtişam Zafer Cengiz, Oguz Boyraz, Osman Enver Aydin, Onder Tan
For the web space contractures, our choice of flap was the V-M plasty and K-M plasty (Figure 5). It is practical and provides flap coverage of the deep web space. No linear incision remains as a scar. Relapse rates are very low with this technique [12]. Z-plasty techniques have been the backbone of the contracture surgery. It is a simple and effective modality in distal hand contractures. V-Y-Z plasty is a very useful technique to provide sufficient lengthening and to prevent recurrence in the treatment of serious postburn scar contractures. Tan et al. [13] have defined the use of V-Y-Z plasty in treatment of postburn contractures. We effectively use the Z-plasty and V-Y-Z-plasty method in contracture release. V-Y-Z plasty combines the advantages of Z-plasty with the subcutaneous pedicle rhomboid flap [14,15]. We used V-Y-Z plasties in different regions such as finger, palm, axilla and antecubital region (Figure 6).