Angular Effects of Z-Plasty Technique on Extent of Relaxation of Contracted Scar, Cosmetic Appearance and Tip Necrosis in Dogs

Muhammad Asif,Aisha Mahmood,Ghulam Abbas,Muhammad Arif Khan,Muhammad Sajid,Shehla Gul Bokhari,Muhammad Ijaz

doi:10.13189/azb.2017.050402

Abstract

Z-plasty is a plastic surgery technique which is used to improve the functional and cosmetic appearance of a scar by redirecting it into better alignment and allowing the closure of a large wound by increasing circumference of its orifices. This experimental study was executed to evaluate the extent of relaxation of contracted scar, cosmetic appearance and tip necrosis in dogs by using Z-plasty technique at different angles, i.e. 45°, 60° and 75°, respectively. 18 mongrel dogs were randomly selected and divided in three groups (A, B and C) comprising six dogs each; after induction of scar tissue, Z-plasty was applied at 45° in Group A, 60° in Group B and 75° in Group C, respectively. % Gain in length was superior for the 60° group (P<0.05), as compared with the 45° and 75° Z-plasty, respectively. Tip Necrosis Status and cosmetic appearance for the 60° group were also found superior (P<0.05) than at 45° and 75°, respectively. The results of the experimental trial showed that the parameters of extent of relaxation of the contracted scar, cosmetic appearance and tip necrosis, were mainly governed by two factors, (1) length of contracted scar and (2) angle of Z-plasty technique. Conclusively, 60° Z-plasty serves a better option for correction of burn scar contractures since it provides average gain in length, good cosmetic appearance and causes no tip necrosis.

Highlights

Z-plasty is a plastic surgery technique which incorporates a Z- shaped skin incision, composed of one central and two lateral limbs, with two triangular flaps of equal sizes and these flaps are raised on opposite sides of the two ends of the “Z”, and transposed to each other [3, 14].Z-plasty is mostly indicated for burn scar contractures which are one of the most pressing challenges to burn-patients [16, 19, 20] because they result in poor aesthetic appearance, functional impairment and musculoskeletal discomfort
The wound healing was delayed inGroup A dogs due to tip necrosis and wound healed in 4-7 weeks
The Z-plasty technique was evaluated on the basis of physical findings, wound healing, extent of relaxation of contracted scar, cosmetic appearance and tip Necrosis at 45°, 60° and 75°, respectively

Summary

Introduction

Z-plasty is a plastic surgery technique which incorporates a Z- shaped skin incision, composed of one central and two lateral limbs, with two triangular flaps of equal sizes and these flaps are raised on opposite sides of the two ends of the “Z”, and transposed to each other [3, 14].Z-plasty is mostly indicated for burn scar contractures which are one of the most pressing challenges to burn-patients [16, 19, 20] because they result in poor aesthetic appearance, functional impairment and musculoskeletal discomfort.Initially, some non-surgical procedures like appropriate wound care, splinting and physiotherapy have been used to release the scar. Permanent relief from burn scar necessitates implication of some relaxing incision For this purpose, many surgical procedures like skin grafting, flap technique, Z-plasty, Y-V advancement, W-plasty and combinations of the above-mentioned techniques have been used as relaxing incision [8, 18]. The major advantage is that Z-plasty can be performed in an area of high skin tension to allow skin relaxation and lengthening [14]; Z-plasty improves the functional and cosmetic appearance of scars, rather, it prevents the contracture of linear scars [11] It redirects a scar into better alignment with the line of least skin tension or a natural skin fold to allow the closure of large wounds by increasing the circumference of its orifices [1]

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Discussion

Conclusion