Z-plasty Technique Research Articles

Comparative analysis of length gain provided by five-flap z-plasty and double z-plasty techniques for correction of digital flexion contractures

Introduction: Persistent postburn flexion contractions of the digits present challenging deformities. The surgical goal is to lengthen the linear scar band on the flexion surface of a finger through local tissue rearrangement using different z-plasty techniques. This study aimed to analyse the length gain and compare outcomes between 5-flap z-plasty and double serial z-plasty techniques for correcting digital flexion contracture.Patients & method: This retrospective study was conducted from November 2022 to January 2024 on patients who presented with digital flexion contractures caused by volar linear scar contracture and who needed surgical intervention. All patients who underwent correction via the 5-flap z-plasty or double z-plasty technique were categorized into two groups.Results: A total of 12 patients were included in this study. All patients successfully achieved complete release of their digital contracture in both groups. While there was a significant increase in the length of the contracture band and extensor lag angle postoperatively in both groups, the mean increase in band length for patients treated with five-flap Z-plasty was significantly greater than that for patients treated with double z-plasty (63.667 ± 13.125% vs. 41.333 ± 12.1764%, respectively).Conclusion: The 5-flap Z-plasty technique could be a more favourable alternative to the frequently used double z-plasty method due to its ability to achieve a superior rate of elongation in the contracture band and restore finger function when treating linear digital flexion contractures.

Advancement-Rotation–Modified Z-plasty Technique to Prevent Notching in Congenital Cleft Earlobe Repair

The surgical correction of congenital cleft earlobes poses a unique set of challenges in achieving optimal aesthetic outcomes. While various surgical techniques have been proposed, most of them result in the appearance of irregularity and asymmetry of the earlobe. This paper presents a modification to the traditional Z-plasty technique that prevents the postoperative appearance of notching of the earlobe. Our technique achieves this by creating 2 flaps, a medial-advancement flap and a lateral-rotation flap, that are surgically constructed in a manner that ensures the posterior earlobe is directly attached to the mandibular cheek subcutaneous tissue as opposed to adjacent to it to render the appearance of a more natural-looking and volume-sufficient earlobe. The exact technique involved is discussed further in this paper, with supporting case-based examples to demonstrate its efficacy in enhancing overall aesthetic outcomes.

Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome

IntroductionWhile there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla. MethodsA retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint. ResultsAll patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively. ConclusionThe square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

Outcomes of Palatoplasty Techniques: A 10-Year Review of Intravelar Veloplasty Compared with Furlow Double-Opposing Z-Plasty Techniques

Outcomes of Palatoplasty Techniques: A 10-Year Review of Intravelar Veloplasty Compared with Furlow Double-Opposing Z-Plasty Techniques

Does Primary Cleft Palate Repair by Furlow Z-Plasty Technique With a Buccinator Myomucosal Flap Change Speech and Middle Ear Outcomes?

Children with repaired cleft lip and palate may present with middle ear effusion and disturbed speech due to velopharyngeal (VP) insufficiency. Furlow Z-palatoplasty with a buccinator myomucosal flap is one of the effective surgical techniques for primary cleft palate repair and lengthening of the palate. This study aimed to evaluate the effect of Furlow Z-palatoplasty with buccal myomucosal flap as a primary cleft palate repair technique on the VP function during speech and the Eustachian tube function. Forty patients with non-syndromic cleft lip and palate aged 3 to 7 years surgically repaired with Furlow palatoplasty with a buccinator myomucosal flap were assessed. Perceptual speech assessment, nasopharyngoscopic examination, otoscopic examination, and tympanometry were done for all patients to assess the speech and middle ear function. The percentage of mild hypernasality was significant in 22.5% of children with repaired cleft lip and palate, while 77.5% showed no hypernasality. Speech intelligibility was normal in 77.5% and mildly affected in 22.5% of children with repaired cleft palate. Compensatory misarticulations were recorded in 12.5% of children. Nasopharyngoscopic examination revealed adequate VP closure in 75% of children with repaired cleft palate. Twenty-five percent of children with repaired cleft lip and palate had middle ear effusion and required myringotomy with insertion of tympanostomy tubes. Primary cleft palate repair with Furlow Z-palatoplasty with buccal myomucosal flap had beneficial effects on speech outcomes. It was associated with a low prevalence of middle ear effusion, and a low number of tympanostomy tubes were needed.

A CASE REPORT: EARLOBE RECONSTRUCTION ON CONGENITAL AURICULAR LOBE DEFECT USING Z-PLASTY

Highlights: Congenital ear defects typically result from growth failures during the fifth to ninth weeks of gestation or from mechanical stress during this period. Auricular lobuloplasty using the Z-plasty flap technique effectively addresses earlobe defects, resulting in optimal aesthetic outcomes with no keloid formation, minimal scarring, and no complications. Abstract: Introduction: Earlobe defects, often due to embryonal growth failure or injury, can affect aesthetics and social interactions despite not impacting hearing. Earlobe defect can be formed either from birth as congenital defect or secondary manifestation of other causes such as tumor and external factor such as earring usage or trauma. This study aimed to address these issues by performing auricular lobuloplasty using a Z-plasty flap technique. The procedure, crucial for protecting the auditory canal and facilitating eyeglass use, was successful in achieving the desired aesthetic outcome. Data on microtia prevalence, particularly in Indonesia, highlights the need for such reconstructive surgeries. Case Illustration: A 9-year-old boy underwent auricular lobuloplasty to correct a cleft earlobe deformity, which caused social discomfort. The surgery, performed under general anesthesia, utilized a Z-plasty technique to lengthen and reorient the scar. Postoperative care included wound dressing changes and oral pain medication. After two weeks, satisfactory results were observed with no reported complications. Discussion: The study on congenital ear deformities focuses on Z-plasty for earlobe reconstruction, detailing classifications, surgical techniques, and case results. The surgery was successful with minimal scarring and no keloid formation. Using Weerda's classification, the technique showed minimal scarring and no keloid formation. The approach, emphasizing proper skin envelope and alignment with Langer lines, offers effective aesthetic restoration, making it a valuable reference for future earlobe reconstruction cases. Conclusion: Utilizing Z-plasty for earlobe defect reconstruction aids in improving the earlobe's appearance with minimal to no complications.

The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t -tests, with a P -value of less than 0.05 denoting statistical significance. Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32mm, expanding postoperatively to 35.19±2.26mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high. The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.

Unveiling a Misdiagnosed Midline Cervical Cleft: A Case Report and Review of the Literature

Congenital midline cervical cleft (CMCC) is a rare congenital abnormality of the ventral neck that is often misdiagnosed. We present a case of a 12-year-old male with a history of incomplete CMCC excision and limited neck extension. We highlight the need for increased awareness of this anomaly and propose a clinical algorithm for clinicians when faced with this rare congenital condition. CMCC typically presents at birth and involves a defect along the midline of the neck, characterized by a nipple-like protrusion of the skin and a fibrous cord with an underlying sinus. Micrognathia and mandibular growth restriction are anticipated consequences of CMCC, requiring early intervention. Current treatment guidelines recommend surgical excision prior to age two using a Z-plasty technique. This report emphasizes the rarity and diagnostic challenges of CMCC. It underscores the significance of accurate identification and appropriate surgical planning in a timely manner. Based on the authors’ experience with this case and a review of the literature, we propose a clinical algorithm aimed to enhance CMCC diagnosis and management.

Effectiveness of Frenuloplasty in Ankyloglossia on Speech Quality: A Systematic Review

BACKGROUND: Ankyloglossia, known as tongue-tie, is an inherited anomaly and is caused by a short nonelastic frenulum that causes limited tongue movement. Because of the limitations of tongue movement, it can affect the quality of speech. Ankyloglossia treatment is to divide or separate fibrous bands or frenuloplasty. The purpose of making this systematic review is to systematically review the results of frenulopasty governance in cases of ankyloglossia related to speech quality. AIM: The aim of this systematic review is to explain the original study in patients with Ankiloglosia who underwent a frenectomy procedure on the tongue tie. This study included research evaluating results related to speech quality. METHODS: PubMed, EMBASE, and Cochrane Databases, No restrictions on published studies until September 10, 2021. Studies are included if subjects of all ages have ankyloglossia and performed frenuloplasty procedures. The results assessed were the level of speech quality in the subjects of preoperative ankyloglossia and postoperative frenuloplasty. RESULTS: Overall, 473 abstracts resulted from literature searches; 13 studies met the criteria for data extraction and analysis. Of the 13 studies, eight studies were Randomize control trial studies and 5 case–control studies. Three studies evaluated speech outcomes using Likert scores, 3 studies using questionnaires, and 7 studies using different assessments pre-operative and post-operative speech quality. CONCLUSION: Frenuloplasty in subjects with ankyloglossia mostly gives good results in terms of speech quality. Improvements in articulation and mention of consonant phonation improve after frenuloplasty. Frenuloplasty with the 4 flap Z-Plasty Technique provides better results compared to conventional and horizontal vertical frenuloplasty. A long-term study of the correlation of ankyloglossia and speech difficulties and the effects of frenuloplasty is needed.

Two novel mutations within FREM1 gene in patients with bifid nose

BackgroundBifid nose is a rare congenital deformity and the etiology is unknown. The purpose of this study was to report genetic variation in family of patients with bifid nose.MethodsTwenty-three consecutive patients who were diagnosed with mild bifid nose were operated with z-plasty from 2009 to 2021. Three underage patients (a pair of twins and a girl) from two family lines, who came to our hospital for surgical treatment, were enrolled. Whole exome sequencing and Sanger sequencing were conducted. Z-shaped flaps were created and the cartilago alaris major were re-stitched. Photographs and CT scan before and after surgery were obtained. Clinical outcomes, complications and patients’ satisfaction were evaluated and analyzed. The follow-up time ranges from 2 to 3 years (2.4 ± 1.2 years).ResultsMost patients were satisfied with the outcome (96.2%). The nasal deformities were corrected successfully with z-plasty technique in one-stage. FREM1 c.870_876del and c.2 T > C were detected with Whole exome sequencing, which have not been reported before. The results of Sanger sequencing were consistent with those of Whole exome sequencing.ConclusionsThe newly detected mutations of FREM1 have a certain heritability, and are helpful to make an accurate diagnosis and provide a better understanding of bifid nose mechanism. Z-plasty technique can be an effective technical approach for correcting mild bifid nose deformity.

Comparative quantitative analysis of intravelar veloplasty and Furlow double opposing z plasty techniques for transposition of LVP muscles to correct VPI

Purpose The present study was performed to use quantitative analysis of LVP by magnetic resonance imaging (MRI) to compare intravelar veloplasty versus Furlow double opposing z-plasty technique in VPI correction. Materials and methods This is an interventional, comparative study that was carried out on 16 patients with velopharyngeal insufficiency due to decreased velar mobility divided into two equal groups, group I: included eight patients in whom VPI was repaired with intravelar veloplasty, group II: included eight patients in whom VPI was repaired with Furlow double opposing z-plasty. All patients underwent regular follow-up for 3 months by clinical, nasopharyngoscopy and MRI. Results Clinically, there was primary wound healing uneventfully was achieved in all patients in the two groups with no signs of infection. By MRI there was a significant increase in the angle of origin, length and thickness of the LVP postoperatively in both groups with no significant differences between them which confirmed with increased velum mobility postoperatively in both groups in nasopharyngoscopy. Conclusion According to quantitative analysis of LVP by MRI preoperatively and postoperatively, there was no statistically significant differences between intravelar veloplasty and Furlow double opposing z-plasty technique in VPI correction.

Correction of Cryptotia With Double Z-plasty:Modified Large Z-plasty Technique.

Some cases of moderate or severe cryptotia are accompanied by a shortage of the helix. Although various operative techniques for correcting cryptotia have been reported, elongation of the helix is not considered in most of those techniques. In cases of a shortage of the helix, a drooped wide helix like a constricted ear or a cranially and posteriorly hypoplastic ear, which is characteristic of cryptotia, can appear after surgery if the helix has not been elongated. We previously reported a large Z-plasty technique that has become one of the popular techniques for correcting cryptotia. However, satisfactory results are not always achieved by using this technique in cases with a shortage of the helix. We developed a new technique (double Z-plasty) in which a small Z-plasty in the helical rim is added to the usual large Z-plasty technique. An improved helical shape and enlargement of the ear can be achieved by using this technique. Almost all types of cryptotia can be treated by appropriately using the large Z-plasty and double Z-plasty techniques.

External Z-plasty Technique for Correction of Alar Retraction in Asian Patients.

Current strategies for correcting alar retraction mainly include cartilage grafting and composite grafting, which are relatively complicated and may produce injury to the donor site. Herein, we introduce a simple and effective external Z-plasty technique for correcting alar retraction in Asian patients with poor skin malleability. Twenty-three patients were presented with alar retraction and poor skin malleability, and they were very concerned about the shape of the nose. These patients undergoing external Z-plasty surgery were analyzed retrospectively. In this surgery, no grafts were needed, and the location of the Z-plasty was according to the highest point of the retracted alar rim. We reviewed the clinical medical notes and photographs. During the postoperative follow-up period, patients' reported satisfaction with aesthetic outcome were also evaluated. The alar retraction of all the patients was successfully corrected. The postoperative mean follow-up period was 8 months (range: 5-28mo). No incidents of flap loss, recurrence of alar retraction, or nasal obstruction were observed during postoperative follow-up. Within postoperative 3-8 weeks, minor red scarring was visible at the operative incisions in most patients. However, these scars turned unobvious after postoperative 6 months. There were 15 cases (15/23) being very satisfied with the aesthetic outcome of this procedure. Seven patients (7/23) were satisfied with the effect and the invisible scar of this operation. Only one patient was dissatisfied with the scar, but she was satisfied with the correction effect of the retraction. This external Z-plasty technique can be an alternative method for correction of alar retraction with no need of cartilage grafting, and the scar can be unobvious with fine surgical suture. However, the indications should be limited in patients with severe alar retraction and poor skin malleability, who should not particularly care about the scars.

Assessment arch dimensions in children with unilateral cleft lip and palate treated surgically by Furlow double-opposing Z-plasty protocol

Objectives: The present study aimed to analyze the outcomes of Furlow double-opposing Z-plasty techniques and to know the effect of this technique on arch dimensions and also to compare these outcomes with the ordinary technique (pushback technique) and with the control group. Materials and Methods: There are two treatment groups and one control group. Forty-two (20 males and 22 females) patients as a total number of the sample with unilateral cleft lip and palate (UCLP) children were included in this study, 1st group (10 males and 14 females) those treated with Furlow double-opposing Z-plasty performed at the age of 10 weeks repair of the lip, at 10 months closure of soft palate followed by construction of obturator done by an orthodontist, at 6 years of patient`s age a closure of hard palate, 2nd group (10 males and 8 females) treated with pushback technique. Criteria for selecting patients (two treatment groups), those without systemic diseases, cerebral disabilities, or any syndromes. The 3rd group consists of 20 healthy children (10 males and 10 females) those free from systemic diseases, aged 9–10 years old, free from oral habits and with limited or no crowding of teeth. Impressions of the upper arch of the patients were taken and the study model was poured at ages 9–10 years. Measurements include anterior arch width (ARW) or intercanine distance, posterior arch width (PAW) or intermolar distance, and arch depth (Adp). Statistical analysis; after collecting the data SPSS software program (version no. 21 Chicago, Illinois, USA) used for analysis, P ≤ 0.05 will be considered as statistically significant. The data were analyzed for their normal distribution, and a comparison of dental arch dimensions between genders and between the two techniques of surgical repair was tested by independent t-test of samples. Results: Significant larger mean values for arch measurements ARW and Adp for males and Adp for females than with the pushback technique. This is related to the growth pattern that occurred without surgical intervention. Conclusion: An improvement in surgical outcomes, and the patients with UCLP treated with Z-plasty technique, revealed an increase in the mean values of arch measurements (anterior and PAW and Adp) for both genders when compared to the pushback technique, but less than that of healthy non-cleft children.

Velopharyngeal Insufficiency Treatment in Cleft Palate Patients: Umbrella Review.

Velopharyngeal insufficiency may occur as a result of an anatomical or structural defect and may be present in patients with cleft lip and palate. The treatment options presented in the literature are varied, covering invasive and non-invasive methods. However, although these approaches have been employed and their outcomes reviewed, no conclusions have been made about which approach is the gold-standard. This umbrella review aimed to synthesize the current literature regarding velopharyngeal insufficiency treatments in cleft lip and palate patients, evaluating their effectiveness based on systematic reviews. A standardized search was carried out in several electronic databases, namely PubMed via Medline, Web of Science, Cochrane Library, and Embase. The quality of the included studies was evaluated using AMSTAR2 and degree of overlap was analyzed using Corrected Covered Area. Thirteen articles were included in the qualitative review, with only 1 in the non-invasive method category, and 12 in the invasive method category. All reviewed articles were judged to be of low quality. In symptomatic patients, treatment did not solely comprise speech therapy, as surgical intervention was often necessary. Although there was no surgical technique considered to be the gold standard for the correction of velopharyngeal insufficiency, the Furlow Z-plasty technique and minimal incision palatopharyngoplasty were the best among reported techniques.

How to Address Scar Pincushioning and Webbing of the Nasal Dorsum Using Surgical Defatting and Z-plasty

Nonmelanoma skin cancer is the most common cancer, typically growing in sun-exposed areas, such as the nose. After complete excision of the tumor, the subsequent scar may exhibit multiple complications that are easily noticeable and cosmetically unsatisfactory. When performing a revision of such a scar, using a single surgical technique may be insufficient; rather, the surgeon may need to carefully plan and utilize several techniques to achieve the best cosmetic outcome. Here, we report a case that demonstrates successful use of surgical defatting and Z-plasty techniques to revise a scar of the nasal dorsum that exhibited pincushioning and webbing.

Review of two cutaneous closure methods for Tessier 7 repair

Aim of the Study: The aim of this study is to retrospectively analyze the surgical outcomes of patients who were treated for Tessier 7 cleft deformity, over a period of 10 years and compare the two cutaneous closure methods used for the treatment of the same in our cleft center. Patients and Methods: This is a retrospective audit of all the patients who had undergone Tessier 7 cleft repair from 2010 to 2020 in our center. Relevant details from recorded case histories were extracted and the surgical technique (Straight-line closure or Z-plasty technique) used for the closure of each case was analyzed. The benefits and drawbacks of linear closure and geometric closure methods were also studied. The preoperative, postoperative, and follow-up records and photographs were assessed for the results. Results: Of the 40 patients, 23 patients had skin closure done using Z-plasty technique while 17 patients had the closure done using the straight-line method. The average age at repair was 10.6 months and the follow-up period was unto 1.5 years. Visual Analog Scale and Scar assessment scales revealed Z-plasty skin closure scars were more conspicuous than straight-line closure ones. Lateral migration of the commissure was not an evident finding. Conclusion: Z-plasty or W-plasty can be avoided in repair of transverse facial clefts. Closure of the orbicularis oris muscle is the critical step to provide a counterforce to the contraction of the cutaneous scar and no lateral migration or hypertrophic scarring is present after straight-line cutaneous closure.

A Modified Double Z-Plasty for Bilateral Cleft Lip Repair.

Repairing bilateral cleft lip (BCL) with a modified Z-Plasty technique to overcome many complications encountered with other traditional techniques was attempted in a group of Egyptian subjects at the Department of Oral and Maxillofacial Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt between May 2018 to May 2021. The study included 20 patients suffering from primary BCL of both genders with ages ranging from one week to one year. 60% of the patients were female and 40% were males. The modified Z-Plasty technique was used in all patients. Wound healing in all cases was uneventful. No inflammation, infection or wound dehiscence were reported in this study. Postoperative gummy show improved significantly (p=0.001), and 70% of patients had zero postoperative maxillary ridge show as lip lengths improved significantly. The clinical results of the modified double Z-Plasty technique used for closure of BCL were very interesting and avoid scarifying vermillion tissue in addition to the increase of both philtrum length and lip volume. Key Words: Bilateral cleft left lip, Repair, Z-Plasty.

Z Plasty – An Aesthetic Surgery for Aberrant Labial Frenum: A Case Report

Background: Aberrant labial frenum can cause central diastema, gingival recession and affect aesthetic appearance. Several techniques are available for removing the attachment of an abnormal frenulum. Z-plasty is a surgical technique used for thick and wide hypertrophy frenum associated with central diastema and short vestibule.
 Objective: To discuss the Z-plasty technique for aberrant labial frenum.
 Case Report: A 23-year-old woman was referred to the Periodontia Department of Hasanuddin University Dental Hospital for a frenectomy. Intraoral examination showed a diastema on maxilla centralis incisive and a labial frenulum’s attachment extending to the palatine papilla. The frenectomy procedure was performed using the Z-plasty technique.
 Results: Follow-up after one week and one month showed a good healing process with minimal scars and gingival color according to the surrounding tissue.
 Conclusion: Z-plasty frenectomy can provide good aesthetic and functional results for removing the attachment of hypertrophy frenum.
 Keywords: frenectomy, labial frenum, hypertrophy frenum, Z-plasty

Z-frenuloplasty: A Versatile and Effective Technique

There are various cases where Z-frenuloplasty, a specific Z-plasty technique, can be used, including prior to mucogingival surgery, to manage localized recession defects, pre-prosthetic surgery, post-orthodontic treatment, oral hygiene and ankyloglossia, to name a few. This case series demonstrates the versatility of the Z-plasty technique in oral surgery/periodontal procedures for a variety of indications, as well as describing the technique in detail. The frenectomy technique using Z-plasty for the removal of the abnormal labial frenum attachment is reliable, easy to perform, and provides excellent aesthetic results for a range of indications. CPD/Clinical Relevance: An appreciation of the Z-plasty technique will allow for tissue healing by primary intention, reduces risk of tissue contractures, improves recovery time, and improves aesthetic results.