Z-shaped Incision Research Articles

Functional and aesthetic results of the Z-shaped and straight lower lip-splitting incision: a randomized clinical trial

The lip-splitting approach enables excellent access to all areas of the mouth and pharynx to remove tumors; however, traditional lower lip-splitting incisions produce an unsatisfactory scar. To achieve better functional and aesthetic results, we used a Z-shaped incision and compared the functional and aesthetic outcomes of the straight and Z-shaped incisions. Sixty patients who fulfilled the inclusion criteria were randomly divided into two groups and underwent lip-splitting between March 2021 and September 2023. Eventually, 77 patients were reviewed within 6 months and evaluated using the lip function assessment scale, patient and observer scar assessment scale, naïve observer scar assessment scale, and a clinical examination. The Z-shaped incision group performed better in terms of the lip pout movement at 3 months and in the subjective overall opinion, color, irregularity, and pigmentation at 6 months. The Z-shaped incision group had a lower incidence of notched vermilion. In conclusion, Z-shaped lower lip-splitting incisions have better functional and aesthetic outcomes than traditional straight incisions.Trial registration: Public title: Difference between the effect of Z-shaped and vertical incisions of labiobuccal flap on the recovery of lower lip scars. Registration date: 09/03/2021. Registration number: ChiCTR2100044084. Registry URL: http://www.chictr.org.cn.

Z-shaped incision without epithelial resection in pterygium surgery.

To introduce a novel surgical technique using a Z-shaped incision without epithelial resection in ophthalmic pterygia. This was a prospective study. During pterygium surgery, all proliferative tissues were separated from the cornea and conjunctiva without resection of the tissues. The unaffected conjunctiva was incised in a Z-shape. The upper (or lower) conjunctival flap was sutured to the lower (or upper) normal conjunctiva on the limbal sclera, while the proliferative tissue was sutured to the upper conjunctiva (or lower) near the fornix. Ten patients with pterygia were eligible for this study. Eight patients with primary pterygia and 2 with recurrent pterygia were included. The age of patients at surgery ranged from 47 to 90y (average: 71.9y). Five patients each showed right and left-sided pterygia. The postoperative follow-up periods were from 8 to 78mo (average: 25.0mo). The surgery was successfully conducted and wounds were favorably reconstructed in all patients. The proliferative tissues sutured to the normal conjunctiva showed palor and attenuated neovessles, and never showed re-growth after surgery. Nine patients did not show recerrence. Recerrent pterygium was noted in 1 patient, but additional treatments were not required. The procedure involves the reconstruction of pterygial tissue and normal conjunctiva using a Z-shaped incision. The scleral limbal wound can be covered with non-affected conjunctiva without any excision of conjunctival epithelia in patients with primary or recurrent pterygia.

Modified Partial Lateral Facetectomy of the Patella for Stage III Patellofemoral Osteoarthritis with 5-Year Follow-Up.

The main aim of this article was to examine the therapeutic evaluation of our modified partial lateral facetectomy of the patella for stage III lateral patellofemoral osteoarthritis (PFOA), which includes (1) partial lateral patella articular facet that was resected; (2) coronal Z-shaped incision to lengthen lateral retinaculum; (3) patellar perimeter electrocoagulation to denervate. Between December 2008 and January 2013, 36 knees of 32 patients with severe patellofemoral (PF) osteoarthritis (OA) were treated with our modified partial patellar lateral facetectomy. All patients were stage III according to the Iwano scale, and their patellas were all Wiberg type III or Baumgartl type IV in shape. The study group included 6 males and 26 females with an average age of 54.03 years and an average disease course of 8.67 years. The modified Kujala scores were used to evaluate PF function, and the congruence angle was used to evaluate the patellar position. Knee Society Scores (KSS) were used to evaluate overall knee function. Six knees of five cases were lost to follow-up. Thirty knees of 27 cases were followed up for 5 years, with an average follow-up time of 60 ± 3.2 months. The average preoperative modified Kujala score was 15.93, and the average score at last follow-up was 32.03; The satisfactory PF function was achieved in 28 knees (93.33%). The congruence angle improved from preoperative +23. 07 degrees to 11. 91 degrees at the last follow-up. The average preoperative KSS were 110.40 points, which increased to 156.77 points at the last postoperative follow-up. Pain was significantly relieved, and the ability to climb stairs was significantly improved. All scores showed statistically significant improvements after surgery (p < 0.05). No complications were reported. Our modified partial lateral facetectomy of the patella for stage III lateral PFOA can relieve pain and partially improve function. This modified procedure is relatively simple, safe, and an effective treatment method for middle-aged and elderly patients with PFOA. Furthermore, this surgery can be used as an alternative or prephase to total knee arthroplasty. This is a Level IV, therapeutic study.

The Use of Temporoparietal Fascia Flap for Surgical Treatment of Traumatic Auricle Defects.

Background:Auricular reconstruction is 1 of the biggest challenges of facial plastic surgery. The aim of this study was to evaluate the efficacy of 1-stage reconstruction of an auricle using a temporoparietal fascia flap (TPFF).Methods:In this nonrandomized study, autologous auricle bodies with emergency condition and cartilaginous graft from projection of a costal arch from the VI–VII ribs were used. Temporal fascia sample with vascular pedicle (a temporal artery with the accompanying veins) by the Z-shaped incision of skin in temporal area for auricular reconstruction was extracted. Skin grafts were taken from the supraclavicular area or from the left or right flank. Grafts of partial auricle bodies (n = 8) along with cartilaginous framework from a costal arch (n = 21) were used for auricle reconstruction. The follow-up period studied after 6 months in 29 operated patients.Results:The graft of partial auricle bodies or the graft of a cartilaginous framework from a costal arch presented a perfect auricular reconstruction. By avoiding a difficult microsurgery and its possible complications, the use of TPFF led to beneficial results in 75% and 90.4% of cases, respectively. Overall, no major complication (alopecia, hematoma, or necrosis) occurred, and further surgery was not required.Conclusion:TPFF is a technique of choice for surgical treatment of traumatic auricle defects.

ONCOPLASTIC RESECTION OF THE MAMMARY GLAND WITH A SLIDING DERMOGLANDULARY FLAP WITH A Z-SHAPED INCISION

Oncoplastic resections are a radical surgical treatment for breast cancer, as well as a method for the rehabilitation of patients, since operations are classified as organ preserving. When the tumor node is localized in the upper-inner quadrant of the breast, it is difficult to achieve good aesthetic results. One of the solutions to the problem is the use of a sliding flap with a Z-shaped incision. In P. Hertsen MORI from 2014 to 2016, the operation with the use of a sliding flap was performed in 13 patients. The prevalence of the process, patients were distributed as follows: ТisN0 М0–1, Т1N0 М0–7, Т2N0 М0–3, Т1N1 М0–2 .Molecular subtypes distribution was the following — luminal type A— 8, luminal type B — 3, triple-negative subtype — 1 patient. Localization of the tumor site in the breast: the upper-internal quadrant — 9, upper — 1, lowerinner quadrant — 3 .The upper Zshaped flap was used in 10 patients, the lower Zshaped flap in 3 cases. Postoperative period in all patients was without com plications. The wound healed by primary intention in all patients. Cosmetic effect was good. The observation period is from 6 months to 2 years, the median is 1.1 years. Data for local recurrence and distant metastases were not detected. 2 patients had only surgical treatment, in the remaining 8 cases, radiation therapy with or without drug therapy. In all cases the operation is performed on one breast, correction of the second breast was not required.The article presents the clinical observation of patients with oncoplastic resection of the Zshaped flap, a detailed procedure of the operation.

Correction of cryptotia and cartilage malformation with Z-plasty without skin grafting

To explore the curative effect of Z-plasty without skin grafting for correction of cryptotia. Twenty-five cases (29 ears) with cryototia were corrected by Z-plasty without skin grafting in our department from June 2009 to January 2014. A Z-shaped incision with one arm on the back of antihelix and the other arm on the edge of hair was made on the back of ear and scalp. The adhesion on the back of antihelix cartilage was dissected and the cartilage framework was lifted and re-positioned. The postauricular flap was transferred to cover the wound on the back of antihelix. The other flap was transferred to cover the remnant wound and correct the malformation of cryptotia. All the patients were followed up from 6 months to 1 year with stable and symmetric appearance. The shape of auricle is natural after operation without skin grafting. It is a simple and ideal method for the treatment of cryptotia.

Nipple reduction by using a modified Z-shaped incision technique

To explore an ideal surgical method for nipple hypertrophy correction. From July 2008 to June 2011, 44 nipple reductions were performed for 22 women (44 sides) by using the modified Z-shaped incision technique. The incision consists of two circles, one quadrangle and one triangle located on the top, body and base of the nipple. The nipple's height was decreased and the nipple diameter and base area were reduced. Bilateral nipples were designed symmetrically. 22 cases(44 sides) were treated with primary healing. The mean diameter of the nipple was reduced to (9.8 +/- 1.6) mm from (17.6 +/- 3.4) mm, the average height from (18.8 +/- 3.6) mm to (8.2 +/- 1.4) mm, with the patient supine. All the patients were followed up for 14 months to 4 years with satisfactory results. No nipple necrosis, infection and numb happened. 20 patients completed the self-designed survey scale 1 year after operation, of which 4 cases achieved normal lactation, and the remaining patients didn't have childbirth and breastfeeding yet. The modified Z-shaped incision technique could reduce the height, diameter, and most importantly, reduce the basal shape of all types of hypertrophic nipple to create a desired new cylindrical nipple without affection of nipple sensation and function.

Reverse Posterior Interosseous Artery Flap for Reconstruction of the Wrist and Hand after Sarcoma Resection

To report our experience of posterior interosseous artery flap reconstruction of the wrist and hand after soft tissue sarcoma resection. Thirteen patients who presented to our institution for treatment of soft tissue sarcomas of the wrist and hand from February 2007 to January 2009 were prospectively enrolled. After tumor resection, the soft tissue defects were covered with posterior interosseous artery flaps. Relevant patient characteristics, results of creation of flap and functional outcomes were reviewed. Relevant clinical characteristics were recorded prior to surgery. The size, pedicle length and thickness of flaps were measured intraoperatively and complications evaluated two weeks after surgery. Functional outcomes and aesthetic results were evaluated 6 to 24 months after surgery, using Enneking's Musculoskeletal Tumor Society (MSTS) 93 functional scoring system. The patients' ages ranged from 14 to 82 years (54.92 ± 19.09 years), including six aged >65 years. Flap sizes varied from 5 cm × 3 cm to 8 cm × 5 cm. Flap survival rate was 100%. One patient had partial necrosis of the Z-shaped incision, which healed with routine wound care. Mean Musculoskeletal Tumor Society functional score was 27.31 ± 3.68. Eleven patients were alive and disease-free at a mean follow-up of 36 months. One patient died of pulmonary metastases 18 months after surgery. One patient developed recurrence and underwent amputation 12 months after surgery. Reverse posterior interosseous flaps are reliable flaps for reconstruction of the wrist and hand after soft tissue sarcoma resection. They are suitable for elderly patients. The one-stage surgery and primary healing allow for timely postoperative adjuvant therapy following this type of reconstruction.

Nipple reduction using a three-dimensional Z-shaped incision technique

Nipple hypertrophy is a seldom-discussed aesthetic problem. Many patients feel uncomfortable with it and seek for correction. However, it is difficult to reshape nipples to an actual cylindrical form with the published methods. This study presented a novel three-dimensional Z-shaped incision technique, which can not only decrease the height anddiameter of a hypertrophic nipple but also narrow the nipple base without destroying its function. A total of 44 nipple reductions were performed for 22 women using the three-dimensional Z-shaped incision technique between July 2008 and June 2011. It consists of two circles, one quadrangle and one triangle incision lines on the top, body and base of the nipple to reduce the nipple's height, diameter and base. Bilateral nipples were designed symmetrically. A total of 44 operated nipples in 22 healthy female patients, aged 18-42 years (mean age, 28 years) were corrected with this method. The mean follow-up period was 28 months (range, 14-48 months). A survey was also performed to evaluate long-term patient satisfaction. Our survey showed that our surgical technique was capable of producing satisfactory results. No complications such as nipple necrosis, infection or numbness occurred. The three-dimensional Z-shaped incision technique could reduce the height and diameter and, most importantly, reduce the basal shape of all types of hypertrophic nipples to create a desired new nipple cylindrical in shape without compromising neurovascular supply and functions.

Z-Pharyngoplasty for Sleep Disorder and Rhonchopathy

We developed an operation that leaves the uvula intact and opens the pharynx by creating a Z-shaped incision in the palate, a procedure known as a Z-pharyngoplasty (ZPP). Twenty-four patients were studied before and after ZPPs. None of the patients complained of symptoms after the procedure. In terms of subjective changes, 79% of patients felt that they could breathe better after ZPPs and 75% felt that they had slept well upon waking. In terms of differences noted by sleep monitoring, the minimum oxygen saturation (SaO 2 ) level increased significantly ( p =0.0025), the number of hours of sleep during which SaO 2 was >95% increased significantly ( p =0.0345), the apnea index decreased significantly ( p =0.0316), snoring decreased ( p =0.0637) and pulse rate decreased significantly ( p =0.0144) after ZPP.

Z-shaped skin incision applying Kraissl's lines for an axillary thoracotomy.

A Z-shaped skin incision applying Kraissl's lines for a thoracotomy is presented herein. The center of the Z-shape is located on the intercostal space of the thoracotomy. Parallel Z-shaped lines are described on circular Kraissl's lines in the axillary region. The oblique cross-line of the Z-shape is drawn from the dorsal edge of the cranial line to the anterior edge of the caudal line. The angle of the triangular skin flaps is adjusted to 30 degrees or greater in order to keep good microcirculation. The incision gives good exposure for the operative fields and results in a cosmetically satisfactory scar.

Connective tissue structures in the first intermetacarpal space in cases of malformations of the hand with and without syndactyly

In three clinical cases of cutaneous syndactyly and varying degrees of serious disorders to the skeleton of the hand and in one case of hypoplasia of the thumb, hypoplastic carpometacarpal and metacarpophalangeal joints we were struck by the narrowness of the first intermetacarpal space. At the same time a lack of thumb opposition was clinically evident. Our own previous anatomical investigations and embryological considerations on a series of hands with cutaneous and osseous syndactylies lead us to suspect that abnormal ligaments or connective tissue bands might be responsible for the functional restrictions mentioned above [9]. The findings concerning both the bone structure and the soft tissue can be traced back to disorders in the distribution of mesenchymal material of the handplate and to a failure in resorption. Our procedure consisted of making a Z-shaped incision in the first intermetacarpal space and in radically extirpating abnormal ligaments and connective tissue bands therefrom. The freeing of the thumb thus obtained was completed by exchanging the triangular skin flaps in accordance with the technic of Z-plasty. In the four cases an improvement in the whole functioning of the malformed hands was attained.