The Use of Zigs and Zags to Reduce Scarring over “Keloid Triangles” during Excisional Surgery: Biomechanics, Review and Recommendations

Abstract

Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.

Biodynamic Excisional Skin Tension Lines for Excisional Surgery of the Lower Limb and the Technique of Using Parallel Relaxing Incisions to Further Reduce Wound Tension

“… 16 Another study using a multiphoton microscopic camera has demonstrated that under low-load levels such as during incisional surgery, elastin stretches, and collagen buckles, the reverse of what occurs at high-load levels during excisional surgery. 17 Given this differential interplay between elastin and collagen based on low and high loads of tension, the importance of differentiating incisional and excisional lines has been suggested, 18 and this may be most important on the lower limb. As this study has shown, BEST lines lie in the vertical direction and are best adopted for lower limb excisional surgery.…”

Biodynamic excisional skin tension lines for surgical excisions: untangling the science

“…12 A simple zigzag excision has also been shown to reduce wound tension in keloid zones and that was also confirmed during this study. 13 A limitation of this report is that, because of the large volume of cases, measurements of each lesion that was studied are not reported.…”