The Z-plasty: Biomechanics and mathematics

Small-Wave Incision Method for Linear Hypertrophic Scar Reconstruction: A Parallel-Group Randomized Controlled Study

“…However, when the scar crosses the lines of skin tension at an angle smaller than 60°and larger than 30°, a stair W-plasty is preferred [11]. With regard to Z-plasty, while many different limb sizes and angles have been tried [15], it is believed that an angle less than 45°is tenuous from a vascular point of view, while a 90°Z-plasty is very difficult to transpose. Moreover, for scars that require lengthening, it is best to use a 60°Z-plasty [9].…”

Congenital midline cervical cleft: A practical approach to Z-plasty closure

“…The distorting effects of larger Z-plasties are also dissipated over greater areas. However, the tension required to close the flap tips increases exponentially with an increase in size of the Z-plasty, and anatomical structures can limit flap transposition with larger Z-plasties [16].…”

“…First, the predicted gain in length of a single Z-plasty is equal to that of serial Z-plasties of the same total length; however, experimental values show that the gain in length actually decreases with increasing numbers of serial Z-plasties. Second, the field of tension surrounding each individual Z-plasty Congenital midline cervical cleft 557 overlaps, thereby decreasing the overall extensibility of the tissues [16]. Nevertheless, serial Z-plasties may be useful when a single Z-plasty extends beyond acceptable boundaries or when a single Z-plasty causes excess tissue distortion [17].…”

A new method in the treatment of postburn and post-traumatic scar contractures: Double-opposing Z- and V- (K-M-N) plasty

“…For example, a 1 cm scar would be 1.75 cm using a 60° angle Z-plasty. This lengthening is mostly obtained in 40% to 65% of cases (9,10). Increase in the elongation of the contracture line is achieved by adding new V-plasties on both sides of the M flap, and recurrence of the contracture is avoided by shaping the scar line in sharply broken incisions.…”