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18-09-2011 | Article

Novel Z-plasty technique ‘as effective’ as traditional method in lip reconstruction surgery


Free abstract

MedWire News: Researchers have devised a modification of the traditional Z-plasty technique called "sliding Z-plasty," which is as effective as the traditional technique in improving the outcomes of vertical (radial) lip reconstructions.

Z-plasties, which are Z-shaped interconnecting transposition flaps, are used in lip reconstruction procedures to help disguise and break up the scar line. They can take many different forms, with variations in factors such as angle and arm shape. These variations were developed in order to treat wounds of all shapes and sizes.

All of the "traditional" Z-plasties have three main arms of equal length, with an initial angle between the arms of 90 degrees or less.

Joseph Wentzell (Billings Clinic, Montana, USA) and colleagues affirm that the main goal of lip reconstruction procedures is not vermillion border alignment, but instead is alignment of the wet line. To that end, they constructed the sliding Z-plasty to allow simultaneous vermillion border alignment and wet line alignment in the same procedure.

This is especially needed for patients who may have sharply marginated vermillion borders or very protuberant lips, where prioritizing one technique over the other could lead to more visible scarring, they say.

Wentzell and colleagues explain that the sliding Z-plasty reworks the traditional version to provide for simultaneous flap transposition and opposing advancement and counteradvancement of the tissues on both sides of the wound. It incorporates a central limb that can be either longer or shorter than the two side arms, with the initial angle measuring up to 180 degrees. This modification creates asymmetrical ''lift'' of one side relative to the other.

Writing in the journal Dermatologic Surgery, the researchers say that no study has investigated how to incorporate Z-plasties into routine vertical lip reconstructions. Through the description of four different cases, Wentzell and colleagues note the efficacy of both traditional and sliding Z-plasties in camouflaging scars and avoiding trigone deformities, triangular deformations of the vermillion border caused by an opposing balance of tension vectors.

For maximum effect, the authors argue that the best use of Z-plasties is in situations where the lengthening effects of the Z-plasty would not exacerbate deflection of an intact vermillion border.

In conclusion, the authors state that "the sliding Z-plasty is a novel modification in Z-plasty design" that can align the vermillion border once the wet line area has been secured. They conclude that "traditional and sliding Z-plasties, applied to primary lip repairs, can be valuable tools augmenting the surgeon's 'reconstructive quiver'."

By Stephanie Leveene