After the Z has been incised, undermine the flaps of the Z and the skin between the Z and the original wound (Figure 5). This will allow the relaxation needed to appose the wound margins (Figure 6). Thorough hemostasis is important to avoid hematoma development, which can contribute to flap necrosis. A subcutaneous drain
can be placed if seroma formation is expected.2 The original wound, if not already apposed, is closed by using a simple interrupted pattern, automatically bringing the Z
flaps into transposition (Figure 7). Use half-buried horizontal mattress sutures at the flaps' tips to keep them in place.2,3,6 Interrupted subcutaneous sutures can be placed after the flaps have been secured with a few skin sutures to help alignment.
One or two tacking sutures may also be needed between the wounds to help eliminate dead space.2,6 Complete the closure of the skin of the newly formed Z with a simple interrupted pattern.
Figure 8. In this dog, a second Z-plasty is performed on the opposite side of the primary wound closure.
Proper planning of the Z incision will provide optimal results. If the Z-plasty limb lengths or angle sizes are too large,
however, dehiscence is likely. The use of double opposing or multiple Z-plasties may need to be considered as an alternative
to a large, single Z-plasty (Figures 8 & 9).3,4
As long as the Z-plasty is used prudently, the complications are few. The most common complication of Z-plasty is avascular
necrosis of the flap tips.3 Placing half-buried horizontal mattress sutures at the tips can reduce the likelihood of this occurring. A modified Z-plasty
can also be used, in which the arms of the Z are slightly curved.3 This modified technique will widen the flap tips and increase the blood supply.
Figure 9. The final appearance
of the wound closure and bilateral Z-plasties one
day after surgery.
Cary Bosworth, BS
Karen M. Tobias
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4554
1. Trout, N.J.: Principles of plastic and reconstructive surgery. Textbook of Small Animal Surgery, 3rd Ed. (D.H. Slatter, ed.). W.B. Saunders, Philadelphia, Pa., 2003; pp 274-292.
2. Swaim, S.F.: Z-, V-Y, and W-plasties. Surgery of Traumatized Skin: Management and Reconstruction in the Dog and Cat. W.B. Saunders, Philadelphia, Pa., 1980; pp 395-415.
3. Vig, M.M.: Management of experimental wounds of the extremities in dogs with Z-plasty. JAAHA 28:553-559; 1992.
4. Pavletic, M.M.: Tension-relieving techniques. Atlas of Small Animal Reconstructive Surgery, 2nd Ed. W.B. Saunders, Philadelphia, Pa., 1999; pp 131-171.
5. Bowman, K.F.; Swaim, S.F.: Double opposing Z-plasty for correction of stenotic naris in a horse. JAVMA 180(7):772-775; 1982.
6. Swaim, S.F.; Henderson, R.A.: Management of skin tension. Small Animal Wound Management, 2nd Ed. Williams & Wilkins, Philadelphia, Pa., 1997; pp 143-190.
7. Hudson, D.A.: Some thoughts on choosing a Z-plasty: The Z made simple. Plast. Reconstr. Surg. 106(3):665-671; 2000.
8. Furnas, D.W.; Fischer, G.W.: The Z-plasty: Biomechanics and mathematics. Br. J. Plast. Surg. 24(2):144-160; 1971.
9. Rohrich, R.J.; Zbar, R.I.: A simplified algorithm for the use of Z-plasty. Plast. Reconstr. Surg. 103(5):1513-1518; 1999.