Skin reconstruction techniques: Z-plasty as an aid to tension-free wound closure - Veterinary Medicine
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Skin reconstruction techniques: Z-plasty as an aid to tension-free wound closure
Creating a Z-shaped wound adjacent to a high-tension wound is a great way to ease the primary wound's closure, provided the technique is performed correctly and under the right circumstances.


VETERINARY MEDICINE



Figure 8. In this dog, a second Z-plasty is performed on the opposite side of the primary wound closure.
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.

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


Figure 9. The final appearance of the wound closure and bilateral Z-plasties one day after surgery.
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.

Cary Bosworth, BS
Karen M. Tobias
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4554

REFERENCES

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.


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