Design
Authors: Liv Schöllhammer, MD, Christian Kaare Paaskesen, MD, Frederik Gulmark Hansen, MD, and Magnus Balslev Avnstorp, MD
On this page you will find the design of a Z-plasty facial flap.
Background
Z-plasty is a versatile surgical technique used to lengthen contracted scars, reorient scar direction, or improve functional and cosmetic outcomes. It involves creating two triangular skin flaps in a Z-shaped incision, which are then transposed to redistribute tension and lengthen the central limb. Common indications include contracture release (e.g., after burns) and camouflage of scars by aligning them with natural skin creases. The effectiveness depends on flap design, angle selection, and tissue mobility.
Flap design
The scar or area with contractures makes up the central limb of the Z-plasty.
If a scar or contracture area contains hypertrophic tissue or is characterized by poor blood supply, it may be useful to excise the affected tissue before performing the Z-plasty.
A Z-plasty consists of a central limb and two peripheral limbs arranged in the shape of a Z. All three limbs are of equal length, meaning that the length of the scar tissue defines the two peripheral limbs. The scar or contracture itself forms the central limb. The procedure can be designed with angles between 30° and 90°, with 60° being the most commonly used(This figure is 45°).
The two triangular flaps, here marked as 1 and 2, are transposed to exchange positions. Undermining of the flaps may facilitate movement, but careful attention must be paid to preserving an adequate blood supply.
The two triangular flaps have been transposed, resulting in lengthening of the central limb and release of the contracture. In this example, the extension corresponds to an increase of approximately 50%.
Increasing the flap angles provides greater length gain but also results in a larger standing cutaneous defect. When the flaps are elevated and transposed, the orientation of the central limb changes; in a 60° Z-plasty this corresponds to an approximate 90° reorientation.
Acknowledgement
Illustrations: Christian Kaare Paaskesen, MD.