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Technique of Z plasty

- See:
       - Skin Grafts: for hand defects;

- Discussion:
     - indicate for soft tissue contracture including Dupuytren's;

- Technique:
     - all three parts of the Z plasty should always be of equal length;
     - angle: most often a 60 deg Z plasty is used;
     - size:
           - one must plan whether one large Z plasty versus several small Z plasties will be required;
     - incise central limb which is inline w/ soft tissue contracture;
     - incise one limb of the Z plasty and raise a flap;
           - w/ a single pronged skin hook pull the edge of the flap across the central limb;
           - it is important that this limb can be pulled easily across the midline;
           - if there is tension, a smaller Z plasty needs to be performed, which means that part of the limb needs to be resutured;
           - at this point, incise the second limb of the Z plasty;
     - suture down the transposed flap;
           - w/ severe soft tissue contracture, the flaps will often auto-transpose

Z-plasties and related procedures for the hand and upper limb.

The Z-plasty in hand surgery.

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