Q: Hi, I am trying to find an expert z plasty surgeon and I was wondering if you could help? Thank you.
A: Z-plasty is a common plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It has a long history of use in plastic surgery and is one of the original scar revision procedures. It can lengthen a contracted scar or change the direction of a scar’s tension line. It is conceptually done by initially drawing the he middle line of the Z-shaped incision along the line of greatest tension or contraction. Triangular-shaped flaps are then raised on opposite sides of the two ends and then switched or transposed. The transposition of these two triangular skin flaps creates the classic Z shape of the final scar lines. The angles at which the triangular flaps are cut will determine how much the scar is really lengthened. The traditional 60° angle Z-plasty will give a theoretical lengthening of the central limb of 75%. Different angles of the flaps will give variable amounts of lengthening. While the mathematics of these flap angles are interesting, the most important thing is that the z-plasty will always lengthen a scar. Single or multiple z-plasties can also be used in a variety of clever ways for longer scar problems.
The use of z-plasty scar revision and contracture releases is very common and every plastic surgeon is trained and knows how to use them. Therefore, ‘expert z-plasty’ surgeons would be any board-certified plastic surgeon in your local or regional community.
Dr. Barry Eppley
Q: I had cancer in the parotid gland and it was removed with a neck dissection which left a deep horrible scar from the back of my right ear to the middle of my neck. The scar is mostly flat except when it gets close to the adam’s apple where it gets really wide. The scar is 4 years old and is still tender. I really hate it and it takes away from my appearance. One doctor did injections which didn’t really help it.
A: While any scar can be cut out and reclosed by different methods (scar revision), the question is always whether it would be beneficial or not. There are four features of scars that only surgical treatment can improve. Scars that are wide, depressed, raised (hypertrophic or keloid) or contracted (painful and movement restrictive) are very likely to be improved by getting rid of the bad (complete scar) and replacing it by moving your own unscarred tissue in its place. This neck scar has several of those features including being years old which means it is mature and no further improvement in its appearance or feeling can be expected.
Tumor excision in the neck with removal of lymph nodes (neck dissection) will leave a long scar that traverses the neck from around the ear to across the adam’s apple in many cases. While most of the scar should lie in a very favorable horizontal skin crease, portions of the scar may not. It is these areas in particular that often end up as a wide and distorted scar. Many patients with this type of surgery have also had radiation which may be another reason why it resulted in poor scarring.
Much of this scar can simply be cut out and reclosed along the skin line which it currently lies. But near and around the adam’s apple, re-orientation of the scar through a z-plasty will relieve the tension on it and allow it to heal with less distortion and be closer to a fine line in width.
Dr. Barry Eppley