THE INTEREST OF Z-PLASTY IN THE TREATMENT OF CERVICO-FACIAL BURNS SEQUELAE

Annals of Burns and Fire Disasters - vol. XVII - n. 3 - September 2004

THE INTEREST OF Z-PLASTY IN THE TREATMENT OF CERVICO-FACIAL BURNS SEQUELAE

Bouladaas M., Mourtada F., Lahlou M., Moudjir D.B.,Essqualli L., Alaoui F., Benchekroun L., El Jazouli N., Kzadri M.

Service d’ORL et de Chirurgie Maxillofaciale, Rabat, Morocco

SUMMARY. Z-plasties make it easy to release contractures either by changing the orientation of the scar or by lengthening it, especially when it is retractile.

A reminder of the Z-plasty technique

History

Denovillers first described the Z-plasty technique in 1856, followed by Morestin. Lindesberg provided mathematical principles.


Principles

Two triangular flaps with opposed bases are performed from the central line. If free, the upper triangle takes the place of the lower triangle and conversely. All flaps have the same length, with a 60° angle after their transposition. The scar is thus lengthened.


Z-plasty technique

* Step one (Fig. 1)



Fig. 1Step one.

Fig. 1 - Step one.



Draw a line passing by the scar. From this line, draw two incisions the same length as the main line, with an angle of 60°.

* Step two

With a scalpel number 15, perform an incision perpendicular to the drawn line as far as the subcutaneous fatty tissue.

* Step three

Using a hook retractor, two subhypodermic triangular flaps are made with a scalpel 15.

* Step four

After transposing and reversing the flaps, suture the shape using Y points with 3/0 monofilaments. The edges are sutured with separate points in one time with 3/0 or 4/0 monofilaments.

Different Z-plasties

There are three types of Z-plasty.

* Lengthened Z-plasty

This gives a lengthened effect to the central axis by reducing the transversal axis. A lengthened Z-plasty is indicated in two cases: to release a contracture scar and to avoid or prevent a retracting scar. Z-plasties can be single (Fig. 2), double (Fig. 3), or multiple.



Fig. 2Single Z-plasty

Fig. 2 - Single Z-plasty





Fig. 3Double Z-plasty

Fig. 3 - Double Z-plasty



* Transposed tissue Z-plasty

The angle between the axis and the branch of the Z is less than 60°. We lose the lengthening effect, which is replaced by transposition.

* Closing of cutaneous defect (Fig. 4)

The Z-plasty is drawn inside or close to the cutaneous defect in order to give a lengthened effect and to facilitate the closure (Fig. 5).



Fig. 4Z-plasty for cutaneous defect.

Fig. 4 - Z-plasty for cutaneous defect.





Fig. 5Z-plasty closer to the cutaneous defect.

Fig. 5 - Z-plasty closer to the cutaneous defect.



Indications of Z-plasty in cervico-facial burns

In spite of preventive treatment, burns always cause scars and sometimes leave functional sequelae. Cervico-facial contracture scars lead to limitation of movement and functional disabilities. The Z-plasty, a simple practice with a limited hospitalization duration (one day), offers a quick recovery in the post-surgical period and is very efficient for the patient.

For the burn patient, there should be a three-month interval between operations.

It is better to perform many small Z-plasties than one big one, which may lead to flap viability problems. The long-term result is the same (Figs. 6-9).



Fig. 6

Fig. 6 -





Fig. 7Cervico-facial scar (burns sequelae).

Fig. 7 - Cervico-facial scar (burns sequelae).





Fig. 8

Fig. 8 -





Fig. 9After Z-plasty.

Fig. 9 - After Z-plasty.



Conclusion

The Z-plasty is a simple surgical practice without great honour for the surgeon but very helpful for patients, who after each operation notice an improvement in their movement.


RESUME. Les Auteurs ont effectué une étude rétrospective de 85 patients atteints d’infections dues aux brûlures hospitalisés à University College Hospital, Ibadan, Nigeria, entre avril 1998 et mars 2001. En tout, 85 spécimens, qui consistaient en 35 tampons (41,2%) et 50 biopsies (58,8%) provenant des lésions, ont été examinés pendant cette période. Les infections des brûlures étaient plus fréquentes, en manière significative, parmi les enfants et les adolescents (5-20 ans) par rapport aux adultes (p < 0.05). L’espèce Klebsiella était le pathogène isolé le plus fréquemment (34,4%), suivi par Pseudomonas aeruginosa (29,0%) et Staphylococcus aureus (26,8%). Le taux d’isolement des organismes à Gram négatif était plus de deux fois superieur à celui des organismes à Gram positif. Plus de 75% des espèces isolées à Gram négatif étaient résistantes au gentamicine, un antibiotique communément utilisé seulement pour les infections à Gram négatif, mais sensibles au ceftazidime et à la péfloxacine. Les organismes isolés à Gram positif étaient surtout le Staphylococcus aureus sensible à l’azithromycine et à la péfloxacine. Les Auteurs dans cette étude ont mis en lumière les pathogènes bactériens principaux et leur profil antimicrobien parmi les brûlures infectées traitées dans leur centre.


Bibliography

  1. Banzet P., Servant J.M.: “Chirurgie plastique reconstructive et esthétique”. Flammarion, Paris, 33-6.
  2. Revol M., Servant J.M.: “Manuel de chirurgie plastique, reconstructive et esthétique”. Pradel, Paris, 31-4.
  3. Robbe M.: “Séquelles de brûlures: libération des brides localisées ou étendues par la réalisation de plasties en Z”. Ann. Chir. Plast. Esthét., 46: 243-51, 2001.

This paper was received on 25 November 2003.
Address correspondence to: Dr Malik Bouladaas, B.P. 8247, Avenue Nations Unies, Agdal, Rabat, Morocco.