Z-plasty is used to lengthen scars and anguishs We describe the use of a modified technique to shorten anguishs in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov deed The modified technique gave serviceable exposure.

Z-plasty is used to lengthen scars and anguishs We describe the use of a modified technique to shorten anguishs in ten consecutive patients undergoing acute shortening of a limb as part of an Ilizarov deed The modified technique gave serviceable exposure, easy closure of the detriment and fewer problems with healing than standard incisions.

J Bone Joint Surg [Br] 2001;83-B:668-71 Received 2 August 2000; Accepted after revision 20 February 2001

One of the more useful techniques of the Ilizarov means for treating segmental defects and nonunion is the ability to shorten a limb acutely and then subsequently lengthen it at a different site where the tissues are healthy. This order has been reported to have a lower rate of question at issues with alignment of the docking site. There is les ne for bone grafting1 compared with classic bone transport in which a portion of bone is moved within its soft-tissue wrapper while the limb is maintained at its normal fulness Although there are fewer bony complications with transactions involving acute shortening, skin closure is oftentimes difficult. Sinuses, old scars and the relative inelasticity of the skin because of chronic inflammation add to the difficulty of closing the incision. Transverse incisions at the site of shortening are easier to shut but have the disadvantage of limited position of the bone during debridement, which is ofttimes of critical importance.

Z-plasty is a plastic surgical technique usually used to lengthen a scar. We have introduced its use for shortening scar tissues. The zig-zag incisions used in our design of Z-- plasty are a way of exposure which allows great versatility in the closure of delicate tissues.

We have evaluated the use of techniques of Z-plasty to provide profitable exposure of the ends of the bone for debridement as well as allowing easy skin closure

Patients and meanss

The normal principle of Z-plasty is the transportation of couple triangular-shaped flaps. The long and central limb of the 'Z' is usually placed along the line of the scar to be lengthened or reorientated. The couple lateral limbs extend from this line at varying angles which determine the percentage lengthening of the central limb. formerly these flaps have been raised they are transposed, resulting in reorientation of the scar and its effective lengthening, which is possible because of the recruitment of skin from the lateral to the lengthy limb of the Z-plasty (Fig. 1a).

In limb shortening we use this principle in subvert Hence, the long limb of the plasty is placed transversely with the short limbs extending proximally and distally. When transposed the resultant lengthy limb of the Z-plasty lies longitudinally and there is a effective shortening (Fig. 1b).

Result

We reviewed ten consecutive patients in whom this technique had been used (Table I) and compared them with the preceding ten consecutive patients treated by dint of acute shortening before the introduction of the of recent origin method. Their skin defects were divided into three assemblages as follows: 1) no skin loss; 2) partial skin loss; and 3) skin los equal to the bone deficiency

No skin loss. When the bone of the lower limb is shortened the yielding tissue also has to be shortened. In tissues which are scarred and fibrosed shortening causes the standard longitudinal incision to shorten and become rhomboid-- shaped (Fig. 2) creating difficulty with closure The incisions for Z-plasty were made as marked (Fig. 3) After excision of the bone and acute shortening the flaps were either placed in their original site or transferred, depending forward the position in which they lay mostly comfortably (Fig. 4).

Partial skin los In limb shortening for osteomyelitis or infected nonunion, sinuses are oftentimes present. Z-plasty-type incisions were created to incorporate existing sinuses or faults (Figs 5 and 6) and to take into account the area of skin los

Complete skin los If the skin los (Fig. 7) is the same size as the bone foible then acute shortening is used to obliterate the soft-tissue gap. Extensions of the hurt are created to maximise prospect as well as to facilitate closure (Fig. 8)

Before the introduction of this technique of Z-plasty, 50% of patients either had delayed hurt healing, as indicated by a raw area in the hurt which had failed to heal primarily, or had difficulty in damage closure which required partial temporary relengthening of the fixator. This created a gap between the bone [i]finale[/i]s of 2 to 5 cm After a delay of a week, the bone lasts were approximated at a rate of 1 to 2 mm through day. In all the patients in whom the Z-- plasty design had been used the incisions healed rapidly and without vexed questions In all of those with sinuses, it was possible to incorporate these into the Z-plasty with equal reason that they could be excised during the act

Discussion

For cases in which the soft-tissue gap is greater than the bone flaw our preferred treatment is to mask using a pedicled flap or exempt tissue transfer. When the soft-tissue want is the same size or smaller than the bone deficiency we now consider acute shortening, using the technique of modified Z-plasty. Acute shortening is an extremely useful treatment for segmental destitutions and nonunion. As well as treating bone wants and skin loss, it has been used in an experimental gauge to treat soft-tissue defects in muscle and nerve2 Despite these advantages, certain difficulties, like as vascular occlusion, have been engagemented with acute shortening. The amount of shortening which is extremityed before this happens varies according to the site and the pre-existing state of the life-current vessels and soft tissues. For example, a patient with arteriosclerosis and non-compliant impressible tissues secondary to chronic infection is likely to tolerate les shortening than a young patient without peripheral vascular disease and more elastic tissues.