ABSTRACT
One of the most common uses of the Z-plasty is the release of skin contractures. In clinical practice, one or a few large Z-plasties instead of many smaller ones are more effective for lengthening the skin in a desired direction (1). Therefore, in many situations, it is desirable to use as large as possible a Z-plasty. However, the larger the Z-plasty, the more the tension results in the transverse direction. A too large Z-plasty cannot be transposed because of excessive tension. Fortunately, planning of such a too large Z-plasty can usually be avoided by clinical examination; that is, pinching the skin adjacent to the contracture band or scar when flap planning. A special type of ruler can also be used during the clinical examination to determine the largest safely transposable Z-plasty (2). The clinical examination will help ensure that crucial mistakes will not be made; however, minor errors may occur in which a Z-plasty design, slightly larger than appropriate, may result in linear excess tension limited to the transversely oriented new central limb. This linear tension can interfere with the blood supply to the adjacent skin area, including distal points of the flaps, and the resulting furrow may have a constrictive effect on the extremity; at the very least, it looks unsightly. The problem caused by this linear tension and the resulting furrow can be overcome by using a supplementary mini Z-plasty in certain cases (3).
