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Review Question - QID 219790

QID 219790 (Type "219790" in App Search)
A patient presents to the hand clinic several years after suffering index finger lacerations following a car accident in which their hand went through the passenger window. On examination, there is significant scarring along the volar aspects of the involved finger. They are concerned about the significant contracture and you plan to perform a scar revision. Which of the following techniques will allow you to increase the skin length by the greatest amount?
  • A
  • B
  • C
  • D
  • E

Figure A

20%

144/718

Figure B

18%

130/718

Figure C

49%

352/718

Figure D

2%

13/718

Figure E

10%

73/718

  • A
  • B
  • C
  • D
  • E

Select Answer to see Preferred Response

Z-plasty is the technique of choice in the revision scar setting and can lengthen the involved area by up to 75% with 60° corners (Figure C).

Z-plasty is a surgical technique commonly employed for scar revision. It involves creating two triangular flaps of equal size, which are then transposed to reposition the scar and reorient its direction. Variable angles can be used, which has differential effects on lengthening; corners of 30° can lengthen by 25%, 45° by 50%, and 75% with 60° corners. While this method has many applications across surgical specialties, it is advantageous in orthopaedics to improve motion in the setting of contracture. This method helps to break up the straight line of a scar, making it less noticeable while also releasing tension in the scar tissue, thereby improving function and cosmetic appearance. Z-plasty can also be used as a prophylactic technique to prevent contractures from index surgeries in the fingers.

Garg et al reviewed techniques for scar revision following facial trauma. They emphasize the importance of understanding anatomy, wound healing processes, and meticulous planning before performing any type of scar revision. The authors instruct that scar revision does not erase surgical scars but can improve cosmesis with proper planning.

Zito et al review the history, indications, and techniques of Z-plasty for treating surgical scar revision. They describe the biomechanical properties of the skin that allow for manipulation and revision of previous scar tissue. Relative indications within orthopedics include the release of motion-limiting scars, contracture release, and cosmesis of aberrant scar formation. The authors emphasize the usefulness of this transposition flap for scar revision while also advocating its use as a prophylactic to prevent contracture of linear scars especially when used in the fingers.

Figures A-C demonstrate Z-plasty excisions with varying angles (A: 30°, B: 45°, C: 60°). Figure D: demonstrates the outline for a Moberg flap. Figure E shows a V-Y turndown flap.

Incorrect Answers:
Answers A & B: Z-plasty with 30/45 degree would not allow as much lengthening as 60-degree flaps
Answer D: A Moberg flap is typically performed for injuries to the volar thumb and not in the setting of scar revision
Answer E: A V-Y turndown is more appropriate for a fingertip injury and not scar excision.

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