The Z-plasty contributes to the coalescence of a chronic non-healing wound

Abstract

This study aimed to explore the treatment effect of Z-plasty on a non-healing wound. A total of 72 patients diagnosed with a chronic non-healing wound in Peking University Third Hospital from November 2009 to August 2019 were retrospectively analysed. Among them, 27 patients were treated with Z-plasty, and 45 patients were treated with the general method. Detailed patient information was retrieved from medical records, including age, gender, body mass index (BMI), alcohol, smoking, and comorbidities (diabetes mellitus, hypertension, heart disease). Surgical parameters included operation time and intraoperative blood loss. Wound swelling, epidermal blisters, wound edge colour, and skin temperature at 1 day after surgery were assessed to evaluate the blood supply of the wound. Surgical complications included infection, haematoma, dehiscence, and non-healing within 2 weeks postoperatively. Student t test (for continuous data) and Chi-square test (for categorical data) were conducted to determine the statistical difference. We found no significant differences in age, gender, BMI, alcohol, smoking, and comorbidities between the two groups. Z-plasty did not show any advantages in the surgical time, invasive blood loss, hospital days, and hospitalisation expenses. The incidence of abnormal wound edge colour with Z-plasty was significantly lower than that with the general treatment (P < .05), and the Z-plasty enables better healing of the patient's wound (P < .05). Z-plasty promoted better recovery of chronic non-healing wounds than direct suturing.

Keywords: Z-plasty; aetiology; non-healing wound.

FIGURE 1

The basic principle of Z‐plasty. Opposing triangles of equal angles to a central incision along the line of tension are transposed. The result was a break up and lengthening of scar tissue and redirection of the scar in a perpendicular direction. A is a typical diagram of a preoperative incision. Red lines represent chronic non‐healing wounds. B is the image of a typical postoperative wound

FIGURE 2

The case of a 19‐year‐old woman with a non‐healing chronic wound on the right clavicle, with postprocedural status of clavicle fracture. A is the preoperative view. B to D are the design of the Z‐plasties. E is the immediate postoperative view. F is the view 2 weeks after surgery. Z‐plasty changed the wound direction to avoid the incision direction completely overlapping with the prosthesis, thereby promoting wound healing

FIGURE 3

The case of a 28‐year‐old woman with chronic sinus of the right thigh. A is the preoperative view. B to C are the postprocedural status of debridement. D is the design of the Z‐plasties. E is the immediate postoperative view. F is the view 2 weeks after surgery. The triangular flap of the Z‐plasty was rich in subcutaneous tissue, which could fill the subcutaneous defect of the wound after debridement, thereby promoting wound healing