Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. With this technique, it is possible to redirect a scar into better alignment with a natural skin fold or the lines of least skin tension.
Contracted scars may be lengthened with this technique. Z-plasty involves the creation of two triangular flaps of equal dimension that are then transposed. Basic z-plasty flaps are created using an angle of 60 degrees on each side, which can lengthen a scar by 50 to 70 percent and reorient the direction of the central wound by 90 degrees. Keeping the length and angle of each flap precisely the same is key to avoiding mismatched flaps that may be difficult to close.
Some possible complications of z-plasty include flap necrosis, hematoma formation under the flaps, wound infection, trapdoor effect, and sloughing of the flap caused by high wound tension. Z-plasty is a plastic surgery technique used to improve the functional and cosmetic appearance of scars.
It involves the creation of two triangular flaps of equal dimension that are then transposed. For a basic z-plasty, the triangular flaps are created using an angle of 60 degrees Figures 1a through 1e. Theoretically, this angle can lengthen a contracted scar by about 75 percent and reorient the direction of the central wound by 90 degrees. In practice, the lengthening and reorientation will be less, owing to increased wound tension. The basic degree z-plasty technique.
The original defect is 90 degrees perpendicular to the lines of least skin tension. Tension on the healing wound eventually widens and thickens the scar. The scar length AB is 2.
The diagonal lines should be the same length as the scar 2. The new flap tips are E and F. Angles smaller than 60 degrees are easier to transpose but result in less lengthening and realignment of the scar to less than 90 degrees. Angles larger than 60 degrees should be avoided because the force required to transpose the flaps increases markedly, making closure of the wound difficult.
The length of each of the lateral limbs of the z-plasty must be precisely equal to the central incision over the original scar, or puckering at the corners will result, and additional undermining and trimming of the flaps will be necessary to obtain proper closure. The multiple variations of the basic z-plasty are beyond the scope of this article. Incisions are made vertically through the skin using a no. The triangular flaps and the surrounding skin are undermined.
In a primary care setting, z-plasty is reserved for improvement of linear, thin scars and is not used as a primary closure technique. The most common situation in which a z-plasty would be used is an unfavorable cosmetic or functional scar that has not improved after waiting for a reasonable length of remodeling time e. More complicated scar situations, such as burn scar contractures, wide scar contractures on fingers, and hypertrophic or keloid scars, typically involve plastic surgery techniques other than basic z-plasty.
The F flap is pulled above the E flap.In vertebroplasty, bone cement is injected into fractured vertebrae to stabilize the spine and relieve pain. Vertebroplasty is an outpatient procedure for stabilizing compression fractures in the spine. Bone cement is injected into back bones vertebrae that have cracked or broken, often because of osteoporosis.
The cement hardens, stabilizing the fractures and supporting your spine. For people with severe, disabling pain caused by a compression fracture, vertebroplasty can relieve pain, increase mobility and reduce the use of pain medication. Kyphoplasty is similar to vertebroplasty, but uses special balloons to create spaces within the vertebra that are then filled with bone cement.
Kyphoplasty can correct spinal deformity and restore lost height. Vertebroplasty care at Mayo Clinic. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Vertebroplasty procedure Open pop-up dialog box Close. Vertebroplasty procedure In vertebroplasty, bone cement is injected into fractured vertebrae to stabilize the spine and relieve pain. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Rosen HN, et al.
Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment. Accessed Sept. Fillippiadas DK, et al. Pecutaneous vertebroplasty and kyphoplasty: Current status, new developments and old controversies. Cardiovascular and Interventional Radiology. In press. Vertebral augmentation vertebroplasty and kyphoplasty.
Rochester, Minn. Thielen KR expert opinion. Mayo Clinic, Rochester, Minn. Brown AY.This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action. Medically reviewed by Drugs. Last updated on Feb 3, Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them.
Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Ask your caregiver when it is OK for you to return to work and do your normal daily activities. Do not drive or lift heavy objects after your surgery until your caregiver says it is OK.
You will need to wear a support garment after your surgery, such as a binder or body suit. These garments help support your abdomen muscles while they are healing. Support garments may also help you feel less pain after your surgery. Do not wear support garments that are too tight.
Ask your caregiver which support garments are the right size for you. Your caregiver will tell you when it is OK to stop wearing your support garment. Ask your caregiver for more information on how often you should clean your wound and change your bandage.
Ask your caregiver when it is OK to take a shower or a bath. Smoking causes lung cancer and other long-term lung diseases. It increases your risk of many cancer types. Smoking also increases your risk of blood vessel disease, heart attack, and vision disorders. Not smoking may help prevent such symptoms as headaches and dizziness for yourself and those around you. Smokers have shorter lifespans than nonsmokers. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.This material must not be used for commercial purposes, or in any hospital or medical facility.
Failure to comply may result in legal action. Medically reviewed by Drugs. Last updated on Feb 3, Treating osteoporosis may decrease your risk of further vertebral compression fractures. Ask you caregiver for more information about osteoporosis and how to best treat it.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Available for Android and iOS devices.
Subscribe to Drugs. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. We comply with the HONcode standard for trustworthy health information - verify here.
Skip to Content. Vertebroplasty Medically reviewed by Drugs. More About Vertebroplasty Aftercare Instructions. Care Notes 1 related article. Subscribe to our newsletters. FDA alerts. Daily news summary. Weekly news roundup.
You lie face down on a table. The health care provider cleans the area of your back and applies medicine to numb the area. A needle is placed through the skin and into the spine bone. Real-time x-ray images are used to guide the doctor to the correct area in your lower back.
A balloon is placed through the needle, into the bone, and then inflated.
This restores the height of the vertebrae. Cement is then injected into the space to make sure it does not collapse again. A common cause of compression fractures of the spine is thinning of your bones, or osteoporosis. Your provider may recommend this procedure if you have severe and disabling pain for 2 months or more that does not get better with bed rest, pain medicines, and physical therapy.
Your provider may also recommend this procedure if you have a painful compression fracture of the spine due to:. You will probably go home on the same day of the surgery. You should not drive, unless your provider says it is OK. People who have kyphoplasty often have less pain and a better quality of life after the surgery.
They often need fewer pain medicines, and can move better than before. Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.
J Neurointerv Surg. PMID: www. Osteoporotic spinal fractures. Philadelphia, PA: Elsevier; chap Weber TJ. Goldman-Cecil Medicine. Williams KD. Fractures, dislocations, and fracture-dislocations of the spine.Mentioned in? References in periodicals archive? Lower lateral crural reverse plasty : a technique to correct severe concavities of the lateral crus. Lower lateral crural turnover flap combined with alar batten graft for the long-term result of the treatment of alar convexities.
Subsequently, Askar 4 published their modification of the rhomboid flap under the name "double reverse V-Y plasty ". Y-V plasty was performed in 11 patients and dismembered pyeloplasty in patients. Any surgical procedure with ' plasty ' on the end of its name means repair. A thrilled Josie told fans: "So happy with the results of my abdominal plasty in September. Josie Gibson tucks into crisps as she embraces fuller figure in blue bikini nearly two years after tummy tuck; The reality TV star lost 7st in a year after leaving Big Brother and had surgery to remove excess skin.
Y llynedd, cafodd camerau Heno gipolwg y tu ol i ddrysau Plasty Glynllifon sydd ar hyn o bryd yn cael ei adnewyddu. The criteria that were analyzed included the following: age, sex, age at time of presentation, other associated anomalies, investigations, type of skin plasty used, histopathology reports, postoperative complications, and scar evolution.
In case of patch plasty a longitudinal incision was performed in the common carotid artery and extended to the internal carotid artery beyond the distal extent of the plaque. In the procedure, the proximal fragment was mobilized and fixed with the lower fragment using V-Y plasty and double-tension band wires. The oral and maxillofacial surgeons OMFS with their unique background of above knowledge in their foundation studies can combine the plastic principles of Z and V-Y plasty to close two basic layers in CLAP.
Medical browser? Full browser?Urethroplasty is the repair of an injury or defect within the walls of the urethra. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies.
The Basic Z-Plasty
It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group. There are four commonly used types of urethroplasty performed; anastomotic, buccal mucosal onlay graft, scrotal or penile island flap graftand Johansen's urethroplasty. With an average operating room time of between three and eight hours, urethroplasty is not considered a minor operation. Hospital stays of two or three days duration are the average.
More complex procedures may require a hospitalization of seven to ten days. Ideally, the patient will have undergone urethrography to visualize the positioning and length of the defect. The patient will be transported to the operating room and the procedures for induction of the type of anesthesia chosen by both the patient and medical staff will be started.
The subject area will be prepped by shaving, application of an antiseptic wash usually povidone iodine or chlorhexidine gluconate - if sensitive or allergic to the formersurgically draped and placed in the Lloyd-Davies position. Note: throughout the duration of the procedure, the patient's legs will be massaged and manipulated at predetermined intervals in an attempt to prevent compartment syndromea complication from circulatory and nerve compression resultant from the lithotomy positioning.
Some hospitals utilize the Allen Medical Stirrup System, which automatically inflates a compression sleeve applied to the thigh-portion of the stirrup device at predetermined intervals. This system is designed to prevent compartment syndrome in surgeries lasting more than six hours. At this time the surgical team will perform testing to determine if the anesthesia has taken effect.
Upon satisfactory finding sa suprapubic catheter with drainage system will be inserted into the urinary bladder to create urinary diversion during the procedureand the chosen procedure will then be initiated. Note: The surgical procedures listed below may have small variances in the methodology used from surgeon to surgeon. Consider the following as a generalized description of each individual procedure, although every precaution was taken to ensure the accuracy of the information.
The choice of procedure is dependent on factors including: . Note: in more complex cases, more than one type of procedure may be performed, especially where longer strictures exist. In this single-stage procedure the urethra will be visualized in the area of the defectand the incision will be started at its mid-line usually using a bovie knife to dissect the dermal and sub-dermal layers until the associated musculature, corpus cavernosumcorpus spongiosumand ventral urethral aspects are exposed.
Particular care is used during the dissection to prevent damage to nerves and blood vessels which could result in erectile dysfunction or loss of tactile sensation of the penis. The area of the defect is evaluated and marked both mid-line laterallyand at the distal and proximal borders transversely. Using an index finger, the urethra is gently separated from the cavernosum, and a specially designed retractor is then placed behind the urethra to protect vulnerable areas from damage during the transecting and removal of the urethral defect.
The now patent ends of the urethra are prepared using a technique called "spatulation", which essentially allows for the end-to-end anastomosis to adjust to the differing diameters of the urethra. A silicone catheter is inserted through the penis and temporary distal-urethral end, and threaded into the temporary proximal-urethral end, leaving a wide loop for the surgeon to have access to the dorsal urethral aspect for micro-suturing, and start of the anastomosis.
The dorsal one-third of the urethral anastomosis is begun, completed, and the catheter is retracted slightly to allow for its positioning within the pre-anastomosed urethra. At this time, using micro surgical technique, the anastomosis is completed and fibrin glue is applied to the anastomotic suture line to help prevent leakage and fistula formation. The silicone guide catheter will then be withdrawn from the penis and a replaced by an appropriately sized Foley catheter and urinary drainage systemand the incision closed layer by layer.
Micro-doppler circulatory measurement of the penile vasculature is performed at way points throughout the procedure, and a final assessment is taken and recorded. The incision is inspected and dressed, and the patient is discharged to recovery. The area of the defect is evaluated and marked laterally mid-line, and marked positioning sutures are positioned one, each at the proximal and distal ends of the area of urethra closest to border of the defective area.
Upon retrieval, the buccal graft is presented to the urethral surgeon, who will then prepare the graft by trimming and removal of extraneous tissue. The surgeon will create an incised opening laterally between the known outer borders of the defect, retract the incised opening to the desired diameter, and position the graft to cover the incision.
Using micro surgical techniques, the buccal graft will be sutured in place and fibrin glue applied to the suture line to prevent leakage and formation of a fistula. At this time an appropriately sized a Foley catheter will be inserted through the repair and into the bladder and connected to a urinary drainage systemand the incision closed layer by layer.