Use of the Z-Plasty Technique for Forehead Defects

• Published in: Dermatologic surgery 2005-12, Vol.31 (12), p.1720-1723
• Main Authors: Pomaranski, Mark R, Krull, Edward A, Balle, Mark R
• Format: Article
• Language: English
• Subjects: Carcinoma, Basal Cell - surgery; Forehead - surgery; Humans; Reconstructive Surgical Procedures - methods; Skin Neoplasms - surgery; Surgical Flaps; Surgical Procedures, Operative - adverse effects; Wounds and Injuries - etiology; Wounds and Injuries - surgery
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1097/00042728-200512000-00019

BACKGROUNDSurgical defects of the forehead are commonplace for the Mohs surgeon. The relaxed skin tension lines (RSTLs) of this region allow for repairs ranging from direct linear closures to more complex advancement flaps. Defects in which the longitudinal axis orients perpendicular to the RSTLs, whether secondary to wound shape or ease of tissue movement, present a somewhat more challenging problem. OBJECTIVETo describe the use of the Z-plasty in repairing forehead surgical defects. METHODWe illustrate two Mohs surgical cases in which the size and location of the forehead defect did not allow for a straightforward and cosmetically acceptable closure. Tissue mobility and defect shape permitted design and implementation of a Z-plasty. RESULTSUse of the Z-plasty technique allowed a portion of the vertical incision line to be reoriented within the forehead RSTLs, producing a favorable cosmetic outcome. CONCLUSIONForehead defects that are shaped such that the long axis is perpendicular to the RSTLs or located in a region where tissue mobility more easily permits a vertical closure can present a challenge for the reconstructive surgeon. Knowledge of tissue mechanics and use of rotation and advancement make the Z-plasty a favorable option in many of these situations.