Technique of Z plasty

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- See:
        - Skin Grafts: for hand defects;

- Discussion:
      - indicate for soft tissue contracture including Dupuytren's;

- Technique:
      - all three parts of the Z plasty should always be of equal length;
      - angle: most often a 60 deg Z plasty is used;
      - size:
            - one must plan whether one large Z plasty versus several small Z plasties will be required;
      - incise central limb which is inline w/ soft tissue contracture;
      - incise one limb of the Z plasty and raise a flap;
            - w/ a single pronged skin hook pull the edge of the flap across the central limb;
            - it is important that this limb can be pulled easily across the midline;
            - if there is tension, a smaller Z plasty needs to be performed,
                  which means that part of the limb needs to be resutured;
            - at this point, incise the second limb of the Z plasty;
      - suture down the transposed flap;
            - w/ severe soft tissue contracture, the flaps will often auto-transpose;