Problems in treating burn sequelae include scar tissue contraction, which may develop after wound infections, after secondary wound healing by granulations, and also after split-skin transplants. Development of scar cords near or even over joints can ultimately lead to deformities of the body and limbs because of restriction of mobility. Compression bandages have the goal of counteracting these problems, but are not always effective. An attempt must be made to resect the scar cords and to cover the defect with skin transplants or to change the line of the scar cord with Z plasties. However, the altered blood flow in the nodularly twisted collagen fiber structure of the hypertrophic scar frequently causes the tips of transposed skin flaps (as, for example, in Z plasties) to become necrotic. This situation is avoided by application of Y-V plasties, in which the skin for transposition is not detached from its substratum (in contrast to the Z plasty) but is displaced by sliding it on its substratum. For this purpose, the tension of the scar cord is eliminated over the entire length by several transverse Y-shaped incisions situated in parallel. If the tongues of the upper part slide into the stem of the Y and finally form a V, the scar cord can be lengthened without raising the dermis from its substratum and endangering its blood flow. Because of good results, Y-V plasty has entirely replaced Z plasty in the correction of contracted burn scars at my hospital.
