Double opposing rectangular advancement elongates tension line as much as Z-plasty: An experimental study in the rat inguinal skin

Purpose: Z-plasty is a well-known and commonly used local flap technique in the treatment of contracture bands. Double opposing rectangular advancement is a new and alternate local flap design which can be used in the treatment of wide and linear postburn scar contractures. The technique consists of opposition of two adjacent rectangular flaps by advancement. This experimental study compares lengthening provided by Z-plasty and double opposing rectangular advancement. Materials and method: Lower extremities of 10 male Sprague-Dawley rats were strained by hanging 400 g of weight to provide tension lines over both inguinal areas. We planned Z-plasty with 2 cm central limb and with 60 degrees angles to the inguinal tension line on one side. On the other side, we sketched double adjacent rectangular flaps with 2 cm long axis and 1 cm short axis over the tension line. Triangular flaps were elevated over the muscle, transposed and sutured in Z-plasty. Rectangular flaps were incised down to the muscle, advanced and opposed to each other before suturing. The final lengthening provided by both techniques were measured and the results were statistically analysed. Results: Both Z-plasty and double opposing rectangular advancement techniques were effective in relief of tension over both inguinal areas and in lengthening the tension lines. Z-plasties provided lengthening ranging between 4 and 4.6 cm. The difference between pre- and post-operative (Delta) measurements in Z-plasty ranged between 2-2.6 cm (mean +/- stan-standard deviation = 2.26 +/- 0.24 cm). The lengthening provided by double opposing rectangular advancement were between 3.9 and 4.5 cm and the Delta measurements ranged between 1.9 and 2.5 cm (mean +/- S.D. = 2.22 +/- 0.22 cm). Statistical analysis revealed that the elongation provided by both techniques are not significantly different from each other (p > 0.05). Conclusion: Double opposing rectangular advancement technique elongates a tension line as much as Z-plasty in the rat inguinal skin. (C) 2007 Elsevier Ltd and ISBI. All rights reserved.