Z-plasties for the Pediatric Orthopaedic Surgeon.

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Z-plasty refers to a local soft-tissue transposition using interdigitating triangular flaps and is a simple but powerful surgical technique to transpose skin, lengthen scars, and shift topography. There are a host of applications of this technique within pediatric orthopaedics, given the spectrum of traumatic, post-traumatic, and congenital differences affecting the growing child. The purpose of this Master's Surgical Technique supplement is to describe the principles and common applications of z-plasties in pediatric orthopaedic surgery.

KEY CONCEPTS

•Z-plasties are defined by the number of triangular flaps, length of the equilateral limbs, and angles subtended by the incision lines.•As skin and soft tissue are transposed, the central limb of the Z is "lengthened" or "deepened."•The basic principles of the two-part z-plasty may be applied to different variations, including z-plasties in series, multi-part z-plasties, and double-opposing z-plasties.•Meticulous flap elevation and closure will allow for primary healing without ischemic tip necrosis.