Elsevier

Burns

Volume 42, Issue 2, March 2016, Pages 243-245
Burns

Editorial
TG (Tri-Goniometry) technique: Obtaining perfect angles in Z-plasty planning with a simple ruler

https://doi.org/10.1016/j.burns.2015.08.018Get rights and content

Abstract

The Z-plasty is used frequently in hand surgery to release post-burn scar contractures. Correct angles and equalization of each limb are the most important parts of the Z-plasty technique. A simple ruler is enough for equalization of limb but a goniometer is needed for accuracy and equalization of angles. Classically, angles of 30°, 45°, 60°, 75°, and 90° are used. These angles are important when elongating a contracture line or decreasing tension. Our method uses only trigonometry coefficients and a simple ruler, which is easily obtained and sterilized, enabling surgeons to perform all types of Z-plasty perfectly without measuring angles using a goniometer.

Introduction

The Z-plasty is used frequently in plastic surgery to improve contractures, especially due to burn scars. This procedure, which involves the transposition of corresponding triangular flaps, can either elongate a contracture band in the skin or decrease scar tension.

The basic variable in Z-plasty flaps is the angle. Classically, angles of 30, 45, 60, 75, and 90° are used. These angles are important when elongating a contracture line or decreasing tension. For example, a contracture line can be elongated by 50% using a Z-plasty performed with a 45° angle; the amount can be increased to 75% with a procedure performed using a 60° angle.

Many Z-plasty options have been reported, including the classical Z-plasty, double opposing Z-plasty, and four-, five-, and six-flap Z-plasties.

In all of these methods, it is important that the angles of the flaps be calculated correctly. Although many methods have been proposed for this purpose, all require angle-measuring equipment [1].

Our method uses only trigonometry coefficients and a simple ruler, which is easily obtained and sterilized, enabling surgeons to perform all types of Z-plasty without measuring angles using a goniometer.

Section snippets

Technique

In this technique, the corner angles of a simple ruler are used to draw right angles. The other angles are constructed using simple virtual axes. The limbs of the Z-plasty are considered the hypotenuse, and simple sine and cosine values are calculated from the hypotenuse during planning. In the following procedures the contracture band has a length of x.

Discussion

Correct angles and equalization of each limb are the most important parts of the Z-plasty technique, which is commonly used when releasing burn scar contractures or revising scars [2]. A simple ruler is enough for equalization of limb but a goniometer is needed for accuracy and equalization of angles.

Many methods have been used to calculate angles, but most require a goniometer [3]. Classically, a 30° angle can be obtained by dividing the 90° angle formed by drawing a line perpendicular to the

Funding

None declared.

Conflicts of interest

The authors have no conflict of interest to disclose for this study.

Ethical approval

Not required.

References (3)

  • D. Gahankari

    Z-plasty template: an innovation in Z-plasty fashioning

    Plast Reconstr Surg

    (1996)
There are more references available in the full text version of this article.

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