The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

PURPOSE: To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. METHODS: We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t -tests, with a P -value of less than 0.05 denoting statistical significance. RESULTS: Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6 mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32 mm, expanding postoperatively to 35.19±2.26 mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high. CONCLUSION: The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.

Evaluation of a new tension relief system for securing wound closure: A single-centre, Chinese cohort study.

BACKGROUND: Wounds that have been closed under excessive tension, and skin defects that cannot be closed primarily, pose a daily challenge for the reconstructive surgeon. OBJECTIVE: To evaluate a new tension relief system (TRS) device for skin stretching and secure wound closure. METHODS: From September 2013 to March 2014, a consecutive series of 41 Chinese patients with 43 wounds were enrolled for application of 50 cycles of TRS therapy. TRS was used for two main clinical applications: closure of a variety of surgical/traumatic wounds; and securing wound closure after high-tension suture closure. Basic information and details regarding this therapy and its complications were recorded. Follow-up visits were conducted three to six months after wound closure. RESULTS: Mean residual wound width decreased approximately 20% every two days during cycles of TRS therapy. Infection was the most common complication (five cases). Other complications included dehiscence (two cases) and pressure ulcer (one case). At the six-month follow-up visit, (21 wounds in 20 patients), both the extent of healing and the scar were acceptable. DISCUSSION: There are no absolute contraindications to TRS therapy. The authors have formulated instructions for the prevention and treatment of the most common complications. CONCLUSIONS: The results demonstrate that TRS therapy is a simple, effective method for primary closure of difficult wounds, and large skin and soft-tissue defects. Larger randomized studies are required to further evaluate of the effectiveness, indications, complications and cost effectiveness of this innovative TRS therapy.

HISTORIQUE: Les plaies fermées sous tension excessive et les anomalies cutanées qui ne peuvent pas être fermées par une intervention primaire représentent un problème quotidien pour le plasticien. OBJECTIF: Évaluer un nouveau système de soulagement des tensions (SST) pour étirer la peau et assurer la fermeture des plaies. MÉTHODOLOGIE: De septembre 2013 à mars 2014, une série consécutive de 41 patients chinois présentant 43 plaies ont été inscrits pour recevoir 50 cycles de traitement par SST. Le SST était utilisé pour deux principales applications cliniques : fermer diverses plaies chirurgicales ou traumatiques et assurer la fermeture des plaies après une suture à haute tension. Les chercheurs ont colligé l'information générale et détaillée au sujet de ce traitement et de ses complications. Les rendez-vous de suivi ont eu lieu de trois à six mois après la fermeture des plaies. RÉSULTATS: La largeur des plaies résiduelles moyennes diminuait d'environ 20 % tous les deux jours pendant les cycles de traitement par SST. L'infection était la complication la plus courante (cinq cas). Les autres complications étaient la déhiscence (deux cas) et l'ulcère de pression (un cas). Au rendez-vous de suivi six mois plus tard (21 plaies chez 20 patients), tant le processus de cicatrisation que la cicatrice étaient acceptables. EXPOSÉ: Il n'y a pas de contre-indications absolues au traitement par SST. Les auteurs ont formulé des directives pour prévenir et traiter les complications les plus courantes. CONCLUSIONS: Les résultats démontrent que le traitement par SST est une méthode simple et efficace pour assurer la fermeture primaire de plaies complexes et d'importantes anomalies de la peau et des tissus mous. Des études aléatoires plus vastes s'imposent pour approfondir l'évaluation de l'efficacité, des indications, des complications et du rapport coût-efficacité de ce traitement novateur par SST.

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.