This graft has a much wider usage than the full thickness graft, and within limits the surgeon is able to control its thickness and make use of that variable in its characteristics and clinical behaviour. DONOR SITES The donor site is chosen in any set instance by such factors as the amount of skin required; […]

Skin grafts can vary both in their thickness and the vascularity of the skin from which they are taken. Each of these variables affects their speed of vascularisation and consequently the ease with which they take. Variations in graft thickness relate to the thick-ness of their dermal component and this influ-ences their vascularity, dermis in […]

The bed on which the graft is laid must be capa-ble of providing the necessary initial fibrin anchorage, and also have a rich enough blood supply to vascularise the graft. Vascularisation is achieved by the outgrowth of capillary buds, and the more rapid the process and profuse the out-growth the more suitable the surface is […]

Initially, the graft adheres to its new bed by fib-rin. Within 48 hours, the fibrin starts to break down. This coincides with revascularisation by means of outgrowth of capillary buds from the recipient area to unite with those on the deep surface of the graft. This link-up is usu-ally well advanced by the third day, […]

This problem is seen in its worst form when a trap-door of skin which has been uplifted, usually as a result of trauma, is sutured back in place. Contraction of the resulting scar tissue causes eleva-tion of the tissue within its concavity Seen later the result may be assumed, not unreasonably, to be due to […]

Scars in the face tend to be more cosmetically acceptable the more nearly they lie in a line of election, and a problem of acceptability can arise when an otherwise satisfactory scar is more than 30° off the line of election. When a Z-plasty is used to improve the appearance of a scar, its effect […]

In designing a multipl e Z-plasty the line of the contracture can be viewed as a series of contrac-ted segments, on each of which a small Z-plasty is constructed, creating a line of individual Z-plasties, but in practice it is more usual to con-struct them in the form of a continuous multiple Z-plasty. In this, […]

Use in contractures From the theoretical discussion it follows that the Z-plasty is most effective where the contrac-ture is narrow and the surrounding tissues are reasonably lax. Scarred and contracted tis-sue on either side can yield no ‘slack’ to allow lengthening, which explains why the postburn contracture is so seldom totally correctable by a Z-plasty, […]

The Z-plasty is used in different clinical situa-tions, in some of which the theoretical basis of the procedure is not immediately obvious, but in each one analysis of the changes which take place with transposition of the flaps is capable of explaining the effect of the change in terms of lengthening and shortening, or of […]