Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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274 Surgery and Healing in the Developing World
Figure 67. Z-plasty. Severe scar contracture
of perineum approximating both medial
thighs.
Figure 68. Multiple Z-plasties used in surgical
treatment of this patient.
Z-Plasty (Figs. 67, 68)
Figure 67 shows a woman who has a scar contracture, which has pulled her two
legs together. She is completely unable to walk because of this. The scar was the
result of a severe burn of the perineum and upper medial thighs.
A spinal anesthetic is used. The patient can be operated on in the supine position.
The skin of the contracture is cut in a zig-zag fashion with the angles being at
forty-five degrees for both the anterior and posterior scar. The inverted ‘V’ of the
lower skin in then sutured into the ‘V’ of the upper scar as pictured. Both deep and
superficial skin sutures are used.
Advancement Rotation Flap
Figure 69 shows a woman with a lesion on her left cheek after it has been made
dark with various herbs. The pathology report showed that this was a neglected
basal cell skin cancer.
After a wide excision, the skin and superficial subcutaneous tissues are raised
laterally all the way to the tragus of the ear and inferiorly well down on the neck.
The dissection is kept superficial in a plane previously infiltrated with 20 cc of
0.25% xylocaine to which one drop of epinephrine has been added. The facial nerves
will thus be protected. The blunt nose scissors dissector is used with its tip toward
the skin. The skin is then incised lateral to the defect and high on the left cheek. It