Multiple z-plasties for medial canthal web
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:17
This video demonstrates multiple Z-plasties in a young patient with thermal burns. The patient has bilateral webbing of the medial canthus secondary to vertical shortening of the tissue. Options were discussed with the parents and they elected for Z-plasties as opposed to placement of skin grafts. The medial canthal webs have been marked at their vertex and Z-plasties have been planned along the medial canthus. These are incised with a 15 blade. Transposition of these flaps will result in lengthening of the vertical portion of the medial canthus which should improve the webbing. After incision with the 15 blade, the flaps are raised and transposed. The flaps are then sutured into position with deep interrupted 6–0 Vicryl sutures followed by 7-0 Vicryl suture on the skin. Attention is then directed to the opposite side and the Z-plasties are planned with the marking pen. The incisions are then made with the 15 blade again along the vertex of the web. Westcott scissors are then used to undermine the flaps so that they can be transposed. The flaps are transposed and sutured into position with 6–0 Vicryl suture. This will effectively result in lengthening the skin vertically. Attention is then directed to the nasal root which will also have a Z-plasty performed in order to lengthen the area vertically. This transposes horizontal tissue so that the area can be lengthened vertically. The flaps are raised and transposition is performed to demonstrate not only the lengthening of the tissue vertically but also the shortening of the tissue horizontally which should help in improving the medial canthal webs. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the incisions. The postoperative appearance can be seen in a video of a full-thickness skin graft to the lower lid.