The Z-plasty in hand surgery.

The Z-plasty has for many years been recognised as a most valuable technique in hand surgery but its use has tended to be restricted to the relief of linear contractures. The recent trend towards Conservative in preference to radical fasciectomy in the treatment of Dupuytren’s contracture, however, has given it a much wider currency. Used in the treatment of this condition it can make exposure of the affected fascia easier and excision both simpler and more effective ; indeed, the planning and execution of a Z-plasty is often literally the beginning and end of a good fasciectomy. The theory and practice of the Z-plasty in other parts of the body and in other circumstances has been well covered in the monographs of Limberg (1946, 1963), but it has not hitherto been discussed adequately in the specific context of the hand. In particular, the limiting factors imposed by the anatomical peculiarities of the hand and the modifications made necessary remain to be considered. Yet if it is true elsewhere in the body that full exploitation of the virtues of the Z-plasty calls for a corresponding recognition of its limitations it is doubly true in the hand where the limitations are if anything even more strictly imposed by the local conditions. The purpose of this paper is to discuss the role of the Z-plasty in Dupuytren’s contracture and skin contractures, and in particular to indicate the reasons for the modifications of basic technique which must so often be used. In the hand the Z-plasty has of course a role in the deepening of finger clefts and the correction of congenital ring constrictions. The mode of action of the procedure in these conditions has, however, already been discussed (McGregor 1966) and they will not be considered further. In the hand as elsewhere the Z-plasty is capable of subserving not only its primary function of increasing length in a particular direction but also a secondary one of providing exposure of deeper structures. This secondary role is not invariably required but it is there in the background. It will be assumed throughout since it virtually goes without saying.