Plastic Surgery is an enormous topic, and one too complicated to discuss in detail here, but we have added a page on this topic to emphasize that plastic surgical concepts must always be considered when foot surgery is done, and to mention a brief list of some techniques that are frequently used with surgery of the foot.   

Relaxed Skin Tension Lines  You can't see them when you look at the skin, but there are lines of tension in the skin running throughout the body.  When the skin is cut counter to the skin tension line concept, the scar tends to gap apart, and the wound may heal more slowly and with a less appealing scar.  The challenge for the surgeon is that there may be good reasons to make an incision counter to the Relaxed Skin Tension Line philosophy--such as trying to avoid nerves, arteries or other important structures.   

Skin Plasties

V-Y Plasty  A V-Y plasty is a technique to advance skin in an attempt to diminish skin tension.  A "V"-shaped incision is made in the direction of skin tension, and the central flap of skin that was created (shaded red) is allowed to contract in the direction of tension.  The skin is then sewn up in the relaxed position, thereby creating a "Y"-shaped wound, and thereby lengthening the skin.   This is by far the most common skin plasty technique.  

Z-Plasty  The second most common technique to address abnormal skin tension.  In this procedure, a Z-shaped incision is made, and the two flaps made by that incision (marked red and blue) are rotated relative to each other, thereby lengthening the skin in the direction of the central arm of the Z-shaped incision.  The angles of each arm in the "Z" should be 60 degrees.  

Double Z-Plasty  Two Z-plasties immediately adjacent to each other to provide additional lengthening.   A good technique in tight areas.  

90:90 Plasty  (Four Flap Plasty)  A 90:90 skin plasty is a more complicated 4-flap skin plasty that also seeks to lengthen skin in the direction of skin tension.

V-M Plasty  Another way to lengthen skin in the direction of tension.  

Tendon Lengthening

Z-Lengthening  Performed on tendons when they are excessively tight, a Z-lengthening is used to elongate the tendon.