Paired five-flap Z-plasty.

Abstract

Web-like contractures may occur along both the outer borders of joints, creating double-parallel contracture bands that turn into webs during movements. A combination of two "five-flap z-plasties" lying in confrontation to each other was used to release such contractures. The two Vs face each other and meet at their upper ends, forming a rhomboid (Fig. 1, a and b) or hexagon (Fig. 1, c and d) whose position remains unchanged after the contractures have been released and all the flaps transferred or advanced. This method has been used to release a total of seven double-parallel web-like linear contractures with very satisfactory results. Paired five-flap z-plasty seems to be superior when release of double web-like contractures, with the presence of sufficient spared skin, is contemplated.