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tion of scar contraction is not generally unA review of the literature was made by derstood although the Z-type incision by ,~__~. He--and myself in order to which it is accomplished is an old procedure, detei-m~,~ossible, who first devised the It is a good plastic principle to remove all Z-type incision and transposed the flaps thus scar tissue before attempting any sort of remade. As far as we can find, the earliest deconstruction and this should be carried out scription of this incision with the transposiwhenever possible. However, there are many tion of the flaps thus made was by Denoncontracted scars where complete excision of villiers in 1856, who apparently developed the entire scar is impracticable on account of the procedure in steps. He used it successits extent and location. In these instances, fully for the relief of ectropion of the outer unless skin grafting or flap shifting from a third of the lower lid. This type of incision distant part is done, it is necessary to utilize may have been used even before Denonvilscar or scar-infiltrated tissues, and often a liers, but we were unable to find an earlier great deal can be gained and much relief report. given by the proper use of such tissues. Szymanowski, in his book published in In order to utilize flaps of scar-infiltrated 1870, illustrated the use of a similar incision tissue some manoeuvre must be carried out for the relief of a deviation of the angle of which will relax the contracted band and mouth, so the method was well known to break the line of scar tension. In suitable him. Pidchaud reported in 1896 the use of cases, this may be accomplished by the use a modified Z-type incision for the restoraof the Z, or reversed Z, or staggered Z, or S, tion of the axilla and for the relief of scar or reversed S-incision as one may choose to contractures in other regions. He stressed call it. the utilization of scar-infiltrated tissues and The transposition of the flaps thus formed apparently made considerable use of the is made possible because there is always method. Berger and Bonset in 1904 used a T.he editors and publishers of Plastic & ReconZ-incision with the transposition of flaps for

THE RELAXATION OF SCAR CONTRACTURES BY MEANS OF THE Z∼, OR REVERSED Z-TYPE INCISION