Comparing Z-Plasty versus Z-Plasty and Skin Grafting for Surgical Tension-Free Treatment of Post-Burn Elbow Contractures: A Randomized Clinical Trial

Background: Elbow contracture is a common incidence. It has surgical treatments such as scar release and skin graft, Z or V-Y plasty, and lateral or medial arm flap. In this study, we compared Z-plasty versus Z-plasty and skin grafting in the surgical tensionfree treatment of post-burn elbow contractures. Methods: 30 patients with elbow joint extension restriction participated in this randomized clinical trial in two groups: experimental (Z-plasty with skin graft) and control (Z-plasty alone) groups. In both groups, Z-plasty was designed with a 60 angle. In the experimental group, the flaps were rotated without tension, and then the upper and lower parts of the flaps were grafted by a midsplit- thickness skin graft. The surgery area was examined regarding infections, wound healing time, necrosis, and scar. Significant differences were evaluated using unpaired student t-test. Results: Only seven participants in the control group had complications. The statistical analysis of all variables in both groups showed that Z-plasty with skin graft treatment had a significantly better result than the Z-plasty alone (P = 0.006). However, the two groups showed no significant differences in terms of infection, flap tip necrosis, surgery site infection, and feeling of pressure in joint extension or scar recurrence (P = 0.273). Conclusions: Tension-free flap must be used in patients with mild or moderate wide elbow scar contracture. Combining Z-plasty with skin graft is easy and has better results than Z-plasty alone. It is recommended using this technique in patients with intraoperative flap tension.