title: "Beak"-plasty: a new effective modification of Z-plasty.
abstract: BACKGROUND
  Because the "lateral limbs" resulting from conventional Z-plasty form a steep angle against the relaxation skin tension line (RSTL), they often develop hypertrophic change, whereas the "central limbs" become inconspicuous after being realigned parallel to the RSTL.
  
  
  OBJECTIVE
  To alleviate the above-mentioned hypertrophic change of the lateral limbs, we modified the conventional Z-plasty and invented a new technique. Because the shape of the flap resembles a bird's beak, we call the technique "beak-plasty." The purpose of this study is to present the new technique.
  
  
  METHODS
  The technique is described and effectiveness of the technique is reviewed on 21 patients. In particular, three representative cases are presented with photographs.
  
  
  RESULTS
  In all patients, the lateral limbs of the flaps did not become hypertrophic after a minimum follow-up period of 9 months.
  
  
  CONCLUSIONS
  Our technique can effectively reduce Z-plasty's risk of postoperative hypertrophy in the lateral limb. Therefore, it can make the scar less conspicuous than in conventional Z-plasty. For this advantage, we recommend our technique as an effective armament for scar revision. The authors have indicated no significant interest with commercial supporters.
authors.affiliation: Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Kyoto, Japan. nagasao@sc.itc.keio.ac.jp
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nagasao
authors.forename: Junpei
authors.initials: J
authors.lastname: Miyamoto
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ando
authors.forename: Maki
authors.initials: M
authors.lastname: Nagasao
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakajima
mesh_terms: D001696:Biomechanical Phenomena; D002921:Cicatrix / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006984:Hypertrophy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation