Outcomes of Z-Plasty vs W-Plasty in Scar Revision for Post-Burn Contractures Among Iraqi Patients: A Prospective Comparative Clinical Study
Bibliographic record
Abstract
Background: Post-burn scar contracture is a significant cause of disability in the long-run in Iraq, which is worsened by the inadequate access to reconstructive care and the impact of sociocultural factors. Z-plasty is a geometric flap method extensively applied in both functional and cosmetic restoration, but strong prospective evidence of its utilization in conflict-impacted, resource-limited areas is limited. Purpose: To compare the prospective functional, aesthetic, and patient-reported outcomes of Z-plasty, and W-plasty in the management of mature post-burn linear contracture in Iraqi patients. Methods: The study was a prospective cohort, 24 months, single center and site study based on Ghazi Al-Hariri Hospital, a Surgical Specialty Hospital, Baghdad ( January 2022-December 2023). Sixty eight individuals with mature (>6 months) linear contractures who had undergone a burn were randomly assigned as 1:1 to the Z-plasty and W-plasty group. The results were changes in the scar length, range of motion (ROM; assessed by goniometry), the Vancouver Scar Scale (VSS) scores, patient satisfaction (measured on a 5-point Likert scale), and the rates of complications at 6 months. Results: The mean age was 28.4/12.7 years; 57.4 was male. Flame burns contributed 64.7 percent to the injuries, and the displaced mean of surgery was 3.8 + 2.1 years. Z-plasty showed much better results in terms of cervical flexion ( +28.3 vs. +23.6, p = 0.04) and total VSS score ( –5.4 vs. - 4.8, p = 0.048) than W-plasty (see Tables 2 and 3). The scar length was 4.2 1.1 cm then 6.8 1.4 cm (p < 0.001); there was a significant improvement in ROM in all joints (Figure 5). The overall patient satisfaction was high (92.7% gave the outcomes as Good or Excellent), and the difference between groups in the case of patient satisfaction was not statistically significant (Table 4). There were no complications or flap necrosis or recurrence of contractures (Table 5) and the rates were low and similar (8.8% in both groups). Conclusion: Z-plasty is a safe and effective and contextually appropriate method of post-burn contracture release in Iraq with better functional outcomes in high tension areas like the neck and axilla. The two methods exhibit great safety profiles, but Z-plasty has better lengthening and scar repositioning capabilities, which are important in scarce health systems. The results are in favor of its inclusion into national guidelines on reconstructive surgery and surgical education programs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.094 | 0.468 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.003 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.009 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".