The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery.

Abstract Purpose To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold. Methods A retrospective analysis was conducted on the clinical data of patients who underwent reverse Z-plasty for epicanthal fold reconstruction from September 2019 to January 2023. The surgical procedure involved preoperative design line incision, dissection beneath the orbicularis oculi muscle to form a muscular flap, and using the temporal side muscular flap as the reconstructed epicanthal fold. Postoperative follow-up included assessing the degree of epicanthal fold reduction, the appearance of the epicanthal fold, incision scars, and patient satisfaction. The intercanthal distance was measured in all patients before surgery and at 6 months postoperatively, and the paired t-test was used for statistical analysis with a significance level of P < 0.05 indicating statistical significance. Results A total of 16 patients (15 females, 1 male) with an average age of 32 years (range: 17–38 years) were included in the study. All patients had a follow-up period of at least 3 months, with an average follow-up of 7 months. Patient satisfaction evaluation showed that 13 patients were very satisfied, 3 patients were satisfied, and there were no cases of dissatisfaction. The degree of exposure of the lacrimal prominence decreased in all patients, the shape of the epicanthal fold was natural, the size of bilateral eyelid fissure was appropriate, and the parallel double eyelids were transformed into fan-shaped double eyelids. The appearance of the incision scars was not prominent and the lines were smooth. The increase in intercanthal distance ranged from 3 to 6mm, with a range of ICD elongation ratio from 9.09–28.30%. The preoperative measurement of intercanthal distance ranged from 28 to 35.0mm, with a mean of 31.25 ± 2.32mm, and the postoperative measurement was 35.19 ± 2.26mm. The difference was statistically significant (t=-4.793, P < 0.001). There were no urgent or discomfort sensations in eye movement, and the results were satisfactory. Conclusion Reverse Z-plasty design is suitable for epicanthal fold reconstruction. The incision design is clear and precise, and the postoperative outcomes are stable, achieving successful reconstruction of the epicanthal fold.