Overview of M-Plasty
An M-plasty is a method used in surgery to get rid of skin deformities, often referred to as “dog ears”, that appear at the end of a wound which has been stitched up. These “dog ears” show up when tissue gets bunched together due to the use of overly broad angles at the ends of a surgical cut. A variety of techniques have been developed to solve this issue.
A commonly used non-cutting method involves re-distributing the excess skin on one side of the incision to match the opposite side. This is typically done by placing stitches further apart on the side of the incision that has more skin. This technique can’t fix all situations and its success depends on the amount of extra tissue and the length of the wound. For instance, it would not have much impact on very short or large “dog ears”.
A more direct solution that is popular among surgeons is to cut out the extra tissue. In this technique, a triangle-shaped tissue, known as the Burow’s triangle, can be removed from anywhere along the wound. Usually, the Burow’s triangle is removed at the end of the incision, which can, unfortunately, make the scar longer.
An M-plasty is an alternative. This technique has the additional benefit of making the final scar shorter, thus preserving more of the normal skin. In certain situations, it might be used at the end of a cut to prevent crossing a natural boundary of a facial region or not to disrupt an otherwise fine structure. But, it’s important to be aware that this technique involves adding a fork to the end of the cut, which might impact the final appearance of the scar.
Anatomy and Physiology of M-Plasty
Our face can be divided into different parts like the forehead, eyebrows, eyes, nose, cheeks, mouth, chin, and ears. Each of these parts is made up of smaller areas. When it comes to the aesthetics or the appearance of the face, it’s preferred to keep scars within one part or between two parts as this can make them less noticeable. A surgical technique known as M-plasty can be useful in these situations as it helps limit or direct the scar towards the boundaries of these parts.
There are also certain areas on the face like the sides of the nose, the folds of the ears, the eyebrows, the hairline, and the eyelids which have clear borders. If these borders are disturbed, it may lead to an irregularity in the scar, often seen as a ‘notch.’ So, it’s best not to disturb these areas and the M-plasty technique can again be very helpful in these cases.
Why do People Need M-Plasty
An M-plasty is a surgical technique that is often used to make the final scar from a surgery shorter. This comes in handy particularly at times when a longer cut or incision is not advised, for example, to protect cosmetic features or sensitive body parts. For instance, an M-plasty can be used near the outer corner of the eye to remove any unwanted tissue without disrupting the area. The resultant scar can be hidden within the fine lines near the eyes, also known as crow’s feet.
The M-plasty technique can also be used in the brow area. If a full cut is needed, it would result in a scar extending to the corner of the eyes, which can be avoided by using an M-plasty and directing the incisions towards the upper or lower eyelids. Most often, M-plasty is used when closing wounds from the removal of skin lesions or when dealing with skin grafts.
In certain cases, M-plasty can be used to remove excess tissue resulting from the use of skin grafts. M-plasty can be applied at the beginning or end of an incision to shorten its length. Although this technique makes the scar shorter, it results in a slightly wider scar due to the “forking”, or splitting, at the end of the incision. However, this is often more aesthetically appealing than having a long, straight scar. This technique can be particularly beneficial when removing large masses from the back, where shorter scars resulting from an M-plasty can be less noticeable than longer, straight ones. The main goal of M-plasty is to ensure that the entire process of cutting and healing takes place within a single cosmetic unit, improving aesthetic outcomes.
Finally, M-plasty has also been used to help in the orientation of pathological specimens, a process that can save on the use of stitches and tissues.
When a Person Should Avoid M-Plasty
An M-plasty is a type of surgical procedure. Unlike another common procedure called Z-plasty, it doesn’t change the direction of the pulling forces (‘tension vectors’) on the skin. This means that there are very similar situations where both M-plasty and primary closures (simply stitching up the wound) shouldn’t be used.
One such situation is when there’s too much pulling force (‘tension’) on the wound, which would prevent it from being reliably closed up. Too much tension can cause the wound to reopen or parts of it to die off (‘necrosis’) because the small blood vessels in the layer beneath the skin (‘subdermal plexus’) are being stretched and get too narrow. Apart from this, tension can make the scar look unattractive, particularly if it ends up being wide and looking a bit like a fish’s mouth.
Even more seriously, if there is too much tension on the skin, it can distort important structures like the eyelid, eyebrow, side part of the nose (‘nasal ala’), outer ear (‘auricle’), or lips. Therefore, it is crucial to avoid attempting an M-plasty in such situations as it could lead to unfavourable outcomes.
Equipment used for M-Plasty
Depending on the size and location of your wound, the medical instruments used may change. But typically, the doctor will use these tools:
- A skin marker: This is like a special pen used to mark specific places on your skin before the procedure.
- Suture for the skin surface: This is a special kind of thread doctors use to stitch up the skin after an injury or surgery.
- Suture for the deep layer: This a stronger type of thread used to stitch up deeper tissues inside your body.
- Needle driver: This is a tool doctors use to hold the suture needle while they are stitching up a wound.
- Forceps: These are like tweezers that doctors use to hold or move tissues during surgery.
- Suture scissors: These are special scissors used to cut the sutures.
- #15 blade scalpel: This is a small, sharp knife used in surgeries.
- Electrocautery or other hemostatic equipment: These tools use heat or electricity to stop bleeding during surgery.
- Dissecting scissors, such as Metzenbaum or Kaye blepharoplasty: These are special types of scissors used to cut delicate tissues.
All these tools help your doctor to work on your wound safely and effectively.
Who is needed to perform M-Plasty?
A surgeon can do this procedure without any help. However, having an assistant can make the process smoother and more effective. If the procedure is to remove a skin lesion (an abnormal area on your skin), and it leaves behind a wound that needs a special type of stitching called an M-plasty for healing, a pathologist (a doctor who studies diseases) may need to be involved. The need for an anesthesiologist (a doctor who helps you not feel pain during the procedure) and nurses will depend on the size and position of the area being treated.
Preparing for M-Plasty
Skin surgeries can be done in a regular doctor’s office. The doctor might use gloves that are sterile (completely free from germs) or not, based on what they think is best. Even without sterile gloves, there’s generally a low risk of infection after minor skin surgeries. This is especially true for surgeries on the face, as the face has a good blood supply and the body’s immune system works well there. To make sure the skin is clean before surgery, the doctor will apply a special cleaning agent. The type of this agent is chosen depending on where the surgery will be and what the doctor prefers.
Before the surgery, the doctor will talk with the patient about what they should expect. They’ll explain the risks, which might include infection, bleeding, noticeable scars, and the chance that the problem might come back even after the surgery. The doctor will walk the patient through the steps of the procedure to make sure they understand what will happen. They might use visual aids, like a picture of a tumor, to show how it will be removed and what the surgical site will look like afterwards.
For surgeries on sensitive areas like the face, the doctor will also discuss the possibility that the patient might not be satisfied with how the scar looks. After the surgery, it’s important to protect the surgical site from the sun for about a year. This will help prevent any uneven skin coloring from happening as the scar heals.
How is M-Plasty performed
An M-plasty is a surgical technique performed by doctors, often used to treat wounds. This method may be planned in advance or during the repair process. It gets its name from arranging an excision (removal of a part of body tissue) in the shape of an “M” where each ‘tip’ of the M is at angles of roughly 30 degrees. This method helps to minimize scars but it’s important that the “M” isn’t too deep to affect the main area of treatment.
The M-plasty technique involves a standard skin incision and lifting up the skin in a specific way depending on the area to be treated. When completed, the M-plasty takes a “Y” shape, with the base being the standard wound closure and the arms being the M-plasty shaped cut. The wound can then be stitched up in layers. In some cases, for proper tissue alignment, additional stitches may be applied at the tip of the M-plasty.
If an M-plasty is used to ‘remove a dog ear’ or correct extra skin or tissue at the end of a surgical wound, the excess skin is carefully lifted with forceps, then cut at 45 degree angles from the main incision. This results in a “Y” shaped closure. Additional tissue may be removed to simplify the closure process, which is then stitched up.
A variation of the traditional M-plasty is known as the ‘nested M-plasty’. This technique simply repeats the M-plasty process within the original cut, resulting in an even shorter scar while preserving more tissue. This method tends to be more complex and leaves a unique, branched scar. A vital part of this technique is proper stitch placement, and it works best on flatter body surfaces to avoid uneven skin gatherings. This skin bunching, while typically temporary, may last longer if the surgical incision is performed on rounded body surfaces.
Several modifications of M-plasty exist which are used for particular needs. The ‘modified M-plasty’ uses a shorter version of the cut with wider angles and additional tangential cuts. The resulting scar is Y-shaped but shorter in length. In another variant, the angle between the two triangles is increased up to 30 degrees, which changes the method’s approach, making it similar to a different surgical technique known as the ‘V to Y advancement closure’.
Possible Complications of M-Plasty
M-plasty is a type of wound closure technique used in surgeries. Just like any other surgical procedure, it also has potential complications. These can include pain, bleeding, infection, the requirement for additional surgery, and unsatisfactory scarring, which might affect the patient’s appearance. Some people might not like the forked appearance of the final scar, or find the scar to be too wide, raised, depressed (sunken), pigmented (colored), pale, or erythematous (red). There is also a chance that skin may not look normal if the M-plasty isn’t performed correctly or if the healing process doesn’t go as planned.
If a patient isn’t happy with how their scar looks, there are several treatment options that can improve its appearance. These options can include topical therapies, which are treatments applied directly to the skin, like silicone gel or hydroquinone, a skin-bleaching agent. Other treatments could include skin resurfacing, which improves the texture and appearance of the skin, laser treatments that remove or repair damaged skin, intense pulsed light treatments that use light to improve the skin’s appearance, and surgical revision, or further surgery to correct or improve the original procedure.
What Else Should I Know About M-Plasty?
The M-plasty is a surgical method that saves as much of your healthy tissue as possible and allows wounds to be closed up right after the operation. This procedure also helps to keep the cut on your skin shorter. Additionally, M-plasty can be used to get rid of unwanted skin deformities, often called ‘dog ears’.
This technique is important for every skin surgeon to master because it’s helpful in both planning and performing the actual operation to close the wounds.
