Vol. 9, Issue 4, Part A (2025)

Post-burn scar contractures represent one of the most debilitating long-term sequelae of thermal injuries, particularly in low- and middle-income countries such as Iraq. Decades of conflict, infrastructural fragility, limited access to specialized burn care, and cultural barriers to early intervention have resulted in a disproportionately high burden of mature, functionally restrictive scars among Iraqi survivors. These deformities not only impair mobility and dexterity but also inflict profound psychological trauma and social stigmatization, especially among women and children. Z-plasty, a time-honored geometric rearrangement technique in plastic surgery, offers a technically accessible, cost-effective, and functionally restorative solution. Despite its global ubiquity, there remains a critical gap in prospective, outcome-driven data evaluating Z-plasty specifically within the Iraqi population a cohort characterized by delayed presentation, complex scar biology, and unique psychosocial dynamics.
Objectives: This study aims to prospectively evaluate the functional, aesthetic, and patient-reported outcomes of Z-plasty in the revision of post-burn scar contractures among Iraqi patients treated at a tertiary referral center in Wasit Province. Secondary objectives include identifying predictors of optimal outcomes, documenting complication profiles, and assessing patient satisfaction in a culturally sensitive manner.
Methods: A single-center, prospective clinical cohort study was conducted between January 1, 2021 - December 31, 2022 at the Plastic Surgery Ghazi Al-Hariri Hospital For Surgical Specialties/Baghdad medical city. Sixty-eight consecutive patients with mature (>6 months) post-burn linear contractures amenable to Z-plasty were enrolled. All procedures were performed by a single senior plastic surgeon (F.G.M.A.). Preoperative and postoperative (at 3 and 6 months) assessments included: (1) objective scar metrics (length, pliability, height, pigmentation via Vancouver Scar Scale), (2) functional outcomes (range of motion measured by goniometry), (3) patient-reported satisfaction (5-point Likert scale), and (4) complication tracking (infection, dehiscence, hypertrophy, recurrence). Statistical analysis employed paired t-tests and ANOVA using SPSS v26, with significance set at p<0.05.
Results: The mean age of participants was 28.4±12.7 years (range: 5-62), with 57.4% males. The most common anatomical sites were the neck (32.4%), axilla (23.5%), and elbow (19.1%). Mean scar length increased significantly from 4.2±1.1 cm to 6.8±1.4 cm (p<0.001). Functional improvement was dramatic: cervical flexion improved from 35.2° to 62.4° (p<0.001), shoulder abduction from 98.5° to 158.2° (p<0.001), and elbow extension deficit reduced from 28.3° to 5.1° (p<0.001). Vancouver Scar Scale scores decreased from 9.2±1.8 to 4.1±1.3 (p<0.001). Patient satisfaction was “Excellent” in 72.1% and “Good” in 20.6%. Complications occurred in 6 patients (8.8%), all minor and managed conservatively. No cases of flap necrosis or recurrence were observed at 6-month follow-up.
Conclusion: Z-plasty is a remarkably effective, safe, and culturally adaptable technique for managing post-burn contractures in the Iraqi context. It delivers statistically and clinically significant improvements in both function and aesthetics, with high patient satisfaction and minimal complications. Given Iraq’s constrained healthcare resources and high burden of burn-related disability, Z-plasty should be prioritized in national reconstructive surgery protocols and integrated into surgical training curricula. This study provides the first prospective Iraqi dataset to support evidence-based adoption of this technique at scale.