Outcomes of z-plasty technique in scar revision for post-burn deformities among Iraqi patients: A prospective clinical study

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