this retrospective study reviewed 22 consecutive patients who underwent scar revision with a modified dovetail - plasty between november 2010 and august 2012 . our study group consisted of 28 cases in 22 patients ( 9 males and 13 females ) with a mean age of 33.6 years ( range , 661 years ) . two patients had scars in 2 locations , and the other 2 patients had scars in 3 locations for the modified dovetail - plasty . the 28 procedures were for conspicuous scars on the face ( n = 14 ) and extremities ( n = 14 ) that was caused by trauma ( 8 patients ) , an operation ( 4 patients ) , burns ( 3 patients ) , full - thickness skin graft ( 3 patients ) , split - thickness skin graft ( 2 patients ) , and flaps ( 2 patients ) . the defined scar locations on the face were the upper eyelid ( n = 3 ) , glabella ( n = 3 ) , upper lip ( n = 3 ) , philtrum ( n = 2 ) ( fig . ( n = 1 ) , mandibular border ( n = 1 ) , and chin ( n = 1 ) . the defined scar locations on the extremities were the dorsal digital web ( n = 4 ) , dorsal foot ( n = 3 ) ( fig . 3a ) , dorsal toe web ( n = 2 ) , axilla ( n = 2 ) , shoulder ( n = 1 ) , upper arm ( n = 1 ) , and thigh ( n = 1 ) . the conspicuous scars were classified as contracted ( 8 patients ) , depressed ( 7 patients ) , uneven ( 4 patients ) , or wide ( 3 patients ) . these types can lead to a combined appearance . the scar length measured less than 5 cm in 21 cases and greater than 5 cm in 7 cases . there are surgical techniques for the modified dovetail - plasty , which are divided into serial ( fig . , linear wide scar can be used as an alternative dovetail flap for diverting both lateral perpendicular tensions . the design of the original dovetail - plasty is the same as the dovetail joint . the technique consisted of a precut trapezoid flap and its insertion and was intended for making a philtrum fold ( fig . our design for the modified dovetail - plasty has a unique y - shape incision , which can be opened into an m or inverted u shape for a releasing effect . our design also was effective in wide and contracted scars by releasing , lengthening , and reducing the tension of the scars ( fig . when the y - shape incision was opened , the grafted scar margin was adequately released . large trapezoid flaps were progressively made and inserted into the releasing space from the proximal site of the scar . intraoperative marking of the fusiform excision line for the scar was performed before local anesthetic infiltration . the authors designed y - shape incision lines along the relaxed skin tension lines on one side of the excision line and trapezoid incision lines on the other side . the length of each line was 2 to 3 mm for a facial scar ( fig . we determined the interval between each dovetail flap according to the size of the flap . the area of the scar revision was then infiltrated with 1% lidocaine with 1:100,000 units of epinephrine . the y - shape incision was opened , and a trapezoid flap on the other side of the excision line was inserted into opened space . we performed subcutaneous and dermal suturing with 5 - 0 vicryl or 6 - 0 pds and skin sutures with 6 - 0 or 7 - 0 nylon . large dovetail flaps greater than 5 mm were used in the dorsal foot ( 2 patients ) and axillary web ( 2 patients ) . the outcome over 6 months after surgery was characterized as excellent for inconspicuous scars , good for partially depressed scars , fair for partially hypertrophic scars , and poor for extensively hypertrophic scars . the total number of dovetail flaps in 22 patients was 54 ( mean , 2.45 ; range , 16 ) . the serial type of dovetail flap was used for 25 of 28 procedures . the mean follow - up period after surgery was 8.4 months ( range , 125 months ) . sixteen of 22 patients were evaluated over 6 months after the operation for their outcomes . there were scar depressions ( 2 patients ) and hypertrophic scars ( 1 patient ) in the interval area between the dovetail flaps . diffuse hypertrophic scarring occurred in 1 patient on the dorsal foot scar , which she did not manage with a pressure garment . minimal tip abrasions on the dovetail flaps during the early stage after surgery were managed with conservative dressing . the overall success rates for the procedure as assessed by the surgeons were as follows : excellent ( 12 patients , 75% ) , good ( 2 patients , 12.4% ) , fair ( 1 patient , 6.3% ) , and poor ( 1 patient , 6.3% ) ( figs . there are many types of scars , such as linear , wide , smooth , uneven , depressed , trapdoor , and hypertrophic scars . the ultimate goal of any operation in plastic surgery is to leave a linear scar . thus , every attempt should be made to leave a linear scar as inconspicuous as possible in asian patients.1 the success of scar revision , or camouflage , is dependent on many parameters . some of these include scar location , patient age , nature of the initial injury , condition of the adjacent tissue , skin loss , ethnic background , skin type , patient expectations , and scar orientation.5 one of the conditions is tension . the multidirectional tension may overstimulate the fibroblast , causing the production of excess collagen , which is the main constituent of a conspicuous scar.6 mechanical conditions , such as flap immobilization and extensive tension , for example , induced by sutures , have a detrimental influence on the healing process7 local flaps , such as z - plasty , w - plasty , or a geometric broken - line suture ( gblc ) , reduce the wound tension.2,3 an important factor for the modified dovetail - plasty is wound tension . the tension between the concave and convex areas is higher than that for simple closure . however , as trapezoid flaps are being inserted to counter the insertion area , each face of the flap became packed . in addition , the interval areas between the flaps are tension - free because of excessive approximation during flap packing . the modified dovetail - plasty could free scar tension more than a simple z - plasty . this technique also could insert many flaps in limited space without unnecessary tissue sacrifice compared with w - plasty . a modified dovetail - plasty can be used to camouflage scars located in areas with extensive tension . this technique was used for scar revision of the glabella , chin , philtrum , upper lip ( fig . , the technique can be used for scar revision of contracted and/or wide scars of the extremities on the joint areas , resulting in motion and/or excessive tension ( fig . however , the technique does not work for hypertrophic scars resulting from excessive sebum production and for genetic scars without excessive tension . in addition to the revision of scars under extensive tension , this modified dovetail - plasty can be used to revise trapdoor and marginal scars from skin flaps and grafts ( fig . the sheet of the internal scar is primarily responsible for raising the skin inside of the semicircle . as a result of the contraction on the semicircular scar surface , an uneven trapdoor deformity developed . the modified dovetail - plasty can release the contracted trapdoor part of the scar , and a trapezoid flap for the counterpart of the scar can be inserted into the empty place after releasing the contracted trapdoor part . the sizes of the dovetail flaps were 2 to 3 mm for the face and 5 mm or greater for the extremities . in addition to the flap itself , the interval area between the flaps is an important factor in the modified dovetail - plasty . the interval area is a negative tension area ; therefore , the wound tends to be inverted or everted , not flat . if the wound for the interval area is repaired with the usual suture technique , the wound will be depressed during scar maturation . the interval area between the dovetail flaps is an important factor for a modified dovetail - plasty . if the interval length is too long , visible scar widening can occur in this area because of decreased absorption of the perpendicular tensions . we decided that the length of the interval area between the flaps was similar to the size of the flaps . the depression deformity can occur in the interval area of the dovetail flaps on the face postoperatively . this scarring will gradually improve over a long follow - up period and can also be prevented using a pressure garment . this modified dovetail - plasty is a more complicated and time - consuming technique than other flaps for scar revision . however , this technique reduces perpendicular tension more than z - plasty and sacrifices less tissue than w - plasty , gblc , or the original dovetail cheiloplasty .
abstractscar revision is one of the fundamental techniques in the field of plastic and reconstructive surgery . 
 local flaps , such as a z - plasty , w - plasty , or geometric broken - line closure , have been used for scar revision . 
 camouflaging a scar during scar revision for marginal scars from skin grafts and flaps , trapdoor scars , and linear scars is difficult . 
 we describe our experience with the use of modified dovetail - plasty for scar revision in these difficult areas . 
 our study group consisted of 28 cases among 22 patients ( 9 males and 13 females ) with a mean age of 33.6 years ( range , 661 years ) . 
 the conspicuous scars were located on the face ( 50% ) and extremities ( 50% ) . 
 the authors designed y - shaped incision lines to relax the skin tension lines on one side of the excision line and trapezoid incision lines on the other side . 
 there were 16 follow - up operations performed over 6 months after the initial operation among a total of 22 patients . 
 there were scar depressions ( 2 patients ) and a hypertrophic scar ( 1 patient ) at the interval area between the dovetail flaps . 
 a diffuse hypertrophic scar occurred in 1 patient with a dorsal foot scar . 
 the overall success rates of the procedure as assessed by the surgeons were as follows : excellent ( 75% ) , good ( 12.4% ) , fair ( 6.3% ) , and poor ( 6.3% ) . 
 this new local flap can achieve an inconspicuous scar using a blurred scar line and reducing tension . 
 the authors recommend a modified dovetail - plasty for the revision of trapdoor scars and scars under excessive tension .