Recreation of the natal cleft by reverse Z-plasty

The use of Z-plasties in the closure of elliptical or circular defects is not uncommon. We present a patient in whom a double Z-plasty was performed in order to close a sacral pressure sore. The patient returned 21 years later seeking aesthetic improvements of the resultant obliteration of the natal cleft and the soft tissue and skin redundancy in the central inferior aspect of the buttocks. We met this challenge with a practical solution. The triangular flaps of the Z-plasties were returned to their original positions. This resulted in a natural shortening of the central portion of the buttock and the recreation of the natal cleft. The postoperative result was aesthetically pleasing. We report this unusual case and discuss the geometry behind the reversal of the Z-plasties as the solution to this problem. In addition, a novel interpretation of Z-plasties is presented.