Objective: Design a z-plasty to lengthen a 3 cm scar contracture by 75%.

Instructions: Using the AmoSmile app, follow the guided physical simulation to achieve the above objective. Stepwise self-assessment questions are integrated into the app to provide a performance feedback loop towards mastery learning. After completion of the simulation, your score will be displayed alongside customized guidance for targeted review. All questions must be answered correctly in order to earn a Certificate of Completion.

Step 1: Set-up

Set-up your physical simulator (assembly instructions) and mark a 3cm linear scar contracture

Step 2: Design

Design a z-plasty to achieve 75% lengthening of the marked scar contracture

Step 3: Incision

Incise your markings through epidermis, dermis, and into subcutaneous tissue

Step 4: Elevation

Elevate the triangular flaps in the subcutaneous plane. Aim to maintain a minimum of 4mm of subcutaneous tissue attached to the elevated flap dermis. Use an adson or skin hook to apply gentle upwards traction at the apex of each triangular flap to aid in elevation. Continue your elevation to the base of each triangular flap.

Step 5: Transposition

Transpose the flaps by reorienting the apex of each flap to the opposite corner of the other flap.

Step 6: Inset

Suture the transposed flap apices using a buried horizontal mattress suture, with the buried end in the flap apex

Step 7: Closure

Complete your closure with simple interrupted sutures.

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