Mutaf procedure: expanding the indications
Ahmed Hassan El-Sabbagh
Received: 23 February 2011 / Accepted: 27 June 2011 /Published online: 2 August 2011
Abstract Depressed scars may be congenital or acquired.
Different methods have been widely used for the correction
of these deformities. The Mutaf procedure was described
previously for the correction of the constriction ring
syndrome. In this article, the indication was expanded to
include non-congenital scars. Eighteen patients underwent
the Mutaf procedure for depressed scar correction. These
scars included congenital and non-congenital scars. It was
applied to both upper and lower limbs. All flaps survived
completely with only one minor complication. The Mutaf
procedure is an effective method for correction of large
Keywords Mutaf procedure
Numerous techniques have evolved in plastic surgery to
camouflage depressed scars. It is important to point out that
scarring is the natural healing response to cutaneous injury.
The goal is to hide scars and make them as inconspicuous
as possible, accepting that they can never be completely
There are multiple surgical techniques, mainly injections,
for scar correction. Techniques range from surgical excision
to resurfacing with grafts or flaps. In addition, there are
non-surgical methods such as autologous fat, hyaluronic
acid, collagen, and permanent fillers such as silicone.
Choosing a treatment modality depends upon careful
evaluation of scar characteristics [1–7].
From Turkey, Mutaf was the innovator of a technique for
the correction of the constriction ring syndrome. In this
study, the Mutaf procedure was used again but the
indications for correction of congenital scars were expand-
ed to include acquired depressed scars .
Patients and methods
From September 2007 to November 2010, 18 patients were
admitted to the Plastic Surgery Department at Mansoura
University Hospital after undergoing correction of depressed
scars on different parts of the body including congenital and
acquired scars. All patients with congenital constriction
syndrome and patients with depressed scars were included
in the study.
All patients were subjected to thorough history taking and
complete neurological assessment. Local examination involved
the site and dimensions of the scars in adults and rings in
children. Routine laboratory workup was performed.
Surgical technique (as described by Dr. Mutaf )
After general anesthesia and tourniquet application, first,
the scar is surgically excised. After excision of all the
fibrotic tissue, rectangular flaps are designed on both sides
of the groove. The heights of these rectangular flaps are
extended up to the point where the normal extremity
contour is reached.
The width of each rectangular flap is then designed to be
twice its height. The rectangular flaps are deepithelialized
in an alternating pattern on each side of the groove as each
deepithelialized rectangle opposes an intact rectangle. Then,
A. H. El-Sabbagh (*)
Mansoura University Hospital,
Eur J Plast Surg (2012) 35:277–283