Langer's lines: to use or not to use.
ABSTRACT Thirty-six differently named guidelines have developed as surgeons have searched for an ideal guide for elective incisions. Many surgeons prefer Langer's lines. These lines were developed by Karl Langer, an anatomy professor, from cadavers in rigor mortis. However, Kraissl preferred lines oriented perpendicular to the action of the underlying muscles. Later, Borges described relaxed skin tension lines, which follow furrows formed when the skin is relaxed and are produced by pinching the skin. However, these are only guidelines; there are many contributors to the camouflaging of scars, including wrinkle and contour lines. Borges's and Kraissl's lines (not Langer's) may be the best guides for elective incisions of the face and body, respectively.
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ABSTRACT: BACKGROUND: The S-shaped incision is a novel technique we have developed to minimise wound complications for the insertion of bilateral deep brain stimulators. METHODS: An S-shaped incision incorporating both burrholes allows better exposure compared to the traditional bilateral incisions. The burrholes are drilled under each limb of the S and the incision does not run across them, decreasing the risk of infection. The electrodes are subsequently tunneled down the right side and connected to the battery. CONCLUSION: The use of the S-shaped incision results in less wound and electrode complications compared to the traditional bilateral linear incisions in our experience.Acta Neurochirurgica 05/2013; · 1.55 Impact Factor
Article: The tangled web of Langer's lines.[Show abstract] [Hide abstract]
ABSTRACT: Langer's lines are often considered to be guides for elective surgical incisions. Interestingly, Karl Langer was not the first to describe the property of skin that leads to the lines he depicted, nor are these lines in common use today. Rather, it is common that relaxed skin tension lines provide a guide for cosmetically pleasing surgical results. Nevertheless, Langer did conduct extensive studies on human skin that remain as a scholarly body of work. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.Clinical Anatomy 08/2013; · 1.16 Impact Factor
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ABSTRACT: Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.Journal of Korean medical science. 06/2014; 29(6):751-757.