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.
"A punch excision in the skin usually results in a circular defect that immediately deforms into an ellipse. When multiple punch excisions are performed and the major axes of these ellipses are connected, the resulting line is considered as a Langer's line (Fig. 1) (7). These lines run parallel to the main collagen bundles in the dermis but do not always follow the line of wrinkle. "
[Show abstract][Hide abstract] 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. DOI:10.3346/jkms.2014.29.6.751 · 1.27 Impact Factor
"A practical method for understanding the skin’s anisotropy has, therefore, been sought. Several types of skin lines including the Langer’s line and relaxed skin tension lines have been proposed in the surgical field [1–3]. Langer created a map of the directions in which wounds created on the skin of human cadavers using a round tipped awl would be stretched, and these are called Langer’s lines . "
[Show abstract][Hide abstract] ABSTRACT: We performed an in vivo three-dimensional analysis of anisotropic changes in the dermal birefringence of mechanically deformed human skin using polarization-sensitive optical coherence tomography (PS-OCT). The papillary-dermal birefringence of the forehead increased significantly when the skin was shrunk parallel to the body axis, and decreased significantly when the skin was shrunk perpendicular to the body axis. En-face images of the papillary-dermal birefringence revealed variations among individual subjects, and that both shrinking parallel to and stretching in perpendicular to the body axis promoted the formation of macro rope-like birefringent domains. We found that PS-OCT is useful for understanding anisotropic properties of collagen structure in the skin.
"Langer's lines describe the patterns of biomechanical anisotropy in human skin. Directions within skin and along (parallel to) Langer's lines have the least flexibility (highest Young's modulus ) . We chose the volar forearm for these measurements because the Langer's lines are easily defined at this site to be parallel to the long axis of the arm . "
[Show abstract][Hide abstract] ABSTRACT: Dynamic optical coherence elastography is used to determine in vivo skin biomechanical properties based on mechanical surface wave propagation. Quantitative Young's moduli are measured on human skin from different sites, orientations, and frequencies. Skin thicknesses, including measurements from different layers, are also measured simultaneously. Experimental results show significant differences among measurements from different skin sites, between directions parallel and orthogonal to Langer's lines, and under different skin hydration states. Results also suggest surface waves with different driving frequencies represent skin biomechanical properties from different layers in depth. With features such as micrometer-scale resolution, noninvasive imaging, and real-time processing from the optical coherence tomography technology, this optical measurement technique has great potential for measuring skin biomechanical properties in dermatology.
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