Langerʼs Lines: To Use or Not to Use

Department of Surgery, University of Texas Medical Branch, Galveston 77555-0724, USA.
Plastic & Reconstructive Surgery (Impact Factor: 2.99). 08/1999; 104(1):208-14. DOI: 10.1097/00006534-199907000-00033
Source: PubMed


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.

188 Reads
  • Source
    • "Langer's lines tend to be parallel; however, they form discrete groups that intersect each other. Later, Willhelmi et al. (1999) reported that Langer's lines change with body posture. He suggested alternative guidelines for facial incisions called " Borges' relaxed skin tension lines (RSTLs), " and alternatives for body incisions called " Kraissl's wrinkle lines. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With the advent of 3D technology in the design process, a tremendous amount of scanned data is available. However, it is difficult to trace the quantitative skin deformation of a designated location on the 3D body surface data during movement. Without identical landmarks or reflective markers, tracing the same reference points on the different body postures is not easy because of the complex shape change of the body. To find the least deformed location on the body, which is regarded as the optimal position of seams for the various lengths of functional compression pants, landmarks were directly marked on the skin of six subjects and scanned during knee joint flexion. Lines of non-extension (LoNE) and maximum stretch (LoMS) were searched for, both by tracing landmarks and newly drawn guidelines based on ratio division in various directions. Considering the waist as the anchoring position of the pants, holistic changes were quantified and visualized from the waistline in lengthwise and curvilinear deformation along the dermatomes of the lower body for various lengths of pants. Widthwise and unit area skin deformation data of the skin were also provided as guidelines for further use such as streamlined pants or design of other local wearing devices. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.
    Full-text · Article · May 2015 · Applied Ergonomics
  • Source
    • "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. Graphical Abstract
    Full-text · Article · Jun 2014 · Journal of Korean Medical Science
  • Source
    • "He advised that surgical incisions are carried out in the direction of Langer's lines, because the scars would be least conspicuous and heal better. Since then, many surgeons have searched for the ideal guide to use for elective incisions, and there exist more than thirty differently named guidelines today [3]. One problem with Langer's line has been that they represent lines of cleavage in cadavers and not lines of relaxed skin ✩ This work has been supported by Specific & Fundamental Research Program (No. 2009-0083874) of Korean National Research Foundation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Skin tension lines, defined as the lines of maximal tension, often provide guidelines for surgical incisions and pattern design of tight-fit, functional clothing. In this work, we are interested in developing methods for finding personalized, dynamic skin tension lines (DSTL) in a non-invasive manner. We base our study on the kinematic analysis of point markers that are colored on the skin. By tracking the motion-induced displacement of point markers, we locally analyze the skin deformation and numerically compute the maximum tension directions. Then, finding DSTL is transformed to the problem of finding continuous, interpolating locally computed lines of the maximum tension directions. Compared to existing methods, our method involves less invasive measurement on the skin, and is equipped with computational methods for identifying dynamic skin tension automatically. Consequently, our method is convenient to carry out, less prone to erroneous measurement, and repeatable. Our experiments have been successfully carried out on, though not limited to, lower body skins of male subjects.
    Full-text · Article · Feb 2013 · Computer-Aided Design
Show more