Careers. A dedicated team of UK doctors who want to make learning medicine beautifully simple. Some error has occurred while processing your request. 1987 Mar;88(3 Suppl):44s-51s. National Library of Medicine The aim was to measure the orientation of the long axis of the wound with the face at rest and subsequent rotation of the wound with facial movement. This site needs JavaScript to work properly. Skin Tension - an overview | ScienceDirect Topics your express consent. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Their course depends on the patient's age, nutritional status, general condition and anatomical peculiarities, if any. Lakhani P, Dwivedi KK, Parashar A, Kumar N. Front Bioeng Biotechnol. PMC A skin graft can be performed faster than a local flap, and it has the advantage that it has less donor site morbidity and can be repeatedly implemented. The cleavability of the cutis. Skin tension or skin compression? Results: The reason for this name, the actual direction they follow, and the great importance they bear in the sthetic appearance of a scar are stated.The reasons, advantages, and disadvantages for . Abstract Objective There remains confusion between Langer's lines and wrinkle lines with respect to the optimal orientation of elliptical excisions on the trunk. Relaxed Skin Tension Lines - ScienceDirect Instruction for Registration and Activation. Epub 2013 Oct 30. Forensic Sci Int 121:161165, Saukko P, Knight B (2004) Knights forensic pathology, 3rd edn. A punch excision in . The author undertakes a detailed literature. Previously these lines have been considered as a static feature. Arch Kriminol 161:3140, Byard RW, James RA, Gilbert JD (2002) Diagnostic problems associated with cadaveric trauma from animal activity. Search Bing for all related images, Search other sites for 'Relaxed Skin Tension Lines', Skin Tension Lines followed during elective incision, Historically used to determine optimal incision line, Worse cosmetic result than with Skin Tension Lines. The site is secure. Karl Langer (1819-1887), the man behind the famous lines, was born in Vienna, Austria, where he spent most of his life and later became professor of anatomy at Josephs Academy.1 In 1861, Langer began publishing a series of 5 articles detailing his seminal work on the physical and mechanical properties of the skin.2 In the first of these articles, Langer credited Dupuytren and Malgaigne for their earlier observations. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Please try again soon. Rechtsmedizin 1:4750, Bajanowski T, Paldauf E, Brinkmann B (1991c) Zum Nachweis von Glassplittern in Glasschnittverletzungen. The underlying convexities have the most influence on skin stress. official website and that any information you provide is encrypted Acta Biochim Biophys Sin (Shanghai). official website and that any information you provide is encrypted The conventional wisdom is that Langer identified the existence of skin tension lines in 1861. Full Disclaimer. . Lacerations against Langer's lines: to glue or suture? Skin tension lines Relaxed skin tension lines, z-plasties on scars, and fusiform excision . In the area of the joints, they take . Would you like email updates of new search results? Disclaimer. The tangled web of Langer's lines - PubMed Radiologe 31:452455, Bajanowski T, Paldauf E, Brinkmann B (1991b) Morphologie von Glasschnittverletzungen. Scot Glasberg, M.D. sncRNA changes induced by tension in hypertrophic scar. Arnold, London, Schmidt U, Faller-Marquardt M, Tatschner T, Walter K, Pollak S (2004) Cuts to the offenders own handsunintentional self-infliction in the course of knife attacks. Vischi S, Roesel R, Capriata G, Baratelli GM. Federal government websites often end in .gov or .mil. Biomed Res Int. If you have already registered, please login. Relaxed skin tension lines are determined at the time of operation by pinching the skin and observing the linear creases. eCollection 2022. The elliptical punch biopsy: a simple technique. Aged skin: a study by light, transmission electron, and scanning electron microscopy. Unable to load your collection due to an error, Unable to load your delegates due to an error. sharing sensitive information, make sure youre on a federal Would you like email updates of new search results? This section has been translated automatically. 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Excision; Langers lines; Skin; Skin cancer; Skin tension. doi: 10.7759/cureus.12457. This led Dupuytren to study the matter in cadavers and discover that a round instrument indeed produced linear clefts when thrust through the skin. Wolters Kluwer Health The seven best known skin tension lines are presented. Langer's lines of skin tension are important only from a historical point of view. Evidence suggests that the facial musculature in cadavers is not always relaxed, as some cadavers . Linearity and Surface Anatomy of the Face: From Embryo to Senescence. Langer's Lines | SpringerLink Pawlaczyk M, Lelonkiewicz M, Wieczorowski M. Postepy Dermatol Alergol. Thread Lifting of the Jawline: A Pilot Study for Quantitative Evaluation. Therefore, tension (i.e. These lines were developed by Karl Langer, an anatomy professor, from cadavers in rigor mortis. If that doesn't work, please contact support so we can address the problem. Straith et al used the terms "normal tension line," and "Langer . A medical odyssey. Scheepens KMJ, Marsidi N, Genders RE, Horeman-Franse T. IEEE J Transl Eng Health Med. Overview of Surgical Scar Prevention and Management - PMC Article Full-text available Oct 2016 Islam Hany Sameh Roshdy Saleh Saleh Mohamed Ezzat INTRODUCTION Marjolin's ulcer (MU) is an uncommon malignancy occurring on top of old scars. The zigzag closure described is similar to primary closure; many flaps with geometric patterns are used routinely for skin cancer surgery, especially for non-melanoma skin cancers. in 1984 Broges described simple method to determine the Relaxed Skin Tension Lines (RSTL) by pinching skin and observing the formed furrows and ridges rather than furrows formed by. If you haven't, you can register for free (medical professionals only). In case 1, rectangular stab wounds to the base of the neck in a 53-year-old man, which suggested that a square or rectangular tool may have caused the injuries, were altered to more typical knife stab wounds once skin tension had been released at autopsy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Accessibility Statement, Our website uses cookies to enhance your experience. Skin tension lines | DermNet doi: 10.1097/GOX.0000000000001614. Customize your JAMA Network experience by selecting one or more topics from the list below. Bush J, Ferguson MW, Mason T, McGrouther G. J Plast Reconstr Aesthet Surg. Four major groups of linear patterns can be distinguished: Langer lines, dermatomes, Blaschko lines and exogenous patterns. In this respect, these tension lines have a practical significance for the surgeon, since observance of the skin tension lines is a prerequisite for optimal wound healing and scar formation. FOIA Br J Plast Surg 1978;31:93-106]. Click on the image (or right click) to open the source website in a new browser window. Int J Legal Med 119, 226230 (2005). and transmitted securely. Langer's lines have relevance to forensic . [1] Whereas Langer's lines were defined in cadavers, [2] Kraissl's lines have been defined in living individuals. Privacy Policy| eCollection 2022. 2021 Sep 15;2021:7398090. doi: 10.1155/2021/7398090. Plast Reconstr Surg. Aka: Relaxed Skin Tension Lines, Skin Tension Lines, Langer Lines, Langer's Lines, Cleavage Lines, These images are a random sampling from a Bing search on the term "Relaxed Skin Tension Lines." Full-Thickness Skin Graft according to Surrounding Relaxed Skin Tension 2022. The best defined lines occur when the skin is pinched perpendicular to the line of optimum incision. The https:// ensures that you are connecting to the 1999 Jul;104(1):208-14. Microanatomy of the dermis in relation to relaxed skin tension lines Clipboard, Search History, and several other advanced features are temporarily unavailable. ABSTRACT OBJECTIVE There remains confusion between Langer's lines and wrinkle lines with respect to the optimal orientation of ellipti-cal excisions on the trunk. Unauthorized use of these marks is strictly prohibited. Ann R Coll Surg Engl. Please try refreshing the page. Skin tension lines essentially refer to the direction of maximal skin tension at different body sites. 11 Incisions made parallel to lines of maximal tension will gap to a lesser extent and heal with a finer scar than incisions made at right or oblique angles to them. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Materials and methods Some 1181 consecutive skin lesion excisions were investigated (age range 13-95 years, median 64 years) using a tensiometer to determine directions of least wound tension. 2023 Mar 8;10:1132353. doi: 10.3389/fmolb.2023.1132353. This is a preview of subscription content, access via Mechanobiology in the Comorbidities of Ehlers Danlos Syndrome. Recently, it has been questioned whether measurements of cadaveric skin can provide accurate representations of living skin tension lines [3,4]. Materials and Accessibility When the skin is folded, the tension lines become clear. MeSH In the thoracodorsal region, the distribution of Langer lines leads to a so-called "Christmas tree pattern". MeSH Unauthorized use of these marks is strictly prohibited. Langer's lines - Wikipedia 8600 Rockville Pike Extracellular matrix stiffness-The central cue for skin fibrosis. Get new journal Tables of Contents sent right to your email inbox, Relaxed Skin Tension Lines (RSTL) versus Other Skin Lines, The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago, Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Lower Face, Effective Rejuvenation with Hyaluronic Acid Fillers: Current Advanced Concepts. Our content is available exclusively to medical professionals. Biodynamic excisional skin tension lines for surgical excisions: untangling the science. stretch) can be reduced by creating an incision parallel to relaxed skin tension lines. PubMedGoogle Scholar. 2009 May;62(5):705-6. doi: 10.1016/j.bjps.2008.12.025. Aligning surgical incisions or excisions with these lines produces less tension, optimal scar formation, and ultimately a better cosmetic result. Published by ACT Publishing Group Ltd. All rights reserved. Have comments about these notes? Sharad Paul Surgical literature is inundated with references to Langer's Lines, Cleavage Lines, Wrinkle Lines and Skin Tension Lines. FOIA 1998 Mar-Apr;16(2):185-9. doi: 10.1016/S0736-4679(97)00285-0. Langer's lines: to use or not to use - PubMed On the face, skin tension lines follow the mimic musculature. 2021 Jan;146:104177. doi: 10.1016/j.jmps.2020.104177. 1-1 to 1-3).A cosmetic incision may not be parallel to the underlying dissection. The Geometry of Incompatibility in Growing Soft Tissues: Theory and Numerical Characterization. Biodynamic Excisional Skin Tension Lines for Excisional Surgery of the Zhonghua Kou Qiang Yi Xue Za Zhi. The lines of Langer or relaxed skin tension lines. | Download sharing sensitive information, make sure youre on a federal ShoulderDoc.co.uk satisfies the INTUTE criteria for quality and has been awarded 'editor's choice'. Age-dependent biomechanical properties of the skin. The https:// ensures that you are connecting to the The lines represent the orientation of the collagen in the underlying dermis, and they are important because the collagen and the healing wound aligns itself along the length of the incision, regardless of the orientation of the wound (Figs. 2013 Oct;30(5):302-6. doi: 10.5114/pdia.2013.38359. The skin wrinkle lines are only visible when the skin is relaxed. These lines were originally determined in the 19th century by piercing cadaver skin and observing the orientation of skin. Continuous NPWT Regulates Fibrosis in Murine Diabetic Wound Healing. J Emerg Med. The vessels pass vertically from the posterior humeral circumflex artery through the septa in the muscle to the overlying dermis rather than follow in an oblique course. Skin tension lines, also known as Langer's lines or lines of cleavage, are linear clefts in the skin that indicate the direction of orientation of the underlying collagen fibers. These lines run in the same direction as Langers lines in many areas of the body. 2023 Apr 18;10:1167067. doi: 10.3389/fsurg.2023.1167067. This is an interactive guide to help you find relevant patient information for your shoulder problem. Relaxed Skin Tension Lines (RSTL) versus Other Skin Lines Borges, Albert F. M.D. Additional factors that may change the shape of wounds are (1) the relationship of the wound to the so-called skin cleavage lines (Langer's lines) and . Relaxed skin tension lines, z-plasties on scars, and fusiform excision Elsevier, New York, Rains AJ, Capper WM (1973) Bailey and Loves short practice of surgery, 15th edn. Keywords: Langer's lines; elective surgical incisions; plastic surgery; relaxed skin tension lines. Am J Forensic Med Pathol 23:238244, Canuto G (1929) Die Umkehrung der Endchen bei Halsschnittwunden. Int J Leg Med 117:229231, Von Hofmann E (1898) Atlas der Gerichtlichen Medizin. Thus Langer lines are more accurately referred to as relaxed skin tension lines. 2022;56:281-305. doi: 10.1159/000529557. When multiple punch excisions are performed on skin to create ellipses, if their major axes (i.e. FOIA Subfascial dissection offers no additional circulation to skin in this area; in fact, it offers a disadvantage of disturbing some of the overlying collagen of the deltoid muscle that is necessary for bony reattachment. After excision elliptical distortion was seen in 171 of the 175 wounds at rest. Tension and/or skin cleavage lines may transform round skin defects into slit-like wounds resembling knife stab wounds, round out genuine stab wounds and artefactually lengthen stab wounds. They differ from Langer's lines in that unlike Langer's lines, which are defined in term of collagen orientation, Kraissl's lines are the lines of maximum skin tension. Epub 2023 Jun 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Each line represents a, Biodynamic excisional skin tension lines:, Biodynamic excisional skin tension lines: a guide for excisional surgery, MeSH Medical professionals receive free and unrestricted access to all articles and images. Philos Trans R Soc Lond B Biol Sci. Lesions such as lipomas, which entail incisional rather than excisional surgery (i.e. 2022 Oct 6;14(10):2125. doi: 10.3390/pharmaceutics14102125. It is possible that this rotation in the axis of mechanical tension will affect the appearance of the resulting scar. Please enable it to take advantage of the complete set of features! Wang K, Wen D, Xu X, Zhao R, Jiang F, Yuan S, Zhang Y, Gao Y, Li Q. government site. 2017 Dec 22;5(12):e1614. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In the remaining wounds the long axis of the wound rotated by up to 90 degrees . Skin lines vary between people and between men and women. The directions they convey are schematically compared with those of the relaxed skin tension lines. They do represent the lines of skin tension in a body with rigor mortis. The uppermost wounds, however, continued to gape due to the effects of skin cleavage lines. 2004 May 29;359(1445):839-50. doi: 10.1098/rstb.2004.1475. A comparative study of the fetal skin of calves, where relaxed skin tension lines were absent, offered further evidence that the presence of tension lines in the skin depends on the interrelationship between elastic fibers and collagen fibers, as well as on the anchorage of collagen bundles one upon another. 2007;60(4):393-9. doi: 10.1016/j.bjps.2006.06.008. Bookshelf 2022 Jul;17(7):1201-1211. doi: 10.1007/s11548-022-02657-5. An official website of the United States government. Epub 2023 May 19. Disclaimer. On the trunk and extremities, they run largely horizontally. HHS Vulnerability Disclosure, Help Unauthorized use of these marks is strictly prohibited. 1. Consequently, on the head and face, relaxed skin tension lines become BEST lines, but this is not necessarily the case elsewhere, such as on the neck or lower limbs. Before Data is temporarily unavailable. 2022 Aug 25;54(8):1197-1200. doi: 10.3724/abbs.2022103. Langer's lines; elective surgical incisions; plastic surgery; relaxed skin tension lines. Plast Reconstr Surg Glob Open. Google Scholar, Karger B, Rothschild MA (2004) Postmortaler Tierfra durch Wirbeltiere. 1997 Aug 15;38(4):413-27. doi: 10.1002/(SICI)1097-0029(19970815)38:4<413::AID-JEMT9>3.0.CO;2-J. This site complies with the HONcode standard for trustworthy health information: verify here. Epub 2013 Aug 27. Linearity and Surface Anatomy of the Face: From Embryo to Senescence. Int J Leg Med 118:332336, Rainio J, Lalu K, Ranta H, Penttil A (2003) Morphology of experimental assault rifle skin wounds. notes. 2007 Mar;36(3):265-8, 270-2. doi: 10.1007/s00132-007-1048-9. Unfortunately, quantitative measurement of skin tension is neither reliable nor practical in clinical settings. Langer lines run in the direction of the underlying collagen fibers (least skin tension) and play an important diagnostic role for some exanthematous skin diseases. Yin C, Zhang S, Ya C, Wang C, Liang Y, Wang C. Acta Biochim Biophys Sin (Shanghai). The .gov means its official. Skin tension lines reflect internal tension within the skin. Pulsenotes uses cookies. Kbner phenomenon describes the eruption of an inflammatory skin disease following mechanical alteration of the skin. All lesions were cut out in a circular fashion following tension measurements. There are different types of skin tension lines. Small circular wounds are likely to shrink, not gape. Linear skin diseases may follow Blaschko's lines, Langer's relaxed skin tension lines or head zones (dermatomes), thus indicating an embryogenic, hematogenic or neuronal aspect in their pathogenesis. where overlying skin was not excised) were excluded. PMC Langer's lines, Langer lines of skin tension, or sometimes called cleavage lines, are topological lines drawn on a map of the human body. In these circumstances, it is necessary to raise skin flaps while protecting the circulation of the skin. Skin tension lines commonly depicted in textbooks. An official website of the United States government. Articles in PubMed by Albert F. Borges, M.D.
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