The Direction of Optimal Skin Incisions Derived from Striae Distensae

Abstract

Background:In an effort to achieve inconspicuous scars, plastic surgeons try to place their incisions in established creases and folds of skin. Although well established in the face and abdomen, these folding lines are often disputable on other parts of the body. Striae distensae always develop perpendicular to lines of tension, and their direction can be used to determine optimal incision lines. Methods: The authors examined photographs of 213 individuals with striae, and a composite diagram was created. This composite along with descriptions of Langer lines, Pinkus main folding lines, and Kraissl lines were compared with a clinical scar revision database and 276 images of incisions and scars from the Internet. Results: Pinkus described the main folding lines in 1927 and Kraissl in 1951 recommended that incision lines be placed perpendicular to the direction of underlying muscles. Both references bear some similarities to what we noted in our composites. In comparison, Langer lines, although of historical interest, poorly predicted the direction of optimal skin incisions. Conclusions: The optimal direction for surgical skin incisions should take into strong consideration patterns defined by nature's striae distensae, which always develop perpendicular to skin tension lines. Main folding lines can be used as guides when addressing or refining problem scars and similarly facilitate surgical planning of elective incisions, which may prevent problem scar formation for our patients. (Plast. Reconstr. Surg. 133:

Evaluation of inguinal vascular surgical scars treated with closed incisional negative pressure wound therapy using three‐dimensional digital imaging—A randomized controlled trial on bilateral incisions

“…It is well known that longitudinal inguinal incisions are associated with a considerable higher frequency of wound complications and thereby also increased scar formation . In particular, lateral retraction forces in the wound edges of the incisional line, which are decreased when using NPWT, is much higher in vertical incisions . Consequently, a larger proportion of longitudinal incisions might have had an impact on wound healing and scar width in the two studied groups.…”

“…The distribution of SSI's and wound complications, however, were equally distributed between the iNPWT and standard dressing group. The high proportion of transverse incisions contributed to the general low scar complication rates and fine scars at digital evaluation since they tend to be in line with Langer's and Kraissel's lines leading to a better scar appearance . The long time, ranging from 394 to 1194 days, between surgery and photography also had a positive influence on the scar characteristics.…”

Biodynamic Excisional Skin Tension (BEST) Lines: Revisiting Langer’s Lines, Skin Biomechanics, Current Concepts in Cutaneous Surgery, and the (lack of) Science behind Skin Lines used for Surgical Excisions

“…Kraissl's lines can be considered antimuscular lines [155] and therefore only useful for incisions (for surgical egress) or excisions (of small defects) where the load is low [156] . Striae distensae, a reflection of cellular, fibrillar, hormonal, and mechanical alterations -lines that are implicated in various pathological and physiological conditions --have also been described by authors as a possible alternative while planning surgery [157] . Another problem with all these lines when considered individually is that they seem to differ in different textbooks, and people have not hitherto separated incisional and excisional lines while studying them.…”

Commentary to: ‘Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag‐plasty according to Tschopp’

“…An old rule of plastic surgery allows for skin excess to be excised as long as it can be lifted by pinching and does not impair the movement of the neck, abdomen or extremities. To achieve optimal scarring, all skin excision should be performed along the ‘main folding lines’ . These occur always horizontally in the neck; however, the unwanted excess of skin is vertical – and a straight vertical excision bears the risk of hypertrophic scarring in patients under the age of 50.…”

“…To achieve optimal scarring, all skin excision should be performed along the 'main folding lines'. 2,3 These occur always horizontally in the neck; however, the unwanted excess of skin is verticaland a straight vertical excision bears the risk of hypertrophic scarring in patients under the age of 50.…”