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Series 1: The Skin · Episode 2

Langer's Lines

The Decision Every Surgeon Makes

24 minutes. 12 references, each checked at source.

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For a hundred and seventeen years, every English-speaking surgeon who cited Langer's lines was citing a paper none of them had read. It sat in Vienna, in German, from 1861 until Gibson translated it in 1978, and when it finally arrived in English, the title said *Spaltbarkeit*. Cleavability. Not tension.

Every time you plan an incision, you make a decision. How many surgeons understand the structural logic behind that decision?

In this episode, Dev explores Langer's lines, the collagen orientation maps first described by the Viennese anatomist Karl Langer in 1861 using a circular awl and a set of cadavers. The history of how he discovered them, the century-long controversy they provoked, and what surgeons should actually be using in theatre today.

The Anatomy Purist is for surgeons, trainees and students whose love for anatomy goes far beyond the knife.

Themes from this episode

Practice what you just heard

Two questions on the themes of this episode, free, marked as you go. Then one from the Vault on the same ground.

Question 1 · Applied

Why do incisions placed obliquely to Langer's lines heal with wider scars?

Answer to see the explanation and the source.

Question 2 · Foundation

Who systematically mapped the cleavage lines of cadaveric skin, in what year, and by what method?

Answer to see the explanation and the source.

From the Vault, on the same theme

General Principles: Fascia, Compartments & Tissue Planes · Purist Locked

Marking an elective excision on the trunk, a surgeon finds that the classical cadaveric map of skin cleavage lines disagrees at this site with the fine furrows raised by pinching the patient’s relaxed skin. Which lines better predict the behaviour of the scar, and why?

  • AThe cadaveric map, because rigor displays the fixed weave of dermal collagen
  • BThe pinch-derived lines, because they register the tension acting in life
  • CThe cadaveric map, because living tension shifts too often to be charted
  • DNeither, because closure technique determines how the scar matures
  • EThe pinch-derived lines, because they mirror the muscle fibres beneath

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References

  1. Langer K. Zur Anatomie und Physiologie der Haut. I. Über die Spaltbarkeit der Cutis. Sitzungsber Math-Naturwiss Cl Kaiserl Akad Wiss Wien. 1861;44:19, 46. [English translation: On the anatomy and physiology of the skin. I. The cleavability of the cutis. Br J Plast Surg. 1978;31(1):3, 8. PMID 342028.]
  2. Gibson T. Karl Langer (1819, 1887) and his lines. Br J Plast Surg. 1978;31(1):1, 2. PMID 342024.
  3. Carmichael SW. The tangled web of Langer's lines. Clin Anat. 2014;27(2):162, 8. PMID 24038134.
  4. Yazdani Abyaneh MA, Griffith R, Falto-Aizpurua L, Nouri K. Famous lines in history: Langer lines. JAMA Dermatol. 2014;150(10):1087. PMID 25321654.
  5. Kraissl CJ, Conway H. Excision of small tumors of the skin of the face with special reference to the wrinkle lines. Surgery. 1949;25(4):592, 600. PMID 18117631.
  6. Kraissl CJ. The selection of appropriate lines for elective surgical incisions. Plast Reconstr Surg. 1951;8(1):1, 28. PMID 14864071.
  7. Borges AF, Alexander JE. Relaxed skin tension lines, Z-plasties on scars, and fusiform excision of lesions. Br J Plast Surg. 1962;15:242, 54. PMID 13871292.
  8. Borges AF. Relaxed skin tension lines (RSTL) versus other skin lines. Plast Reconstr Surg. 1984;73(1):144, 50. PMID 6691065.
  9. Wilhelmi BJ, Blackwell SJ, Phillips LG. Langer's lines: to use or not to use. Plast Reconstr Surg. 1999;104(1):208, 14. PMID 10597698.
  10. Paul SP. Biodynamic excisional skin tension lines for surgical excisions: untangling the science. Ann R Coll Surg Engl. 2018;100(4):330, 7. PMID 29543064.
  11. Reverdin JL. Greffe épidermique, expérience faite dans le service de M. le Docteur Guyon, à l'hôpital Necker. Bull Soc Imp Chir Paris. 1869;10. *(Pre-index; pagination is cited variably in the secondary literature and has not been verified against the original volume, cited here without page numbers for that reason.)*
  12. Standring S, editor. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2020.
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