Borges compares seven historical skin tension line systems against his relaxed skin tension lines (RSTL) to determine which best guides elective incision placement. The analysis focuses on the face but addresses whole-body patterns. The central question: which system actually reflects resting skin tension in a living patient?
For over a century, Langer's lines were the default reference for incision planning — but they were derived from awl punctures in cadavers stiffened by rigor mortis, with joints in non-physiologic positions. Borges makes the case that this methodology guaranteed error.
In practice: when planning any elective skin incision, use the pinch test at the bedside. Pinch perpendicular to your intended incision line. If prominent ridges and furrows form easily, you are aligned with RSTL. If the skin resists or forms an S-shape, reorient.
For reconstructive cases involving the anterior elbow, remember that RSTL are transverse. A longitudinal incision here crosses tension lines and risks a widened scar.
This paper is the foundation for teaching fusiform excision orientation and Z-plasty design. The pinch test it champions is a first-day resident skill, and the three body-wide anatomic rules (transverse everywhere, oblique at bony landmarks, transverse across the breast) are board-testable anatomy.
Borges compares seven historical skin tension line systems against his relaxed skin tension lines (RSTL) to determine which best guides elective incision placement. The analysis focuses on the face but addresses whole-body patterns. The central question: which system actually reflects resting skin tension in a living patient?
For over a century, Langer's lines were the default reference for incision planning — but they were derived from awl punctures in cadavers stiffened by rigor mortis, with joints in non-physiologic positions. Borges makes the case that this methodology guaranteed error.
In practice: when planning any elective skin incision, use the pinch test at the bedside. Pinch perpendicular to your intended incision line. If prominent ridges and furrows form easily, you are aligned with RSTL. If the skin resists or forms an S-shape, reorient.
For reconstructive cases involving the anterior elbow, remember that RSTL are transverse. A longitudinal incision here crosses tension lines and risks a widened scar.
This paper is the foundation for teaching fusiform excision orientation and Z-plasty design. The pinch test it champions is a first-day resident skill, and the three body-wide anatomic rules (transverse everywhere, oblique at bony landmarks, transverse across the breast) are board-testable anatomy.