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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The skin of the neck also has tension or Langer’s lines, orientated in a horizontal slightly downward direction. These represent the orientation of collagen under the skin and are important for scar formation after skin penetration and may affect the appearance of a stab wound.
Neck and chest
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
Yana A. Yutskovskaya, Anna Daniilovna Sergeeva
Mark the area of the middle, lower third of the face, neck, and décolletage (Figure 28.1). In this case, there are several options for injection techniques. When using a needle, injections are done along the skin tension lines (Langer lines). When using a cannula, the preferred technique is the fanning technique.
Skin damage from environmental hazards
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
We are subjected to a constant barrage of mechanical stimuli, which vary in intensity, direction, area to which they are delivered and rate of delivery. The dermis contains a network of oriented, tough, collagenous fibres, in the interstices of which there is a viscid proteoglycan ground substance as well as elastic fibres and fibroblasts. Most of the mechanical response to physical stimuli is due to dermal connective tissue. The mechanical stimuli include stretching forces, both linear and torsional, shear and compressive forces. Overall, the mechanical properties of skin can be described as viscoelastic. This means that skin extends in response to a linear force and will tend to regain its original length after release of the force (elastic). It also flows and creeps with some mechanical stimuli (viscous). Skin is also said to be anisotropic, as its mechanical properties vary according to the orientation of the body axis in which the mechanical stimulus is delivered. The anisotropy results from the orientation of the collagen fibres, which varies according to site. Different resting tensions result from the differing orientations and account for the development of broad and ugly scars if incisions are made across the main orientation of the collagen fibres rather than parallel to it. Langer’s lines (made by joining the long axes of circular incisions pulled by the internal forces over the skin surface) were an early attempt at revealing the resting tensions in skin. However, they did not take into account important additional local considerations specific to each anatomical region.
Kaposi’s sarcoma management from a plastic surgery perspective
Published in Journal of Dermatological Treatment, 2022
Selman Taskin, Tugce Yasak, S. Tiber Mentese, Burak Yilmaz, Ozlem Çolak
The lesions in KS are seen in the skin, oral mucosa, lymph nodes, and visceral organs. Most patients present with cutaneous lesions. Although these lesions can be seen throughout the body, they are typically seen in the lower extremities and head and neck region. Lesions may appear as macules, papules, nodules, or plaques, and they are usually palpable and nonpruritic. The size of the lesions can vary from a few mm to several cm. Lesions of various colors such as brown, pink, red, or purple-violet can be seen. Individual or combined lesions usually show a symmetrical and linear distribution matching the Langer lines. Mucous membrane involvement is also common, and palate, gingiva, and conjunctiva should be checked during an examination. Gastrointestinal system lesions are generally asymptomatic. However, it is known that it may cause odynophagia, dysphagia, nausea, vomiting, abdominal pain, hematochezia, hematemesis, or melena (19). Pulmonary lesions can cause chest pain, cough, dyspnea, and hemoptysis.
Helix Thigh Lift. A Novel Approach to Severe Deformities in Massive Weight Loss Patients
Published in Journal of Investigative Surgery, 2022
Luigi Losco, Ana Claudia Roxo, Carlos Weck Roxo, Alessandro de Sire, Alberto Bolletta, Roberto Cuomo, Luca Grimaldi, Emanuele Cigna, Carlos del Pino Roxo
The pancake stack deformity (Figures 1 and 2) with its peculiar skin folds pattern, suggested us to make up something different. We abandoned the medial vertical excision (aimed to address the horizontal vector), and advocated a fold-targeted excision in respect of the Langer lines. The need to add a transverse component to a vertical medial thigh lift simultaneously or in a later stage is another example of tailored-surgery. A suprapatellar excision has already been described with the aim to treat a significant skin excess just above the knee [9, 23]. In our series, the transverse scar was not placed in an extension area, so any chance of functional impairment was unlikely. The helix thigh lift addressed a whole lipodystrophic saddlebag from medial to lateral side. The procedure resulted in two short visible scars on the medial and lateral aspect of the proximal thigh, but both were easily concealable wearing shorts. On the other hand, the patient recovered self-confidence, ease in clothing and ability to walk: The goal is to obtain a significant improvement in overall functioning and psychosocial health [24] (Figures 3).