Famous Lines in History: Langer Lines

The orientation of surgical incisions over the skin is widely considered to affect scarring and the final cosmetic outcome for patients. When most surgeons visualize lines on the skin surface to guide such incisions, it is Langer lines (also known as skin cleavage or tension lines) that most readily come to mind. 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 Joseph’s 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. In 1834, Dupuytren reported seeing a young man who had attempted to commit suicide by stabbing himself over the heart 3 times. The patient claimed to have used a round awl as the instrument, but he did not fashion round stab wounds on his chest. This led Dupuytren to study the matter in cadavers and discover that a round instrument indeed produced linear clefts when thrust through the skin. He also noticed that these clefts had different orientations in different parts of the body. Malgaigne confirmed these findings and observed from his experience as a surgeon that the retraction of wounds differed with the direction of incisions.³