Most dermatologists doing skin surgery are well aware that care in closing an excisional skin wound is well repaid by the cosmetic result achieved at a later date. Despite such care, the problem of the spreading scar, particularly on the thorax and the proximal portions of the extremities, is a frequent cause for postoperative concern and patient dissatisfaction.
The following ideas may be of assistance to those who wish to minimize this problem. Whenever possible, the proposed excision line should be placed so that the resultant line scar or long axis of the excision will fall parallel to the direction of the greatest skin laxity. In certain areas, contraction of the underlying muscles results in folding or wrinkling of the skin above these muscles. While Langer's lines and wrinkle lines may coincide in certain areas, it is desirable in general to place the excision lines parallel to the wrinkle lines.
POPKIN GL, BRODIE SJ. The Spreading Excision Scar. Arch Dermatol. 1962;85(4):536–538. doi:10.1001/archderm.1962.01590040100019
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