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AN4.1-5 | General features of skin and fascia — Part 3
SELF-CHECK
A surgeon is planning an incision on the face for a cosmetic procedure. To minimise scarring, the incision should be made:
A. Perpendicular to Langer's lines, to allow maximum wound gaping for drainage
B. Parallel to Langer's lines, so collagen fibres are separated gently and the scar is thin
C. In any direction, because facial skin heals well regardless of incision orientation
D. Diagonally to Langer's lines, as a compromise between access and cosmesis
Reveal Answer
Answer: B. Parallel to Langer's lines, so collagen fibres are separated gently and the scar is thin
Incisions made parallel to Langer's lines cut between collagen bundles rather than across them. The wound edges stay close together, and the resulting scar is thin and neat. On the face, where cosmetic outcome is critical, this is essential. An incision across Langer's lines produces a wide, unsightly scar because the collagen bundles pull the wound edges apart.
CLINICAL PEARL
Compartment syndrome is a surgical emergency. After a fracture (especially of the forearm or leg), swelling inside a tight fascial compartment can compress the arteries and nerves within it. The classic signs are the 5 P's: Pain (out of proportion, especially on passive stretching), Pallor, Pulselessness, Paraesthesia (tingling), and Paralysis. The treatment is an emergency fasciotomy — cutting open the deep fascia to release the pressure. Knowing that deep fascia forms rigid compartments explains why this happens and why it's so urgent.