The Technique of the Knife: Tantalizing Transverse and Terrible Transected

When you slide onto the operating theater table, are you worried about shivering, whether you shaved your legs or how hungery you  are, of course not, well, ok, may be a little, but you are worried about how your scar will look! Of course. And if your surgeon could perhaps nip tuck just a bit, why not, well, that's a different subject. But in thinking about just why those incisions either turn out for the better, or slightly worse, there's a lot to think about. But there are some things we notice. Like, why are those nice little across incisions, such as for C-sections so tantalizing when placed in the transverse direction along the lower abdomen and yet so terrible when that direction is transected in a vertical incision? Dr. Kark Langer, after slaving away many hours studying cadavers in rigor mortis he discovered that certain lines of cleavage pull apart when you cut them, and these run horizontally, and he presented these carefully worked out channels  to the Royal Acadamey of Sciences in 1861 just around the time that the little skirmish was beginning in Fort Sumpter that changed a different landscape forever. And he forever changed the landscape of surgery. These lines have become to be known as Langer's lines, and I myself operate along them fairly routinely. Inquiry into the perfect incision did not stop there however and over 35 other named guidelines have slipped into the lexicon of skillful operators. Not only the lines of the skin, but the underline muscles factor into the teachings of  Kraissl  and at a later date completely Borges developed a skin pinch technique that specifically looked for the furrows that form.Wrinkles, freckles, prior scars and even tattoos and tan lines can be used to guide where we will aim our knives. And the face, the breast, the thighs and the arms are very different than that of the abdomen and may require. But don't be afraid to discuss, as we all know, like beauty, scars are more than skin deep, and your surgeon will have a plan and be happy to bring you into the discussion!

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