Longitudinal scars on the radial quadrant of the distal forearm skin envelope are typically observed to be wider than those on the ulnar quadrant and have an increased incidence of hypertrophic change. Forearm rotation movements may produce differential skin tensions within the forearm skin envelope, and this may lead to differential scarring patterns. This study was designed to measure skin tension changes in the forearm as a result of rotational position to see if these would be consistent with the hypothesis that greater tension changes are observed on the radial aspect of the forearm.
The effect of forearm position on the magnitude and direction of skin tension was measured on human volunteers. Standardized circles were marked in circumferential fashion at specified intervals on forearm skin, and the angular and dimensional distortion of these circles that occurred with forearm rotation was measured with caliper and goniometer. Data were analyzed for statistical significance using paired t-test.
Pronation and supination resulted in marked angular rotation of the lines of maximal skin tension at all sites on the forearm. Supination resulted in a greater angular deviation of the lines of maximal skin tension from the longitudinal line of usual surgical incision, particularly on the radial aspect of the forearm. In supination, the magnitude of ellipsoid deformation at the distal forearm was greater on the radial aspect compared with that of the ulnar. Similar significant changes were also demonstrated at the mid-forearm and proximal forearm levels.
This study systematically maps the effects of pronation and supination on skin tension within the forearm skin envelope. The significant changes occurring in both the ellipsoid deformation and ellipsoid orientation support our hypothesis that the magnitude of skin tension changes significantly with forearm rotation. The radial aspect of the distal forearm experiences the greatest changes, particularly as the forearm supinates.
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- Langer's lines: to use or not to use.Plast Reconstr Surg. 1999; 104: 208-214
- Lacerations against Langer's lines: to glue or suture?.J Emerg Med. 1998; 16: 185-189
- On the anatomy and physiology of the skin.Br J Plast Surg. 1978; 31: 3-8
- On the anatomy and physiology of the skin.Br J Plast Surg. 1978; 31: 93-106
- The dynamic rotation of Langer's lines on facial expression.J Plast Reconstr Aesthet Surg. 2007; 60: 393-399
- Molecular responses of human dermal fibroblasts to dual cues: contact guidance and mechanical load.Cell Motil Cytoskeleton. 2000; 45: 1-9
- Effect of precise mechanical loading on fibroblast populated collagen lattices: morphological changes.Cell Motil Cytoskeleton. 1998; 40: 13-21
- Fibroblast contraction occurs on release of tension in attached collagen lattices: dependency on an organized actin cytoskeleton and serum.Anat Rec. 1992; 232: 359-368
- Mechanical tension controls granulation tissue contractile activity and myofibroblast differentiation.Am J Pathol. 2001; 159: 1009-1020
- Mechanical properties of the extracellular matrix influence fibronectin fibril assembly in vitro.Exp Cell Res. 1995; 217: 109-117
- Duration and orientation of mechanical loads determine fibroblast cyto-mechanical activation: monitored by protease release.Wound Repair Regen. 2000; 8: 238-246
- On the anatomy and physiology of the skin.Br J Plast Surg. 1978; 31: 273-276
- On the anatomy and physiology of the skin.Br J Plast Surg. 1978; 31: 185-199
- The cleavage lines of skin.Br J Surg. 1942; 29: 234-240
- The directional effects of skin.J Invest Dermatol. 1966; 46: 341-346
- Force required for wound closure and scar appearance.Plast Reconstr Surg. 1983; 72: 380-382
- Wound healing.Arch Otolaryngol Head Neck Surg. 1990; 116: 798-802
- Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis.FASEB J. 2007; 21: 3250-3261
- Skin tension or skin compression?.J Plast Reconstr Aesthet Surg. 2008; 61: 529-534
- Langer's lines: a commentary.Surg Annu. 1976; 8: 25-46
Accepted: October 28, 2008
Received: January 3, 2008
The authors are greatly indebted to the staff of the medical illustration and medical engineering departments at South Manchester University Hospital Trust for providing photographs, illustrations, and precision engineered templates.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.