Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Key words
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Article info
Publication history
Accepted:
October 28,
2008
Received:
January 3,
2008
Footnotes
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.
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
