The Experts below are selected from a list of 276 Experts worldwide ranked by ideXlab platform
Sharad P. Paul - One of the best experts on this subject based on the ideXlab platform.
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Biodynamic Excisional Skin Tension (BEST) Lines for Scalp Reconstruction After Skin Cancer Surgery
Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery, 2018Co-Authors: Sharad P. PaulAbstract:Since Langer first observed cleavage lines on Skin in 1861, his lines have been the reference point for Skin excisional lines while planning surgery. However, areas like the scalp pose a special challenge for wound closures, especially as many of the existing descriptions of Skin Tension lines seem to have different directional preferences. When wrongly-orientated elliptical incisions are used, this may result in Skin grafts and/or may lead to a less than ideal cosmetic result. This chapter looks at the best lines of closure of scalp wounds for excisional surgery after Skin cancer. The author hypothesizes that incisional and excisional lines must be considered differently, and that there is a preferred orientation for wound closure-lines on the scalp. Biodynamic Excisional Skin Tension (BEST) lines of the scalp are mapped in this study on the scalp using a computerized digital tensiometer that has been described earlier.
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Examining the Science Behind Skin Lines Currently Used for Surgical Excisions, and Introducing a New Concept of BEST (Biodynamic Excisional Skin Tension) Lines
Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery, 2018Co-Authors: Sharad P. PaulAbstract:Surgical literature is inundated with references to Langer’s Lines, Cleavage Lines, Wrinkle Lines and Skin Tension Lines. The author undertakes a detailed literature review to understand current evidence behind Skin lines in cutaneous surgery and puts forward a hypothesis that incisional and excisional lines are different. While the lines mentioned above are fine for making incisions, when wound Tension is created after excision of Skin lesions or cancers, as opposed to creating incisions for egress, the dynamics change—and therefore (what the author terms) Biodynamic Excisional Skin Tension Lines matter and need to be determined accurately. Further, areas like the scalp (due to no underlying attachment of muscles and the galeal aponeurosis layer) and the lower limb (due to the vascular plane) need special considerations in cutaneous surgery. Therefore, when it comes to current practice in dermatological and cutaneous surgery, the science of Skin biodynamics suggests that best excisional lines do not always conform to current surgical practice.
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Biodynamic Excisional Skin Tension (BEST) Lines on the Trunk
Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery, 2018Co-Authors: Sharad P. PaulAbstract:A biomechanical study was undertaken, using an especially-designed tensiometer, during the excision of 1181 Skin cancer excisions on various parts of the body. We report on our findings in this large clinical series as this study gives a clear idea of BEST lines across the trunk and limbs, and is the largest study of Skin lines ever reported, to our knowledge.
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Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery
2018Co-Authors: Sharad P. PaulAbstract:This book is a detailed review of the 'state-of-the art' of Skin lines in cutaneous surgery. Surgical literature is inundated with references to Langer's Lines, Cleavage Lines, Wrinkle Lines and Relaxed Skin Tension Lines, but this title discusses the difference between these and incisional and excisional lines biomechanically, introducing the concept of biodynamic excisional Skin Tension (BEST) Lines. The problem with current concepts of Skin Tension lines is that they seem to differ in different textbooks, and lines for surgical egress, which work in conditions of low Tension, are not necessarily suitable for Skin cancer surgery. Biodynamic Excisional Skin Tension Lines for Cutaneous Surgery describes Skin biomechanics, the properties of collagen and elastin, lower limb Skin vascularity and also maps BEST lines across the body, making it a great reference guide for plastic or dermatologic surgery worldwide. As such, it will be beneficial for anyone performing cutaneous surgery and Skin cancer excisions in clinical practice, or for those planning further research into Skin biomechanics to read this volume.
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biodynamic excisional Skin Tension lines using a new Skin tensiometer device and computational analyses to understand excisional Skin biomechanics
2018Co-Authors: Sharad P. PaulAbstract:One of the problems in planning cutaneous surgery has been the knowledge that Skin is anisotropic, or directionally dependent. Indeed, Skin Tension varies between individuals and at different body sites. Since Langer described ‘Skin cleavage lines’ and Borges described ‘relaxed Skin Tension lines’, many a surgeon has tried to design different devices to measure Skin Tension between wound edges to help plan excisional surgery or to understand wound healing. However, many of the devices have been beset with problems due to many confounding variables—user strength, differences in technical ability, material (sutures) used and variability between different users. In this chapter, the development of a new Skin tensiometer is described that overcomes many historical technical issues. An overview of the surgical research applications and how we have developed this to help us improve the planning of surgical excisions of Skin lesions is discussed.
James Bush - One of the best experts on this subject based on the ideXlab platform.
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Dynamic Skin Tension in the Forearm: Effects of Pronation and Supination
The Journal of hand surgery, 2009Co-Authors: Craig J.h. Russell, James Bush, Gary W.p. Russell, Anthony Thorlby, Duncan A. Mcgrouther, V. C. LeesAbstract: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.
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Skin Tension or Skin compression small circular wounds are likely to shrink not gape
Journal of Plastic Reconstructive and Aesthetic Surgery, 2008Co-Authors: James Bush, Mark W. J. Ferguson, Tracey Mason, Angus D McgroutherAbstract:The final appearance of a scar may be influenced by Tension or mechanical factors [Borges AF. Scar prognosis of wounds. Br J Plast Surg 1960;13:47-54; Arem AJ, Madden JW. Effects of stress on healing wounds. J Surg Res 1976;20:93-102; Burgess LP, Morin GV, Rand M, et al. Wound healing. Relationship of wound closing Tension to scar width in rats. Arch Otolaryngol Head Neck Surg 1990;116:798-802; Meyer M, McGrouther DA. A study relating wound Tension to scar morphology in the pre-sternal scar using Langer's technique. Br J Plast Surg 1991;44:291-4] Karl Langer suggested that information could be gained about the Tension inherent in Skin, in all directions, by observing the wound edge retraction that occurred after making circular Skin incisions [Langer K. On the anatomy and physiology of the Skin II. Skin Tension. Br J Plast Surg 1978;31:93-106]. Circular wounds may be used to demonstrate the orientation of the dominant axis of 'Tension' in the Skin but is this always a tensile stress as opposed to a compressive stress? This is the second article in a series documenting the mechanical properties of circular punch biopsy wounds. The aim of this study was to make detailed observations of the dimensional distortions of circular wounds on the face and neck, from which deductions could be made with regard to mechanical stress. One hundred and seventy-five benign head and neck lesions were excised from 72 volunteers using circular dermal punch biopsies. The distortions of the resulting wounds were observed to be elliptical in most cases. Measurements were taken of the maximum and minimum diameters of the wound and expressed as ratios of the size of the punch biopsy used for excision. The change in area from the area of the punch biopsy to that of the wound was also calculated. The maximum diameter of the wound was smaller than the diameter of the punch biopsy in 40.6% of cases, the minimum diameter of the wound was smaller in 97.7% of cases and the area of the wound was smaller than that of the punch biopsy in 90.3%. These dimensional changes varied between sites (P=0.0005, P=0.0001 and P<0.0001, respectively). We conclude that the reported rhomboidal or lattice structure [Ridge MD, Wright V. The directional effects of Skin. A bioengineering study of Skin with particular reference to Langer's Lines. J Invest Dermatol 1966;46:341-6] of Skin has individual components which are under Tensional force due to elastic retraction. Wounds smaller than the rhomboidal unit will reduce in area, due to the intact Tensional forces in the individual dermal components, giving an appearance of the Skin overall being under compression. Larger wounds, disrupting more of the lattice structure, will gape.
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Skin Tension or Skin Compression? Small Circular Wounds Are Likely to Shrink, Not Gape
Journal of plastic reconstructive & aesthetic surgery : JPRAS, 2007Co-Authors: James Bush, Mark W. J. Ferguson, Tracey Mason, D. Angus McgroutherAbstract:The final appearance of a scar may be influenced by Tension or mechanical factors [Borges AF. Scar prognosis of wounds. Br J Plast Surg 1960;13:47-54; Arem AJ, Madden JW. Effects of stress on healing wounds. J Surg Res 1976;20:93-102; Burgess LP, Morin GV, Rand M, et al. Wound healing. Relationship of wound closing Tension to scar width in rats. Arch Otolaryngol Head Neck Surg 1990;116:798-802; Meyer M, McGrouther DA. A study relating wound Tension to scar morphology in the pre-sternal scar using Langer's technique. Br J Plast Surg 1991;44:291-4] Karl Langer suggested that information could be gained about the Tension inherent in Skin, in all directions, by observing the wound edge retraction that occurred after making circular Skin incisions [Langer K. On the anatomy and physiology of the Skin II. Skin Tension. Br J Plast Surg 1978;31:93-106]. Circular wounds may be used to demonstrate the orientation of the dominant axis of 'Tension' in the Skin but is this always a tensile stress as opposed to a compressive stress? This is the second article in a series documenting the mechanical properties of circular punch biopsy wounds. The aim of this study was to make detailed observations of the dimensional distortions of circular wounds on the face and neck, from which deductions could be made with regard to mechanical stress. One hundred and seventy-five benign head and neck lesions were excised from 72 volunteers using circular dermal punch biopsies. The distortions of the resulting wounds were observed to be elliptical in most cases. Measurements were taken of the maximum and minimum diameters of the wound and expressed as ratios of the size of the punch biopsy used for excision. The change in area from the area of the punch biopsy to that of the wound was also calculated. The maximum diameter of the wound was smaller than the diameter of the punch biopsy in 40.6% of cases, the minimum diameter of the wound was smaller in 97.7% of cases and the area of the wound was smaller than that of the punch biopsy in 90.3%. These dimensional changes varied between sites (P=0.0005, P=0.0001 and P
Michel Destrade - One of the best experts on this subject based on the ideXlab platform.
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Tension lines of the Skin
Studies in Mechanobiology Tissue Engineering and Biomaterials, 2019Co-Authors: A. Ní Annaidh, Michel DestradeAbstract:Skin Tension lines are natural lines of Tension that occur within the Skin as a result of growth and remodeling mechanisms. Researchers have been aware of their existence and their surgical implications for over 150 years. Research in the twentieth century showed clearly, through destructive mechanical testing, that the orientation of Skin Tension lines greatly affects the mechanical response of Skin in situ. More recent work has determined that this anisotropic response is, at least in part, due to the structural arrangement of collagen fibres within the dermis. This observation can be incorporated into mathematical and mechanical models using the popular Gasser-Ogden-Holzapfel constitutive equation. Advances in non-invasive measurement techniques for the Skin, such as those based on elastic wave propagation, have enabled patient-specific identification of Skin Tension lines in an accurate and rapid manner. Using this technique on humans, we show that there is considerable variation in the level of anisotropy as the Skin ages. Furthermore, we identify that both the structural arrangement of fibres and the in vivo levels of pre-strain play a significant role in the anisotropic behavior of Skin.
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non invasive evaluation of Skin Tension lines with elastic waves
Skin Research and Technology, 2017Co-Authors: C Deroy, Michel Destrade, Mc A Alinden, Ni A AnnaidhAbstract:BACKGROUND Since their discovery by Karl Langer in the 19th Century, Skin Tension Lines (STLs) have been used by surgeons to decide the location and orientation of an incision. Although these lines are patient-specific, most surgeons rely on generic maps to determine their orientation. Beyond the imprecise pinch test, there remains no accepted method for determining STLs in vivo. METHODS (i) The speed of an elastic motion travelling radially on the Skin of canine cadavers was measured with a commercial device called the Reviscometer® . (ii) Similar to the original experiments conducted by Karl Langer, circular excisions were made on the Skin and the geometric changes to the resulting wounds and excised samples were used to determine the orientation of STLs. RESULTS A marked anisotropy in the speed of the elastic wave travelling radially was observed. The orientation of the fastest wave was found to correlate with the orientation of the elongated wound (P<0.001, R2 =74%). Similarly, the orientation of fastest wave was the same for both in vivo and excised isolated samples, indicating that the STLs have a structural basis. Resulting wounds expanded by an average area of 9% (+16% along STL and -10% across) while excised Skin shrunk by an average area of 33% (23% along STL and 10% across). CONCLUSION Elastic surface wave propagation has been validated experimentally as a robust method for determining the orientation of STLs non-destructively and non-invasively. This study has implications for the identification of STLs and for the prediction of Skin Tension levels, both important factors in both human and veterinary reconstructive surgery.
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Non‐invasive evaluation of Skin Tension lines with elastic waves
Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digita, 2016Co-Authors: C Deroy, Michel Destrade, A. Mc Alinden, A. Ní AnnaidhAbstract:BACKGROUND Since their discovery by Karl Langer in the 19th Century, Skin Tension Lines (STLs) have been used by surgeons to decide the location and orientation of an incision. Although these lines are patient-specific, most surgeons rely on generic maps to determine their orientation. Beyond the imprecise pinch test, there remains no accepted method for determining STLs in vivo. METHODS (i) The speed of an elastic motion travelling radially on the Skin of canine cadavers was measured with a commercial device called the Reviscometer® . (ii) Similar to the original experiments conducted by Karl Langer, circular excisions were made on the Skin and the geometric changes to the resulting wounds and excised samples were used to determine the orientation of STLs. RESULTS A marked anisotropy in the speed of the elastic wave travelling radially was observed. The orientation of the fastest wave was found to correlate with the orientation of the elongated wound (P
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Non-invasive evaluation of Skin Tension lines with elastic waves
arXiv: Medical Physics, 2016Co-Authors: C Deroy, Michel Destrade, A. Mc Alinden, A. Ní AnnaidhAbstract:Background: Since their discovery by Karl Langer in the 19th Century, Skin Tension Lines (STLs) have been used by surgeons to decide the location and orientation of an incision. Although these lines are patient-specific, most surgeons rely on generic maps to determine their orientation. Beyond the imprecise pinch test, there remains no accepted method for determining STLs in vivo. Methods: (i) The speed of an elastic motion travelling radially on the Skin of canine cadavers was measured with a commercial device called the Reviscometer. (ii) Similar to the original experiments conducted by Karl Langer, circular excisions were made on the Skin and the geometric changes to the resulting wounds and excised samples were used to determine the orientation of STLs. Results: A marked anisotropy in the speed of the elastic wave travelling radially was observed. The orientation of the fastest wave was found to correlate with the orientation of the elongated wound (P
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Mechanics of Stabbing: Biaxial Measurement of Knife Stab Penetration of Skin Simulant
Forensic Science International, 2008Co-Authors: Michael Gilchrist, Stephen Keenan, Michael Curtis, Mary Cassidy, Greg Byrne, Michel DestradeAbstract:In medicolegal situations, the consequences of a stabbing incident are described in terms that are qualitative without being quantitative. Here, the mechanical variables involved in knife-tissue penetration events are used to determine the parameters needed to be controlled in a measurement device. They include knife geometry, in-plane mechanical stress state of Skin, angle and speed of knife penetration, and underlying fascia. Four household knives with different geometries were used. Synthetic materials were used to simulate the response of Skin, fat and cartilage: polyurethane, foam, and ballistic soap, respectively. The force and energy applied by the blade and the Skin displacement were used to identify Skin penetration. The Skin Tension is shown to have a direct effect on the force and energy for knife penetration and on the depth of displacement of the simulant prior to penetration: larger levels of in-plane Tension in the Skin are associated with lower penetration forces, energies and displacements. Less force and energy are required for puncture when the blade is parallel to a direction of greater Skin Tension than when perpendicular. Surprisingly, evidence suggests that the quality control processes used to manufacture knives fail to produce consistently uniform blade points in nominally identical knives, leading to penetration forces which can vary widely.
Koppada Lavanya Kumari - One of the best experts on this subject based on the ideXlab platform.
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A comparative study of scar from zigzag incisions with those from linear incisions made along Skin Tension lines during routine surgery.
Plastic and reconstructive surgery, 2010Co-Authors: Satyanarayan Mishra, Koppada Lavanya KumariAbstract:Sir:Surgical incisions are commonly linear. It is recommended that they be placed along Skin Tension lines to obtain a fine line and less conspicuous scar.1,2 However, made against these lines, a linear incision produces a thick and prominent scar, which can be avoided by making the incision zigzag.
Nick Charlton - One of the best experts on this subject based on the ideXlab platform.
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a new Skin tensiometer device computational analyses to understand biodynamic excisional Skin Tension lines
Scientific Reports, 2016Co-Authors: Sharad P. Paul, Justin Matulich, Nick CharltonAbstract:One of the problems in planning cutaneous surgery is that human Skin is anisotropic, or directionally dependent. Indeed, Skin Tension varies between individuals and at different body sites. Many a surgeon has tried to design different devices to measure Skin Tension to help plan excisional surgery, or to understand wound healing. However, many of the devices have been beset with problems due to many confounding variables - differences in technical ability, material (sutures) used and variability between different users. We describe the development of a new Skin tensiometer that overcomes many historical technical issues. A new Skin Tension measuring device is presented here. It was designed to be less user-dependent, more reliable and usable on different bodily sites. The design and computational optimizations are discussed. Our Skin tensiometer has helped understand the differences between incisional and excisional Skin lines. Langer, who pioneered the concept of Skin Tension lines, created incisional lines that differ from lines caused by forces that need to be overcome when large wounds are closed surgically (excisional Tension). The use of this innovative device has led to understanding of Skin biomechanics and best excisional Skin Tension (BEST) lines.
