Non-invasive evaluation of skin tension lines with elastic waves

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 (R). (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, R-2=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.