Lokes K. P., Avetikov D. S., Rozkolupa O. O., Stavitskiy S. O., Gavrilev V. M.


About the author:

Lokes K. P., Avetikov D. S., Rozkolupa O. O., Stavitskiy S. O., Gavrilev V. M.



Type of article:

Scentific article


The article presents the analysis of literary sources concerning the features of the operative access of maxillofacial localization. The established the stress and relaxation lines of skin in different topographical and anatomical areas are indicated. Defects and deformities of the maxillofacial localization are an important and widespread problem of modern medicine. The significant increase in the number of patients with such pathologies causes the rapid development of reconstructive-restorative surgery of the maxillofacial area. An important problem in this section of medical science is the necessary to consider the aesthetic component during planning and conducting surgical treatment. Therefore, the study of ways to make the most optimal incisions is an urgent need. It is well known that the closure of wounds at the lowest tension leads to the best result. It is characterized by faster wound healing and reduced risk of pathological scarring. In this case, the lines of incisions lead to the lowest tension are often contradictory. Langer’s lines, which are widely used in the planning of surgical access in various topographic-anatomical areas of the head and neck, are lines of skin tension. But it is noted that in many publications their direction is indicated in various ways, which complicates the rational planning of cuts and increases their empirical. It is histologically proved that the collagen fibers underlying the Langer’s lines are irregularly interwoven and intertwined, parallel to the Kraissl’s lines. Elastic fibers can be parallel or perpendicular to the epidermis, but Kraissl’s lines are characterized by their exceptional perpendicular location. These histological studies have determined the separation of the face into three zones, depending on the direction of the desired incisions. Namely: incisions along to Kraissl’s lines, along both lines and regardless of the direction of the lines. The incisions according to the Kraissl’s lines extend along the direction of the greatest stretching of the skin and the smallest divergence of the wound, also due to the fact that the collagen of the newly formed scar is organized in accordance with the surrounding structures. The enlargement of the wound on the scalp and the tension at the closing of its edges are particularly related, which is conditioned by biomechanical research data. The overwhelming reduction of tension and, accordingly, the improvement of reparative processes in the skin, occur when the incision lines correspond to the so-called “golden spiral”. To improve the cosmetic result during closing the defects of the skin, some authors recommend the so-called “Acute tissue expansion”, which is carried out with the help of special expanders. This manipulation when combined with flap mobilization contributes to an increase in skin volume of up to 25% than using only skin flap mobilization. Moreover, long-term tissue expansion in the experiment yielded minimal differences in cosmetic results. Thus, the analysis of literary sources indicates the relevance of the selected topic, the ambiguity of the use of conventional incisions and necessitates further studies of biomechanical and histological substantiation of incisions in the head and neck to create optimal conditions for wound healing.


operative accesses, lines of relaxation, lines of stress.


  1. Avetikov DS. Cuchasni metodyky mistsevoplastychnykh operatsiy na holovi shkirno-zhyrovymy klaptyamy, vrakhovuyuchi yikh biomekhanichni ta histotopohrafichni osoblyvosti [monohrafiya]. Poltava, SPDFO Harazha M.F.; 2013. 110 s. [in Ukrainian].
  2. Avetikov DS, Lokes KP, Stavickij SO, Yatsenko IV. Optimization of Replacement of Defects and Deformation of Head and Neck by Using of Angiosome Temporal Flap. Intermedical journal. 2016;1: 6-10.
  3. Avetikov DS, Sokolov VM, Yatsenko IV, Lokes KP. Vdoskonalennya khirurhichnoho likuvannya patsiyentiv z involyutsiynym ptozom shkiry verkhnʹoyi ta serednʹoyi zon oblychchya [monohrafiya]. Poltava: 2017. 151 s. [in Ukrainian].
  4. Paul SP. Biodynamic Excisional Skin Tension Lines for Excisional Surgery of the Lower Limb and the Technique of Using Parallel Relaxing Incisions to Further Reduce Wound Tension. Plast Reconstr Surg Glob Open. 2017;5(12):1614-8.
  5. Paul SP. Biodynamic excisional skin tension lines for surgical excisions: untangling the science. Ann R Coll Surg Engl. 2018;100(4):330-7.
  6. Borges AF. Relaxed skin tension lines (RSTL) versus other skin lines. Plast Reconstr Surg Jan. 1984;73(1):144-50.
  7. Paul SP, Matulich J, Charlton N. A New Skin Tensiometer Device: Computational Analyses To Understand Biodynamic Excisional Skin Tension Lines. Sci Rep. 2016;6:301-17.
  8. Barbenel JC, Serup J, Jemec GBE. Identification of Langer’s lines. In: Handbook of Non-invasive Methods and the Skin. Boca Raton, Fla.: CRC Press. 1995;7:341-4.
  9. Maranda EL, Heifetz R, Cortizo J, Hafeez F, Nouri K. Kraissl lines – a map. JAMA Dermatol. 2016;152:1014.
  10. Paul SP. Biodynamic Excisional Skin Tension (BEST) lines: revisiting Langer’s lines, skin biomechanics, current concepts in cutaneous surgery, and the (lack of) science behind skin lines used for surgical excisions. J Dermatol Res. 2017;2:77-87.
  11. Min JH, Park KH, Choi HL, Park JS, Lee JH, Kim H, et al. Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the ED. Am J Emerg Med. 2017;35(12):1804-9.
  12. Bush JA, Ferguson MW, Mason T, McGrouther DA. Skin tension or skin compression? Small circular wounds are likely to shrink, not gape. J Plast Reconstr Aesthet Surg. 2008;61(5):529-34.
  13. Paul SP. The use of zigs and zags to reduce scarring over “keloid triangles” during excisional surgery: biomechanics, review and recommendations. Surg Sci. 2017;8:240-55.
  14. Paul SP. Revisiting Langer’s lines, introducing BEST lines, and studying the biomechanics of scalp skin. Spectrum Dermatologie. 2017;2:8-11.
  15. Paul SP. Are incisional and excisional skin tension lines biomechanically different? Understanding the interplay between elastin and collagen during surgical procedures. IJBM. 2017;7:111-4.
  16.  Bush J, Ferguson MW, Mason T, McGrouther G. The dynamic rotation of Langer’s lines on facial expression. J Plast Reconstr Aesthet Surg. 2007;60(4):393-9.
  17. Peng W, Tan C. Lichen planus pigmentosus-inversus following Langer’s lines of cleavage: a rare clinical presentation. Dermatologica Sinica. 2015;33:241-2.
  18. Wollenberg A, Eames T. Skin diseases following a Christmas tree pattern. Clin Dermatol. 2011;29:189-94.
  19. Paul SP. The Golden Spiral Flap: A New Flap Design that Allows for Closure of Larger Wounds under Reduced Tension – How Studying Nature’s Own Design Led to the Development of a New Surgical Technique. Front Surg. 2016;3:63.
  20. Krishnan NM, Brown BJ, Davison SP, Mauskar N, Mino M, Jordan MH, et al. Reducing Wound Tension with Undermining or Imbrication – Do They Work? Plast Reconstr Surg Glob Open. 2016;4(7):799.
  21. Chandawarkar RY, Cervino AL, Pennington GA. Intraoperative acute tissue expansion revisited: a valuable tool for challenging skin defects. Dermatol Surg. 2003;29(8):834-8.
  22. Zhu Y, Luo J, Barker J, Hochberg J, Cilento E, Reilly F. Identification of genes induced by rapid intraoperative tissue expansion in mouse skin. Archives of Dermatological Research. 2002;293(11):560-8.
  23. Johnson TM, Lowe L, Brown MD, Sullivan MJ, Nelson BR. Histology and physiology of tissue expansion. The Journal of Dermatologic Surgery and Oncology. 1993;19(12):1074-8.
  24. Jinming W, Caiyue L, Baojin W, Antang L, Yingfan Z, Hui W, et al. Effects of Platelet-Rich Plasma on Tissue Expansion in Rabbits. Aesthetic Plastic Surgery. 2017;41(2):454-60.
  25.  Lee MK, Park SO, Choi TH. Serial Tissue Expansion at the Same Site in Pediatric Patients: Is the Subsequent Expansion Faster? Archives of Plastic Surgery. 2017;44(6):523-9.

Publication of the article:

«Bulletin of problems biology and medicine» Issue 4 Part 1 (153), 2019 year, 35-38 pages, index UDK 616.314-089.23