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Relaxed skin tension lines incision

Relaxed Skin Tension Lines - FPnotebook

Biodynamic Excisional Skin Tension Lines for Excisional

  1. Relaxed skin tension lines rarely follow published diagrams, and closures should mimic the subtle arcs in the facial lines of expression. When possible, excisions should be restricted to one of the major cosmetic units (e.g., forehead, nose, periorbital area, lips and perioral area, chin, and cheeks) (Fig. 243-2)
  2. imal. The transverse plantar approach also avoids the susceptible neurovascular bundles located on the lateral and medial aspects of the digit, therefore avoiding the complications of devascularization and necrosis. The transverse plantar approach delivers the expecte
  3. imize scarring and maximize function. Langer's lines of
  4. Borges first described the concept of relaxed skin tension lines (RSTL). When the skin is relaxed, furrows are formed - these are made more noticeable by pinching skin and noting the direction of furrows and ridges
  5. The ultimate location for an elective skin incision is within the relaxed skin tension lines (RSTLs) or at right angles to the direction of muscle-tendon pull. Following natural crease lines, however, is not always possible
  6. Langer's lines, Langer lines of skin tension, or sometimes called cleavage lines, are topological lines drawn on a map of the human body. They are parallel to the natural orientation of collagen fibers in the dermis, and perpendicular to the underlying muscle fibers.Langer's lines have relevance to forensic science and the development of surgical techniques

When making incisions or revising scars on the face, it is essential to respect the relaxed skin tension lines (RSTL, Fig. 5.2b) and the wrinkle lines of the skin. Whereas the RSTL correspond to the spontaneous course of wrinkles after relax- Fig. 5.1 Surgical anatomy of the skin Placement of the Incision Line. Major factors to be considered when determining the placement of the incision line are wrinkle lines and relaxed skin tension lines (RSTLs). The design of an ellipse on the face is usually done within wrinkle lines Optimally, perform an incision or an excision within or parallel to the relaxed skin-tension lines (RSTLs) of the face (see following image). The drawing shows relaxed skin-tension lines (RSTLs) of the face as seen on magnified facial image

Incisions around the Shoulder Relaxed skin tension lines have been found to be more reliable than Langer's lines in assessing the optimum position for a cosmetic incision. Relaxed skin tension lines are determined at the time of operation by pinching the skin and observing the linear creases the dermis but do not always follow the line of wrinkle. Relaxed skin tension line (RSTL) is a furrow created when the skin is pinched and relaxed in the absence of local tension (Fig. 2) (8, 9). Clinically, the skin is maximally extensible perpendic-ular to RSTL, and this implies that the tension is minimized when incisions are created along. FINDING THE RELAXED SKIN TENSION LINES The relaxed skin tension lines are those skin tension lines that follow the furrows formed when the skin is relaxed. They are not visible features of the skin, such as wrinkle lines. Rather, they are derived from the act of pinching the skin and observing the furrows and ridges that form Principles of Wound Incision • Relaxed Skin Tension Lines (Langer's line) Is the skin lines oriented perpendicular to the direction of the underlying muscle fibers determined by examination of patient's natural skin creases at rest orientation of the final scar parallel to or within a natural skin crease gives a superior cosmetic result 70 CHAPTER 13 Relaxed skin tension lines (RSTL) were described by Borges and Alexander.'a They determined the tension on the skin with respect to elasticity of the skin, stretch of the skin as related to muscle pull, and 1oca1 anatomy considerations. These lines have proven to be more effective in determining orientation of scars to prevent hypertrophy. Incisions parallel to RSTL do not g

Relaxed Skin Tension Lines - Lie perpendicular to the neurovascularture structures - Perpendicular to the long axis of muscles Placing an incision ____ to RSTL will result in fine scar and less tension Borges used the term relaxed skin tension line. At the medial end of the eyebrow, his relaxed skin tension line ran obliquely upward and medially, to meet the contralateral line. Namikawa et al used the term cleavage lines of the skin Non-observance of skin tension lines causes widening or hypertrophy of scars. A linear incision develops a wider gap if it occurs parallel to striae rather than transverse to them. Relaxed skin tension lines [6-8] seems to be a confusing expression, while main folding lines are easier to se

Learn how to perform an elliptical incision of a skin lesionVisit http://www.teachmesurgery.com/skills/surgical/excision-lesion to see our written guide for. relaxed skin tension lines. the natural skin lines and creases of the face and neck, which are the preferred lines of incision in surgery of those areas; called also l's of expression and l's of minimal tension. Medical dictionary. 2011. Reid base line The lines of minimal tension, also called relaxed skin tension lines, are result of the skin's adaptation to function and are also related to the elastic nature of the underlying dermis (Fig. 1-1). The intermittent and chronic contraction of the muscles of facial expression create depresse The incision is made with a no. 15 scalpel blade held vertical to the skin. Relaxed skin tension lines, Z-plasties on scars, and fusiform excision of lesions. Br J Plast Surg. 1962;15:242. The incision can either be parallel to the inferior border of the mandible (A) or be placed in an existing skin crease (B) for maximum cosmetic benefit. If using skin creases for the incision, the orientation of the scalpel blade is parallel to the relaxed skin tension lines (RSTL)

relaxed skin tension lines — the natural skin lines and creases of the face and neck, which are the preferred lines of incision in surgery of those areas; called also l s of expression and l s of minimal tension Medical dictionary. Tension Transitoire de Retablissemen The MacFee incision respects the relaxed skin tension lines in the neck and is therefore cosmetically superior, but it can be awkward to work through. The hockey-stick incision avoids trifurcations and provides plentiful exposure for a comprehensive neck dissection Seven Corners Medical Building, 6305 Castle Place, Falls Church, Virginia 2204

Langer's research on skin tension lines was done on cadavers. Anatomical skin lines on living human beings are a bit different. Kraissl discovered that wrinkles occur perpendicular to underlying muscle action and drafted his own map of skin tension lines. Borges is credited with describing relaxed skin tension lines. Essentially, these are. Tension can be minimized by placing incisions parallel to relaxed skin tension lines; the incision should be placed so that closure is possible with minimal tension. Relaxed skin tension lines, also known as wrinkles, natural skin lines, lines of facial expression, or lines of minimal tension, lie perpendicular to the long axis of the. Surgical skin incisions should be conducted with the scalpel in a perpendicular direc-tion to create a clean incision edge. By placing them parallel to the relaxed skin tension lines, also called Langer lines, the most satisfactory aesthetic result can be achieved

Prevention of hyper- and hypotrophic scars through

Skin lines used to plan incisions have been contentious, with differing descriptions. 1 Karl Langer, who originally investigated cleavage lines, studied cadavers that were punctured with a round-tipped awl (like an ice-pick) published a series of papers on 'cleavage lines' in 1861 that were not translated until 1978 by Gibson. 2 Cox, who recreated Langer's experiment in 1941, studied 28. Wrinkle lines of the skin that are caused by the alignment of the elastic and collagenous fibre systems of the skin. The skin wrinkle lines are only visible when the skin is relaxed. The surgical incision is generally made along the skin fold lines. In this respect, these tension lines have a practical significance for the surgeon

as orientation of the incision to relaxed skin tension lines. The first metatarsophalangeal joint (MTPJ) and the distal first metatarsal can be exposed from several approaches. The dorsal-medial approach is the most widespread technique taught for first MTPJ exposure. The Comprehensive Textbook of Foot Surgery (2) advocate There are many variables, however, that effect how long a scar will stay red. These include body location (face incisions fade much quicker than on the body), orientation of the scar or incision to the relaxed skin tension lines of the surgical area, age and ethnicity of the patient, and how much tension has been placed on the closure

The skin incision should be made through the epidermis and dermis, which is the thinnest in the eyelid and the thickest immediately above the brow. especially if the wound crosses the relaxed skin tension lines. A straight scar from a wound that has been carelessly trimmed may ultimately be more disfiguring than the scar from a carefully. Relaxed skin tension line give better result than any other lines. If natural skin crease is prominent in one site it should be used instead of relaxed skin tension line. In areas where incision have to be put perpendicular to relaxed skin tension line a running W plasty should be done. Incisions in growing children heal with a broad scar incision made parallel to the lines heals with a fine linear scar, while an incision across the lines may set up irregular tensions that result in an unsightly scar. In other areas of the body Langer's lines are visible or can easily be seen by compressing the skin. On the scalp Langer's lines are not obviou Figure 21-2. A 4-cm-long incision placed in alignment with relaxed skin tension lines and closed with multilayered closure and vertical mat-tress sutures. Figure 21-3. Scar on right cheek with unfa vorable characteristics: depressed and not in alignment with relaxed skin tension lines

Relaxed skin tension line-oriented keystone-designed

Next, a dermatological approach to your relaxed skin tension lines not only helps to expedite wound healing but hide the scar as well. When your skin is at rest and when you are in motion, the resting tension lines are in the direction of the least amount of skin strain. Making an incision along the resting skin tension lines provides fewer. Skin tension lines (STLs) are the result of a complex interaction between internal and external factors involving the skin. The intrinsic framework, which consists of elastin and collagen, progressively loosens with age. Its interaction with the muscles of facial expression leads to the development of STLs 1504) C Relaxed skin tension lines are ideal for incision incision placement but the Langer lines are not. Moubayed S. P., Mourad M. W., Riera March A. Facial Plastic & Reconstructive Surgery, Concepts, Questions, Answers, chapter 16 in Scar Revision and Dermabrasion, Jaypee Brothers Medical Publishers, 2020, pp. 130-13 The surgical technique is performed through a 2-4cm skin incision over the sinus tarsi along the relaxed skin tension lines (Figure 1-1). Care should be taken to avoid the intermediate dorsal cutaneus nerves superior to the incision as well as the sural nerve which should course inferior to the incision

Skin Lesions | Musculoskeletal Key

Scars: In the Line of Tension Seminar Marjorie Brook, LM

  1. Incision lines are placed in relaxed skin tension lines. Long axis of the ellipse is oriented perpendicular to free margins. While repairing a large cheek defect after flap surgery, you begin to anesthetize a patient who weighs 50 kg. What is the maximum amount of 1% lignocaine with 2.5% epinephrine that this patient can receive? 50 ml. 350 ml.
  2. Incision planning for the foot, ankle, or leg includes three important considerations: the type and amount of surgical exposure required, the relationship of the incision with the relaxed skin tension lines (RSTLs), and the avoidance of local neurovascular structures
  3. RESULTS: Postoperative scars were easily camouflaged by wrinkles or relaxed skin tension lines of the eyelid without major complications. CONCLUSIONS: An eyelid incision can be used for dacryocystorhinostomy in Asians, regardless of the lack of a definite lower eyelid crease and the presence of epicanthus
  4. C. Relaxed skin tension lines are ideal for incision incision placement but the Langer lines are not. C. Langer lines are lines formed by the natural orientation of the collagen in the dermis D. Langer lines are lines parallel to the underlying facial muscles. 1505) Which of the following statements regarding dermabrasion is FALSE
  5. Langer's lines, defined as Spaltrichtungen or cleavage lines, lie partially in line with the underlying muscle fibres. Kraissl's dynamic lines, as well as the Borges relaxed skin tension lines, suggest that incision lines should be placed perpendicular to the direction o
  6. Langer's lines, defined as Spaltrichtungen or cleavage lines, lie partially in line with the underlying muscle fibres. Kraissl's dynamic lines, as well as the Borges relaxed skin tension lines, suggest that incision lines should be placed perpendicular to the direction of the underlying muscles [1-3]

Relaxed skin tension line (RSTL) is a furrow created when the skin is pinched and relaxed in the absence of local tension (8, 9). Clinically, the skin is maximally extensible perpendicular to RSTL, and this implies that the tension is minimized when incisions are created along RSTLs The best aesthetic result is achieved when electively placed incision lines are placed in borders of aesthetic units or in relaxed skin tension lines. Borders of aesthetic units are important in facial surgery and are natural lines separating distinct anatomic units. The upper lip and cheek are separated by the melolabial fold, for example, and.

Surgical Tension Lines—Where to Cut Clinician's Brie

Your face has relaxed skin tension lines which we try to make our incisions parallel to in order to reduce tension like OP said. The forces are directed perpendicular to the incision line. Also natural skin wrinkles or creases are helpful. 12. Reply. Share. Report Save. level 1. 2 days ago Incision was given around the nevus in an elliptical pattern, three times as long as it was wide and along the relaxed skin tension lines. Dissection was carried down to mid-subcutaneous tissue to remove the nevus down to its full depth. Wound was closed by simple interrupted sutures using 5-0 prolene with adequate undermining of the wound edges Surgical Wound Closure Guidelines • • Adequate debridement and hemostasis Atraumatic technique Alignment with the relaxed skin tension lines Angle of incision • Perpendicular to skin surface or slightly undermined • Angle incisions parallel to hair shafts • Consider area of the body for vascularity and tension on the wound forces and dispersing them along the three lines, and therefore may help reduce adverse scarring. In addition, closure shape can be used to accommodate anatomic irregularity or to follow a curved skin line. Incision planning should emphasize placement of the incision parallel to relaxed skin tension lines. Careful consider

Surgical Approaches Plastic Surgery Ke

  1. Skin tension measurements of skin lines (relaxed skin tension lines (RSTL) versus BEST) and vertical closure (BEST) versus vertical closure with a parallel relaxing incision were undertaken and followed by statistical analyses utilizing the paired t test and the unpaired Student's t tests. Results:
  2. ence. • Breaks up the straight line of the scar and attempts to conceal the incision in the skin crease. • Crosses vertical relaxed skin tension lines to produce a more noticeable scar. 15. ROBSON INCISION • Produce an unobtrusive (better- looking) scar
  3. Four main facial lines that delineate the prevailing direction of relaxed skin tension lines (RSTLs). Nearly all RSTLs follow one or the other of the lines described above. A thorough working knowledge of their courses over the facial contours ensures that the surgeon can preoperatively plan scar revision excisions and incisions that are most.
  4. Relaxed skin tension lines are lines that follow the furrows formed when the skin is relaxed, and incisions made in tension lines heal better than those made tangentially to tension lines. In the lower eyelid, relaxed skin tension lines run roughly parallel to wrinkle lines.9 In this regard, an eyelid incision is more suitable for.

Local anesthesia was administered in the form of 1% lidocaine with epinephrine 1:100,000, for a total of 10 mL at the laryngeal prominence, on the face of the left aspect of the thyroid cartilage ala, and along the inferior border of the thyroid cartilage and alsoinjected to our planned incision site within a relaxed skin tension line along the. l's of expression the natural skin lines and creases of the face and neck; the preferred lines of incision in facial and cervical surgery. gingival line. 1. a line determined by the level to which the gingiva extends on a tooth; called also gum line. 2. any linear mark visible on the surface of the gingiva In this article, we aim to present our transverse incision technique in treatment of these fractures, which might be associated with fewer skin problems. The 7 best known skin tension lines are presented. The directions they convey are schematically compared with those of the relaxed skin tension lines Again, tumor clearance before flap implementation is of utmost importance. Previous scars, facial subunits, relaxed skin tension lines, and lines formed from facial expression should be noted at rest and with movement. Rhombic Flap. The rhombic flap was originally described by Limberg in 1963 and is often called the Limberg flap Here, the double S incision represents half of the rhombic incision which has a wastage of 103%, so the wastage of skin is reduced in half and the resultant suture line shows a mild wave shape. The vertical lines represent the minimal tension lines of the skin, and the axis X-X represents the center of these lines

(D) Robson incision. 18392 (Fig 1A) was a midline incision of the lower lip Bhatt et al. Modified Lip Split Incision. J Oral Maxillofac Surg that lies in a relaxed skin tension line and minimizes 2009. injury to the muscles, vessels, and nerves of the lower lip This technique, like others, 6 relies on breaking a long linear scar into smaller, triangular segments, which are typically less than 6 mm long and are oriented along relaxed skin tension lines. 7 For scar revision, the existing scar is excised and the surrounding triangular segments of the W-plasty are interdigitated and closed, thus.

Excisional Surgery and Repair, Flaps, and Grafts Plastic

Incision Placement Relaxed Skin Tension Lines . The concept of relaxed skin tension lines (RSTLs) is obvious in the older face, and these lines of minimal tension are good choices for incision placement because they heal with less chance of scar hypertrophy and may be less noticeable due to decreased skin shadowing This statement of following relaxed skin tension lines is reiterated in the literature multiple times (Lawrence's An Introduction to Dermatological Surgery, Bolognia's Dermatology, etc.). The podiatric surgeon will be the best at ultimately determining where and how to place the incision on a case to case basis relaxed skin tension lines. The incision should be carried down through skin and subcutaneous tissues to the platysma. The platysma can then be divided with elec-trocautery or sharp dissection. The superficial layer of deep cervical fascia should then be incised parallel to th

Relaxed skin tension line (RSTL) is a furrow created when the skin is pinched and relaxed in the absence of local tension (Fig. 2) (8, 9). Clinically, the skin is maximally extensible perpendicular to RSTL, and this implies that the tension is minimized when incisions are created along RSTLs The scar should be placed along relaxed skin tension lines or at the boundary of facial subunits where there will be the least amount of pull on the scar and the best scar camouflage. Identification of relaxed skin tension lines can be determined by looking at natural skin wrinkles or pinching the skin between two fingers to determine the.

Incisions: Planning the Direction of the Incision

Biodynamic Excisional Skin Tension (BEST) Lines

  1. d, incisions should be placed parallel to the relaxed skin tension lines to.
  2. The scar is oblique, traversing relaxed skin tension lines (which are horizontal in the forehead) and appears to be hypertrophic (wide and red). Given your more pigmented skin type (type 4 Fitzpatrick), the possibility of hyperpigmentation with a technique such us dermabasion is higher
  3. Borges AF. Relaxed skin tension lines (RSTL) versus other skin lines. Plastic and Reconstructive Surgery. 1984 Jan 1;73(1):144-50. Langer K. On the anatomy and physiology of the skin: I. The cleavability of the cutis. British Journal of Plastic Surgery. 1978 Jan 1;31(1):3-8. Pinkus F. Die normale anatomie der haut
  4. If using skin creases for the incision the orientation of the scalpel blade is parallel to the relaxed skin tension lines (RSTL). Neurovascular structures The main neural structure is the marginal mandibular branch of the facial nerve (CN VII). The facial artery and vein can also be encountered during this dissection
  5. This donor site, most commonly, parallels the relaxed skin tension lines. We prefer to remove the Burow's triangle at the pivot point prior to insetting of the flap. This ensures more accurate incision lines and allows more precise suture placement in order to distribute flap tension evenly
  6. Controlled scars are scars created by careful surgical incision placement in relaxed skin tension lines, to make the scars almost invisible. Uncontrolled scars are generally caused by injury or injudicious placement of surgical scars. Hypertrophic scars are scars that are raised, whilst keloids will spill over the edge from the line of the scar
  7. Background The elliptical (fusiform) excision is a basic tool of cutaneous surgery.. Objective To assess the design, functionality, ease of construction, and aesthetic outcomes of the ellipse.. Design A systematic review of elliptical designs and their site-specific benefits and limitations. In particular, we consider the (1) context of prevailing relaxed skin tension lines and tissue laxity.

Skin Tension - an overview ScienceDirect Topic

Skin Tension Lines (STLs) are series of lines based on the direction of tension as this relaxed skin tension lines run perpendicular to the underlying muscles contraction. For best results and aesthetic outcome, place skin incisions along skin tension lines. Skin tension lines run parallel to the dermal collagen bundles but at right-angles to. However, as in reconstruction in any area of the face, by understanding the anatomy (superficial and deep), keeping tension off the free margin (the vermillion lip), and placing incision lines in cosmetic unit junctions and/or along relaxed skin tension lines, aesthetically pleasing reconstruction can be consistently achieved Skin incisions should be planned along or parallel to the relaxed skin tension lines (RSTLs). This allows, on one hand, a better wound healing, an easier matching of edge of the wound and lower tension of the sutures and, on the other hand, to hide the wound in a skin fold

Langer's lines - Wikipedi

This entails carefully orienting an incision along relaxed skin tension lines, the natural lines and creases of our body, which creates a scar that is barely perceptible once healed. The lesion is then completely excised and the wound is meticulously closed. This procedure takes anywhere from fifteen minutes to one hour Consideration must be taken to best camouflage incision lines within existing lines or creases, at the junction of cosmetic units, or at least parallel to lines of relaxed skin tension. CONCLUSIONS. A complete knowledge of the possible variations and modifications of transposition flaps can help fine-tune the execution of the flap to provide. Scar revision surgery involves excision (removal) of the unsightly scars in alignment with the lines of the face known as relaxed skin tension lines (RSTLs). Unsightly facial scars are scars which are not aligned with these RSTLs, which causes them to be under constant tension by the skin and facial muscles

Closing of defects of the lower limb after skin cancer excision poses a challenge in lower limb skin. Although the concept of relaxed skin tension lines has been established as ideal on the face, on the lower limb there remains confusion between Langer's lines and wrinkle lines, and this study was done with the task of identifying and mapping biodynamic excisional skin tension (BEST) lines on. 3. The lines of least skin tension should be identified for the area to be biopsied. For example, on the arm, these lines run perpendicular to the long axis of the extremity. The incision line created by the suturing after the biop-sy is performed will be oriented parallel to the lines of least skin tension. Physicians who cannot recall the line incision through importantstructures (including the conjunctiva, tarsus, levator aponeurosis, and Müller's muscle) and has the potential for greater scarring because the incision lies perpendicular to the relaxed skin tension lines of the eyelid skin. Leone7 and Wolfley11 described the use of an incision in the natural upper eyelid crease. In order to achieve tension-free wound closure, the course of the skin tension lines (Relaxed Skin Tension Lines according to Borges) must be taken into account in the first instance. In the face, for example, the incision line is mainly dependent on the aesthetic units as well as facial expression and ageing wrinkles Incision Create a 1-3cm incision within the relaxed skin tension lines overlying the sinus tarsi which can be identified with direct palpation, or approximately 1cm inferior and 1.5cm anterior to the tip of the lateral malleolus. Note: Open the deep fascia with a blunt ringed instrument (i.e. hemostat) once the skin is incised

Scars which are wide, depressed, or running against what is referred to as the relaxed skin tension lines or laugh lines, often need surgical excision and re-closure in hopes of improving the scar into a fine line. Also, the orientation of the scar, at times, is changed to fall within the relaxed skin tension lines for better camouflage Z-plasty is used to redirect scar into relaxed skin tension lines (ie, Langer's lines ), natural skin folds, or along the border of an aesthetic unit (ie, nasolabial fold) to improve cosmetic or functional outcome

A hockey stick incision provides excellent access to neck levels I and II, but invades the relaxed skin-tension line and can result in scar hypertrophy . A single low transverse incision is parallel to, and does not invade, the relaxed skin-tension line, and therefore usually favors a good postoperative scar Z-plasty [ze´plas-te] repair of a skin defect by the transposition of two triangular flaps of adjacent skin, for relaxation of scar contractures. Called also zigzagplasty. Z-plasty, showing the direction of relaxed skin tension lines (arrow), desired position of final scar (dotted line), and the two flaps to be juxtaposed (a, b). From Dorland's, 2000. The RSTLs represent lines of skin tension in living tissue that are clinically useful in planning incisions that minimize wound separation and scar width. They are not easily visible but are found along the fine skin furrows that form when the skin is relaxed or gathered

The Elliptical Excision Clinical Gat

Incision Placement: Overview, Concepts, Incision Techniqu

Attention was directed to the medial instep where a transverse incision was made in the direction of the relaxed skin tension lines. The incision was dissected down to the level of the medial band of the fascia. Care was taken to identify and retract all vital neurovascular structures. A medial fasciotomy was performed Apr 8, 2021 - Fig. 1. Relaxed skin tension lines (RSTL) and lines of maximum extensibility (LME). Inset shows rhomboid flap superimposed in optimum orientation. Dotted lines are short diagonals of the flap and indicate preferred flap orientation. Numbers 1, 2, 3, and 4 indicate possible flaps Infantile hemangiomas of the neck are usually resected with lenticular excisions, because linear incisions are well concealed. The neck has favorable relaxed skin-tension lines. The surgeon should not remove too much skin in this area. If a large residual lesion is present, it should be removed by serial excision. Trun The maximum dimensions of the template in length and width were used to plan and perform an elliptical full-thickness skin graft at the sinus tarsi, orienting the long axis of the graft parallel to the relaxed skin tension lines of the donor site (Figure 5). After lavage of the recipient site with copious sterile normal saline, the skin graft. The orbicularis was closed with a single 5-0 polyglactin 910 suture. A small amount of redundant cutaneous tissue was excised using a Burrow's triangle along the relaxed skin tension lines inferolaterally. The eyelid margin was repaired with a vertical mattress 7-0 silk suture, which was then run superiorly to close the skin

Incisions around the Shoulder ShoulderDo

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Place Incisions in the Line of Minimal Tension

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