Background:In an effort to achieve inconspicuous scars, plastic surgeons try to place their incisions in established creases and folds of skin. Although well established in the face and abdomen, these folding lines are often disputable on other parts of the body. Striae distensae always develop perpendicular to lines of tension, and their direction can be used to determine optimal incision lines. Methods: The authors examined photographs of 213 individuals with striae, and a composite diagram was created. This composite along with descriptions of Langer lines, Pinkus main folding lines, and Kraissl lines were compared with a clinical scar revision database and 276 images of incisions and scars from the Internet. Results: Pinkus described the main folding lines in 1927 and Kraissl in 1951 recommended that incision lines be placed perpendicular to the direction of underlying muscles. Both references bear some similarities to what we noted in our composites. In comparison, Langer lines, although of historical interest, poorly predicted the direction of optimal skin incisions. Conclusions: The optimal direction for surgical skin incisions should take into strong consideration patterns defined by nature's striae distensae, which always develop perpendicular to skin tension lines. Main folding lines can be used as guides when addressing or refining problem scars and similarly facilitate surgical planning of elective incisions, which may prevent problem scar formation for our patients. (Plast. Reconstr. Surg. 133:

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Background: Patients, particularly those who are young, often develop noticeable orthopaedic scars. In order to achieve minimal scarring, surgeons should attempt to place incisions in skinfolds or skin creases. Methods: Optimal incision lines can be determined from the direction of stretch marks (striae distensae), which develop perpendicular to lines of tension or main folding lines. A composite diagram of photographs of 213 individuals with striae distensae was created and compared with 276 images of incisions and scars derived from the Internet. Results: Classically described Langer cleavage lines often run counter to real tension lines and poorly predict the optimal direction for skin incisions. Conclusions: Whenever possible, main folding lines should be utilized as a guide in planning surgical incisions for young patients as well as for correction of problem scars.

Summary— Presentation of unusual crystalluria following intravenous urography (IVU) initiated study of the occurrence, identity and aetiology of urinary cystals following IVU. Crystalluria composed of the parent diatrizoate compound can occur following contrast studies.

Rupture of the pectoralis major muscle is a rare injury. In total 125 cases of complete and uncomplete ruptures are reported. This injury is the result of excessive muscle tension, a direct blow or a combination of both. In a case study the aetiology, diagnostic, treatment and functional outcome of complete muscle ruptures are shown. The reported results of 14 cases who underwent conservative and 51 cases with surgical treatment were classified and analysed. Conservative management is recommended for partial and proximal ruptures. Distal ruptures of the musculo-tendinous or tendinous insertion in active patients should be treated surgically to return previous muscle strength and contour.