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Page 18 of 25 Lemperle Plast Aesthet Res 2020;7:40 I http://dx.doi.org/10.20517/2347-9264.2020.14

A

B

Figure 23. Most abdominal incisions are still perpendicular to the main folding lines, even if some surgeons are using wide horizontal
incisions in patients with acute abdominal pain (from iknowledge: R.E. D’Souza and R. Novell: Pancreatectomy and Whipple 2015) (A
and B)

beneath a horizontal bra or bikini strap. Elevating a myocutaneous latissimus dorsi flap must be performed
according to the defect. The skin island can often be designed horizontally to hide the scar behind a bra.
Towards the lateral rib cage, incisions are made obliquely, following the direction of the ribs.

On the back and over the buttocks, the anti-striae lines differ from the Langer and Kraissl lines in a right-
angle fashion. Adolescents develop inconspicuous striae in an oblique direction over the hip and gluteus
muscle [Figure 10A], it is therefore recommended to consider skin incisions in hip joint surgery in children
and adolescents in an oblique direction, but parallel to the fibers of the gluteus maximus between the
posterior iliac crest and trochanter major [Figure 26A and B].

Mini-invasive incisions in total hip arthroplasty are a marketing tool for patients refusing a large lateral
[42]
or anterior incision as a hip prosthesis flag . An incision in the direction along the folding lines would
produce the best scars.