125 lines
No EOL
28 KiB
XML
125 lines
No EOL
28 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
|
||
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
||
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
||
|
||
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
||
<!-- AppResources meta begin -->
|
||
<meta name="paf-app-resources" content="" />
|
||
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
||
|
||
<!-- AppResources meta end -->
|
||
|
||
<!-- TemplateResources meta begin -->
|
||
<meta name="paf_template" content="" />
|
||
|
||
<!-- TemplateResources meta end -->
|
||
|
||
<!-- Logger begin -->
|
||
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK563191" /><meta name="ncbi_domain" content="statpearls" /><meta name="ncbi_report" content="printable" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK563191/?report=printable" /><meta name="ncbi_app" content="bookshelf" />
|
||
<!-- Logger end -->
|
||
|
||
<title>Axial Flaps - StatPearls - NCBI Bookshelf</title>
|
||
|
||
<!-- AppResources external_resources begin -->
|
||
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
||
|
||
<!-- AppResources external_resources end -->
|
||
|
||
<!-- Page meta begin -->
|
||
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="StatPearls [Internet]" /><meta name="citation_title" content="Axial Flaps" /><meta name="citation_publisher" content="StatPearls Publishing" /><meta name="citation_date" content="2023/07/24" /><meta name="citation_author" content="Aradhana Mehta" /><meta name="citation_author" content="Joshua J. Goldman" /><meta name="citation_pmid" content="33085338" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK563191/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Axial Flaps" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="StatPearls Publishing" /><meta name="DC.Contributor" content="Aradhana Mehta" /><meta name="DC.Contributor" content="Joshua J. Goldman" /><meta name="DC.Date" content="2023/07/24" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK563191/" /><meta name="description" content="An axial pattern flap incorporates an anatomically named vascular pedicle.[1] Due to the direct cutaneous blood supply, a large skin area can be transferred acutely rather than in a delayed fashion that has previously been the gold standard. Historically, random pattern flaps were harvested in a delayed manner to foster better circulation to the flap. There are several advantages when using an axial pattern flap, which includes no need for delay procedures, full-thickness, durable skin, and excellent cosmetic results.[2] Furthermore, it has been shown that the area of survival in axial pattern flaps is significantly better versus flaps which do not incorporate a direct cutaneous blood supply. Studies have shown the difference in 95% survival for axial pattern flaps versus 53% survival in flaps without a direct cutaneous supply.[3] Some examples of axial pattern flaps include: " /><meta name="og:title" content="Axial Flaps" /><meta name="og:type" content="book" /><meta name="og:description" content="An axial pattern flap incorporates an anatomically named vascular pedicle.[1] Due to the direct cutaneous blood supply, a large skin area can be transferred acutely rather than in a delayed fashion that has previously been the gold standard. Historically, random pattern flaps were harvested in a delayed manner to foster better circulation to the flap. There are several advantages when using an axial pattern flap, which includes no need for delay procedures, full-thickness, durable skin, and excellent cosmetic results.[2] Furthermore, it has been shown that the area of survival in axial pattern flaps is significantly better versus flaps which do not incorporate a direct cutaneous blood supply. Studies have shown the difference in 95% survival for axial pattern flaps versus 53% survival in flaps without a direct cutaneous supply.[3] Some examples of axial pattern flaps include: " /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK563191/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-statpearls-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/statpearls/article-35963/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK563191/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
|
||
|
||
<!-- Page meta end -->
|
||
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8E316A7D8885F10000000000290027.m_5" />
|
||
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/3984801/12930/3964959.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
||
<body class="book-part">
|
||
<div class="grid no_max_width">
|
||
<div class="col twelve_col nomargin shadow">
|
||
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
||
<div class="sysmessages">
|
||
<noscript>
|
||
<p class="nojs">
|
||
<strong>Warning:</strong>
|
||
The NCBI web site requires JavaScript to function.
|
||
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
||
</p>
|
||
</noscript>
|
||
</div>
|
||
<!--/.sysmessage-->
|
||
<div class="wrap">
|
||
<div class="page">
|
||
<div class="top">
|
||
|
||
<div class="header">
|
||
|
||
|
||
</div>
|
||
|
||
|
||
|
||
<!--<component id="Page" label="headcontent"/>-->
|
||
|
||
</div>
|
||
<div class="content">
|
||
<!-- site messages -->
|
||
<div class="container content">
|
||
<div class="document">
|
||
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. </p></div></div></div>
|
||
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK563191_"><span class="title" itemprop="name">Axial Flaps</span></h1><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Aradhana Mehta</span><sup>1</sup>; <span itemprop="author">Joshua J. Goldman</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> University of Nevada, Reno School of Medicine, Reno, NV</div><div class="affiliation"><sup>2</sup> HCA, UMC, UNLV</div><p class="small">Last Update: <span itemprop="dateModified">July 24, 2023</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="article-35963.s1"><h2 id="_article-35963_s1_">Continuing Education Activity</h2><p>Trauma and resection of tumors often leave large defects requiring coverage, which have historically meant multi-stage procedures. However, axial pattern flaps, which rely on an anatomically named direct cutaneous blood supply, have presented a single-stage procedure that provides a reliable, cosmetically appealing option. This activity reviews the indications, complications, and contraindications regarding axial flaps and highlights the role of the interprofessional team in evaluating and caring for axial flaps preoperative, intraoperatively, and postoperatively.</p><p>
|
||
<b>Objectives:</b>
|
||
<ul><li class="half_rhythm"><div>Identify the indications for use of axial flaps.</div></li><li class="half_rhythm"><div>Describe the anatomy and physiology of axial flaps.</div></li><li class="half_rhythm"><div>Summarize the most common complications associated with axial flaps.</div></li><li class="half_rhythm"><div>Explain the importance of post-operative monitoring for axial flaps.</div></li></ul>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=35963&utm_source=pubmed&utm_campaign=reviews&utm_content=35963" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</p></div><div id="article-35963.s2"><h2 id="_article-35963_s2_">Introduction</h2><p>An axial pattern flap incorporates an anatomically named vascular pedicle.<a class="bk_pop" href="#article-35963.r1">[1]</a> Due to the direct cutaneous blood supply, a large skin area can be transferred acutely rather than in a delayed fashion that has previously been the gold standard. Historically, random pattern flaps were harvested in a delayed manner to foster better circulation to the flap. There are several advantages when using an axial pattern flap, which includes no need for delay procedures, full-thickness, durable skin, and excellent cosmetic results.<a class="bk_pop" href="#article-35963.r2">[2]</a> Furthermore, it has been shown that the area of survival in axial pattern flaps is significantly better versus flaps which do not incorporate a direct cutaneous blood supply. Studies have shown the difference in 95% survival for axial pattern flaps versus 53% survival in flaps without a direct cutaneous supply.<a class="bk_pop" href="#article-35963.r3">[3]</a> Some examples of axial pattern flaps include: </p><ul><li class="half_rhythm"><div>Nasolabial flap off of the angular vessels </div></li><li class="half_rhythm"><div>Paramedian forehead flap off of the supratrochlear vessels </div></li><li class="half_rhythm"><div>Facial artery musculomucosal flap </div></li><li class="half_rhythm"><div>Melolabial flap</div></li></ul></div><div id="article-35963.s3"><h2 id="_article-35963_s3_">Anatomy and Physiology</h2><p>Understanding basic skin anatomy is crucial to understanding the anatomy and physiology of flaps. The deep and superficial vascular plexus supply the skin. The deep vascular plexus is also known as the subdermal plexus. This vascular supply serves two main functions- nutritional support and thermoregulation. All flaps rely on the skin's plexuses for survival.<a class="bk_pop" href="#article-35963.r4">[4]</a></p><p>There are four basic types of cutaneous flaps- random, axial, reverse flow axial pattern flaps, and island flaps. Random flaps rely on blood supply from the subdermal plexus, which is supplied by unnamed musculocutaneous perforators.<a class="bk_pop" href="#article-35963.r5">[5]</a> Axial pattern flaps derive their blood supply directly from an anatomically named fasciocutaneous artery that runs beneath the flap's longitudinal axis.<a class="bk_pop" href="#article-35963.r6">[6]</a> These arteries ensure blood supply to the subdermal plexus and guarantee blood supply to the flap. Outside of the territory that is immediately supplied by the artery, the flap behaves like a random flap because the more distal regions rely on the deep and superficial vascular plexus for survival.<a class="bk_pop" href="#article-35963.r7">[7]</a> </p><p>Reverse flow axial pattern flaps are axial flaps in which the main blood supply is divided proximally. The blood flows in a retrograde manner through the distal vessel, which is accomplished via venae comitantes, bypass vessels, and valvular incompetence. Finally, island flaps also represent a type of axial pattern flap raised on a pedicle that lacks skin to facilitate transfer to a distant site.<a class="bk_pop" href="#article-35963.r4">[4]</a></p></div><div id="article-35963.s4"><h2 id="_article-35963_s4_">Indications</h2><p>Axial flaps are indicated for one-stage reconstruction of wounds when a large amount of skin is needed to fill a defect following trauma or mass resection. There are various areas from which axial flaps can be taken. The recipient site must be healthy and without any infection indications; however, granulation tissue does not have to be present. Unlike grafts, the flap carries its own blood supply and does not require a vascular bed. Advantages of axial flaps include a greater width to length ratio versus random pattern flaps, full-thickness coverage, durable skin, and excellent cosmetic results. Due to these flaps' predictable vascular supply, they can provide durable full-thickness skin, which can result in minimal scar tissue and near-normal hair growth.<a class="bk_pop" href="#article-35963.r2">[2]</a></p></div><div id="article-35963.s5"><h2 id="_article-35963_s5_">Contraindications</h2><p>The use of axial flaps is contraindicated in patients who present with an active infection at the recipient site, or if there is any compromise to the flap pedicle or inadequate debridement of the wound bed. Relative contraindications, including smoking, are common to all flap surgery as it increases the risk of flap necrosis. Furthermore, avoiding radiated skin areas as the donor site is recommended to reduce the risk of flap failure.</p></div><div id="article-35963.s6"><h2 id="_article-35963_s6_">Equipment</h2><p>Axial flaps do not require any specialized equipment and are less technically demanding compared to microvascular free transfer. The equipment required is generally the same for other regional and local flap surgery.<a class="bk_pop" href="#article-35963.r8">[8]</a><a class="bk_pop" href="#article-35963.r9">[9]</a> Doppler can be useful for axial vessel and perforator mapping.</p></div><div id="article-35963.s7"><h2 id="_article-35963_s7_">Personnel</h2><p>Axial flaps can be performed efficiently with one surgical assistant to assist with retraction, suturing, cutting, and achieving hemostasis.</p></div><div id="article-35963.s8"><h2 id="_article-35963_s8_">Preparation</h2><p>Before surgery, the physical examination is crucial to assess any prior hypertrophic, hyper/hypopigmented scars, or any keloids and appropriately caution the patient. Additionally, a manual pinch test at the donor site will confirm the ability to close the donor site primarily. If needed pre-operatively, vessel position and patency can be confirmed with a handheld doppler. As is the case with any surgical intervention, it is crucial to have an informed discussion with the patient pre-operatively in which all the risks, benefits, and alternatives are discussed regarding axial flaps. When discussing with elderly patients, they should be cautioned that the flap is at a greater risk of necrosis as dermal blood vessels tend to collapse, become disorganized or absent with age.<a class="bk_pop" href="#article-35963.r4">[4]</a></p></div><div id="article-35963.s9"><h2 id="_article-35963_s9_">Technique or Treatment</h2><p>When considering where to make the initial incision, it is important to consider skin tension and understand that the greatest tension exists along the relaxed skin tension lines, and the least tension exists along the lines of maximum extensibility. Keeping this in mind, incisions should be placed parallel to the relaxed skin tension lines to minimize tension.<a class="bk_pop" href="#article-35963.r10">[10]</a> </p><p>Generally, axial flaps are typically raised from the trunk, neck, or proximal limbs in areas where there is sufficient loose skin to facilitate the donor site's closure with minimal morbidity. There are a variety of different axial flaps which can be raised; however, the basic operative technique is as follows:<a class="bk_pop" href="#article-35963.r4">[4]</a></p><ul><li class="half_rhythm"><div>Measure the dimensions of the defect </div></li><li class="half_rhythm"><div>Design a skin paddle which is centered over the axial course of the vascular pedicle, taking care to ensure that the plan of dissection includes the fasciocutaneous vessel within the subcutaneous fat </div></li><li class="half_rhythm"><div>It is useful to leave a cuff of fascia and subcutaneous fat around the pedicle to avoid injuring. It is unnecessary to visualize the pedicle, but if there is evidence of arterial insufficiency in the flap, you may need to skeletonize the vessels. </div></li><li class="half_rhythm"><div>Transfer the flap into the defect </div></li><li class="half_rhythm"><div>Inset the flap into the defect </div></li><li class="half_rhythm"><div>Close the donor site either primarily or with skin grafts depending on the size of the defect</div></li></ul></div><div id="article-35963.s10"><h2 id="_article-35963_s10_">Complications</h2><p>Potential complications regarding axial flap include:</p><ul><li class="half_rhythm"><div>Seroma formation</div></li><li class="half_rhythm"><div>Wound drainage</div></li><li class="half_rhythm"><div>Donor site dehiscence</div></li><li class="half_rhythm"><div>Distal flap necrosis<a class="bk_pop" href="#article-35963.r9">[9]</a></div></li><li class="half_rhythm"><div>There is also the potential for delayed or incomplete wound healing, venous congestion requiring suture release or placement back to original positions for the delay to augment axial supply</div></li></ul></div><div id="article-35963.s11"><h2 id="_article-35963_s11_">Clinical Significance</h2><p>Axial flaps can provide a low complexity, one-step method for reconstruction for defects which are larger in area. They can obviate the need for multistep procedures and provide patients with durable skin and a better cosmetic result. They offer an efficient, less complicated means to repair defects that would otherwise be difficult or impossible to repair.</p></div><div id="article-35963.s12"><h2 id="_article-35963_s12_">Enhancing Healthcare Team Outcomes </h2><p>As with all flap surgery, it is of the utmost importance to have cooperation and understanding of the flap's success. Postoperative bleeding and flap complications typically occur in the first 24-72 hours postoperatively. Intraoperatively, the surgeon needs to achieve appropriate hemostasis and protect the pedicle and prevent any postoperative complications. Postoperatively the nursing staff must be appropriately trained to understand the early signs of flap compromise.</p></div><div id="article-35963.s13"><h2 id="_article-35963_s13_">Review Questions</h2><ul><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/account/trialuserreg/?articleid=35963&utm_source=pubmed&utm_campaign=reviews&utm_content=35963" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://mdsearchlight.com/surgical/axial-flaps/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=35963" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Click here for a simplified version.</a>
|
||
</div></li><li class="half_rhythm"><div>
|
||
<a href="https://www.statpearls.com/articlelibrary/commentarticle/35963/?utm_source=pubmed&utm_campaign=comments&utm_content=35963" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Comment on this article.</a>
|
||
</div></li></ul></div><div id="article-35963.s14"><h2 id="_article-35963_s14_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="article-35963.r1">McGregor IA, Morgan G. Axial and random pattern flaps. <span><span class="ref-journal">Br J Plast Surg. </span>1973 Jul;<span class="ref-vol">26</span>(3):202-13.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4580012" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4580012</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="article-35963.r2">Mankin KT. Axial Pattern Flaps. <span><span class="ref-journal">Vet Clin North Am Small Anim Pract. </span>2017 Nov;<span class="ref-vol">47</span>(6):1237-1247.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28797554" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28797554</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="article-35963.r3">Pavletic MM. Canine axial pattern flaps, using the omocervical, thoracodorsal, and deep circumflex iliac direct cutaneous arteries. <span><span class="ref-journal">Am J Vet Res. </span>1981 Mar;<span class="ref-vol">42</span>(3):391-406.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7271004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7271004</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="article-35963.r4">Gaboriau HP, Murakami CS. Skin anatomy and flap physiology. <span><span class="ref-journal">Otolaryngol Clin North Am. </span>2001 Jun;<span class="ref-vol">34</span>(3):555-69.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11447002" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11447002</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="article-35963.r5">Kunert P. [A simple classification system for all skin flaps]. <span><span class="ref-journal">Handchir Mikrochir Plast Chir. </span>1995 May;<span class="ref-vol">27</span>(3):124-31.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7622125" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7622125</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="article-35963.r6">Zito PM, Hohman MH, Mazzoni T. <span class="ref-journal">StatPearls [Internet].</span> StatPearls Publishing; Treasure Island (FL): Apr 19, 2024. Paramedian Forehead Flaps. [<a href="https://pubmed.ncbi.nlm.nih.gov/29763107" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29763107</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="article-35963.r7">Pavletic MM. New techniques in small animal reconstructive surgery. <span><span class="ref-journal">Vet Q. </span>1997 Apr;<span class="ref-vol">19</span>(sup1):25-27.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22047419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22047419</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="article-35963.r8">Swaim SF. Skin grafts. <span><span class="ref-journal">Vet Clin North Am Small Anim Pract. </span>1990 Jan;<span class="ref-vol">20</span>(1):147-75.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2405565" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2405565</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="article-35963.r9">Cornell K, Salisbury K, Jakovljevic S, Bauer M, Petryk D. Reverse saphenous conduit flap in cats: an anatomic study. <span><span class="ref-journal">Vet Surg. </span>1995 May-Jun;<span class="ref-vol">24</span>(3):202-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7653033" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7653033</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="article-35963.r10">Borges AF. Relaxed skin tension lines. <span><span class="ref-journal">Dermatol Clin. </span>1989 Jan;<span class="ref-vol">7</span>(1):169-77.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2646046" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2646046</span></a>]</div></dd></dl></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Aradhana Mehta declares no relevant financial relationships with ineligible companies.</p></div></dd><dt></dt><dd><div><p class="no_top_margin">
|
||
<b>Disclosure: </b>Joshua Goldman declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></div></div></div>
|
||
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
|
||
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
|
||
(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
|
||
http://creativecommons.org/licenses/by-nc-nd/4.0/
|
||
</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
|
||
</p></div><div class="small"><span class="label">Bookshelf ID: NBK563191</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/33085338" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">33085338</a></span></div></div></div>
|
||
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="bottom">
|
||
|
||
<div id="NCBIFooter_dynamic">
|
||
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
||
<component id="Breadcrumbs" label="helpdesk"/>-->
|
||
|
||
</div>
|
||
|
||
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
||
</div>
|
||
</div>
|
||
<!--/.page-->
|
||
</div>
|
||
<!--/.wrap-->
|
||
</div><!-- /.twelve_col -->
|
||
</div>
|
||
<!-- /.grid -->
|
||
|
||
<span class="PAFAppResources"></span>
|
||
|
||
<!-- BESelector tab -->
|
||
|
||
|
||
|
||
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK563191&ncbi_domain=statpearls&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK563191/?report=printable&ncbi_app=bookshelf" /></noscript>
|
||
|
||
|
||
<!-- usually for JS scripts at page bottom -->
|
||
<!--<component id="PageFixtures" label="styles"></component>-->
|
||
|
||
|
||
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
||
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
||
|
||
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
|
||
</html> |