Histological Comparison of the Human Trunk Skin Creases

The Role of the Elastic Fiber Component

Andreas Mallouris, MD, PhD; Despoina Kakagia, MD, PhD; Andreas Yiacoumettis, MD, PhD; Thivi Vasilakaki, MD, PhD; Aggeliki Drougou, MD; Maria Lambropoulou, MD, PhD; Constantinos Simopoulos, MD, PhD; Alexandra K. Tsaroucha, MD, PhD


ePlasty. 2016;16 

In This Article

Materials and Methods

For the purpose of this study, 69 specimens from fresh cadavers were collected. The study complied with guidelines on experimental research set by the University Bioethics Committee and the Declaration of Helsinki, and it commenced following the approval of the Bioethics Committee.

According to the inclusion criteria regarding the selection of cadavers, only whites without a history of surgery or trauma at the relevant area, nor any disorder of the connective tissue, were included. This study investigated skin creases of the trunk.

Dissection was standardized and performed using no. 10 and 15 blades. The collected specimens were skin sections that included the relevant skin crease centrally (along the longitudinal axis) and approximately up to 2 cm of the additional tissue, superior and inferior to the relevant crease. The full-thickness specimens included all layers of the skin, subcutaneous fat with fascia, the fascia plane of the underlying muscle, and part of the muscle tissue, as well as the periosteum of the underlying osseous substrate when anatomically related to the skin crease. The lateral and medial borders of the specimens were tagged so that their original orientation on the human body remains identifiable. The specimens were then fixed in 10% buffered formaldehyde.

Fifteen specimens of the inframammary crease were collected, from 11 female and 4 male cadavers, aged 45 to 82 years. The deep margin of dissection was over the periosteum and the intercostal plane, medially extended to the sternum and laterally to the anterior axillary line (Fig 2a).

Figure 2.

Dissection and orientation of the specimens. (a) The skin crease specimen extends from the medial to the lateral edge of crease. Specimens of the skin at a distance 2 cm superior and 2 cm inferior of the crease were also collected. (b) The specimens were examined with vertical dissections of the medial, lateral, and central sites of the crease.

The infragluteal crease was studied in 16 fresh cadaver specimens, 12 female and 4 male cadavers, aged 42 to 80 years. Tissue samples were dissected to the fascia plane of the underlying muscle and were oriented in relation to their medial and lateral borders.

Fourteen specimens were collected for the study of the anterior axillary fold, 8 female and 6 male cadavers, aged 45 to 76 years. Tissue samples were dissected up to the suprafascial plane.

Tissue samples were obtained from 14 fresh cadavers, 7 female and 7 male cadavers, aged 42 to 76 years, for the study of the inguinal crease, and they were also dissected down to the suprafascial plane.

Ten specimens were also collected, from approximately 2 cm superior and 2 cm inferior to the central site of the relevant skin crease (Fig 2a), 5 superior or inferior to the inframammary crease, and 5 to the infragluteal crease.

The specimen study was conducted by staining with hematoxylin and eosin as a standard staining, using Masson Trichrome stain for collagen and muscle fibers, Van Gieson stain for collagen and muscle fibers, and Reticulin stain for reticular and collagen type III fibers. For the study of the elastic fibers, Verhoef and Orcein stains were applied.

Further evaluation of the specimens included the observation of the structure of the tissue with a Nikon Eclipse 50i microscope. The type of the digital camera used for the documentation of microscopy findings was Nikon Sight ds-L1.