Non-invasive prediction of skin flap shrinkage: A new concept based on animal experimental evidence

Lim, Kok Hwa; Jeyapalina, Sujee; Ho, H.N.; Chew, Chee-Meng; Chen, P.C.Y.; Teo, Chee Leong; Lim, Brian Y.

doi:10.1016/j.jbiomech.2008.03.012

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…The goal was to identify an elastic constitutive equation that can characterize the skin of the scalp and lower leg during each expansion. However, the parameters of the constitutive equation for each region and expansion are not the same, since the collagen fibers of the stretched skin offer more resistance to expansion over the course of the expansion, as observed in [Lim et al 2008].…”

Section: Numerical Analysismentioning

confidence: 99%

“…The most frequently used techniques are indentation and suction of the skin, and some studies have used Young's modulus to establish the stiffness of the skin [Diridollou et al 2000;Pailler-Mattei et al 2009]. In addition, more recent studies have characterized the nonlinear mechanical behavior of human skin under indentation and suction processes [Hendriks et al 2003;Delalleau et al 2006;Geerligs et al 2011;Lim et al 2008].…”

Section: Introductionmentioning

confidence: 99%

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Characterization of human skin through skin expansion

Pamplona

Carvalho

2012

J. Mech. Mater. Struct.

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This study characterized human skin of the lower leg and scalp during the surgical process of skin expansion. To our knowledge, this is the first study in this field, which has provided results that considerably improve our understanding of human skin. A detailed in vivo analysis was carried out involving four different patients that allowed for observation during the relaxation process. A comparison between the in vivo and numerical finite elements model of the expansion was used to identify the material elastic parameters of the skin. After a comprehensive search of constitutive equations for describing skin, Delfino's constitutive equation was chosen to model the in vivo results. We considered skin as an isotropic, homogeneous, hyperelastic, and incompressible membrane. The parameters of Delfino's exponential function obtained for the first skin stretch process were a = 40.0 KPa and b = 20.2. As skin is extended, such as with expanders or in other procedures that tighten the skin, the collagen fibers are also extended and cause stiffening in the skin, which results in it being more and more resistant to expansion or further stretching. We observed this phenomenon as an increase in parameters a and b as subsequent expansions continued. The results of this study allow for the quantification of stiffening of the skin after several stretches, when the skin becomes more and more inelastic. These results are very encouraging and provide insight into our understanding of the behavior of stretched skin and maybe other biological tissues, as swollen artery and veins.A list of symbols can be found on page 653.

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Section: Numerical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characterization of human skin through skin expansion

Pamplona

Carvalho

2012

J. Mech. Mater. Struct.

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“…5 For example, it has been shown how at the end of the procedure, when the flap is harvested, skin typically retracts implying that not all the deformation is irreversible skin growth; skin expansion also induces some reversible elastic deformation. 34 Other groups have tested the mechanical properties of expanded skin at different time points and have showed that expanding skin in vivo leads to the deposition of new tissue which retains the same mechanical properties as the original, unexpanded skin. 6,68 More closely aligned with clinical outcomes, the quantification of net area gain has shown differences between different expander geometries and timing of inflations.…”

Section: Introductionmentioning

confidence: 99%

The Incompatibility of Living Systems: Characterizing Growth-Induced Incompatibilities in Expanded Skin

et al. 2015

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Skin expansion is a common surgical technique to correct large cutaneous defects. Selecting a successful expansion protocol is solely based on the experience and personal preference of the operating surgeon. Skin expansion could be improved by predictive computational simulations. Towards this goal, we model skin expansion using the continuum framework of finite growth. This approach crucially relies on the concept of incompatible configurations. However, aside from the classical opening angle experiment, our current understanding of growth-induced incompatibilities remains rather vague. Here we visualize and characterize incompatibilities in living systems using skin expansion in a porcine model: We implanted and inflated two expanders, crescent, and spherical, and filled them to 225 cc throughout a period of 21 days. To quantify the residual strains developed during this period, we excised the expanded skin patches and subdivided them into smaller pieces. Skin growth averaged 1.17 times the original area for the spherical and 1.10 for the crescent expander, and displayed significant regional variations. When subdivided into smaller pieces, the grown skin patches retracted heterogeneously and confirmed the existence of incompatibilities. Understanding skin growth through mechanical stretch will allow surgeons to improve— and ultimately personalize—preoperative treatment planning in plastic and reconstructive surgery.

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“…Flexion or extension of the underlying joints apply further positive (stretching) or negative (relaxing) forces to the dermal tissues. When negative forces exceed the supporting capability of the dermal tissues, skin wrinkles form (Lim et al., 2008; Silver et al., 2003). Our study showed that different zones and regions of the dorsal skin of the wrist and hand have different levels of extensibility, increasing from distal to proximal and from ulnar to radial.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal extensibility of the dorsal skin of the hand

Bağır

Eskandari

2019

J Hand Surg Eur Vol

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We aimed to assess the longitudinal extensibility of the dorsal skin of the hand. Measurements were done in five hand positions on the dominant hands of 64 volunteers. The positions were full flexion of the wrist and fingers, drop hand, flat hand, hand with opposed thumb and full extension. Dorsal marks were made on the skin in full flexion. The marks were transferred to transparent parchment paper strips with the hand in the different positions. Skin extensibility was assessed by the change in the distance between two skin marks from the full extension position to the other positions. Opposition required the highest degree of skin extensibility in the dorsal radial region, followed orderly by ulnar and central regions. Generally, the extensibility increased from distal to proximal and from ulnar to radial. These findings may be useful in the management of dorsal hand soft tissue defects.

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Non-invasive prediction of skin flap shrinkage: A new concept based on animal experimental evidence

Cited by 8 publications

References 18 publications

Characterization of human skin through skin expansion

Characterization of human skin through skin expansion

The Incompatibility of Living Systems: Characterizing Growth-Induced Incompatibilities in Expanded Skin

Longitudinal extensibility of the dorsal skin of the hand

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