Tissue expansion is a common surgical procedure to grow extra skin
through controlled mechanical over-stretch. It creates skin that matches the
color, texture, and thickness of the surrounding tissue, while minimizing scars
and risk of rejection. Despite intense research in tissue expansion and skin
growth, there is a clear knowledge gap between heuristic observation and
mechanistic understanding of the key phenomena that drive the growth process.
Here, we show that a continuum mechanics approach, embedded in a custom-designed
finite element model, informed by medical imaging, provides valuable insight
into the biomechanics of skin growth. In particular, we model skin growth using
the concept of an incompatible growth configuration. We characterize its
evolution in time using a second-order growth tensor parameterized in terms of a
scalar-valued internal variable, the in-plane area growth. When stretched beyond
the physiological level, new skin is created, and the in-plane area growth
increases. For the first time, we simulate tissue expansion on a
patient-specific geometric model, and predict stress, strain, and area gain at
three expanded locations in a pediatric skull: in the scalp, in the forehead,
and in the cheek. Our results may help the surgeon to prevent tissue
over-stretch and make informed decisions about expander geometry, size,
placement, and inflation. We anticipate our study to open new avenues in
reconstructive surgery, and enhance treatment for patients with birth defects,
burn injuries, or breast tumor removal.