Scalp simulation – A novel approach to site-specific biomechanical modeling of the skin

Pittar, Nicholas; Winter, Taylor; Falland-Cheung, Lisa; Tong, D. M.; Waddell, John Neil

doi:10.1016/j.jmbbm.2017.09.024

Cited by 14 publications

(8 citation statements)

References 43 publications

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“…During full-text review, study citations were examined, and 20 articles were identified and included. A total of 186 papers 29–31,33–215 were included for data extraction.…”

Section: Resultsmentioning

confidence: 99%

“…We believe this is because the biomechanical properties of tissues are not considered when choosing synthetic materials for trainers. Four studies from this review assessed how synthetic materials compare with human tissues 61,153,168,206 . Three of the studies determined that synthetic skin 168 and bone 61,206 did not accurately represent the biomechanical properties of cadaveric 61,206 or live 168 tissues.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

Kriener,

Whiting,

Storr

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research. Introduction: Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogenous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests. Inclusion criteria: Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico, or synthetic materials were excluded from this review. Methods: This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats. Results: Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 different countries, with the majority of the studies coming from the United States. Human tissues samples were ex vivo, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young’s (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values. Conclusions: This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and/or experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards. Review Registration: Open Science Framework osf.io/fgb34

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“…During full-text review, study citations were examined, and 20 articles were identified and included. A total of 186 papers 29–31,33–215 were included for data extraction.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

Kriener,

Whiting,

Storr

et al. 2023

JBI Evidence Synthesis

View full text Add to dashboard Cite

show abstract

“…The influence of pre-stress is also ignored in this study, but it could be an important factor [61]. Finally, in vivo measurem in the clinical setting [62,63,64]. Thus, while we are confident that the results shown here provide valuable insight into flap biomechanics and should be used to improve flap design, the models still need to be further validated with clinical data, which is the central task of our ongoing work.…”

Section: Limitations and Ongoing Workmentioning

confidence: 93%

Improving Reconstructive Surgery Design using Gaussian Process Surrogates to Capture Material Behavior Uncertainty

Stowers¹,

Lee²,

Bilionis³

et al. 2020

Preprint

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To produce functional, aesthetically natural results, reconstructive surgeries must be planned to minimize stress because excessive loads near wounds have been shown to produce pathological scarring and other complications [1]. Presently, stress cannot easily be measured in the operating room. Consequently, surgeons rely on intuition and experience [2,3]. Predictive computational tools are ideal candidates for surgery planning. Finite element (FE) simulations have shown promise in predicting stress fields on large skin patches and complex cases, helping to identify potential regions of complication. Unfortunately, these simulations are computationally expensive and deterministic [4]. However, running a few, well selected FE simulations allows us to create Gaussian process (GP) surrogate models of local cutaneous flaps that are computationally efficient and able to predict stress and strain for arbitrary material parameters. Here, we create GP surrogates for the advancement, rotation, and transposition flaps. We then use the predictive capability of these surrogates to perform a global sensitivity analysis, ultimately showing that fiber direction has the most significant impact on strain field variations. We then perform an optimization to determine the optimal fiber direction for each flap for three different objectives driven by clinical guidelines [5,6] . While material properties are not controlled by the surgeon and are actually a source of uncertainty, the surgeon can in fact control the orientation of the flap with respect to the skin's relaxed tension lines, which are associated with the underlying fiber orientation [7]. Therefore, fiber direction is the only material parameter that can be optimized clinically. The optimization task relies on the efficiency of the GP surrogates to calculate the expected cost of different strategies when the uncertainty of other material parameters is included. We propose optimal flap orientations for the three cost functions and that can help in reducing stress resulting from the surgery and ultimately reduce complications associated with excessive mechanical loading near wounds.

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“…Of the various scar assessment tools currently available, the durometer is a well‐validated instrument 4 . Durometers are handheld devices used to determine skin pliability by measuring the skin's compliance to a compressible pin within the device with readouts in standardized durometer units 5 . The objective of this study is to record and evaluate the process of early scar maturation during surgical wound healing following implantation of cardiac devices using objective and subjective scale assessments.…”

Section: Introductionmentioning

confidence: 99%

Baseline incision characteristics and early scar maturation indices following cardiac device implantation

Mehta

Morgaenko

Haines

et al. 2021

Journal of Arrhythmia

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Aims Dermatologic evaluation for cardiac implantable electronic devices (CIEDs) has not been established. We sought to ascertain baseline wound scar features using quantifiable surgical tools and scar scales on post‐CIED patients. Methods A single‐center, prospective observational case‐control study was performed where 92 study subjects (40 healthy volunteers and 52 post‐CIED patients) completed the study. Durometer was used to quantify skin pliability before CIED placement, postprocedure, and 2 weeks postprocedure. Higher durometer readings signified reduced skin pliability. Durometer readings were compared to the patients’ contralateral pectoral skin and to a healthy volunteer's cohort skin within the prepectoral region. Patient wounds were observed and graded using the Patient Observer Scar Assessment Scale (POSAS) and Manchester Scar Scale (MSS). Results Baseline pectoral skin pliability readings were similar in healthy volunteers and CIED patient population. In comparison to preprocedural measurements, surgical site skin pliability decreased in postprocedural and 2 weeks follow‐up time points (P‐value .004 and <.001, respectively). The increases in durometer readings were higher in the older population (age >75 over time, P = .008). POSAS evaluations showed on average a thin painless hypopigmented scar with moderate stiffness. MSS scar evaluation showed a palpable scar with slight contour differences and color mismatch and appeared to be slightly better in the African American population. There was no difference in scar characteristics with preprocedural use of antiplatelet or anticoagulation or staple closure or gender. Conclusions Serial measurements could be of value for development of new strategies for cosmesis and improved wound healing.

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Scalp simulation – A novel approach to site-specific biomechanical modeling of the skin

Cited by 14 publications

References 43 publications

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

Improving Reconstructive Surgery Design using Gaussian Process Surrogates to Capture Material Behavior Uncertainty

Baseline incision characteristics and early scar maturation indices following cardiac device implantation

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