Growing skin: Tissue expansion in pediatric forehead reconstruction

Alexander M. Zöllner, Adrian Buganza Tepole, Arun K. Gosain, Ellen Kuhl*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Tissue expansion is a common surgical procedure to grow extra skin through controlled mechanical overstretch. 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 geometricmodel, 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 newavenues in reconstructive surgery and enhance treatment for patients with birth defects, burn injuries, or breast tumor removal.

Original languageEnglish (US)
Pages (from-to)855-867
Number of pages13
JournalBiomechanics and Modeling in Mechanobiology
Volume11
Issue number6
DOIs
StatePublished - Jul 2012

Keywords

  • Finite element analysis
  • Growth
  • Reconstructive surgery
  • Residual stress
  • Skin
  • Tissue expansion

ASJC Scopus subject areas

  • Biotechnology
  • Modeling and Simulation
  • Mechanical Engineering

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