Personalized Computational Models of Tissue-Rearrangement in the Scalp Predict the Mechanical Stress Signature of Rotation Flaps

Abstract

Objective: To elucidate the mechanics of scalp rotation flaps through 3D imaging and computational modeling. Excessive tension near a wound or sutured region can delay wound healing or trigger complications. Measuring tension in the operating room is challenging, instead, noninvasive methods to improve surgical planning are needed. Design: Multi-view stereo allows creation of 3D patient-specific geometries based on a set of photographs. The patient-specific 3D geometry is imported into a finite element (FE) platform to perform a virtual procedure. The simulation is compared with the clinical outcome. Additional simulations quantify the effect of individual flap parameters on the resulting tension distribution. Participants: Rotation flaps for reconstruction of scalp defects following melanoma resection in 2 cases are presented. Rotation flaps were designed without preoperative FE preparation. Main Outcome Measure: Tension distribution over the operated region. Results: The tension from FE shows peaks at the base and distal ends of the scalp rotation flap. The predicted geometry from the simulation aligns with postoperative photographs. Simulations exploring the flap design parameters show variation in the tension. Lower tensions were achieved when rotation was oriented with respect to skin tension lines (horizontal tissue fibers) and smaller rotation angles. Conclusions: Tension distribution following rotation of scalp flaps can be predicted through personalized FE simulations. Flaps can be designed to reduce tension using FE, which may greatly improve the reliability of scalp reconstruction in craniofacial surgery, critical in complex cases when scalp reconstruction is essential for coverage of hardware, implants, and/or bone graft.

Biomechanical explanation of W-plasty effectiveness using a finite element method approach

“…However, these models are proven to be insufficient when used to describe elastic bodies that exhibit stresses and deformations. Moreover, we are still unable to quantitatively predict skin stress and deformation during wound closure in everyday clinical practice 11 .…”

“…The finite element method has often been used to assist analyzing local flaps in terms of deformation and stress measurements 1 , 11 – 15 . Its main advantage is that it takes into account complex skin properties, such as anisotropy and nonlinearity, which geometric design alone does not 1 .…”

Basic Biomechanics for Craniofacial Surgeons: The Responses of Alloplastic Materials and Living Tissues to Mechanical Forces

“…Solid FEA has novel applications in surgical planning to include analysis of flap transfer 35 and scalp rotation. 36 FEA can assist with prediction in growing soft tissues with calculations made to forecast skin expansion results, brain atrophy, and cortical folding. 37 These applications of FEA provide new insights into the role of growth in the development of tissue defect and residual stresses.…”