The Golden Spiral Flap: A New Flap Design that Allows for Closure of Larger Wounds under Reduced Tension – How Studying Nature’s Own Design Led to the Development of a New Surgical Technique?

Abstract

This paper details the study of biodynamic excisional skin tension lines on the scalp and the development of a new flap technique for closure of scalp wounds. Recently, a study by this author, on pigskin, replicated whorls by placing tissue under rapid stretch using saline tissue expanders, by recreating rapid dermo-epidermal shear of skin – thereby concluding that the golden spiral pattern is nature’s own pattern for rapid expansion. Given the relationship between tissue expansion and stretch has been shown to cause deformation gradients that have both elastic and growth factors, the author set out to test the hypothesis that a golden spiral pattern therefore would be more efficient at closing wounds under less tension when compared with standard semicircular rotational flap patterns. The author conducted a series of experiments, both on pigskin (to first confirm the hypothesis, using a recently developed computerized tensiometer) and later a clinical study. This paper presents a new random pivotal flap technique for skin closures on the head and neck: the golden spiral flap. Biomechanics, planning, and advantages of this new flap are described in this paper.

The Use of Zigs and Zags to Reduce Scarring over “Keloid Triangles” during Excisional Surgery: Biomechanics, Review and Recommendations

“…In humans and mammals, wounds heal by fibrotic scar formation, which provides early restoration of tissue integrity, as opposed to the functional regeneration that occurs in lower animals [4]. The continuum mechanics approach has shown to be of great use in understanding skin stretch, skin tension, and tissue expansion, especially on sites close to the bone such as the sternum and areas like the scalp [5]. When skin is stretched during the closure phase of excisional surgery, its expansion and tension are interrelated, and the relationship between this stretch and expansion works like this: the deformation gradient has an elastic and a growth part and therefore it is important to understand the biomechanics of skin tension at different sites and the signals it generates [6].…”