Application of finite element modeling to optimize flap design with tissue expansion

Adrian Buganza-Tepole, Jordan Steinberg, Ellen Kuhl, Arun K. Gosain

Research output: Contribution to journalArticle

Abstract

Background: Tissue expansion is a widely used technique to create skin flaps for the correction of sizable defects in reconstructive plastic surgery. Major complications following the inset of expanded flaps include breakdown and uncontrolled scarring secondary to excessive tissue tension. Although it is recognized that mechanical forces may significantly impact the success of defect repair with tissue expansion, a mechanical analysis of tissue stresses has not previously been attempted. Such analyses have the potential to optimize flap design preoperatively. Methods: The authors establish computer-aided design as a tool with which to explore stress profiles for two commonly used flap designs, the direct advancement flap and the double back-cut flap. The authors advanced both flaps parallel and perpendicular to the relaxed skin tension lines to quantify the impact of tissue anisotropy on stress distribution profiles. Results: Stress profiles were highly sensitive to flap design and orientation of relaxed skin tension lines, with stress minimized when flaps were advanced perpendicular to relaxed skin tension lines. Maximum stresses in advancement flaps occurred at the distal end of the flap, followed by the base. The double back-cut design increased stress at the lateral edges of the flap. Conclusions: The authors conclude that finite element modeling may be used to effectively predict areas of increased flap tension. Performed preoperatively, such modeling can allow for the optimization of flap design and a potential reduction in complications such as flap dehiscence and hypertrophic scarring.

Original languageEnglish (US)
Pages (from-to)785-792
Number of pages8
JournalPlastic and Reconstructive Surgery
Volume134
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Tissue Expansion
Skin
Cicatrix
Reconstructive Surgical Procedures
Computer-Aided Design
Anisotropy
Plastic Surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Application of finite element modeling to optimize flap design with tissue expansion. / Buganza-Tepole, Adrian; Steinberg, Jordan; Kuhl, Ellen; Gosain, Arun K.

In: Plastic and Reconstructive Surgery, Vol. 134, No. 4, 01.01.2014, p. 785-792.

Research output: Contribution to journalArticle

Buganza-Tepole, Adrian ; Steinberg, Jordan ; Kuhl, Ellen ; Gosain, Arun K. / Application of finite element modeling to optimize flap design with tissue expansion. In: Plastic and Reconstructive Surgery. 2014 ; Vol. 134, No. 4. pp. 785-792.
@article{515eceeba9f94832af7047ee8066bbb4,
title = "Application of finite element modeling to optimize flap design with tissue expansion",
abstract = "Background: Tissue expansion is a widely used technique to create skin flaps for the correction of sizable defects in reconstructive plastic surgery. Major complications following the inset of expanded flaps include breakdown and uncontrolled scarring secondary to excessive tissue tension. Although it is recognized that mechanical forces may significantly impact the success of defect repair with tissue expansion, a mechanical analysis of tissue stresses has not previously been attempted. Such analyses have the potential to optimize flap design preoperatively. Methods: The authors establish computer-aided design as a tool with which to explore stress profiles for two commonly used flap designs, the direct advancement flap and the double back-cut flap. The authors advanced both flaps parallel and perpendicular to the relaxed skin tension lines to quantify the impact of tissue anisotropy on stress distribution profiles. Results: Stress profiles were highly sensitive to flap design and orientation of relaxed skin tension lines, with stress minimized when flaps were advanced perpendicular to relaxed skin tension lines. Maximum stresses in advancement flaps occurred at the distal end of the flap, followed by the base. The double back-cut design increased stress at the lateral edges of the flap. Conclusions: The authors conclude that finite element modeling may be used to effectively predict areas of increased flap tension. Performed preoperatively, such modeling can allow for the optimization of flap design and a potential reduction in complications such as flap dehiscence and hypertrophic scarring.",
author = "Adrian Buganza-Tepole and Jordan Steinberg and Ellen Kuhl and Gosain, {Arun K.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/PRS.0000000000000553",
language = "English (US)",
volume = "134",
pages = "785--792",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Application of finite element modeling to optimize flap design with tissue expansion

AU - Buganza-Tepole, Adrian

AU - Steinberg, Jordan

AU - Kuhl, Ellen

AU - Gosain, Arun K.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Tissue expansion is a widely used technique to create skin flaps for the correction of sizable defects in reconstructive plastic surgery. Major complications following the inset of expanded flaps include breakdown and uncontrolled scarring secondary to excessive tissue tension. Although it is recognized that mechanical forces may significantly impact the success of defect repair with tissue expansion, a mechanical analysis of tissue stresses has not previously been attempted. Such analyses have the potential to optimize flap design preoperatively. Methods: The authors establish computer-aided design as a tool with which to explore stress profiles for two commonly used flap designs, the direct advancement flap and the double back-cut flap. The authors advanced both flaps parallel and perpendicular to the relaxed skin tension lines to quantify the impact of tissue anisotropy on stress distribution profiles. Results: Stress profiles were highly sensitive to flap design and orientation of relaxed skin tension lines, with stress minimized when flaps were advanced perpendicular to relaxed skin tension lines. Maximum stresses in advancement flaps occurred at the distal end of the flap, followed by the base. The double back-cut design increased stress at the lateral edges of the flap. Conclusions: The authors conclude that finite element modeling may be used to effectively predict areas of increased flap tension. Performed preoperatively, such modeling can allow for the optimization of flap design and a potential reduction in complications such as flap dehiscence and hypertrophic scarring.

AB - Background: Tissue expansion is a widely used technique to create skin flaps for the correction of sizable defects in reconstructive plastic surgery. Major complications following the inset of expanded flaps include breakdown and uncontrolled scarring secondary to excessive tissue tension. Although it is recognized that mechanical forces may significantly impact the success of defect repair with tissue expansion, a mechanical analysis of tissue stresses has not previously been attempted. Such analyses have the potential to optimize flap design preoperatively. Methods: The authors establish computer-aided design as a tool with which to explore stress profiles for two commonly used flap designs, the direct advancement flap and the double back-cut flap. The authors advanced both flaps parallel and perpendicular to the relaxed skin tension lines to quantify the impact of tissue anisotropy on stress distribution profiles. Results: Stress profiles were highly sensitive to flap design and orientation of relaxed skin tension lines, with stress minimized when flaps were advanced perpendicular to relaxed skin tension lines. Maximum stresses in advancement flaps occurred at the distal end of the flap, followed by the base. The double back-cut design increased stress at the lateral edges of the flap. Conclusions: The authors conclude that finite element modeling may be used to effectively predict areas of increased flap tension. Performed preoperatively, such modeling can allow for the optimization of flap design and a potential reduction in complications such as flap dehiscence and hypertrophic scarring.

UR - http://www.scopus.com/inward/record.url?scp=84905661160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905661160&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000000553

DO - 10.1097/PRS.0000000000000553

M3 - Article

C2 - 24945952

AN - SCOPUS:84905661160

VL - 134

SP - 785

EP - 792

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 4

ER -