Taeksang Lee1, Sergey Y Turin2, Casey Stowers1, Arun K Gosain2,3, Adrian Buganza Tepole1,4. 1. Department of Mechanical Engineering, 311308Purdue University, West Lafayette, IN, USA. 2. Department of Plastic Surgery, Feinberg School of Medicine, Chicago, IL, USA. 3. Department of Plastic Surgery, 2429Lurie Children's Hospital, Chicago, IL, USA. 4. Weldon School of Biomedical Engineering, 311308Purdue University, West Lafayette, IN, USA.
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.
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.
Authors: Taeksang Lee; Elbert E Vaca; Joanna K Ledwon; Hanah Bae; Jolanta M Topczewska; Sergey Y Turin; Ellen Kuhl; Arun K Gosain; Adrian Buganza Tepole Journal: J Mech Behav Biomed Mater Date: 2018-03-29
Authors: L Camison; M Bykowski; W W Lee; J C Carlson; J Roosenboom; J A Goldstein; J E Losee; S M Weinberg Journal: Int J Oral Maxillofac Surg Date: 2017-09-14 Impact factor: 2.789
Authors: Josemaria Paterno; Ivan N Vial; Victor W Wong; Kristine C Rustad; Michael Sorkin; Yubin Shi; Kirit A Bhatt; Hariharan Thangarajah; Jason P Glotzbach; Geoffrey C Gurtner Journal: Wound Repair Regen Date: 2010-12-06 Impact factor: 3.617
Authors: Bettina Müller; Julia Elrod; Marco Pensalfini; Raoul Hopf; Oliver Distler; Clemens Schiestl; Edoardo Mazza Journal: PLoS One Date: 2018-08-08 Impact factor: 3.240