Computational modeling of skin: Using stress profiles as predictor for tissue necrosis in reconstructive surgery

Local skin flaps have revolutionized reconstructive surgery. Mechanical loading is critical for flap survival: excessive tissue tension reduces blood supply and induces tissue necrosis. However, skin flaps have never been analyzed mechanically. Here we explore the stress profiles of two common flap designs, direct advancement flaps and double back-cut flaps. Our simulations predict a direct correlation between regions of maximum stress and tissue necrosis. This suggests that elevated stress could serve as predictor for flap failure. Our model is a promising step towards computer-guided reconstructive surgery with the goal to minimize stress, accelerate healing, minimize scarring, and optimize tissue use. (C) 2014 Elsevier Ltd. All rights reserved.