Experimental and numerical analysis of a V-Y advancement flap on human skinex vivo

A hyperelastic model to capture the mechanical behaviour and histological aspects of the soft tissues

It is well established that the soft connective tissues show a nonlinear elastic response that comes from their microstructural arrangement. Tissues' microstructure alters with various physiological conditions and may affect their mechanical responses. Therefore, the accurate prediction of tissue's mechanical response is crucial for clinical diagnosis and treatments. Thus, a physically motivated and mathematically simplified model is required for the accurate prediction of tissues' mechanical and structural responses. This study explored the 'Exp-Ln' hyperelastic model (Khajehsaeid et al., 2013) to capture soft tissues' mechanical and histological behaviour. In this work, uniaxial tensile test data for the belly and back pig skin were extracted from the experiments performed in our laboratory, whereas uniaxial test data for other soft tissues (human skin, tendon, ligament, and aorta) were extracted from the literature. The 'Exp-Ln; and other hyperelastic models (e.g. Money Rivlin, Ogden, Yeoh, and Gent models) were fitted with these experimental data, and obtained results were compared between the models. These results show that the 'Exp-Ln' model could capture the mechanical behaviour of soft tissues more accurately than other hyperelastic models. This model was also found numerically stable for all modes and ranges of deformation. This study also investigated the link between 'Exp-Ln' material parameters and tissue's histological parameters. The histological parameters such as collagen content, fibre free length, crosslink density, and collagen arrangement were measured using staining and ATR-FTIR techniques. The material parameters were found statistically correlated with the histological parameters. Further, 'Exp-Ln' model was implemented in ABAQUS through the VUMAT subroutine, where the mechanical behaviour of various soft tissues was simulated for different modes of deformation. The finite element analysis results obtained using the 'Exp-Ln' model agreed with the experiments and were more accurate than other hyperelastic models. Overall, these results demonstrate the capability of 'Exp-Ln' model to predict the mechanical and structural responses of the soft tissues.

The effects of cyclic tensile and stress-relaxation tests on porcine skin

When a living tissue is subjected to cyclic stretching, the stress-strain curves show a shift down with the increase in the number of cycles until stabilization. This phenomenon is referred to in the literature as a preconditioning and is performed to obtain repeatable and predictable measurements. Preconditioning has been routinely performed in skin tissue tests; however, its effects on the mechanical properties of the material such as viscoelastic response, tangent modulus, sensitivity to strain rate, the stress relaxation rate, etc….remain unclear. In addition, various physical interpretations of this phenomenon have been proposed and there is no general agreement on its origin at the microscopic or mesoscopic scales. The purpose of this study was to investigate the effect of the cyclical stretching and the stress-relaxation tests on the mechanical properties of the porcine skin. Cyclic uniaxial tensile tests at large and constant strain were performed on different skin samples. The change in the reaction force, and skin's tangent modulus as a function of the number of cycles, as well as the strain rate effect on the mechanical behavior of skin samples after cycling were investigated. Stress-relaxation tests were also performed on skin samples. The change in the reaction force as a function of relaxation time and the strain rate effect on the mechanical behavior of skin samples after the stress-relaxation were investigated. The mechanical behavior of a skin sample under stress-relaxation test was modeled using a combination of hyperelasticity and viscoelasticity. Overall, the results showed that the mechanical behavior of the skin was strongly influenced by cycling and stress relaxation tests. Indeed, it was observed that the skin's resistance decreased by about half for two hours of cycling; the tangent modulus degraded by nearly 30% and skin samples became insensitive to the strain rates and accumulated progressively an inelastic deformation over time during cycling. Finally, the hysteresis loops became very narrow at the end of cycling and after relaxation process.

Numerical analysis of the V-Y shaped advancement flap

The V-Y advancement flap is a usual technique for the closure of skin defects. A triangular flap is incised adjacent to a skin defect of rectangular shape. As the flap is advanced to close the initial defect, two smaller defects in the shape of a parallelogram are formed with respect to a reflection symmetry. The height of the defects depends on the apex angle of the flap and the closure efforts are related to the defects height. Andrades et al. 2005 have performed a geometrical analysis of the V-Y flap technique in order to reach a compromise between the flap size and the defects width. However, the geometrical approach does not consider the mechanical properties of the skin. The present analysis based on the finite element method is proposed as a complement to the geometrical one. This analysis aims to highlight the major role of the skin elasticity for a full analysis of the V-Y advancement flap. Furthermore, the study of this technique shows that closing at the flap apex seems mechanically the most interesting step. Thus different strategies of defect closure at the flap apex stemming from surgeon's know-how have been tested by numerical simulations.