Mechanical Strain of the Trilobed Transposition Flap in Artificial Skin Models: Pivotal Restraint Decreases With Decreasing Rotational Angles.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
pubmed:
1
7
2020
medline:
17
4
2021
entrez:
1
7
2020
Statut:
ppublish
Résumé
In transposition flaps, thicker tissue and higher degrees of rotation are associated with increased pivotal restraint; however, limited experimental data exist quantifying the degree to which these affect flap biomechanics. The use of artificial skin models in conjunction with digital image correlation technology allows for investigation into biomechanical properties of skin flaps. To quantify the effects of tissue thickness and rotational angles on pivotal restraint within transposition flaps using artificial skin models. Ninety degree bilobed and trilobed flaps were used to close defects in artificial skin models of increasing thicknesses. Digital image correlation was used to quantify strain. Quantitative and qualitative differences in strain were assessed in increasing flap thicknesses and between flap designs. Increasing flap thickness was associated with decreasing strain. In the bilobed flap, increasing thickness was associated with displacement of the flap pivot point away from the distal flap edge. Comparatively, lower angles of rotation in the trilobed flap were not associated with migration of the flap pivot point. Increased pivotal restraint observed in higher degrees of rotation is due to migration of the flap pivot point. This model supports the common practice of decreasing flap angles to compensate for pivotal restraint.
Sections du résumé
BACKGROUND
In transposition flaps, thicker tissue and higher degrees of rotation are associated with increased pivotal restraint; however, limited experimental data exist quantifying the degree to which these affect flap biomechanics. The use of artificial skin models in conjunction with digital image correlation technology allows for investigation into biomechanical properties of skin flaps.
OBJECTIVE
To quantify the effects of tissue thickness and rotational angles on pivotal restraint within transposition flaps using artificial skin models.
METHODS
Ninety degree bilobed and trilobed flaps were used to close defects in artificial skin models of increasing thicknesses. Digital image correlation was used to quantify strain. Quantitative and qualitative differences in strain were assessed in increasing flap thicknesses and between flap designs.
RESULTS
Increasing flap thickness was associated with decreasing strain. In the bilobed flap, increasing thickness was associated with displacement of the flap pivot point away from the distal flap edge. Comparatively, lower angles of rotation in the trilobed flap were not associated with migration of the flap pivot point.
CONCLUSION
Increased pivotal restraint observed in higher degrees of rotation is due to migration of the flap pivot point. This model supports the common practice of decreasing flap angles to compensate for pivotal restraint.
Identifiants
pubmed: 32604227
pii: 00042728-202101000-00009
doi: 10.1097/DSS.0000000000002522
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-33Informations de copyright
Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Goldman G, LM D, CB Y. Facial Flap Surgery. McGraw-Hill; 2013.
Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol 1987;13:1348–53.
Albertini JG, Hansen JP. Trilobed flap reconstruction for distal nasal skin defects. Dermatol Surg 2010;36:1726–35.
Miller CJ. Design principles for transposition flaps: the rhombic (single-lobed), bilobed, and trilobed flaps. Dermatol Surg 2014;40(Suppl 9):S43–52.
Zhang D, Arola DD. Applications of digital image correlation to biological tissues. J Biomed Opt 2004;9:691–9.
Gruber PJ, Armbrecht E, Pelster MW, Maher IA. Mechanical strain of the nasal bilobed transposition flap-graduated changes in skin thickness superiorly displace the location of the pivot point. Dermatol Surg 2019;45:1136–40.
Dabrowska AK, Rotaru GM, Derler S, Spano F, et al. Materials used to simulate physical properties of human skin. Skin Res Technol 2016;22:3–14.
Cook JL. Reconstructive utility of the bilobed flap: lessons from flap successes and failures. Dermatol Surg 2005;31:1024–33.
Cho M, Kim DW. Modification of the Zitelli bilobed flap: a comparison of flap dynamics in human cadavers. Arch Facial Plast Surg 2006;8:404–9.
Ruvolo EC Jr, Stamatas GN, Kollias N. Skin viscoelasticity displays site- and age-dependent angular anisotropy. Skin Pharmacol Physiol 2007;20:313–21.