Biomedical implications from a morphoelastic continuum model for the simulation of contracture formation in skin grafts that cover excised burns

Daniël C. Koppenol, Fred J. Vermolen

Research output: Contribution to journalArticleScientificpeer-review

11 Citations (Scopus)
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Abstract

A continuum hypothesis-based model is developed for the simulation of the (long term) contraction of skin grafts that cover excised burns in order to obtain suggestions regarding the ideal length of splinting therapy and when to start with this therapy such that the therapy is effective optimally. Tissue is modeled as an isotropic, heterogeneous, morphoelastic solid. With respect to the constituents of the tissue, we selected the following constituents as primary model components: fibroblasts, myofibroblasts, collagen molecules, and a generic signaling molecule. Good agreement is demonstrated with respect to the evolution over time of the surface area of unmeshed skin grafts that cover excised burns between outcomes of computer simulations obtained in this study and scar assessment data gathered previously in a clinical study. Based on the simulation results, we suggest that the optimal point in time to start with splinting therapy is directly after placement of the skin graft on its recipient bed. Furthermore, we suggest that it is desirable to continue with splinting therapy until the concentration of the signaling molecules in the grafted area has become negligible such that the formation of contractures can be prevented. We conclude this study with a presentation of some alternative ideas on how to diminish the degree of contracture formation that are not based on a mechanical intervention, and a discussion about how the presented model can be adjusted.

Original languageEnglish
Pages (from-to)1187-1206
Number of pages20
JournalBiomechanics and Modeling in Mechanobiology
Volume16
Issue number4
DOIs
Publication statusPublished - 8 Feb 2017

Keywords

  • Biomechanics
  • Burns
  • Contracture formation
  • Element resolution refinement / recoarsement
  • Flux-corrected transport (FCT) limiter
  • Morphoelasticity
  • Moving-grid finite-element method
  • Skin graft contraction
  • Splinting therapy
  • Tissue remodeling

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