Abstract
This paper details the study of biodynamic excisional skin tension lines on the scalp and the development of a new flap technique for closure of scalp wounds. Recently, a study by this author, on pigskin, replicated whorls by placing tissue under rapid stretch using saline tissue expanders, by recreating rapid dermo-epidermal shear of skin – thereby concluding that the golden spiral pattern is nature’s own pattern for rapid expansion. Given the relationship between tissue expansion and stretch has been shown to cause deformation gradients that have both elastic and growth factors, the author set out to test the hypothesis that a golden spiral pattern therefore would be more efficient at closing wounds under less tension when compared with standard semicircular rotational flap patterns. The author conducted a series of experiments, both on pigskin (to first confirm the hypothesis, using a recently developed computerized tensiometer) and later a clinical study. This paper presents a new random pivotal flap technique for skin closures on the head and neck: the golden spiral flap. Biomechanics, planning, and advantages of this new flap are described in this paper.
Highlights
Achieving tension-free, primary wound closure is the goal in any reconstructive surgical procedure, and to this end, surgeons have tried undermining wounds or imbrication to preserve dermal perfusion while still reducing tension at the wound edge [1]
The study began on skin of the scalp for two reasons – it is relatively untethered to underlying tissues, and scalp whorls that appear to confirm to nature’s golden spiral pattern are unique to human beings – and were thought to occur due to the rapid expansion of the brain during intrauterine life
While golden spiral patterns are evident in nature, there were considered mysterious until a recent study on skin has suggested that this may be nature’s pattern for rapid expansion [5]
Summary
Achieving tension-free, primary wound closure is the goal in any reconstructive surgical procedure, and to this end, surgeons have tried undermining wounds or imbrication to preserve dermal perfusion while still reducing tension at the wound edge [1]. While golden spiral patterns are evident in nature, there were considered mysterious until a recent study on skin has suggested that this may be nature’s pattern for rapid expansion [5]. It has been established that biomechanically, skin behaves more like an elastic solid – a shell draped on a continuum foundation [6] This continuum mechanics approach has show to be of great use in understanding skin stretch, skin tension, and tissue expansion, especially on sites such as the scalp [7] the golden spiral pattern has previously been shown to be a pattern for rapid expansion of organic tissues [5] – and recent biomechanical studies on the scalp and the resultant mechanical theories all point to a continuum framework for finite growth [8, 9]. Studies suggest that, especially on the scalp, expansion and tension are interrelated, and the relationship between this stretch and expansion works like this: when skin is deformed either due to scalp expansion or stretch (as in the case of pivotal flaps), the deformation gradient has an elastic and a growth part [10]
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