Biomechanics of skin grafts: effect of pattern size, spacing and orientation

Skin graft expansion is the key to the treatment of severe burn injuries requiring skin transplantation. While high expansions have been claimed by a majority of graft manufacturers, the realistic expansions reported to date with skin grafts are much lower. To clarify this discrepancy, we attempted to understand the biomechanics of skin grafts through the study of common graft pattern sizes, spacing, and orientation, and their influence on mesh expansion and induced stress. A novel skin simulant material and additive manufacturing were employed to develop the skin graft models. Tensile testing experiments were conducted to study expansion and overall stresses, and a finite element model (FEM) was used to characterize the local trends. At low strains (i.e., <1), the mesh expansion ratio was reported to be below 1, which increased up to 1.93 at a high strain of 2. The pattern size and spacing were not observed to affect the expansion much (i.e., <10%). With a change in orientation, the expansion decreased across all graft models and strains. High localized induced stresses were reported for high strains, which varied with graft orientation. The novel observations highlight the achievable expansions without overstressing, with standard slit patterning in skin grafts. These findings will not only help achieve better mesh expansion outcomes in burn surgeries but also guide the development of novel graft patterns for enhanced expansion in the future.