Exploring uncertainty in hyper-viscoelastic properties of scalp skin through patient-specific finite element models for reconstructive surgery

Understanding skin responses to external forces is crucial for post-cutaneous flap wound healing. However, the in vivo viscoelastic behavior of scalp skin remains poorly understood. Personalized virtual surgery simulations offer a way to study tissue responses in relevant 3D geometries. Yet, anticipating wound risk remains challenging due to limited data on skin viscoelasticity, which hinders our ability to determine the interplay between wound size and stress levels. To bridge this gap, we reexamine three clinical cases involving scalp reconstruction using patient-specific geometric models and employ uncertainty quantification through a Monte Carlo simulation approach to study the effect of skin viscoelasticity on the final stress levels from reconstructive surgery. Utilizing the generalized Maxwell model via the Prony series, we can parameterize and efficiently sample a realistic range of viscoelastic response and thus shed light on the influence of viscoelastic material uncertainty in surgical scenarios. Our analysis identifies regions at risk of wound complications based on reported threshold stress values from the literature and highlights the significance of focusing on long-term responses rather than short-term ones.