| Popis: |
Breast cancer affects 12.5\% of women over their life time and tissue expansion (TE) is the most common technique for breast reconstruction after mastectomy. However, the rate of complications with TE can be as high as 15\%. Even though the first documented case of TE happened in 1957, there has yet to be a standardized procedure established due to the variations among patients and the TE protocols are currently designed based on surgeon's experience. There are several studies of computational and theoretical framework modeling skin growth in TE but these tools are not used in the clinical setting. This dissertation focuses on bridging the gap between the already existing skin growth modeling efforts and it's potential application in the clinical setting. We started with calibrating a skin growth model based on porcine skin expansions data. We built a predictive finite element model of tissue expansion. Two types of model were tested, isotropic and anisotropic models. Calibration was done in a probabilistic framework, allowing us to capture the inherent biological uncertainty of living tissue. We hypothesized that the skin growth rate was proportional to stretch. Indeed, the Bayesian calibration process confirmed that this conceptual model best explained the data. Although the initial model described the macroscale response, it did not consider any activity on the cellular level. To account for the underlying cellular mechanisms at the microscopic scale, we have established a new system of differential equations that describe the dynamics of key mechanosensing pathways that we observed to be activated in the porcine model. We calibrated the parameters of the new model based on porcine skin data. The refined model is still able to reproduce the observed macroscale changes in tissue growth, but now based on mechanistic knowledge of the cell mechanobiology. Lastly, we demonstrated how our skin growth model can be used in a clinical setting. We created TE simulations matching the protocol used in human patients and compared the results with clinical data with good agreement. Then we established a personalized model built from 3D scans of a patient unique geometry. We verified our model by comparing the skin growth area with the area of the skin harvested in the procedure, again with good agreement. Our work shows that skin growth modeling can be a powerful tool to aid surgeons design TE procedures before they are actually performed. The simulations can help with optimizing the protocol to guarantee the correct amount of skin is growth in the shortest time possible without subjecting the skin to deformations that can compromise the procedure. |
