Biomechanical modeling of novel high expansion auxetic skin grafts

Over 20 million burn injuries are reported every year, with severe cases requiring skin grafting. Traditionally, split thickness skin grafts are prepared by excising a small portion of healthy skin and its incision patterning using a suitable meshing device, which allows the graft to be expanded beyond its capacity. To date, the maximum expansion achieved through skin grafting has been reported to be less than three times, which is not sufficient for covering large burn sites with limited donor site skin. In this work, we have attempted to study skin graft expansion potential with novel auxetic patterns, which are known to exhibit negative Poisson's effect. Two-layer skin graft models were developed using eight different auxetic incision patterns, and subjected to uniaxial and biaxial tensile strains. The Poisson's ratio, meshing ratio, and induced stresses were characterized for all graft models. The numerical results indicated expansion potentials greater than that of traditional skin grafts across all loads. Extremely high expansions (i.e., >30 times) were estimated for the I-Shaped Re-entrant and Rotating Triangles shaped auxetic models without rupture. Such pioneering findings are anticipated to initiate ground-breaking advances towards skin graft research and improved outcomes in burn surgeries.