A Comprehensive Review of Computational and Experimental Studies on Skin Mechanics and Meshing: Discrepancies, Challenges, and Optimization Strategies.

Skin meshing is widely used to treat extensive burn injuries due to its cost-efficiency and capacity to cover large wound areas. As biomimetics focuses on deriving engineering principles from biological structure-function relationships, this review examines how to optimize skin-meshing expansion and investigates factors contributing to reported discrepancies between clinical and manufacturer-reported expansion ratios. The biology and mechanical behavior of skin layer are discussed, emphasizing the anisotropic properties govern by collagen fiber orientation associated with Langer's lines in the dermis. The epidermis and hypodermis show isotropic properties and therefore have minimal influence on load-bearing capacity. Surveying 111 studies, the review evaluates which constitutive equations employed for skin modelling is suitable to replicate mechanical behavior of skin meshing undergoing large expansion. Elastic models fail to capture large expansion ratios. Viscoelastic and QLV are excluded due to negligible sliding of collagen fibers at slow strain rates and limited importance of hysteresis. Consequently, hyperelastic models are recognized as more suitable for predicting large deformations. Among these, the structural GOH model, which represents fiber dispersion through a probability-density function, demonstrates strong agreement with experimental data using few parameters; its damage extensions improve prediction of mesh tearing. Additionally, emerging auxetic mesh geometries with negative Poisson ratios are examined, highlighting their potential to achieve greater expansion when combined with suitable structural anisotropic constitutive models, e.g., GOH.