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Troka M, Szepietowska K, Lubowiecka I. Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour. J Mech Behav Biomed Mater 2024; 156:106578. [PMID: 38781775 DOI: 10.1016/j.jmbbm.2024.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.
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Affiliation(s)
- Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
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2
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Karkhaneh Yousefi AA, Pierrat B, Le Ruyet A, Avril S. Patient-specific computational simulations of wound healing following midline laparotomy closure. Biomech Model Mechanobiol 2023; 22:1589-1605. [PMID: 37024600 DOI: 10.1007/s10237-023-01708-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
In the current study, we developed a new computational methodology to simulate wound healing in soft tissues. We assumed that the injured tissue recovers partially its mechanical strength and stiffness by gradually increasing the volume fraction of collagen fibers. Following the principles of the constrained mixture theory, we assumed that new collagen fibers are deposited at homeostatic tension while the already existing tissue undergoes a permanent deformation due to the effects of remodeling. The model was implemented in the finite-element software Abaqus® through a VUMAT subroutine and applied to a complex and realistic case: simulating wound healing following midline laparotomy closure. The incidence of incisional hernia is still quite significant clinically, and our goal was to investigate different conditions hampering the success of these procedures. We simulated wound healing over periods of 6 months on a patient-specific geometry. One of the outcomes of the finite-element simulations was the width of the wound tissue, which was found to be clinically correlated with the development of incisional hernia after midline laparotomy closure. We studied the impact of different suturing modalities and the effects of situations inducing increased intra-abdominal pressure or its intermittent variations such as coughing. Eventually, the results showed that the main risks of developing an incisional hernia mostly depend on the elastic strains reached in the wound tissue after degradation of the suturing wires. Despite the need for clinical validation, these results are promising for establishing a digital twin of wound healing in midline laparotomy incision.
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Affiliation(s)
| | - Baptiste Pierrat
- Mines Saint-Étienne, Université Jean Monnet, INSERM, U1059 SAINBIOSE, 42023, Saint-Étienne, France
| | | | - Stéphane Avril
- Mines Saint-Étienne, Université Jean Monnet, INSERM, U1059 SAINBIOSE, 42023, Saint-Étienne, France.
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3
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He W, Shen F, Xu Z, Pei B, Xie H, Li X. The effect of mesh orientation, defect location and size on the biomechanical compatibility of hernia mesh. Ing Rech Biomed 2023. [DOI: 10.1016/j.irbm.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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4
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Jourdan A, Rapacchi S, Guye M, Bendahan D, Masson C, Bège T. Dynamic-MRI quantification of abdominal wall motion and deformation during breathing and muscular contraction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106667. [PMID: 35231757 DOI: 10.1016/j.cmpb.2022.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/15/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Biomechanical assessment of the abdominal wall represents a major prerequisite for a better understanding of physiological and pathological situations such as hernia, post-delivery recovery, muscle dystrophy or sarcopenia. Such an assessment is challenging and requires muscular deformations quantification which have been very scarcely reported in vivo. In the present study, we intended to characterize abdominal wall deformations in passive and active conditions using dynamic MRI combined to a semiautomatic segmentation procedure. METHODS Dynamic deformations resulting from three complementary exercises i.e. forced breathing, coughing and Valsalva maneuver were mapped in a transversal abdominal plane and so for twenty healthy volunteers. Real-time dynamic MRI series were acquired at a rate of 182 ms per image, then segmented semi-automatically to follow muscles deformation through each exercise. Circumferential and radial strains of each abdominal muscle were computed from the geometrical characteristics' quantification, namely the medial axis length and the thickness. Muscular radial displacement maps were computed using image registration. RESULTS Large variations in circumferential and radial strains were observed for the lateral muscles (LM) but remained low for the rectus abdominis muscles (RA). Contraction phases of each exercise led to LM muscle shortening down to -9.6 ± 5.9% during Valsalva maneuver with a 16.2 ± 9.6% thickness increase. Contraction also led to inward radial displacement of the LM up to 9.9 ± 4.1 mm during coughing. During maximal inhalation, a significant 10.0 ± 6.6% lengthening was quantified for LM while a significant thickness decrease was computed for the whole set of muscles (-14.7 ± 6.6% for LM and -7.3 ± 6.5% for RA). The largest displacement was observed for the medial part of RA (17.9 ± 8.0 mm) whereas the posterior part of LM underwent limited motion (2.8 ± 2.3 mm). Displacement rate and correlation between muscle thickness and medial axis length during each exercise provided insights regarding subject-specific muscle function. CONCLUSIONS Dynamic MRI is a promising tool for the assessment of the abdominal wall motion and deformations. The corresponding metrics which have been continuously recorded during the exercises provided global and regional quantitative information. These metrics offer perspectives for a genuine clinical evaluation tool dedicated to the assessment of abdominal muscles function in both healthy subjects and patients.
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Affiliation(s)
- Arthur Jourdan
- Aix-Marseille Univ, Univ Gustave Eiffel, IFSTTAR, LBA, F-13016 Marseille, France.
| | | | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France.
| | | | - Catherine Masson
- Aix-Marseille Univ, Univ Gustave Eiffel, IFSTTAR, LBA, F-13016 Marseille, France.
| | - Thierry Bège
- Aix-Marseille Univ, Univ Gustave Eiffel, IFSTTAR, LBA, F-13016 Marseille, France; Department of General Surgery, Aix Marseille Univ, North Hospital, APHM, Marseille, France.
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5
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A novel in vivo approach to assess strains of the human abdominal wall under known intraabdominal pressure. J Mech Behav Biomed Mater 2021; 125:104902. [PMID: 34717119 DOI: 10.1016/j.jmbbm.2021.104902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
The study concerns mechanical behaviour of a living human abdominal wall. A better mechanical understanding of a human abdominal wall and recognition of its material properties is required to find mechanically compatible surgical meshes to significantly improve the treatment of ventral hernias. A non-invasive methodology, based on in vivo optical measurements is proposed to determine strains of abdominal wall corresponding to a known intraabdominal pressure. The measurement is performed in the course of a standard procedure of peritoneal dialysis. A dedicated experimental stand is designed for the experiment. The photogrammetric technique is employed to recover the three-dimensional surface geometry of the anterior abdominal wall at the initial and terminal instants of the dialysis. This corresponds to two deformation states, before and after filling the abdominal cavity with dialysis fluid. The study provides information on strain fields of living human abdominal wall. The inquiry is aimed at principal strains and their directions, observed at the level from -10% to 17%. The intraabdominal pressure related to the amount of introduced dialysis fluid measured within the medical procedure covers the range 11-18.5 cmH2O. The methodology leads to the deformation state of the abdominal wall according to the corresponding loading conditions. Therefore, the study is a step towards an identification of mechanical properties of living human abdominal wall.
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6
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Liu W, Xie Y, Zheng Y, He W, Qiao K, Meng H. Regulatory science for hernia mesh: Current status and future perspectives. Bioact Mater 2021; 6:420-432. [PMID: 32995670 PMCID: PMC7490592 DOI: 10.1016/j.bioactmat.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.
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Affiliation(s)
- Wenbo Liu
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
- Center for Medical Device Evaluation, National Medical Products Administration, Intellectual Property Publishing House Mansion, Qixiang Road, Haidian District, Beijing, China
| | - Yajie Xie
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Yudong Zheng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Wei He
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Kun Qiao
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Haoye Meng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
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7
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El-Monajjed K, Driscoll M. A finite element analysis of the intra-abdominal pressure and paraspinal muscle compartment pressure interaction through the thoracolumbar fascia. Comput Methods Biomech Biomed Engin 2020; 23:585-596. [DOI: 10.1080/10255842.2020.1752682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Khaled El-Monajjed
- Department of Mechanical Engineering, Musculoskeletal Biomechanics Research Lab, McGill University, Montréal, Canada
| | - Mark Driscoll
- Department of Mechanical Engineering, Musculoskeletal Biomechanics Research Lab, McGill University, Montréal, Canada
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8
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Todros S, de Cesare N, Concheri G, Natali AN, Pavan PG. Numerical modelling of abdominal wall mechanics: The role of muscular contraction and intra-abdominal pressure. J Mech Behav Biomed Mater 2020; 103:103578. [DOI: 10.1016/j.jmbbm.2019.103578] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 01/27/2023]
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9
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A numerical method for guiding the design of surgical meshes with suitable mechanical properties for specific abdominal hernias. Comput Biol Med 2020; 116:103531. [DOI: 10.1016/j.compbiomed.2019.103531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
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10
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Tuset L, Fortuny G, Herrero J, Puigjaner D, López JM. Implementation of a new constitutive model for abdominal muscles. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 179:104988. [PMID: 31443865 DOI: 10.1016/j.cmpb.2019.104988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Abdominal hernia repair is one of the most often performed surgical procedures worldwide. Numerical simulations of the abdominal wall mechanics can be a valuable tool to devise actions aimed at preventing hernia formation. A first step towards this goal is the development of consistent constitutive models for the tissues that form the human abdominal wall. In this study we propose, for each of the tissues involved, a new formulation of the so-called transversely isotropic hyperelastic model (TIHM). METHODS We propose a new TIHM for the human abdominal wall tissues and we present a systemic view of the methodology that we have implemented in the present study. First we consider the mathematical background of the TIHM. The novelty of our formulation is that both the isotropic and the fiber contributions to the strain energy function are characterized exclusively by polynomial convex functions of certain invariant quantities. Then, we provide a detailed description on how the constitutive model is implemented into an open source finite element (FE) software. In our approach we use the specific interface provided by the MFront software to incorporate our TIHM formulation into the Code Aster FE solver. For each of the tissues considered, the values of the TIHM constants are adjusted by means of a numerical simulation of previous experimental data from tensile tests. RESULTS We studied the following abdominal wall tissues: linea alba, rectus sheath, external oblique muscle, internal oblique muscle, transversus abdominis muscle and rectus abdominis muscle. Our formulation closely reproduces tensile test data for each tissue in the corresponding FE numerical simulation. CONCLUSIONS The new TIHM formulation is suitable for a future numerical investigation of the abdominal wall, which will in turn help us to assess the best zone to practice a colostomy. The methodology implemented in the present study can be easily extended in the future to develop and implement a TIHM for active muscles and/or a different type of constitutive model which might be suitable to characterize other tissues of biomedical interest.
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Affiliation(s)
- Lluís Tuset
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av Països Catalans 26, Tarragona, Catalunya, Spain.
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av Països Catalans 26, Tarragona, Catalunya, Spain.
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av Països Catalans 26, Tarragona, Catalunya, Spain.
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av Països Catalans 26, Tarragona, Catalunya, Spain.
| | - Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av Països Catalans 26, Tarragona, Catalunya, Spain.
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11
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Pirri C, Todros S, Fede C, Pianigiani S, Fan C, Foti C, Stecco C, Pavan P. Inter‐rater reliability and variability of ultrasound measurements of abdominal muscles and fasciae thickness. Clin Anat 2019; 32:948-960. [DOI: 10.1002/ca.23435] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Carmelo Pirri
- Physical and Rehabilitation Medicine, University of Rome “Tor Vergata” Rome Italy
| | - Silvia Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
| | - Caterina Fede
- Department of Neuroscience University of Padova Padova Italy
| | - Silvia Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
| | - Chenglei Fan
- Department of Neuroscience University of Padova Padova Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, University of Rome “Tor Vergata” Rome Italy
| | - Carla Stecco
- Department of Neuroscience University of Padova Padova Italy
| | - Piero Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
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12
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Todros S, de Cesare N, Pianigiani S, Concheri G, Savio G, Natali AN, Pavan PG. 3D surface imaging of abdominal wall muscular contraction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 175:103-109. [PMID: 31104699 DOI: 10.1016/j.cmpb.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The biomechanical analysis of the abdominal wall should take into account muscle activation and related phenomena, such as intra-abdominal pressure variation and abdomen surface deformation. The geometry of abdominal surface and its deformation during contraction have not been extensively characterized, while represent a key issue to be investigated. METHODS In this work, the antero-lateral abdominal wall surface of ten healthy volunteers in supine position is acquired via laser scanning in relaxed conditions and during abdominal muscles contraction, repeating each acquisition six times. The average relaxed and contracted abdominal surfaces are compared for each subject and displacements measured. RESULTS Muscular activation induces raising in the region adjacent to linea alba along the posterior-anterior direction and a simultaneous lowering along lateral-medial direction of the abdominal wall sides. Displacements reach a maximum value of 12.5 mm for the involved subjects. The coefficient of variation associated to the abdomen surface measurements in the same configuration (relaxed or contracted) is below 0.75%. Non-parametric Mann-Whitney U test highlights that the differences between relaxed and contracted abdominal wall surfaces are significant (p < 0.01). CONCLUSIONS Laser scanning is an accurate and reliable method to evaluate surface changes on the abdominal wall during muscular contraction. The results of this experimental activity can be useful to validate numerical models aimed at describing abdominal wall biomechanics.
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Affiliation(s)
- Silvia Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Niccolò de Cesare
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.
| | - Silvia Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Gianmaria Concheri
- Department of Civil, Environmental and Architectural Engineering, Laboratory of Design Tools and Methods in Industrial Engineering, University of Padova, Padova, Italy
| | - Gianpaolo Savio
- Department of Civil, Environmental and Architectural Engineering, Laboratory of Design Tools and Methods in Industrial Engineering, University of Padova, Padova, Italy
| | - Arturo N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Piero G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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13
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Pavan PG, Todros S, Pachera P, Pianigiani S, Natali AN. The effects of the muscular contraction on the abdominal biomechanics: a numerical investigation. Comput Methods Biomech Biomed Engin 2019; 22:139-148. [DOI: 10.1080/10255842.2018.1540695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Piero G. Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, I–35131 Padova, Italy
| | - Silvia Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, I–35131 Padova, Italy
| | - Paola Pachera
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, I–35131 Padova, Italy
| | - Silvia Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, I–35131 Padova, Italy
| | - Arturo N. Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, I–35131 Padova, Italy
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14
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Hope W, Tenzel P, Bilezikian J, Eckhauser F. Tension measurements in abdominal wall hernia repair: Concept and clinical applications. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_37_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Beninatto R, Barbera C, De Lucchi O, Borsato G, Serena E, Guarise C, Pavan M, Luni C, Martewicz S, Galesso D, Elvassore N. Photocrosslinked hydrogels from coumarin derivatives of hyaluronic acid for tissue engineering applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 96:625-634. [PMID: 30606574 DOI: 10.1016/j.msec.2018.11.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/23/2018] [Accepted: 11/27/2018] [Indexed: 11/16/2022]
Abstract
Hydrogels are an increasingly attractive choice in the fields of regenerative medicine, wound care and tissue engineering as important forms of bio-scaffolds. For many clinical needs, injectable in situ crosslinkable hydrogels are strongly preferred, due to treatment effectiveness and ease of use. In this study, hyaluronic acid (HA), containing side-arms linked to photo-active coumarin moieties, was used for the preparation of wall-to-wall hydrogels. This photocrosslinkable HA, hereafter called HA-TEG-coumarin, produces colourless aqueous solutions that solidify upon near-UV irradiation (at a specific wavelength of 365 nm) via a clean [2 + 2] photocycloaddition reaction, without by-products formation. The crosslinking event, a robust and non-cytotoxic process, does not require catalysts or radical initiators: in the field of hyaluronan photocrosslinking, this innovative feature is significant to ensure the whole biocompatibility and to avoid collateral reactions. Mechanical and rheological tests showed that hyaluronan derivatives became hydrogels after 3-5 min of irradiation, with average values for bulk and surface elastic moduli of about 32 kPa and 193 kPa, respectively. Fluorescence recovery after photobleaching (FRAP) assay showed that the hydrogels are porous and allow a good permeation for nutrients and growth factors. Cell metabolism and proliferation assays revealed that hydrogel-encapsulated fibroblasts maintained their viability and that HA-TEG-coumarin sustained the proliferation of non-adherent myoblasts. For all of these reasons and thanks to a safe free-radical approach, this novel hyaluronan coumarin derivative could be a good candidate for tissue engineering and regenerative medicine applications.
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Affiliation(s)
- Riccardo Beninatto
- Fidia Farmaceutici S.p.A., Via Ponte Della Fabbrica 3/A, 35031 Abano Terme, Italy.
| | - Carlo Barbera
- Fidia Farmaceutici S.p.A., Via Ponte Della Fabbrica 3/A, 35031 Abano Terme, Italy
| | - Ottorino De Lucchi
- Dipartimento di Scienze Molecolari e Nanosistemi, Università Ca' Foscari di Venezia, Italy
| | - Giuseppe Borsato
- Dipartimento di Scienze Molecolari e Nanosistemi, Università Ca' Foscari di Venezia, Italy
| | - Elena Serena
- Dipartimento di Ingegneria Industriale, Università di Padova, Italy; Venetian Institute of Molecular Medicine (VIMM), Padova, Italy
| | - Cristian Guarise
- Fidia Farmaceutici S.p.A., Via Ponte Della Fabbrica 3/A, 35031 Abano Terme, Italy
| | - Mauro Pavan
- Fidia Farmaceutici S.p.A., Via Ponte Della Fabbrica 3/A, 35031 Abano Terme, Italy
| | - Camilla Luni
- Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, China
| | - Sebastian Martewicz
- Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, China
| | - Devis Galesso
- Fidia Farmaceutici S.p.A., Via Ponte Della Fabbrica 3/A, 35031 Abano Terme, Italy
| | - Nicola Elvassore
- Dipartimento di Ingegneria Industriale, Università di Padova, Italy; Venetian Institute of Molecular Medicine (VIMM), Padova, Italy; Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, China.
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16
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Marker Tracking for Local Strain Measurement in Mechanical Testing of Biomedical Materials. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0457-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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de Cesare N, Trevisan C, Maghin E, Piccoli M, Pavan PG. A finite element analysis of diaphragmatic hernia repair on an animal model. J Mech Behav Biomed Mater 2018; 86:33-42. [PMID: 29933200 DOI: 10.1016/j.jmbbm.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/15/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
The diaphragm is a mammalian skeletal muscle that plays a fundamental role in the process of respiration. Alteration of its mechanical properties due to a diaphragmatic hernia contributes towards compromising its respiratory functions, leading to the need for surgical intervention to restore the physiological conditions by means of implants. This study aims to assess via numerical modeling biomechanical differences between a diaphragm in healthy conditions and a herniated diaphragm surgically repaired with a polymeric implant, in a mouse model. Finite Element models of healthy and repaired diaphragms are developed from diagnostic images and anatomical samples. The mechanical response of the diaphragmatic tendon is described by assuming an isotropic hyperelastic model. A similar constitutive model is used to define the mechanical behavior of the polymeric implant, while the muscular tissue is modeled by means of a three-element Hill's model, specifically adapted to mouse muscle fibers. The Finite Element Analysis is addressed to simulate diaphragmatic contraction in the eupnea condition, allowing the evaluation of diaphragm deformation in healthy and herniated-repaired conditions. The polymeric implant reduces diaphragm excursion compared to healthy conditions. This explains the possible alteration in the mechanical functionality of the repaired diaphragm. Looking to the surgical treatment of diaphragmatic hernia in human neonatal subjects, this study suggests the implementation of alternative approaches based on the use of biological implants.
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Affiliation(s)
- N de Cesare
- Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - C Trevisan
- Department of Woman's and Child's Health, University of Padova, Italy; Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - E Maghin
- Department of Woman's and Child's Health, University of Padova, Italy; Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - M Piccoli
- Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy; Department of Biomedical Sciences, University of Padova, Italy
| | - P G Pavan
- Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy.
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18
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Ibrahim MM, Poveromo LP, Glisson RR, Cornejo A, Farjat AE, Gall K, Levinson H. Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech 2018; 71:43-51. [PMID: 29426630 DOI: 10.1016/j.jbiomech.2018.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/18/2017] [Accepted: 01/14/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Approximately 348,000 ventral hernia repairs are performed annually in the United States and the incisional hernia recurrence rate is approximately 20% as a result of suture and mesh device failure. Device failure is related to changes at the suture/tissue interface that leads to acute or chronic suture pull-through and surgical failure. To better manage mechanical tension, we propose a modified mesh design with extensions and demonstrate its mechanical superiority. METHODS Comparative uniaxial static tensile testing was conducted on polypropylene suture and a modified mesh. Subsequently, a standard of care (SOC) mesh and modified mesh were evaluated using a tensometer in an acute hernia bench-top model. RESULTS Modified mesh breaking strength, extension knot breaking strength, extension disruption, and extension anchoring were superior to suture (p < .05). Modified mesh ultimate tensile strength of anchoring was superior to SOC mesh (p < .05). Various stitch patterns and modifications in device design significantly improved device tension-free performance far beyond clinically relevant benchmarks (p < .05). CONCLUSIONS Testing demonstrates that the modified mesh outperforms SOC mesh and suture in all tested failure modes. SOC hernia mesh tears through tissue at stress levels below maximum physiologic stress, whereas, the modified hernia mesh is up to 200% stronger than SOC mesh at resisting suture tearing through tissue and maintains anchoring at stresses far beyond clinically relevant benchmarks. Modifying hernia mesh design significantly improves device mechanical performance and enhances tension-free repair.
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Affiliation(s)
- Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Luke P Poveromo
- Duke University School of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Agustin Cornejo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Alfredo E Farjat
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Dermatology, Duke University, Durham, NC 27710, USA; Department of Pathology, Duke University, Durham, NC 27710, USA.
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19
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Natali AN, Fontanella CG, Todros S, Carniel EL. Urethral lumen occlusion by artificial sphincteric device: Evaluation of degraded tissues effects. J Biomech 2017; 65:75-81. [PMID: 29042057 DOI: 10.1016/j.jbiomech.2017.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/25/2022]
Abstract
Urinary incontinence can be surgically treated by means of artificial sphincters, based on a cuff that provides a pressure around the urethra to occlude the lumen. Considering the frequent access of elderly patients to this surgical practice, tissue degradation phenomena must be investigated, since they could affect treatment reliability and durability. The potential degradation can be interpreted considering a variation within soft tissue constitutive formulation, by means of a correlation between mechanical properties and tissues ageing. The overall compressibility varies, as characteristics aspect of soft tissue mechanical response with age, as well as the stiffness. The investigation is performed by means of a three dimensional numerical model of the urethral duct. The effects of the interaction phenomenon with a cuff is interpreted considering the changes, within the constitutive models, of the basic parameters that define the potential degradation process. The deformation related to compressibility is recalled, ranging between ten and fifty percent in dependence on the degradation level considered. This parameter, reported mostly as representative of the aging effect, shows a large variation that confirms the relevance of the investigation performed toward a sensitivity of the mechanical response of the urethral duct referred to the lumen occlusion.
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Affiliation(s)
- Arturo Nicola Natali
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy.
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, Italy; Department of Biomedical Sciences, University of Padova, Italy
| | - Silvia Todros
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
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Todros S, Pavan PG, Pachera P, Pace G, Di Noto V, Natali AN. Interplay between physicochemical and mechanical properties of poly(ethylene terephthalate) meshes for hernia repair. J Appl Polym Sci 2017. [DOI: 10.1002/app.46014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Silvia Todros
- Department of Industrial Engineering; Centre for Mechanics of Biological Materials, University of Padova; Via Venezia 1, Padova PD 35131 Italy
| | - Piero Giovanni Pavan
- Department of Industrial Engineering; Centre for Mechanics of Biological Materials, University of Padova; Via Venezia 1, Padova PD 35131 Italy
| | - Paola Pachera
- Department of Industrial Engineering; Centre for Mechanics of Biological Materials, University of Padova; Via Venezia 1, Padova PD 35131 Italy
| | | | - Vito Di Noto
- Section of Chemistry for Technology, Department of Industrial Engineering; University of Padua; Via Marzolo 1, Padova PD 35131 Italy
| | - Arturo Nicola Natali
- Department of Industrial Engineering; Centre for Mechanics of Biological Materials, University of Padova; Via Venezia 1, Padova PD 35131 Italy
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Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh. Int J Comput Assist Radiol Surg 2017; 13:73-81. [DOI: 10.1007/s11548-017-1681-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
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22
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Deeken CR, Lake SP. Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater 2017; 74:411-427. [DOI: 10.1016/j.jmbbm.2017.05.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/29/2022]
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Todros S, Pachera P, Pavan PG, Natali AN. Investigation of the Mechanical Behavior of Polyester Meshes for Abdominal Surgery: A Preliminary Study. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0337-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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