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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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Remus R, Sure C, Selkmann S, Uttich E, Bender B. Soft tissue material properties based on human abdominal in vivo macro-indenter measurements. Front Bioeng Biotechnol 2024; 12:1384062. [PMID: 38854855 PMCID: PMC11157078 DOI: 10.3389/fbioe.2024.1384062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical in vivo behavior. To obtain this knowledge for the abdomen, we measured the continuous mechanical responses of the abdominal soft tissue of ten healthy participants in different lying positions anteriorly, laterally, and posteriorly under local compression depths of up to 30 mm. An experimental setup consisting of a mechatronic indenter with hemispherical tip and two time-of-flight (ToF) sensors for optical 3D displacement measurement of the surface was developed for this purpose. To account for the impact of muscle tone, experiments were conducted with both controlled activation and relaxation of the trunk muscles. Surface electromyography (sEMG) was used to monitor muscle activation levels. The obtained data sets comprise the continuous force-displacement data of six abdominal measurement regions, each synchronized with the local surface displacements resulting from the macro-indentation, and the bipolar sEMG signals at three key trunk muscles. We used inverse finite element analysis (FEA), to derive sets of nonlinear material parameters that numerically approximate the experimentally determined soft tissue behaviors. The physiological standard values obtained for all participants after data processing served as reference data. The mean stiffness of the abdomen was significantly different when the trunk muscles were activated or relaxed. No significant differences were found between the anterior-lateral measurement regions, with exception of those centered on the linea alba and centered on the muscle belly of the rectus abdominis below the intertubercular plane. The shapes and areas of deformation of the skin depended on the region and muscle activity. Using the hyperelastic Ogden model, we identified unique material parameter sets for all regions. Our findings confirmed that, in addition to the indenter force-displacement data, knowledge about tissue deformation is necessary to reliably determine unique material parameter sets using inverse FEA. The presented results can be used for finite element (FE) models of the abdomen, for example, in the context of orthopedic or biomedical product developments.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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3
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Szepietowska K, Troka M, Lichodziejewska-Niemierko M, Chmielewski M, Lubowiecka I. Full-field in vivo experimental study of the strains of a breathing human abdominal wall with intra-abdominal pressure variation. J Mech Behav Biomed Mater 2023; 147:106148. [PMID: 37797556 DOI: 10.1016/j.jmbbm.2023.106148] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Abstract
The presented study aims to assess the mechanical behaviour of the anterior abdominal wall based on an in vivo experiment on humans. Full-field measurement of abdominal wall displacement during changes of intra-abdominal pressure is performed using a digital image correlation (DIC) system. Continuous measurement in time enables the observation of changes in the strain field during breathing. The understanding of the mechanical behaviour of a living human abdominal wall is important for the proper design of surgical meshes used for ventral hernia repair, which was also a motivation for the research presented below. The research refers to the strain field of a loaded abdominal wall and presents the evolution of principal strains and their directions in the case of 12 subjects, 8 male and 4 female. Peritoneal dialysis procedure allows for the measurement of intra-abdominal pressure after fluid introduction. High variability among patients is observed, also in terms of principal strain direction. Subjects exhibit intra-abdominal pressure of values from 11 to 21 cmH2O. However, the strain values are not strongly correlated with the pressure value, indicating variability of material properties.
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Affiliation(s)
- Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Michał Chmielewski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
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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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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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Ye Z, Zhang L, Liu T, Xuan W, He X, Hou C, Han D, Yu B, Shi J, Kang J, Chen J. The effect of surface nucleation modulation on the mechanical and biocompatibility of metal-polymer biomaterials. Front Bioeng Biotechnol 2023; 11:1160351. [PMID: 37091349 PMCID: PMC10117951 DOI: 10.3389/fbioe.2023.1160351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
The deployment of hernia repair patches in laparoscopic procedures is gradually increasing. In this technology, however, understanding the new phases of titanium from the parent phase on polymer substrates is essential to control the microstructural transition and material properties. It remains a challenging area of condensed matter physics to predict the kinetic and thermodynamic properties of metals on polymer substrates from the molecular scale due to the lack of understanding of the properties of the metal-polymer interface. However, this paper revealed the mechanism of nucleation on polymer substrates and proposed for the first record a time-dependent regulatory mechanism for the polymer-titanium interface. The interconnection between polymer surface chain entanglement, nucleation and growth patterns, crystal structure and surface roughness were effectively unified. The secondary regulation of mechanical properties was accomplished simultaneously to satisfy the requirement of biocompatibility. Titaniumized polypropylene patches prepared by time-dependent magnetron sputtering technology demonstrated excellent interfacial mechanical properties and biocompatibility. In addition, modulation by low-temperature plasma metal deposition opened a new pathway for biomaterials. This paper provides a solid theoretical basis for the research of titanium nanofilms on medical polypropylene substrates and the medical industry of implantable biomaterials, which will be of great value in the future.
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Affiliation(s)
- Zhenhong Ye
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai High Efficiency Cooling System Research Center, Shanghai, China
| | - Le Zhang
- State Key Laboratory for Oncogenes and Bio-ID Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Taiwei Liu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Weicheng Xuan
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaodong He
- Department of Engineering Mechanics and Innovation Center for Advanced Ship and Deep-Sea Exploration, School of Naval Architecture, Ocean and Civil Engineering Shanghai Jiao Tong University, Shanghai, China
| | - Changhao Hou
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donglin Han
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Binbin Yu
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junye Shi
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Kang
- Department of General Surgery, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jie Kang, ; Jiangping Chen,
| | - Jiangping Chen
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai High Efficiency Cooling System Research Center, Shanghai, China
- *Correspondence: Jie Kang, ; Jiangping Chen,
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Fan Z, Guan W, Zhang T, Zhang D. A Modified Surgical Technique to Prevent Parastomal Hernia. Front Surg 2022; 9:907316. [PMID: 35836595 PMCID: PMC9273896 DOI: 10.3389/fsurg.2022.907316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
An extraperitoneal colostomy is not sufficiently effective in preventing parastomal hernias. On the basis of anatomic structures and mechanical principles, we modified this surgical technique by preserving the integrity of the posterior rectus abdominis sheath to prevent parastomal hernia, and we applied it clinically.
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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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Lubowiecka I, Tomaszewska A, Szepietowska K, Szymczak C, Śmietański M. In vivo performance of intraperitoneal onlay mesh after ventral hernia repair. Clin Biomech (Bristol, Avon) 2020; 78:105076. [PMID: 32535476 DOI: 10.1016/j.clinbiomech.2020.105076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. METHODS This analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. FINDINGS The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. INTERPRETATION The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.
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Affiliation(s)
- Izabela Lubowiecka
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Czesław Szymczak
- Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Medical University of Gdańsk, 2(nd) Department of Radiology, Hospital Swissmed S.A., Department of Surgery, Poland
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Sednieva Y, Viste A, Naaim A, Bruyère-Garnier K, Gras LL. Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study. Front Bioeng Biotechnol 2020; 8:750. [PMID: 32850692 PMCID: PMC7403494 DOI: 10.3389/fbioe.2020.00750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Abstract
Fascia is a fibrous connective tissue present all over the body. At the lower limb level, the deep fascia that is overlying muscles of the outer thigh and sheathing them (fascia lata) is involved in various pathologies. However, the understanding and quantification of the mechanisms involved in these sheathing effects are still unclear. The aim of this study is to observe and quantify the strain field of the fascia lata, including the iliotibial tract (ITT), during a passive movement of the knee. Three fresh postmortem human subjects were studied. To measure hip and knee angles during knee flexion-extension, passive movements from 0° to around 120° were recorded with a motion analysis system and strain fields of the fascia were acquired using digital image correlation. Strains were computed for three areas of the fascia lata: anterior fascia, lateral fascia, and ITT. Mean principal strains showed different strain mechanisms depending on location on the fascia and knee angle. For the ITT, two strain mechanisms were observed depending on knee movement: compression is observed when the knee is extended relative to the reference position of 47°, however, tension and pure shear can be observed when the knee is flexed. For the anterior and lateral fascia, in most cases, minor strain is higher than major strain in absolute value, suggesting high tissue compression probably due to microstructural fiber rearrangements. This in situ study is the first attempt to quantify the superficial strain field of fascia lata during passive leg movement. The study presents some limitations but provides a step in understanding strain mechanism of the fascia lata during passive knee movement.
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Affiliation(s)
- Yuliia Sednieva
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Anthony Viste
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique, Pierre-Bénite, France
| | - Alexandre Naaim
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Karine Bruyère-Garnier
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Laure-Lise Gras
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France
- *Correspondence: Laure-Lise Gras,
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Kirilova-Doneva M, Pashkouleva D, Stoytchev S. Age-related changes in mechanical properties of human abdominal fascia. Med Biol Eng Comput 2020; 58:1565-1573. [PMID: 32415553 DOI: 10.1007/s11517-020-02172-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to assess and model age-related changes in the mechanical properties of human fascia. The samples were divided into three age groups: group A-up to 60 years (mean age 52.5 ± 6 years), group B-61-80 years (mean age 70.4 ± 5.2 years), and group C-81-90 years (mean age 83.2 ± 2 years). A uniaxial tensile test was applied to fascia specimens cut perpendicular and parallel to fibers. The secant modulus at 5% strain, the maximum stress, and the stretch at maximum stress were calculated from the stress-stretch ratio curves. The results indicated an increase in the secant modulus with the increased age. The trend is clearer in the longitudinal direction. Considering the strain energy function which accounts the isotropic and non-isotropic response of the fascia where isotropic and anisotropic parts are split, we evaluated which material model is the most suitable to present isotropic mechanical behavior of the tissue. The experimental stress-stretch ratio curves were approximated using Mooney-Rivlin, Yeoh, and neo-Hookean strain energy functions and a good match between theoretical and experimental results was obtained. On the basis of objective function values and normalized mean square root error, we recommend using the Yeoh model to describe the isotropic mechanical behavior of human abdominal fascia. Graphical abstract .
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Affiliation(s)
- Miglena Kirilova-Doneva
- Faculty of Pharmacy, Medical University of Sofia, 2 Dunav Str., 1000, Sofia, Bulgaria. .,Institute of Mechanics, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 4, Sofia, Bulgaria.
| | - Dessislava Pashkouleva
- Institute of Mechanics, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 4, Sofia, Bulgaria
| | - Stoyan Stoytchev
- Institute of Mechanics, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 4, Sofia, Bulgaria
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Le Ruyet A, Yurtkap Y, Hartog FPJD, Vegleur A, Turquier F, Lange JF, Kleinrensink GJ. Differences in biomechanics of abdominal wall closure with and without mesh reinforcement: A study in post mortem human specimens. J Mech Behav Biomed Mater 2020; 105:103683. [PMID: 32090893 DOI: 10.1016/j.jmbbm.2020.103683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Small bites for the closure of the abdominal wall after midline laparotomy result in significantly less incisional hernias in comparison with large bites. However, fundamental knowledge of underlying biomechanical phenomena remains sparse. The objective of this study was to develop a digital image correlation-based method to compare different suturing techniques in terms of strain pattern after closure of a midline laparotomy in a passive model just after the time of surgery. METHODS A digital image correlation (DIC)-based method was used for the comparison of strain fields on the external surface of the myofascial abdominal wall (skin and subcutaneous fat removed) among six configurations, including an intact linea alba in five post mortem human specimens. The second configuration comprised primary mass closure with small bites (five mm between two consecutive stitches and five mm distance from the incision, 5x5 mm). The third configuration was primary mass closure with large bites (ten mm by ten mm, 10x10 mm). The fourth, fifth and sixth configuration comprised primary mass closure with large bites and the placement of a mesh in onlay position with two different overlaps and the use of glue to simulate the integration of the mesh within the soft tissue. RESULTS No visible difference was observed between 5x5 and 10x10 mm closure configurations. However, the use of mesh as suture line reinforcement highlighted a stiffer behavior of the midline area for similar intra-abdominal pressure, which was amplified when a larger mesh overlap was used. However, the whole abdominal wall showed quite similar shapes for the various configurations, except for the configuration with mesh reinforcement and the use of glue. CONCLUSION Mesh reinforcement incited lower opening tension profiles in the midline area of the abdominal wall. following closure of the linea alba in median laparotomy. The next step should be to investigate the impact of mesh location (e.g. retromuscular) and different time points after surgery.
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Affiliation(s)
- A Le Ruyet
- Medtronic, Sofradim Production, Trévoux, France.
| | - Y Yurtkap
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - A Vegleur
- Medtronic, Sofradim Production, Trévoux, France
| | - F Turquier
- Medtronic, Sofradim Production, Trévoux, France
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - G J Kleinrensink
- Department of Neuroscience and Anatomy, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Eickhoff R, Heise D, Kroh A, Helmedag M, Klinge U, Neumann UP, Klink CD, Lambertz A. Improved tissue integration of a new elastic intraperitoneal stoma mesh prosthesis. J Biomed Mater Res B Appl Biomater 2020; 108:2250-2257. [PMID: 31967402 DOI: 10.1002/jbm.b.34562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
Parastomal herniation is a frequent complication in colorectal surgery, occurring with a prevalence of 30-80%. The aim of the study was to create a new intraperitoneal colostoma mesh prosthesis (IPST) with enhanced elastic properties made with thermoplastic polyurethane (TPU) monofilaments. We performed open terminal sigmoid colostomies reinforced with either a 10 cm by 10 cm polyvinylidene fluoride (PVDF) or a new TPU/PVDF composite mesh in a total of 10 minipigs. Colostoma was placed paramedian in the left lower abdomen and IPST meshes were fixed intraperitoneal. After 8 weeks, the animals were euthanized after laparoscopic exploration and specimen were explanted for histological investigations. Implantation of a new IPST-mesh with enhanced elastic properties was feasible in a minipig model within an observation period of 8 weeks. Immunohistochemically, Collagen I/III ratio as a marker of tissue integration was significantly higher in TPU-group versus PVDF group (9.4 ± 0.5 vs. 8.1 ± 0.5, p = 0.002) with a significantly lower inflammatory reaction measured by a smaller inner granuloma at mesh-colon interface (17.6 ± 3.3 μm vs. 23 ± 5 μm, p < 0.001). A new TPU/PVDF composite mesh with enhanced elastic properties as IPST was created. Stoma surgery and especially the evaluation of the new stoma mesh prosthesis are feasible with reproducible results in an animal model. Tissue integration expressed by Collagen I/III ratio seems to be improved in comparison to standard-elastic PVDF-IPST meshes.
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Affiliation(s)
- Roman Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marius Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian D Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
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14
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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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Liu P, Fu K, Zeng X, Chen N, Wen X. Fabrication and Characterization of Composite Meshes Loaded with Antimicrobial Peptides. ACS APPLIED MATERIALS & INTERFACES 2019; 11:24609-24617. [PMID: 31199612 DOI: 10.1021/acsami.9b07246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Biomaterials-centered infection or implant-associated infection plays critical roles in all areas of medicine with implantable devices. The widespread over use of antibiotics has caused severe bacterial resistance and even super bugs. Therefore, the development of anti-infection implantable devices with non-antibiotic-based new antimicrobial agents is indeed a priority for all of us. In this study, antimicrobial composite meshes were fabricated with broad-spectrum antimicrobial peptides (AMPs). Macroporous polypropylene meshes with poly-caprolactone electrospun nanosheets were utilized as a substrate to load AMPs and gellan gum presented as a media to gel with AMPs. Different amounts of AMPs were loaded onto gellan gum to determine the appropriate dose. The surface morphologies, Fourier-transform infrared spectroscopy spectra, in vitro release profiles, mechanical performances, in vitro antimicrobial properties, and cytocompatibility of composite scaffolds were evaluated. Results showed that AMPs were loaded into the meshes successfully, the in vitro release of AMPs in phosphate-buffered saline was prolonged, and less than 60% peptides were released in 10 days. The mechanical properties of composite meshes were also within the scope of several commercial surgical meshes. Composite meshes with the AMP loading amount of over 3 mg/cm2 showed inhibition against both Gram-negative and Gram-positive bacteria effectively, while they presented no toxicity to mammalian cells even at a loading amount of 10 mg/cm2. These results demonstrate a new simple and practicable method to offer antimicrobial properties to medical devices for hernia repair.
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Affiliation(s)
- Pengbi Liu
- College of Textiles , Donghua University , Shanghai 201620 , P. R. China
- Department of Chemical and Life Science Engineering, School of Engineering , Virginia Commonwealth University , Richmond , Virginia 23284 , United States
| | - Kun Fu
- Department of Chemical and Life Science Engineering, School of Engineering , Virginia Commonwealth University , Richmond , Virginia 23284 , United States
- Department of Stomatology , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , Henan 450052 , P. R. China
| | - Xiaomei Zeng
- Department of Chemical and Life Science Engineering, School of Engineering , Virginia Commonwealth University , Richmond , Virginia 23284 , United States
| | - Nanliang Chen
- College of Textiles , Donghua University , Shanghai 201620 , P. R. China
| | - Xuejun Wen
- Department of Chemical and Life Science Engineering, School of Engineering , Virginia Commonwealth University , Richmond , Virginia 23284 , United States
- Beijing Ditan Hospital , Capital Medical University , Beijing 100015 , P. R. China
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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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Werner LA, Dayan M. Diastasis Recti Abdominis-diagnosis, Risk Factors, Effect on Musculoskeletal Function, Framework for Treatment and Implications for the Pelvic Floor. CURRENT WOMENS HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180222152952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Diastasis Recti Abdominis (DRA) can occur during pregnancy and postpartum. It is defined as an increase of the inter-recti distance (IRD) beyond normal values. The diagnosis of DRA is inconsistent within the literature and varies depending on measurement instrument and activity during measurement (rest versus active curl-up). DRA is characterized by the stretching of linea alba (LA) and contributes to a protrusion of the anterior abdominal wall due to increased laxity in the myofascial system that supports abdominal viscera. DRA has been postulated to affect lumbopelvic support and function due to laxity of the LA and altered angle of muscle insertion, but recent studies have not confirmed this. Risk factors for the development of DRA have been investigated in pregnancy to 12-months postpartum.Objective:Rehabilitation for DRA has been traditionally focused on reducing the IRD, but recent research has proposed that a sole focus on closing the DRA is suboptimal.Results:It is important alongside the rehabilitation of the abdominal wall that there is the consideration of the pelvic floor (PF). In healthy individuals, with the activation of the transversus abdominis, there is a sub-maximal co-contraction of the PF muscles. This co-contraction can be lost or altered in women with urinary incontinence. An increase in intra-abdominal pressure without simultaneous co-contraction of the PF may cause caudal displacement of the PF.Conclusion:The aim of this review is to bring the reader up to date on the evidence on DRA and to propose a rehabilitation framework for the whole abdominal wall in DRA with consideration of the impact on the PF.
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Affiliation(s)
- Laura Anne Werner
- Shelbourne Physiotherapy 100B-3200 Shelbourne V8P 5G8, Victoria, BC, Canada
| | - Marcy Dayan
- Dayan Physiotherapy and Pelvic Floor Clinic 909-750 W Broadway V5Z 1H8 Vancouver, BC, Canada
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Liu P, Chen N, Jiang J, Wen X. New surgical meshes with patterned nanofiber mats. RSC Adv 2019; 9:17679-17690. [PMID: 35520597 PMCID: PMC9064676 DOI: 10.1039/c9ra01917k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/26/2019] [Indexed: 01/21/2023] Open
Abstract
Abdominal wall hernia repair is one of the most common general surgeries nowadays. Surgical meshes used in hernia repair indeed improved the outcomes, but complications like chronic pain or hernia recurrence partly caused by mechanical mismatch cannot be ignored. This work designed six warp-knitted polypropylene (PP) meshes and found the properties of surgical meshes could be improved to better mimic the performances of human abdominal wall by designing meshes with appropriate textile structures. Poly-caprolactone was electrospun onto newly designed PP meshes and formed a thin layer of patterned nanofiber mat. The pattern of nanofiber mats was affected by the structure of meshes. Diverse nanofiber morphology (straight aligned, straight random or spiral random pattern) and fiber diameters (50–70 nm ultra-thin nanofibers or from 330 nm to 700 nm nanofibers) were observed in different regions of a single patterned nanofiber scaffold. The addition of electrospinning nanofibers enhanced cell adherence and proliferation as compared with naked PP meshes. Cell actin filaments spread along the nanofibers and formed a morphology exactly similar with the patterned mats on day 7. Furthermore, cells on thin and aligned patterned nanofibers showed much more elongation and better orientation than that of the spiral random fibers, suggesting that cell morphology can be altered by changing the patterns of scaffolds. This study helps us in further understanding the properties of hernia repair meshes with their textile structures and the biological interactions of cells with different substrates in order to develop new biomedical scaffolds with desired properties. Newly designed warp-knitted meshes with different textile parameters and the interactions between cell and patterned nanofiber mats and different meshes.![]()
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Affiliation(s)
- Pengbi Liu
- College of Textiles
- Donghua University
- Shanghai 201620
- P. R. China
- Department of Chemical and Life Science Engineering
| | - Nanliang Chen
- College of Textiles
- Donghua University
- Shanghai 201620
- P. R. China
| | - Jinhua Jiang
- College of Textiles
- Donghua University
- Shanghai 201620
- P. R. China
| | - Xuejun Wen
- Department of Chemical and Life Science Engineering
- School of Engineering
- Virginia Commonwealth University
- Richmond
- USA
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Tomaszewska A, Lubowiecka I, Szymczak C. Mechanics of mesh implanted into abdominal wall under repetitive load. Experimental and numerical study. J Biomed Mater Res B Appl Biomater 2018; 107:1400-1409. [DOI: 10.1002/jbm.b.34232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/25/2018] [Accepted: 08/18/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Agnieszka Tomaszewska
- Gdańsk University of TechnologyFaculty of Civil and Environmental Engineering, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
| | - Izabela Lubowiecka
- Gdańsk University of TechnologyFaculty of Civil and Environmental Engineering, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
| | - Czesław Szymczak
- Gdańsk University of TechnologyFaculty of Ocean Engineering and Ship Technology, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
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Liao A, Harris HW, Maharbiz MM. A Coupled Magnetoelastic Strain Sensor Array for Guiding and Monitoring Hernia Repairs. IEEE Trans Biomed Eng 2018; 66:4-13. [PMID: 29993427 DOI: 10.1109/tbme.2018.2834361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ventral hernia repairs using mesh prosthetics suffer from high recurrence rates, with 10%-20% of repairs failing within three years. Uneven distribution of stress within the implanted mesh prosthetic is thought to contribute to the high recurrence rate. We propose a method for providing quantitative guidance and monitoring of hernia repairs using an array of magnetoelastic strain sensors. METHODS The magnetoelastic strain sensors presented here are based on a coupled design to achieve measurements with higher signal-to-noise ratio (SNR). A first magnetoelastic element (the transducer) is bonded to the mesh prosthetic and is characterized by a strain-dependent magnetic field. The resonance frequency of a second magnetoelastic element (the resonator) encased in a rigid casing is biased by the transducer element's magneticity and can be measured noninvasively using an external interrogation coil. The coupled magnetoelastic strain sensors are assembled using a combination of photochemical machining, patterning, and heat sealing. RESULTS The dynamic range of the coupled sensors can be tuned by altering the transducer geometry. Additional spring elements are integrated onto the transducer element to achieve high dynamic range measurements saturating at 74 millistrains. CONCLUSION A coupled magnetoelastic strain sensor combines a transducer with an encased resonator element to measure strain with high SNR on an implantable flexible hernia mesh substrate. SIGNIFICANCE This study provides surgeons and researchers with a clinically relevant tool to quantify the strain distributions within implanted mesh prosthetics, with the ultimate goal of reducing the recurrence rate of ventral hernia repairs.
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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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Kahan LG, Lake SP, McAllister JM, Tan WH, Yu J, Thompson D, Brunt LM, Blatnik JA. Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model. Surg Endosc 2017; 32:820-830. [DOI: 10.1007/s00464-017-5749-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/14/2017] [Indexed: 12/29/2022]
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Kahan LG, Guertler C, Blatnik JA, Lake SP. Validation of Single C-Arm Fluoroscopic Technique for Measuring In Vivo Abdominal Wall Deformation. J Biomech Eng 2017; 139:2633404. [DOI: 10.1115/1.4037073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 11/08/2022]
Abstract
Hernia meshes significantly reduce the recurrence rates in hernia repair. It is known that they affect the abdominal wall postimplantation, yet the understanding of in vivo mechanics in the mesh placement area is lacking. We established a single C-arm biplane fluoroscopic system to study strains at the interface between the mesh and repaired abdominal tissues. We aimed to validate this system for future porcine hernia repair studies. Custom matlab programs were written to correct for pincushion distortion, and direct linear transformation (DLT) reconstructed objects in 3D. Using a custom biplane-trough setup, image sets were acquired throughout the calibrated volume to evaluate a radio-opaque test piece with known distances between adjacent beads. Distances were measured postprocessing and compared to known measurements. Repeatability testing was conducted by taking image sets of the test piece in a fixed location to determine system movement. The error in areal stretch tracking was evaluated by imaging a square plate with fixed radio-opaque beads and using matlab programs to compare the measured areal stretch to known bead positions. Minor differences between measured and known distances in the test piece were not statistically different, and the system yielded a 0.01 mm bias in the XY plane and a precision of 0.61 mm. The measured areal stretch was 0.996, which was not significantly different than the expected value of 1. In addition, preliminary stretch data for a hernia mesh in a porcine model demonstrated technique feasibility to measure in vivo porcine abdominal mechanics.
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Affiliation(s)
- Lindsey G. Kahan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Charlotte Guertler
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130 e-mail:
| | - Jeffrey A. Blatnik
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Spencer P. Lake
- Mem. ASME Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Orthopaedic Surgery, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130 e-mail:
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Kroese LF, Harlaar JJ, Ordrenneau C, Verhelst J, Guérin G, Turquier F, Goossens RHM, Kleinrensink GJ, Jeekel J, Lange JF. The 'AbdoMAN': an artificial abdominal wall simulator for biomechanical studies on laparotomy closure techniques. Hernia 2017; 21:783-791. [PMID: 28429087 PMCID: PMC5608802 DOI: 10.1007/s10029-017-1615-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/04/2017] [Indexed: 11/25/2022]
Abstract
Purpose Incisional hernia remains a frequent complication after abdominal surgery associated with significant morbidity and high costs. Animal and clinical studies have exhibited some limitations. The purpose of this study was to develop an artificial human abdominal wall (AW) simulator in order to enable investigations on closure modalities. We hypothesized that a physical model of the human AW would give new insight into commonly used suture techniques representing a substantial complement or alternative to clinical and animal studies. Methods The ‘AbdoMAN’ was developed to simulate human AW biomechanics. The ‘AbdoMAN’ capacities include measurement and regulation of intra-abdominal pressure (IAP), generation of IAP peaks as a result of muscle contraction and measurements of AW strain patterns analyzed with 3D image stereo correlation software. Intact synthetic samples were used to test repeatability. A laparotomy closure was then performed on five samples to analyze strain patterns. Results The ‘AbdoMAN’ was capable of simulating physiological conditions. AbdoMAN lateral muscles contract at 660 N, leading the IAP to increase up to 74.9 mmHg (range 65.3–88.3). Two strain criteria were used to assess test repeatability. A test with laparotomy closure demonstrated closure testing repeatability. Conclusions The ‘AbdoMAN’ reveals as a promising enabling tool for investigating AW surgery-related biomechanics and could become an alternative to animal and clinical studies. 3D image correlation analysis should bring new insights on laparotomy closure research. The next step will consist in evaluating different closure modalities on synthetic, porcine and human AW. Electronic supplementary material The online version of this article (doi:10.1007/s10029-017-1615-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - J J Harlaar
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | - J Verhelst
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - R H M Goossens
- Department Industrial Design Engineering, University of Technology, Delft, The Netherlands
| | - G-J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Szymczak C, Lubowiecka I, Szepietowska K, Tomaszewska A. Two-criteria optimisation problem for ventral hernia repair. Comput Methods Biomech Biomed Engin 2017; 20:760-769. [DOI: 10.1080/10255842.2017.1300658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Czesław Szymczak
- Department of Theory and Ship Design, Faculty of Ocean Engineering and Ship Technology, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
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26
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Towards the mechanical characterization of abdominal wall by inverse analysis. J Mech Behav Biomed Mater 2017; 66:127-137. [DOI: 10.1016/j.jmbbm.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 12/31/2022]
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Bridging with reduced overlap: fixation and peritoneal grip can prevent slippage of DIS class A meshes. Hernia 2017; 21:455-467. [DOI: 10.1007/s10029-017-1583-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 2016; 103:1598-1607. [DOI: 10.1002/bjs.10268] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 06/10/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation.
Methods
A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.
Results
A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.
Conclusion
CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
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Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J R Lyons
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
- National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Prostheses size dependency of the mechanical response of the herniated human abdomen. Hernia 2016; 20:839-848. [DOI: 10.1007/s10029-016-1525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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30
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Tran D, Podwojewski F, Beillas P, Ottenio M, Voirin D, Turquier F, Mitton D. Abdominal wall muscle elasticity and abdomen local stiffness on healthy volunteers during various physiological activities. J Mech Behav Biomed Mater 2016; 60:451-459. [DOI: 10.1016/j.jmbbm.2016.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
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Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther 2016; 46:580-9. [PMID: 27363572 DOI: 10.2519/jospt.2016.6536] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional repeated measures. Background Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall. Objectives This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA. Methods Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance). Results Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0.005; P = .01). Inter-rectus distance and the distortion index did not change from rest or differ between tasks for controls (P≥.55). Conclusion Narrowing of the IRD during automatic curl-up in DRA distorts the LA. The distortion index requires further validation, but findings imply that less IRD narrowing with TrA preactivation might improve force transfer between sides of the abdomen. The clinical implication is that reduced IRD narrowing by TrA contraction, which has been discouraged, may positively impact abdominal mechanics. J Orthop Sports Phys Ther 2016;46(7):580-589. doi:10.2519/jospt.2016.6536.
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Liao A, Harris HW, Maharbiz MM. Towards a full-field strain sensor for guiding hernia repairs. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:1243-6. [PMID: 26736492 DOI: 10.1109/embc.2015.7318592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Each year, approximately 400,000 ventral hernia repairs are performed in the United States [1], [2]. Large ventral hernias (hernias that occur in the abdominal wall) are typically treated by suturing in a surgical mesh to cover and overlap the hernia defect. However, in 10-20% of patients, the hernia repair fails, resulting in recurrence of the hernia, along with other complications including infection and intestinal obstruction [3], [4]. One potential cause of hernia recurrence is the unequal distribution of stress across the mesh resulting in high stress concentrations at the tissue-mesh interface, particularly at the site of mesh fixation to the abdominal wall muscles[5], [6]. Strain across the mesh can be used as an indicator for how evenly stress is distributed across the surface of the mesh. To this end, we have built a full-field, 3D strain measurement system to enable physicians to actively identify and address areas of high strain during the surgery, thus decreasing the rate of hernia recurrence. The strain sensor uses an optical technique, called the grid method, in conjunction with the defocused particle image velocimetry (DPIV) technique to measure the 3D strain distribution across the mesh. The system can achieve a limit of detection down to 0.4% strain and across a 50 cm range z-axis displacement using a Canon EOS 7D camera with a pinhole aperture mask.
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Biaxial Mechanical Evaluation of Absorbable and Nonabsorbable Synthetic Surgical Meshes Used for Hernia Repair: Physiological Loads Modify Anisotropy Response. Ann Biomed Eng 2015; 44:2181-8. [DOI: 10.1007/s10439-015-1503-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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Simón-Allué R, Montiel J, Bellón J, Calvo B. Developing a new methodology to characterize in vivo the passive mechanical behavior of abdominal wall on an animal model. J Mech Behav Biomed Mater 2015. [DOI: 10.1016/j.jmbbm.2015.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Mechanical biocompatibility of highly deformable biomedical materials. J Mech Behav Biomed Mater 2015; 48:100-124. [DOI: 10.1016/j.jmbbm.2015.03.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022]
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