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Lustig M, Epstein Y, Gefen A. An anatomically-realistic computational framework for evaluating the efficacy of protective plates in mitigating non-penetrating ballistic impacts. Comput Biol Med 2023; 166:107490. [PMID: 37738897 DOI: 10.1016/j.compbiomed.2023.107490] [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: 05/29/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND A major threat in combat scenarios is the 'behind armor blunt trauma' (BABT) of a non-penetrating ballistic impact with a ballistic protective plate (BPP). This impact results in pressure waves that propagate through tissues, potentially causing life-threatening damage. To date, there is no standardized procedure for rapid virtual testing of the effectiveness of BPP designs. The objective of this study was to develop a novel, anatomically-accurate, finite element modeling framework, as a decision-making tool to evaluate and rate the biomechanical efficacy of BPPs in protecting the torso from battlefield-acquired non-penetrating impacts. METHODS To simulate a blunt impact with a BPP, two types of BPPs representing generic designs of threat-level III and IV plates, and a generic 5.56 mm bullet were modeled, based on their real dimensions, physical and mechanical characteristics (plate level-III is smaller, thinner, and lighter than plate level-IV). The model was validated by phantom testing. RESULTS Plate level-IV induced greater strains and stresses in the superficial tissues post the ballistic impact, due to the fact that it is larger, thicker and heavier than plate level-III; the shock wave which is transferred to the superficial tissues behind the BPP is greater in the case of a non-penetrating impact. For example - the area under volumetric tissue exposure histograms of strains and stresses for the skin and adipose tissues were 16.6-19.2% and 17.3-20.3% greater in the case of plate level-IV, for strains and stresses, respectively. The validation demonstrates a strong agreement between the physical phantom experiment and the simulation, with only a 6.37% difference between them. CONCLUSIONS Our modelling provides a versatile, powerful testing framework for both industry and clients of BPPs at the prototype design phase, or for quantitative standardized evaluations of candidate products in purchasing decisions and bids.
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Affiliation(s)
- Maayan Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Epstein
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
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Orlov A, Ciliberti M, Somma R, Gefen A. A robotic venous leg ulcer system reveals the benefits of negative pressure wound therapy in effective fluid handling. Int Wound J 2023; 21:e14426. [PMID: 37786996 PMCID: PMC10828725 DOI: 10.1111/iwj.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
We applied a market-leading, single-use negative pressure wound therapy device to a robotic venous leg ulcer system and compared its fluid handling performance with that of standard of care, superabsorbent and foam dressings and compression therapy. For each tested product, we determined a metrics of retained, residual, evaporated and (potential) leaked fluid shares, for three exudate flow regimes representing different possible clinically relevant scenarios. The single-use negative pressure wound therapy system under investigation emerged as the leading treatment option in the aspects of adequate fluid handling and consistent delivery of therapeutic-level wound-bed pressures. The superabsorbent dressing performed reasonably in fluid handling (resulting in some pooling but no leakage), however, it quickly caused excessive wound-bed pressures due to swelling, after less than a day of simulated use. The foam dressing exhibited the poorest fluid handling performance, that is, pooling in the wound-bed as well as occasional leakage, indicating potential inflammation and peri-wound skin maceration risks under real-world clinical use conditions. These laboratory findings highlight the importance of advanced robotic technology as contemporary means to simulate patient and wound behaviours and inform selection of wound care technologies and products, in ways that are impossible to achieve if relying solely on clinical trials and experience.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | - Marino Ciliberti
- Wound Care Centre (Centro Aziendale di Riparazione Tissutale)Castellammare di StabiaItaly
| | - Rosa Somma
- Wound Care Centre (Centro Aziendale di Riparazione Tissutale)Castellammare di StabiaItaly
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Gefen A, Alves P, Beeckman D, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Swanson T, Woo K. Mechanical and contact characteristics of foam materials within wound dressings: Theoretical and practical considerations in treatment. Int Wound J 2022. [PMID: 36564958 DOI: 10.1111/iwj.14056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
In the treatment of acute and chronic wounds, the clinical performance of a given foam-based dressing, and, ultimately, the wound healing and cost of care outcomes are strongly influenced by the mechanical performance of the foam material/s within that dressing. Most aspects of the mechanical performance of foam materials, for example, their stiffness, frictional properties, conformability, swelling characteristics and durability, and the overall mechanical protection provided by a foam-based dressing to a wound strongly depend on the microstructure of the foam components, particularly on their microtopography, density and porosity. This article, therefore, provides, for the first time, a comprehensive, self-inclusive compilation of clinically relevant theoretical and practical considerations, based on published analytical and experimental research as well as clinical experience related to the mechanical performance of foams in foam-based wound dressings. The current bioengineering information is useful for establishing understanding of the importance of mechanical properties of foams in foam-based dressings among clinicians and researchers in industry and academia, and other potential stakeholders in the wound care field, for example, regulators and buyers. This information is also particularly important for the development of standardised test methods for the evaluation of foam-based wound dressings and resulting standard mechanical performance metrics for these dressings.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Wounds Research Lab - Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Terry Swanson
- Wound Education Research Consultancy (WERC), Warrnambool, Victoria, Australia
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Bregovskiy VB, Demina AG, Karpova IA. The use of modern dressings for the local treatment of diabetic foot ulcers in out-patient setting. AMBULATORNAYA KHIRURGIYA = AMBULATORY SURGERY (RUSSIA) 2022. [DOI: 10.21518/1995-1477-2022-19-2-72-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Local treatment of diabetic foot ulcers is one of the most controversial topics in surgery. The choice of a dressing or bandage is still heavily influenced by many subjective factors and is often based on the personal preferences of the medical staff. Based on literature data and practical experience, the article presents the shortcomings of the current domestic practice of using gauze dressings with various drugs, as well as the reasons for the insufficient use of special so-called “outpatient” dressings with special properties. The main classes of modern dressings with special properties (mesh, hydrocolloids, hydroalginates, hydrogels, alginates and sponges or foams) and their areas of application are characterized. The concept of wound treatment in a humid environment with maintaining an optimal moisture balance is highlighted. The key areas of treatment of diabetic foot ulcers in accordance with the modern recommendations of the International Working Group on the Diabetic Foot and the Ministry of Health of the Russian Federation are given: infection control, adequate blood supply, regular debridement and offloading of the affected limb. Special attention is paid to immobilization as the most important factor ensuring healing. On clinical cases, the methodology and tactics of local treatment of postoperative wound and diabetic foot ulcer with alginate dressing and silicone coated sponges are analyzed. Alternative options for local treatment of patients in both clinical cases are discussed.
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Orlov A, Gefen A. Fluid handling performance of wound dressings tested in a robotic venous leg ulcer system under compression therapy. Int Wound J 2022; 20:1384-1392. [PMID: 36267049 PMCID: PMC10088854 DOI: 10.1111/iwj.13985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
We designed, developed, built, and utilised a robotic system of a leg with two venous leg ulcers for testing the fluid handling performance of three wound dressing types. The results showed that a foam-based dressing technology is inferior in fluid handling performance when applied to an exuding venous leg ulcer, such that the dressing needs to manage the exudate in a vertical configuration with respect to the ground, that is, so that gravity pulls the exudate to concentrate in a small region at the bottom of the dressing. Moreover, wound dressings containing superabsorbent polymers do not necessarily function equally in fluid handling for venous leg ulcer scenarios, as the extreme requirements from the dressing (to manage the viscous fluid of a vertical and typically highly-exuding wound) appear to distinguish between optimal and suboptimal product performances despite that the tested products contain a superabsorbent, theoretically lumping them together to belong to a so-called 'superabsorbent dressing category'. In other words, it is a false premise to categorise products from different manufacturers into families based on material contents, and then assume that their laboratory or clinical performance is equal, so that from this point they can be judged solely on the basis of price.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv-Yafo, Israel
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Orlov A, Lustig A, Grigatti A, Gefen A. Fluid Handling Dynamics and Durability of Silver-Containing Gelling Fiber Dressings Tested in a Robotic Wound System. Adv Skin Wound Care 2022; 35:326-334. [PMID: 35293376 PMCID: PMC9119404 DOI: 10.1097/01.asw.0000823972.16446.ff] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a robotic phantom system containing multiple simulated wound replicates to determine the synergy in fluid absorbency and retention (sorptivity) performances and the post-simulated-use mechanical durability of silver-containing gelling fiber primary dressings when used with a secondary dressing, as per clinical practice. METHODS Using a robotic system containing six identical wound simulators, the authors tested the sorptivity performances of the Exufiber Ag + (Mölnlycke Health Care, Gothenburg, Sweden) primary dressing (ExAg-polyvinyl alcohol [PVA]) against a market-leading comparator product, when used with a secondary foam dressing. The durability of the primary dressings after simulated use was further investigated through tensile mechanical testing. RESULTS The ExAg-PVA primary dressing delivered greater fluid amounts for absorbency and retention by the secondary foam dressing, approximately 2- and 1.5-fold more than the comparator dressing pair after 10 and 15 hours, respectively. The ExAg-PVA dressing was also substantially less sensitive to the direction of pulling forces and, accordingly, exhibited post-use mechanical strength that was approximately four and six times greater than that of the other primary dressing (when the latter dressing was tested out-of-alignment with its visible seams) after 10 and 15 hours, respectively. CONCLUSIONS The dynamics of the sorptivity and fluid sharing between primary and secondary dressings and the effect of directional preference of strength of the primary dressings for adequate durability, resulting in safe post-use removals, have been described. The comparative quantification of these capabilities should help clinical and nonclinical decision-makers select dressings that best meet their patient needs.
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Affiliation(s)
- Aleksei Orlov
- At Tel Aviv University, Department of Biomedical Engineering, Tel Aviv, Israel, Aleksei Orlov, MSc; Adi Lustig, MSc; and Angela Grigatti, MSc, are Graduate Students at the research group of Professor Gefen; and Amit Gefen, PhD, is Professor of Biomedical Engineering and the Herbert J. Berman Chair in Vascular Bioengineering. Acknowledgment: This project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Grant Agreement No. 811965; project STINTS (Skin Tissue Integrity under Shear). This work was also partially supported by the Israeli Ministry of Science & Technology (Medical Devices Program grant no. 3-17421, awarded to Prof Amit Gefen in 2020) and by Mölnlycke Health Care (Gothenburg, Sweden). The authors thank Ms Orel Belo, the Laboratory Engineer at the Gefen Laboratory, for supporting the experimental work. The authors have disclosed no other financial relationships related to this article. Submitted July 23, 2021; accepted in revised form November 1, 2021; published online ahead of print March 14, 2022
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Orlov A, Gefen A. The fluid handling performance of the curea P1 multipurpose dressing against superabsorbent and foam dressing technologies. Int Wound J 2022; 19:945-956. [PMID: 35254730 PMCID: PMC9013594 DOI: 10.1111/iwj.13774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
Using a novel, automated robotic phantom system containing multiple wound simulants, we determined the fluid handling performance of the curea P1 multipurpose dressing vs market‐leading comparator superabsorbent and foam‐based dressings (FBDs). Specifically, we measured the retained, residual, evaporated, and (potentially occurring) spillover fluid shares for high‐ vs low‐viscosity exudate‐simulant test fluids, at 12, 24, and 30 hours postapplication of the dressings. These experiments were conducted for off‐loaded (‘prone’), non‐off‐loaded (‘supine’), and vertical (‘side‐lying’) simulated body positions. We found that the multipurpose dressing exhibited the best and most robust fluid handling performance across all the test configurations, for both the low‐ and high‐viscosity fluids. The FBD consistently showed the poorest performance compared to the other dressings, rendering it unlikely to be able to manage viscous exudates in ambulant patients (such as when applied to venous leg ulcers) as effectively as the other dressings. The superabsorbent dressing performed better than the foam dressing, but its fluid handling metrics were inferior to those of the multipurpose dressing. The current comparative quantification of the shares of retained, residual, evaporated, and spillover fluid, acquired through standardised laboratory tests, should help decision‐makers to select dressings that best meet their patient needs.
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Affiliation(s)
- Aleksei Orlov
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Lustig A, Gefen A. The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests. Int Wound J 2022; 19 Suppl 1:3-21. [PMID: 35142062 PMCID: PMC9478960 DOI: 10.1111/iwj.13761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.
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Affiliation(s)
- Adi Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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