Trends in CSF Leakage Associated with Duraplasty in Infratentorial Procedures over the Last 20 Years: A Systematic Review.

Cerebrospinal fluid (CSF) leakage is a common postoperative complication of neurosurgical procedures, with iatrogenic causes accounting for 16% of CSF leakages. This complication increases healthcare costs and patient morbidity. The focus of this review is to analyze the rates of CSF leakage of some of the most commonly used xenogeneic and synthetic dural substitutes following surgeries in the infratentorial region of the brain where surgical repair can be most challenging. A systematic literature search was conducted using studies detailing duraplasty procedures performed with nonautologous grafts in the infratentorial region in PubMed. Studies were identified using the following search terms: "posterior fossa" or "infratentorial" were used in combination with "CSF leak," "CSF leakage," "cerebrospinal fluid leakage," "duraplasty" or "dura graft." The outcome of interest was a measure of the prevalence of CSF leakage rates following posterior fossa neurosurgery. Studies that contributed data to this review were published between 2006 and 2021. The dural graft materials utilized included: bovine collagen, acellular dermis, equine collagen, bovine pericardium, collagen matrix, and expanded polytetrafluoroethylene (ePTFE). The number of subjects in studies on each of these grafts ranged from 6 to 225. CSF leak rates ranged from 0% to 25% with the predominance of studies reporting between 3% and 15%. The studies that utilize bovine collagen, equine collagen, and acellular dermis reported higher CSF leakage rates; whereas studies that utilized ePTFE, bovine pericardium, and collagen matrix reported lower CSF leakage rates. Due to the heterogeneity of methodologies used across these studies, it is difficult to draw a direct correlation between the dural patch products used and CSF leaks. Larger prospective controlled studies that evaluate various products in a head-to-head fashion, using the same methods and animal models, are needed to conclude the relative efficacy of these dural patch products.

A Computational Investigation of Microstructural Damage of the Anterior Cruciate Ligament Under High Loading of the Knee Joint.

The anterior cruciate ligament plays a major role in maintaining the stability of the knee joint and is susceptible to injury under strenuous activity. Anterior cruciate ligament (ACL) injuries can lead to joint instability and complications such as osteoarthritis. Despite this, there is a lack of material models capable of predicting damage at a localized fiber level, hindering our ability to understand how damage develops in real-time. This work develops a continuum-damage material model of the ACL and applies the model to a finite element simulation of the knee undergoing high quadriceps tendon loading. Using quadriceps tendon loadings of 1000, 1500, and 2000 N, the development of microstructural damage within the ACL tissue was examined, and the effects of localized damage on the joint kinematics were investigated. Damage tended to develop in the midsubstance of the ACL in the present model in the anterior medial bundle region and could induce significant changes in the joint kinematics. Using this model, new insights into the development of ACL injury mechanisms can be investigated.

An in vitro study of micromechanics, cellular proliferation and viability on both decellularized porcine dura grafts and native porcine dura grafts.

Damage to the dura mater may occur during intracranial or spinal surgeries, which can result in cerebrospinal fluid leakage and other potentially fatal physiological changes. As a result, biological and synthetic derived scaffolds are typically used to repair dura mater post intracranial or spinal surgeries. The extracellular matrix of xenogeneic dura scaffolds has been shown to exhibit increased cell infiltration and regeneration than synthetic dura materials. In this study, we investigated the biocompatibility of native and decellularized porcine dura by seeding rat fibroblast cells onto the constructs. Cell proliferation, cell viability, and the mechanical properties of these dural grafts were evaluated post-re-seeding on days 3,7 and 14. Live-dead staining and resazurin salts were used to quantify cell viability and cell proliferation, respectively. Micro indentation was conducted to quantify the mechanical integrity of the native and acellular dura graft. The findings indicate that the acellular porcine dura graft creates a beneficial setting for infiltrating rat fibroblast cells. Cell viability, proliferation, and micro indentation results on the acellular grafts are comparable with the native control porcine dura tissue. In conclusion, the porcine scaffold material showed increased cell viability at each time point evaluated. The sustained mechanical response and favorable viability of the cells on the decellularized grafts provide promising insight into the potential use of porcine dura in clinical cranial dura mater graft applications.

Acellular Myocardial Scaffolds and Slices Fabrication, and Method for Applying Mechanical and Electrical Simulation to Tissue Construct.

Cardiac tissue engineering/regeneration using decellularized myocardium has attracted great research attention due to its potential benefit to myocardial infarction (MI) treatment. Here, we described an optimal decellularization protocol to generate 3D porcine myocardial scaffolds with well-preserved cardiomyocyte lacunae, myocardial slices as a biomimetic cell culture and delivery platform, and a multi-stimulation bioreactor that is able to provide coordinated mechanical and electrical stimulations for facilitating cardiac construct development.

Predicting the Effect of Localized ACL Damage on Neighbor Ligament Mechanics via Finite Element Modeling.

The anterior cruciate ligament (ACL) plays a pivotal role in support of the knee under loading. When damaged, it is known that substantial changes in the mechanics of the neighboring ligaments can be observed. However, a localized damage approach to investigating how ACL deficiency influences the neighboring ligaments has not been carried out. To do this, a finite element model, incorporating a continuum damage material model of the ACL, was implemented. Localized ACL damage was induced using high quadriceps force loading. Once damaged, anterior shear forces or tibial torque loadings were applied to the knee joint. The relative changes in stress contour and average mid-substance stress were examined for each of the neighboring ligaments following localized ACL damage. It was observed that localized ACL damage could produce notable changes in the mechanics of the neighboring knee ligaments, with non-homogenous stress contour shape changes and average stress magnitude being observed to increase in most cases, with a notable exception occurring in the MCL for both loading modes. In addition, the ligament bearing the most loading also changed with ACL deficiency. These changes carry implications as to morphological effects that may be induced following localized ACL damage, indicating that early diagnosis of ACL injury may be helpful in mitigating other complications post injury.

Structural and biomechanical characterizations of acellular porcine mitral valve scaffolds: anterior leaflets, posterior leaflets, and chordae tendineae.

Mitral valve (MV) tissue engineering is still in its early stage, and one major challenge in MV tissue engineering is to identify appropriate scaffold materials. With the potential of acellular MV scaffolds being demonstrated recently, it is important to have a full understanding of the biomechanics of the native MV components and their acellular scaffolds. In this study, we have successfully characterized the structural and mechanical properties of porcine MV components, including anterior leaflet (AL), posterior leaflet (PL), strut chordae, and basal chordae, before and after decellularization. Quantitative DNA assay showed more than 90% reduction in DNA content, and Griffonia simplicifolia (GS) lectin immunohistochemistry confirmed the complete lack of porcine α-Gal antigen in the acellular MV components. In the acellular AL and PL, the atrialis, spongiosa, and fibrosa trilayered structure, along with its ECM constitutes, i.e., collagen fibers, elastin fibers, and portion of GAGs, were preserved. Nevertheless, the ECM of both AL and PL experienced a certain degree of disruption, exhibiting a less dense, porous ECM morphology. The overall anatomical morphology of the strut and basal chordae were also maintained after decellularization, with longitudinal morphology experiencing minimum disruption, but the cross-sectional morphology exhibiting evenly-distributed porous structure. In the acellular AL and PL, the nonlinear anisotropic biaxial mechanical behavior was overall preserved; however, uniaxial tensile tests showed that the removal of cellular content and the disruption of structural ECM did result in small decreases in maximum tensile modulus, tissue extensibility, failure stress, and failure strain for both MV leaflets and chordae.

Shear-deformation based continuum-damage constitutive modeling of brain tissue.

Traumatic brain injury (TBI) is a leading cause of death in the United States. Depending on the severity of injury, complications such as memory loss and emotional changes are common. While the exact mechanisms are still unclear, these cognitive deficiencies are thought to arise from microstructural damages to the brain tissue, such as in diffuse-axonal injury where neuron fibers are sheared. Constitutive models can predict such damage at a microstructural level and allow for insight into the mechanisms of injury initiating at lower length scales. In this study, we developed a continuum damage model of brain tissue that is validated by experimental quasi-static stress-strain tests in tension, compression, and shear. The present work shows that damage is most present in the shear stress state, making the tissue suitable for damage modeling via shear interaction terms. Using this model, new insights into microstructural breakdown due to shear stresses and strains can be gained by application to simulations.

Biomechanical properties of acellular scar ECM during the acute to chronic stages of myocardial infarction.

After myocardial infarction (MI), the infarcted tissue undergoes dynamic and time-dependent changes. Previous knowledge on MI biomechanical alterations has been obtained by studying the explanted scar tissues. In this study, we decellularized MI scar tissue and characterized the biomechanics of the obtained pure scar ECM. By thoroughly removing the cellular content in the MI scar tissue, we were able to avoid its confounding effects. Rat MI hearts were obtained from a reliable and reproducible model based on permanent left coronary artery ligation (PLCAL). MI heart explants at various time points (15 min, 1 week, 2 weeks, 4 weeks, and 12 weeks) were subjected to decellularization with 0.1% sodium dodecyl sulfate solution for ~1-2 weeks to obtain acellular scar ECM. A biaxial mechanical testing system was used to characterize the acellular scar ECM under physiologically relevant loading conditions. After decellularization, large decrease in wall thickness was observed in the native heart ECM and 15 min scar ECM, implying the collapse of cardiomyocyte lacunae after removal of heart muscle fibers. For scar ECM 1 week, 2 weeks, and 4 weeks post infarction, the decrease in wall thickness after decellularization was small. For scar ECM 12 weeks post infarction, the reduction amount of wall thickness due to decellularization was minimal. We found that the scar ECM preserved the overall mechanical anisotropy of the native ventricle wall and MI scar tissue, in which the longitudinal direction is more extensible. Acellular scar ECM from 15 min to 12 weeks post infarction showed an overall stiffening trend in biaxial behavior, in which longitudinal direction was mostly affected and manifested with a decreased extensibility and increased modulus. This reduction trend of longitudinal extensibility also led to a decreased anisotropy index in the scar ECM from the acute to chronic stages of MI. The post-MI change in biomechanical properties of the scar ECM reflected the alterations of collagen fiber network, confirmed by the histology of scar ECM. In short, the reported structure-property relationship reveals how scar ECM biophysical properties evolve from the acute to chronic stages of MI. The obtained information will help establish a knowledge basis about the dynamics of scar ECM to better understand post-MI cardiac remodeling.

Mechanical Response of Porcine Liver Tissue under High Strain Rate Compression.

In automobile accidents, abdominal injuries are often life-threatening yet not apparent at the time of initial injury. The liver is the most commonly injured abdominal organ from this type of trauma. In contrast to current safety tests involving crash dummies, a more detailed, efficient approach to predict the risk of human injuries is computational modelling and simulations. Further, the development of accurate computational human models requires knowledge of the mechanical properties of tissues in various stress states, especially in high-impact scenarios. In this study, a polymeric split-Hopkinson pressure bar (PSHPB) was utilized to apply various high strain rates to porcine liver tissue to investigate its material behavior during high strain rate compression. Liver tissues were subjected to high strain rate impacts at 350, 550, 1000, and 1550 s-1. Tissue directional dependency was also explored by PSHPB testing along three orthogonal directions of liver at a strain rate of 350 s-1. Histology of samples from each of the three directions was performed to examine the structural properties of porcine liver. Porcine liver tissue showed an inelastic and strain rate-sensitive response at high strain rates. The liver tissue was found lacking directional dependency, which could be explained by the isotropic microstructure observed after staining and imaging. Furthermore, finite element analysis (FEA) of the PSHPB tests revealed the stress profile inside liver tissue and served as a validation of PSHPB methodology. The present findings can assist in the development of more accurate computational models of liver tissue at high-rate impact conditions allowing for understanding of subfailure and failure mechanisms.

Compressive Mechanical Properties of Porcine Brain: Experimentation and Modeling of the Tissue Hydration Effects.

Designing protective systems for the human head-and, hence, the brain-requires understanding the brain's microstructural response to mechanical insults. We present the behavior of wet and dry porcine brain undergoing quasi-static and high strain rate mechanical deformations to unravel the effect of hydration on the brain's biomechanics. Here, native 'wet' brain samples contained ~80% (mass/mass) water content and 'dry' brain samples contained ~0% (mass/mass) water content. First, the wet brain incurred a large initial peak stress that was not exhibited by the dry brain. Second, stress levels for the dry brain were greater than the wet brain. Third, the dry brain stress-strain behavior was characteristic of ductile materials with a yield point and work hardening; however, the wet brain showed a typical concave inflection that is often manifested by polymers. Finally, finite element analysis (FEA) of the brain's high strain rate response for samples with various proportions of water and dry brain showed that water played a major role in the initial hardening trend. Therefore, hydration level plays a key role in brain tissue micromechanics, and the incorporation of this hydration effect on the brain's mechanical response in simulated injury scenarios or virtual human-centric protective headgear design is essential.

Molecular dynamics simulations showing 1-palmitoyl-2-oleoyl-phosphatidylcholine (POPC) membrane mechanoporation damage under different strain paths.

Continuum finite element material models used for traumatic brain injury lack local injury parameters necessitating nanoscale mechanical injury mechanisms be incorporated. One such mechanism is membrane mechanoporation, which can occur during physical insults and can be devastating to cells, depending on the level of disruption. The current study investigates the strain state dependence of phospholipid bilayer mechanoporation and failure. Using molecular dynamics, a simplified membrane, consisting of 72 1-palmitoyl-2-oleoyl-phosphatidylcholine (POPC) phospholipids, was subjected to equibiaxial, 2:1 non-equibiaxial, 4:1 non-equibiaxial, strip biaxial, and uniaxial tensile deformations at a von Mises strain rate of 5.45 × 108 s-1, resulting in velocities in the range of 1 to 4.6 m·s-1. A water bridge forming through both phospholipid bilayer leaflets was used to determine structural failure. The stress magnitude, failure strain, headgroup clustering, and damage responses were found to be strain state-dependent. The strain state order of detrimentality in descending order was equibiaxial, 2:1 non-equibiaxial, 4:1 non-equibiaxial, strip biaxial, and uniaxial. The phospholipid bilayer failed at von Mises strains of .46, .47, .53, .77, and 1.67 during these respective strain path simulations. Additionally, a Membrane Failure Limit Diagram (MFLD) was created using the pore nucleation, growth, and failure strains to demonstrate safe and unsafe membrane deformation regions. This MFLD allowed representative equations to be derived to predict membrane failure from in-plane strains. These results provide the basis to implement a more accurate mechano-physiological internal state variable continuum model that captures lower length scale damage and will aid in developing higher fidelity injury models.

Quantitative Analysis of Tissue Damage Evolution in Porcine Liver With Interrupted Mechanical Testing Under Tension, Compression, and Shear.

In this study, the damage evolution of liver tissue was quantified at the microstructural level under tensile, compression, and shear loading conditions using an interrupted mechanical testing method. To capture the internal microstructural changes in response to global deformation, the tissue samples were loaded to different strain levels and chemically fixed to permanently preserve the deformed tissue geometry. Tissue microstructural alterations were analyzed to quantify the accumulated damages, with damage-related parameters such as number density, area fraction, mean area, and mean nearest neighbor distance (NND). All three loading states showed a unique pattern of damage evolution, in which the damages were found to increase in number and size, but decrease in NND as strain level increased. To validate the observed damage features as true tissue microstructural damages, more samples were loaded to the above-mentioned strain levels and then unloaded back to their reference state, followed by fixation. The most major damage-relevant features at higher strain levels remained after the release of the external loading, indicating the occurrence of permanent inelastic deformation. This study provides a foundation for future structure-based constitutive material modeling that can capture and predict the stress-state dependent damage evolution in liver tissue.

Modified Drop Tower Impact Tests for American Football Helmets.

A modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test method for American football helmet drop impact test standards is presented that would provide better assessment of a helmet's on-field impact performance by including a faceguard on the helmet. In this study, a merger of faceguard and helmet test standards is proposed. The need for a more robust systematic approach to football helmet testing procedures is emphasized by comparing representative results of the Head Injury Criterion (HIC), Severity Index (SI), and peak acceleration values for different helmets at different helmet locations under modified NOCSAE standard drop tower tests. Essentially, these comparative drop test results revealed that the faceguard adds a stiffening kinematic constraint to the shell that lessens total energy absorption. The current NOCSAE standard test methods can be improved to represent on-field helmet hits by attaching the faceguards to helmets and by including two new helmet impact locations (Front Top and Front Top Boss). The reported football helmet test method gives a more accurate representation of a helmet's performance and its ability to mitigate on-field impacts while promoting safer football helmets.

The geometric effects of a woodpecker's hyoid apparatus for stress wave mitigation.

In this study a woodpecker's hyoid apparatus was characterized to determine its impact mitigation mechanism using finite element (FE) analysis. The woodpecker's hyoid apparatus, comprising bone and muscle, has a unique geometry compared to those of other birds. The hyoid starts at the beak tip, surrounds the woodpecker's skull, and ends at the upper beak/front head intersection while being surrounded by muscle along the whole length. A FE model of the hyoid apparatus was created based on the geometry, microstructure, and mechanical properties garnered from our experimental measurements. We compared the impact mitigation capabilities of the hyoid apparatus with an idealized straight cylinder and a tapered cylinder. The results showed that the hyoid geometry mitigated a greater amount of pressure and impulse compared to the straight or tapered cylinders. The initially applied longitudinal wave lost its strength from attenuation and conversion to transverse shear waves. This is due to the spiral curvature and tapered geometry, which induced lateral displacement in the hyoid bone. The lateral displacement of the bony hyoid induced strains on the adjacent muscle, where the energy dissipated due to the muscle's viscoelasticity. Quantitatively, as the stress wave traveled from the anterior to the posterior end of the hyoid apparatus, its pressure decreased 75% and the associated impulse decreased 84%. The analysis of the woodpecker's hyoid apparatus provides a novel perspective on impact mitigation mediated by a spiral-shaped structure and viscoelastic biocomposite.

Fully non-linear hyper-viscoelastic modeling of skeletal muscle in compression.

Understanding the behavior of skeletal muscle is critical to implementing computational methods to study how the body responds to compressive loading. This work presents a novel approach to studying the fully nonlinear response of skeletal muscle in compression. Porcine muscle was compressed in both the longitudinal and transverse directions under five stress relaxation steps. Each step consisted of 5% engineering strain over 1 s followed by a relaxation period until equilibrium was reached at an observed change of 1 g/min. The resulting data were analyzed to identify the peak and equilibrium stresses as well as relaxation time for all samples. Additionally, a fully nonlinear strain energy density-based Prony series constitutive model was implemented and validated with independent constant rate compressive data. A nonlinear least squares optimization approach utilizing the Levenberg-Marquardt algorithm was implemented to fit model behavior to experimental data. The results suggested the time-dependent material response plays a key role in the anisotropy of skeletal muscle as increasing strain showed differences in peak stress and relaxation time (p < 0.05), but changes in equilibrium stress disappeared (p > 0.05). The optimizing procedure produced a single set of hyper-viscoelastic parameters which characterized compressive muscle behavior under stress relaxation conditions. The utilized constitutive model was the first orthotropic, fully nonlinear hyper-viscoelastic model of skeletal muscle in compression while maintaining agreement with constitutive physical boundaries. The model provided an excellent fit to experimental data and agreed well with the independent validation in the transverse direction.

A Coupled Experiment-finite Element Modeling Methodology for Assessing High Strain Rate Mechanical Response of Soft Biomaterials.

This study offers a combined experimental and finite element (FE) simulation approach for examining the mechanical behavior of soft biomaterials (e.g. brain, liver, tendon, fat, etc.) when exposed to high strain rates. This study utilized a Split-Hopkinson Pressure Bar (SHPB) to generate strain rates of 100-1,500 sec(-1). The SHPB employed a striker bar consisting of a viscoelastic material (polycarbonate). A sample of the biomaterial was obtained shortly postmortem and prepared for SHPB testing. The specimen was interposed between the incident and transmitted bars, and the pneumatic components of the SHPB were activated to drive the striker bar toward the incident bar. The resulting impact generated a compressive stress wave (i.e. incident wave) that traveled through the incident bar. When the compressive stress wave reached the end of the incident bar, a portion continued forward through the sample and transmitted bar (i.e. transmitted wave) while another portion reversed through the incident bar as a tensile wave (i.e. reflected wave). These waves were measured using strain gages mounted on the incident and transmitted bars. The true stress-strain behavior of the sample was determined from equations based on wave propagation and dynamic force equilibrium. The experimental stress-strain response was three dimensional in nature because the specimen bulged. As such, the hydrostatic stress (first invariant) was used to generate the stress-strain response. In order to extract the uniaxial (one-dimensional) mechanical response of the tissue, an iterative coupled optimization was performed using experimental results and Finite Element Analysis (FEA), which contained an Internal State Variable (ISV) material model used for the tissue. The ISV material model used in the FE simulations of the experimental setup was iteratively calibrated (i.e. optimized) to the experimental data such that the experiment and FEA strain gage values and first invariant of stresses were in good agreement.

On the bending properties of porcine mitral, tricuspid, aortic, and pulmonary valve leaflets.

The atrioventricular valve leaflets (mitral and tricuspid) are different from the semilunar valve leaflets (aortic and pulmonary) in layered structure, ultrastructural constitution and organization, and leaflet thickness. These differences warrant a comparative look at the bending properties of the four types of leaflets. We found that the moment-curvature relationships in atrioventricular valves were stiffer than in semilunar valves, and the moment-curvature relationships of the left-side valve leaflets were stiffer than their morphological analog of the right side. These trends were supported by the moment-curvature curves and the flexural rigidity analysis (EI value decreased from mitral, tricuspid, aortic, to pulmonary leaflets). However, after taking away the geometric effect (moment of inertia I), the instantaneous effective bending modulus E showed a reversed trend. The overall trend of flexural rigidity (EI: mitral > tricuspid > aortic > pulmonary) might be correlated with the thickness variations among the four types of leaflets (thickness: mitral > tricuspid > aortic > pulmonary). The overall trend of the instantaneous effective bending modulus (E: mitral < tricuspid < aortic < pulmonary) might be correlated to the layered fibrous ultrastructures of the four types of leaflets, of which the fibers in mitral and tricuspid leaflets were less aligned, and the fibers in aortic and pulmonary leaflets were highly aligned. We also found that, for all types of leaflets, moment-curvature relationships are stiffer in against-curvature (AC) bending than in with-curvature bending (WC), which implies that leaflets tend to flex toward their natural curvature and comply with blood flow. Lastly, we observed that the leaflets were stiffer in circumferential bending compared with radial bending, likely reflecting the physiological motion of the leaflets, i.e., more bending moment and movement were experienced in radial direction than circumferential direction.

Anisotropic compressive properties of passive porcine muscle tissue.

The body has approximately 434 muscles, which makes up 40-50% of the body by weight. Muscle is hierarchical in nature and organized in progressively larger units encased in connective tissue. Like many soft tissues, muscle has nonlinear visco-elastic behavior, but muscle also has unique characteristics of excitability and contractibility. Mechanical testing of muscle has been done for crash models, pressure sore models, back pain, and other disease models. The majority of previous biomechanical studies on muscle have been associated with tensile properties in the longitudinal direction as this is muscle's primary mode of operation under normal physiological conditions. Injury conditions, particularly high rate injuries, can expose muscle to multiple stress states. Compressive stresses can lead to tissue damage, which may not be reversible. In this study, we evaluate the structure-property relationships of porcine muscle tissue under compression, in both the transverse and longitudinal orientations at 0.1 s-1, 0.01 s-1, or 0.001 s-1. Our results show an initial toe region followed by an increase in stress for muscle in both the longitudinal and transverse directions tested to 50% strain. Strain rate dependency was also observed with the higher strain rates showing significantly more stress at 50% strain. Muscle in the transverse orientation was significantly stiffer than in the longitudinal orientation indicating anisotropy. The mean area of fibers in the longitudinal orientation shows an increasing mean fiber area and a decreasing mean fiber area in the transverse orientation. Data obtained in this study can help provide insight on how muscle injuries are caused, ranging from low energy strains to high rate blast events, and can also be used in developing computational injury models.

Preparation of acellular myocardial scaffolds with well-preserved cardiomyocyte lacunae, and method for applying mechanical and electrical simulation to tissue construct.

Cardiac tissue engineering/regeneration using decellularized myocardium has attracted great research attention due to its potential benefit for myocardial infarction (MI) treatment. Here we describe an optimal decellularization protocol to generate 3D porcine myocardial scaffolds with well-preserved cardiomyocyte lacunae and a multi-stimulation bioreactor that is able to provide coordinated mechanical and electrical stimulation for facilitating cardiac construct development.

Hierarchical multiscale structure-property relationships of the red-bellied woodpecker (Melanerpes carolinus) beak.

We experimentally studied beaks of the red-bellied woodpecker to elucidate the hierarchical multiscale structure-property relationships. At the macroscale, the beak comprises three structural layers: an outer rhamphotheca layer (keratin sheath), a middle foam layer and an inner bony layer. The area fraction of each layer changes along the length of the beak giving rise to a varying constitutive behaviour similar to functionally graded materials. At the microscale, the rhamphotheca comprises keratin scales that are placed in an overlapping pattern; the middle foam layer has a porous structure; and the bony layer has a big centre cavity. At the nanoscale, a wavy gap between the keratin scales similar to a suture line was evidenced in the rhamphotheca; the middle foam layer joins two dissimilar materials; and mineralized collagen fibres were revealed in the inner bony layer. The nano- and micro-indentation tests revealed that the hardness (associated with the strength, modulus and stiffness) of the rhamphotheca layer (approx. 470 MPa for nano and approx. 320 MPa for micro) was two to three times less than that of the bony layer (approx. 1200 MPa for nano and approx. 630 MPa for micro). When compared to other birds (chicken, finch and toucan), the woodpecker's beak has more elongated keratin scales that can slide over each other thus admitting dissipation via shearing; has much less porosity in the bony layer thus strengthening the beak and focusing the stress wave; and has a wavy suture that admits local shearing at the nanoscale. The analysis of the woodpeckers' beaks provides some understanding of biological structural materials' mechanisms for energy absorption.