Prostheses size dependency of the mechanical response of the herniated human abdomen.

BACKGROUND: Hernia repairs still exhibit clinical complications, i.e. recurrence, discomfort and pain and mesh features are thought to be highly influent. The aim of this study is to evaluate the impact of the defect size and mesh type in an herniated abdominal wall using numerical models. METHODS: To do so, we have started from a FE model based on a real human abdomen geometry obtained by MRI, where we have provoked an incisional hernia of three different sizes. The surgical procedure was simulated by covering the hernia with a prostheses, and three surgical meshes with distinct mechanical properties were used for the hernia repair: an isotropic heavy-weight mesh (Surgipro @), a slightly anisotropic light-weight mesh (Optilene @) and a highly anisotropic medium-weight mesh (Infinit @). The mechanical response of the wall to a high intraabdominal pressure (corresponding to a coughing motion) was analyzed here. RESULTS: Our findings suggest that the anisotropy of the mesh becomes more relevant with the increase of the defect size. Additionally, according to our results Optilene @ showed the closest deformation to the natural distensibility of the abdomen while Infinit @ should be carefully used due to its excessive compliance.

Biaxial Mechanical Evaluation of Absorbable and Nonabsorbable Synthetic Surgical Meshes Used for Hernia Repair: Physiological Loads Modify Anisotropy Response.

The aim of this study was to obtain information about the mechanical properties of six meshes commonly used for hernia repair (Surgipro(®), Optilene(®), Infinit(®), DynaMesh(®), Ultrapro™ and TIGR(®)) by planar biaxial tests. Stress-stretch behavior and equibiaxial stiffness were evaluated, and the anisotropy was determined by testing. In particular, equibiaxial test (equal simultaneous loading in both directions) and biaxial test (half of the load in one direction following the Laplace law) were selected as a representation of physiologically relevant loads. The majority of the meshes displayed values in the range of 8 and 18 (N/mm) in each direction for equibiaxial stiffness (tangent modulus under equibiaxial load state in both directions), while a few achieved 28 and 50 (N/mm) (Infinit (®) and TIGR (®)). Only the Surgipro (®) mesh exhibited planar isotropy, with similar mechanical properties regardless of the direction of loading, and an anisotropy ratio of 1.18. Optilene (®), DynaMesh (®), Ultrapro (®) and TIGR (®) exhibited moderate anisotropy with ratios of 1.82, 1.84, 2.17 and 1.47, respectively. The Infinit (®) scaffold exhibited very high anisotropy with a ratio of 3.37. These trends in material anisotropic response changed during the physiological state in the human abdominal wall, i.e. T:0.5T test, which the meshes were loaded in one direction with half the load used in the other direction. The Surgipro (®) mesh increased its anisotropic response (Anis[Formula: see text] = 0.478) and the materials that demonstrated moderate and high anisotropic responses during multiaxial testing presented a quasi-isotropic response, especially the Infinit(®) mesh that decreased its anisotropic response from 3.369 to 1.292.

Computational framework to model and design surgical meshes for hernia repair.

Surgical procedures for hernia surgery are usually performed using prosthetic meshes. In spite of all the improvements in these biomaterials, the perfect match between the prosthesis and the implant site has not been achieved. Thus, new designs of surgical meshes are still being developed. Previous to implantation in humans, the validity of the meshes has to be addressed, and to date experimental studies have been the gold standard in testing and validating new implants. Nevertheless, these procedures involve long periods of time and are expensive. Thus, a computational framework for the simulation of prosthesis and surgical procedures may overcome some disadvantages of the experimental methods. The computational framework includes two computational models for designing and validating the behaviour of new meshes, respectively. Firstly, the beam model, which reproduces the exact geometry of the mesh, is set to design the weave and determine the stiffness of the surgical prosthesis. However, this implies a high computational cost whereas the membrane model, defined within the framework of the large deformation hyperelasticity, is a relatively inexpensive computational tool, which also enables a prosthesis to be included in more complex geometries such as human or animal bodies.

A 3D electro-mechanical continuum model for simulating skeletal muscle contraction.

A thermodynamically consistent three-dimensional electro-mechanical continuum model for simulating skeletal muscle contraction is presented. Active and passive responses are accounted for by means of a decoupled strain energy function into passive and active contributions. The active force is obtained as the maximum tetanic force penalized by two functions that consider the external stimulus frequency and the overlap between actin and myosin filaments. Passive response is modelled by a transversely isotropic strain energy function. The robustness of the model is analyzed by means of finite element simulations that reproduce the one-dimensional isometric, concentric and eccentric contractions in a simplified model of a muscle. The model has also been implemented to reproduce isometric and concentric contractions on a three-dimensional finite element model of the rat tibialis anterior (TA) muscle. The finite element model was obtained from magnetic resonance imaging and the preferential directions associated with the collagen and muscular fibres were considered. The proposed model was able to reproduce the observed experimental response of the active force generated by the isolated rat TA muscle during isometric and concentric contractions. In addition, the predicted force-velocity relationship is in good agreement with experimental data reported for the fast-twitch extensor digitorum longus (e.d.l) muscle of male rats.

Short-term behavior of different polymer structure lightweight meshes used to repair abdominal wall defects.

BACKGROUND: While lightweight (LW) polypropylene (PP) meshes are been used for hernia repair, new prosthetic meshes also of low-density and with large pores have recently been introduced composed of other polymer materials. This study compares the behavior in the short-term of two macroporous LW prosthetic materials, PP and non-expanded PTFE. METHODS: Partial defects were created in the lateral wall of the abdomen in New Zealand White rabbits and then repaired using a LW PP mesh or a new monofile, LW PTFE mesh. At 14 days postimplant, shrinkage and tissue incorporation, gene and protein expression of neo-collagens (qRT-PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength were determined. RESULTS: Both meshes induced good host tissue ingrowth, yet the macrophage response was significantly greater for the PTFE implants (p⟨0.05). Collagen 1/3 mRNA expression was greater for the PP mesh but differences lacked significance. Similar patterns of collagen I and III protein expression were observed in the neoformed tissue infiltrating the two meshes. After 14 days of implant, tensile strengths were also similar, while elastic modulus values were higher for the PTFE mesh (p⟨0.05). CONCLUSIONS: In the short term, host collagen deposition and biomechanical performance seemed unaffected by the polymer structure of the implanted mesh. In contrast, the inflammatory response to mesh implant produced at this early time point was more intense for the PTFE.

Understanding the passive mechanical behavior of the human abdominal wall.

The aim of this work is to present a methodology to model the passive mechanical behavior of the human abdomen during physiological movements. From a mechanical point of view, it is possible to predict where hernia formation is likely to occur since the areas that support higher stresses can be identified as the most vulnerable ones. For this purpose, a realistic geometry of the human abdomen is obtained from magnetic resonance imaging. The model defines different anatomical structures of the abdomen, including muscles and aponeuroses, and anisotropic mechanical properties are assigned. The finite element model obtained from the geometric human model, which includes initial strains, is used to simulate the anisotropic passive behavior of the healthy human abdomen under intra-abdominal pressure. This study demonstrates that the stiffest structures, namely aponeuroses and particularly the linea alba, are the structures that perform the most work in the abdomen. Thus, the linea alba is the most important unit contributing to the mechanical stability of the abdominal wall.

Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue.

Mechanical behaviour of synthetic surgical meshes: finite element simulation of the herniated abdominal wall.

The material properties of meshes used in hernia surgery contribute to the overall mechanical behaviour of the repaired abdominal wall. The mechanical response of a surgical mesh has to be defined since the haphazard orientation of an anisotropic mesh can lead to inconsistent surgical outcomes. This study was designed to characterize the mechanical behaviour of three surgical meshes (Surgipro®, Optilene® and Infinit®) and to describe a mechanical constitutive law that accurately reproduces the experimental results. Finally, through finite element simulation, the behaviour of the abdominal wall was modelled before and after surgical mesh implant. Uniaxial loading of mesh samples in two perpendicular directions revealed the isotropic response of Surgipro® and the anisotropic behaviour of Optilene® and Infinit®. A phenomenological constitutive law was used to reproduce the measured experimental curves. To analyze the mechanical effect of the meshes once implanted in the abdomen, finite element simulation of the healthy and partially herniated repaired rabbit abdominal wall served to reproduce wall behaviour before and after mesh implant. In all cases, maximal displacements were lower and maximal principal stresses higher in the implanted abdomen than the intact wall model. Despite the fact that no mesh showed a behaviour that perfectly matched that of abdominal muscle, the Infinit® mesh was able to best comply with the biomechanics of the abdominal wall.