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Research Papers

Mechanical Response of the Herniated Human Abdomen to the Placement of Different Prostheses

[+] Author and Article Information
Belén Hernández-Gascón

Postdoctoral Researcher
e-mail: belenhg@unizar.es

Estefanía Peña

Associate Professor
e-mail: fany@unizar.es

Jorge Grasa

Associate Professor
e-mail: jgrasa@unizar.es
Aragón Institute of Engineering Research (I3A),
University of Zaragoza,
CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina,
Zaragoza 50018, Spain

Gemma Pascual

Associate Professor
Faculty of Medicine,
Department of Medical Specialities,
University of Alcalá,
CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina,
Alcalá 28871, Spain
e-mail: gemma.pascual@uah.es

Juan M. Bellón

Professor
Faculty of Medicine,
Department of Surgery,
University of Alcalá,
CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina,
Alcalá 28871, Spain
e-mail: juanm.bellon@uah.es

Begoña Calvo

Professor
Aragón Institute of Engineering Research (I3A),
University of Zaragoza,
CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina,
Zaragoza 50018, Spain
e-mail: bcalvo@unizar.es

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received October 8, 2012; final manuscript received January 28, 2013; accepted manuscript posted February 19, 2013; published online April 24, 2013. Assoc. Editor: Pasquale Vena.

J Biomech Eng 135(5), 051004 (Apr 24, 2013) (8 pages) Paper No: BIO-12-1472; doi: 10.1115/1.4023703 History: Received October 08, 2012; Revised January 28, 2013; Accepted February 19, 2013

This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.

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Figures

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Fig. 1

Anatomical structures defined in the model of the herniated human abdomen. (a) Linea alba, rectus abdominis muscle, rectus tendon, oblique muscles, oblique muscle tendon, chest, dorsal abdomen, and pelvis. (b) Anterior and posterior rectus sheaths in dark color. (c) Fascia transversalis in dark color.

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Fig. 2

FE model of the herniated human abdomen including a large incisional hernia along the LA and FE model of the surgical mesh. (a) The placement direction and the overlap between prosthesis and tissue is shown. (b) Whole FE model with the prosthesis in place.

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Fig. 3

Experimental data from uniaxial mechanical tests conducted on the prostheses examined obtained from the literature (figure inspired on the image in Hernández-Gascón et al. [10])

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Fig. 4

Two orientations are defined to place the mesh so that it covers the hernia. (a) Orientation A: the most compliant direction of the mesh, Direction 1, is aligned with the craneo-caudal axis. (b) Orientation B: the stiffest direction of the mesh, Direction 2, is aligned with the craneo-caudal axis.

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Fig. 5

MD along the lines AB (a) and CD (c), and MPS along the lines AB (b) and CD (d) in the model of the herniated abdomen just after surgery (see Fig. 2). The abscissa shows the normalized distance of the lines AB and CD. x = 0 and x = 1 correspond to points A/C and B/D, respectively.

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Fig. 6

Displacements (mm) produced in the prostheses after a coughing motion just after surgery. Note the similar distribution of displacements in SUR for both orientations due to its isotropic behavior.

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Fig. 7

Distribution of maximal principal stresses (MPa) produced in the prostheses after a coughing motion just after surgery

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Fig. 8

Maximal principal stress distributions (MPa) in the abdominal tissues: rectus abdominis and their tendons (a), anterior rectus sheath (b), and fascia transversalis (c). In all cases, results are shown for the linea alba and oblique muscles.

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