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Research Papers

A Potential Tool for the Study of Venous Ulcers: Blood Flow Responses to Load

[+] Author and Article Information
Wu Pan

Fellow ASME
Department of Mechanical Engineering,
Michigan State University,
2555 Engineering Building,
East Lansing, MI 48824-1226
e-mail: panwu@egr.msu.edu

Joshua P. Drost

Fellow ASME
Department of Mechanical Engineering,
Michigan State University,
2555 Engineering Building,
East Lansing, MI 48824-1226
e-mail: drostjos@msu.edu

Sara Roccabianca

Fellow ASME
Department of Mechanical Engineering,
Michigan State University,
2555 Engineering Building,
East Lansing, MI 48824-1226
e-mail: roccabis@egr.msu.edu

Seungik Baek

Fellow ASME
Department of Mechanical Engineering,
Michigan State University,
2555 Engineering Building,
East Lansing, MI 48824-1226
e-mail: sbaek@egr.msu.edu

Tamara Reid Bush

Fellow ASME
Chair of the Dynamics,
Design and Rehabilitation (DDR) Committee,
Bioengineering Technical Division,
Department of Mechanical Engineering,
Michigan State University,
2555 Engineering Building,
East Lansing, MI 48824-1226
e-mail: reidtama@msu.edu

1Corresponding author.

Manuscript received December 20, 2016; final manuscript received December 11, 2017; published online January 18, 2018. Assoc. Editor: Jonathan Vande Geest.

J Biomech Eng 140(3), 031009 (Jan 18, 2018) (7 pages) Paper No: BIO-16-1529; doi: 10.1115/1.4038742 History: Received December 20, 2016; Revised December 11, 2017

Venous ulcers are deep wounds that are located predominantly on the lower leg. They are prone to infection and once healed have a high probability of recurrence. Currently, there are no effective measures to predict and prevent venous ulcers from formation. Hence, the goal of this work was to develop a Windkessel-based model that can be used to identify hemodynamic parameters that change between healthy individuals and those with wounds. Once identified, these parameters have the potential to be used as indicators of when internal conditions change, putting the patient at higher risk for wound formation. In order to achieve this goal, blood flow responses in lower legs were measured experimentally by a laser Doppler perfusion monitor (LDPM) and simulated with a modeling approach. A circuit model was developed on the basis of the Windkessel theory. The hemodynamic parameters were extracted for three groups: legs with ulcers (“wounded”), legs without ulcers but from ulcer patients (“nonwounded”), and legs without vascular disease (“healthy”). The model was executed by two independent operators, and both operators reported significant differences between wounded and healthy legs in localized vascular resistance and compliance. The model successfully replicated the experimental blood flow profile. The global and local vascular resistances and compliance parameters rendered quantifiable differences between a population with venous ulcers and healthy individuals. This work supports that the Windkessel modeling approach has the potential to determine patient specific parameters that can be used to identify when conditions change making venous ulcer formation more likely.

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Figures

Grahic Jump Location
Fig. 1

Leg perfusion test setup (a) front view of the test setup with perfusion sensor attached to the participant's lateral lower calf, the customized load applicator can slide in the medial/lateral and vertical directions to apply normal and shear loadings, respectively; (b) noninvasive perfusion sensor attached to the skin; (c) load applicator with the contact platform [34]. (a) Front view of the test, (b) sensor attachment, and (c) load applicator.

Grahic Jump Location
Fig. 2

A typical last Doppler output of perfusion during testing in which the (1) baseline period is prior to loading, (2) the ischemia period is under loading, and (3) the reperfusion is the blood flow recovery after loading. Two loading conditions occurred during one testing with similar LDPM output. This figure represents one loading scenario. The reactive hyperemia is the spike in the blood flow upon the release of the loading. PU refers to perfusion unit, which is defined as the relative number and velocity of blood cells in the tissue (Perimed).

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Fig. 3

Model to simulate the blood flow of the lower leg under external loadings. R1 and R2 are global and local vessel resistances, respectively, C is the local vessel compliance, V0 is the hydrostatic pressure at the testing site, and Vext is the pressure induced by locally applied external loadings.

Grahic Jump Location
Fig. 4

Vext as a rectangular wave function

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Fig. 5

Flowchart for simulation and RCR iteration process

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Fig. 6

Comparison between the model output (smooth line, or red if in color) and experimental data (wavy line, or blue if in color). Left (a): operator 1, R1 = 12, R2 = 2.5, C = 2, NRMSE = 6.0%; Right (b): operator 2, R1=10, R2=3, C = 2, NRMSE = 6.4%.

Grahic Jump Location
Fig. 7

Comparison R1, R2, C between wounded, nonwounded, and healthy legs from operator 1 (left) and operator 2 (right) (* indicates statistical significant difference, p < 0.05)

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