Philippe Beillas

Mechanical response of animal abdominal walls in vitro: Evaluation of the influence of a hernia defect and a repair with a mesh implanted intraperitoneally

Better mechanical knowledge of the abdominal wall is requested to further develop and validate numerical models. The aim of this study was to characterize the passive behaviour of the abdominal wall under three configurations: intact, after creating a defect simulating an incisional hernia, and after a repair with a mesh implanted intraperitonally. For each configuration, controlled boundary conditions were applied (air pressure and then contact loading) to the abdominal wall. 3D local strain fields were determined by digital image correlation. Local strains measured on the internal and external surfaces of the intact abdominal wall showed different patterns. The air pressure and the force applied to the abdominal wall during contact loading were measured and used to determine stiffness. The presence of a defect resulted in a significant decrease of the global stiffness compared to the intact abdominal wall (about 25%). In addition, the presence of the mesh enabled to restore the stiffness to values that were not significantly different from those of the intact wall. These results suggest that intraperitoneal mesh seems to restore the global biomechanics of the abdomen.

Mechanical response of human abdominal walls ex vivo: Effect of an incisional hernia and a mesh repair.

The design of meshes for the treatment of incisional hernias could benefit from better knowledge of the mechanical response of the abdominal wall and how this response is affected by the implant. The aim of this study was to characterise the mechanical behaviour of the human abdominal wall. Abdominal walls were tested ex vivo in three states: intact, after creation of a defect simulating an incisional hernia, and after reparation with a mesh implanted intraperitonally. For each state, the abdominal wall was subjected to air pressure loading. Local strain fields were determined using digital image correlation techniques. The strain fields on the internal and external surfaces of the abdominal wall exhibited different patterns. The strain patterns on the internal surface appeared to be related to the underlying anatomy of the abdominal wall. Higher strains were observed along the linea alba than along the perpendicular direction. Under pressure loading, the created incision increased the strain of the abdominal wall compared to the intact state in 5 cases of a total 6. In addition, the mesh repair decreased the strains of the abdominal wall compared to the incised state in 4 cases of 6. These results suggest that the intraperitoneal mesh restores at least partially the mechanical behaviour of the wall and provides quantification of the effects on the strains in various regions.

Contribution of the skin, rectus abdominis and their sheaths to the structural response of the abdominal wall ex vivo

A better understanding of the abdominal wall biomechanics could help designing new treatments for incisional hernia. In the current study, an experimental protocol was developed to evaluate the contributions of the abdominal wall components to the structural response of the anterior part of the abdominal wall. The specimens underwent 3 dissections (removal of (1) skin and subcutaneous fat, (2) anterior rectus sheath, (3) rectus abdominis muscles). After each dissection, they were subjected to air pressure up to 3 kPa. Ultrasound images and associated elastographic maps were collected at 0, 2 and 3 kPa in the intact state and strains on the internal surface were calculated using stereo-correlation in all states. Strains on the rectus abdominis and linea alba were analyzed. After the dissection of the anterior sheath of the rectus abdominis, longitudinal strain was found significantly different on the linea alba (5% at 3 kPa) and on the rectus abdominis area (11% at 3 kPa). The current results highlight the importance of the rectus sheath in the structural response of the anterior part of the abdominal wall ex vivo. Geometrical characteristics such as thicknesses and radii of curvature and mechanical properties (shear modulus of the rectus abdominis, e.g. at 0 pressure the average value is 14 kPa) were provided in order to facilitate future modeling efforts.

Effects of storage temperature on the mechanical properties of porcine kidney estimated using shear wave elastography.

The objective of this study was to evaluate the effects of different conservation techniques on the mechanical properties of the ex vivo porcine kidney in order to select an appropriate conservation protocol to use prior to mechanical testing. Five groups of eight kidneys each were subjected to different methods of conservation: storage at 4°C, -18°C, -34°C and -71°C, for 7 days, or storage at 20°C for 2 days only (as the tissues degraded quickly). Their shear modulus as a function of depth in the organ was evaluated before (fresh) and after conservation using shear wave elastography. Results obtained on fresh kidneys were collected within 6h of death. Freezing lead to a significant decrease (p<0.05) of the shear modulus in the most superficial zone (renal cortex), irrespectively of the freezing temperature (-18°C, -34°C, -71°C). There were no significant change (p>0.05) in the properties of the renal cortex when stored at 4°C or 20°C. The average moduli in the central region of the kidney (medulla) were much higher than in the cortex and exhibited also exhibited larger specimen to specimen variations. The effects of the conservation method on the central region were not significant. Overall, the results suggest that kidney tissues should not be frozen prior to biomechanical characterization and that inhomogeneity may be important to consider for in biomechanical models.

Conditions of possible head impacts for standing passengers in public transportation: an experimental study

Abstract Standing passenger safety is currently a major challenge for the development of public transportation. One of the current difficulties to overcome this problem is the lack of knowledge about the motion of passengers following a minor incident, e.g. an emergency braking or light collision. This study brings new experimental data about the head kinematics of volunteers in these types of situations. Data were obtained for (1) the three-dimensional head trajectories; (2) the maximal excursions of the head along the longitudinal axis; and (3) corridors of the head tangential velocity versus its longitudinal displacement. Even though there are limitations, these data can be used as a first estimate to predict the risks of impact between the heads of passengers and their surrounding environment. They also provide insight into the impact velocity of this eventual collision. Furthermore, they highlight the influence of the level of perturbation and of the restraint device possibly used.

Combination of a model-deformation method and a positional MRI to quantify the effects of posture on the anatomical structures of the trunk

Understanding the postural effects on organs and skeleton could be crucial for several applications. This paper reports on a methodology to quantify the three-dimensional effects of postures on deformable anatomical structures. A positional MRI scanner was used to image the full trunk in four postures: supine, standing, seated and forward-flexed. The MRI stacks were processed with a custom toolbox, implemented using open source software. The semi-automated segmentation was based on the deformation of generic models of the pelvis, sternum, femoral heads, spine, liver, kidneys, spleen, skin, thoracic and abdominal cavities. The toolbox was designed to be easily extended by additional image filters, deformation schemes, or new generic models. Results obtained on one subject demonstrate that the method can be used to quantify the effects of postures on skeleton and organs. The spinal curvature, the pelvic parameters and the volume of the thoracic cavity were affected by the four postures. The volumes of the kidneys, spleen, liver and abdominal object were mostly unaffected. The movement of organs was coherent with the effect of gravity. The deformation of organs between postures was expressed using geometrical transformations. Investigations should be pursued on a larger population to confirm the patterns observed on the first subject.

Effects of pressure on the shear modulus, mass and thickness of the perfused porcine kidney

Eleven fresh ex vivo porcine kidneys were perfused in the artery, vein and ureter with degassed Dulbecco׳s Modified Eagle Medium (DMEM). The effect of perfusion pressure was evaluated using ten different pressures combinations. The shear modulus of the tissues was estimated during perfusion using shear wave elastography. The organ weight change was measured by a digital scale and cameras were used to follow the changes of the dimensions after each pressure combination. The effect of perfusion on the weight and the thickness was non-reversible, whereas the effect on the shear modulus was reversible. Pressure was found to increase the average shear modulus in the cortex by as much as 73%. A pressure of 80 mmHg was needed to observe tissues shear modulus in the same range as in vivo tests (Gcortex=9.1 kPa, Gmedulla=8.5 kPa ex vivo versus Gcortex=9.1 kPa, Gmedulla=8.7 kPa in vivo in Gennisson et al., 2012).

Modelling hollow organs for impact conditions: a simplified case study.

This study compares the performances of three numerical approaches [Lagrangian (LAG), arbitrary Lagrangian–Eulerian (ALE) and control volume (CV)] for modelling the response of a short cylindrical pipe representing a portion of the intestines subjected to large and rapid compressions. While not being able to simulate sustained fluid flow, the LAG approach provided similar results as the ALE for moderate levels of compression. However, it was the stiffest approach for larger levels and had numerical issues for extreme compressions. While the ALE did not have these issues, its computing cost was very high, which would be problematic for large models. The CV approach had the lowest computing cost and seemed promising for larger compressions. However, its response was the softest and further investigations are needed to define its dependency to modelling parameters.

A new method to assess the deformations of internal organs of the abdomen during impact

ABSTRACT Objectives: Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction. Methods: In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen. Results: The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression. Conclusions: These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.

An investigation of human body model morphing for the assessment of abdomen responses to impact against a population of test subjects

ABSTRACT Objective: Human body models have the potential to better describe the human anatomy and variability than dummies. However, data sets available to verify the human response to impact are typically limited in numbers, and they are not size or gender specific. The objective of this study was to investigate the use of model morphing methodologies within that context. Methods: In this study, a simple human model scaling methodology was developed to morph two detailed human models (Global Human Body Model Consortium models 50th male, M50, and 5th female, F05) to the dimensions of post mortem human surrogates (PMHS) used in published literature. The methodology was then successfully applied to 52 PMHS tested in 14 impact conditions loading the abdomen. The corresponding 104 simulations were compared to the responses of the PMHS and to the responses of the baseline models without scaling (28 simulations). The responses were analysed using the CORA method and peak values. Results: The results suggest that model scaling leads to an improvement of the predicted force and deflection but has more marginal effects on the predicted abdominal compressions. M50 and F05 models scaled to the same PMHS were also found to have similar external responses, but large differences were found between the two sets of models for the strain energy densities in the liver and the spleen for mid-abdomen impact simulations. These differences, which were attributed to the anatomical differences in the abdomen of the baseline models, highlight the importance of the selection of the impact condition for simulation studies, especially if the organ location is not known in the test. Conclusions: While the methodology could be further improved, it shows the feasibility of using model scaling methodologies to compare human models of different sizes and to evaluate scaling approaches within the context of human model validation.