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Hartog FD, Yurtkap Y, Vlot J, Lange J, Tanis P, Kleinrensink G. Developing and validating an implantable suture tension sensor. Heliyon 2024; 10:e28907. [PMID: 38660291 PMCID: PMC11039976 DOI: 10.1016/j.heliyon.2024.e28907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Suture tension has a direct influence on the sutured tissue. For abdominal wall closure, suture tension should be optimal without causing tissue necrosis, which can result in surgical site infection or incisional hernia. The purpose of the present study is to evaluate a device that can measure suture tension in-situ and in real-time. Materials and methods A cheap, commercially available analog-to-digital converter was used, in conjunction with a force sensing resistor. A sensor probe housing was designed and 3D-printed. In order to test the sensor, a mechanical, computer controlled human abdominal wall model called the AbdoMAN was used. Results An implantable suture tension sensor was developed, keeping cost-effectiveness in mind. This sensor can translate tension in the suture into a downward force, applied to the force sensing resistor. The sensor's raw readout was characterized using a set of weights, from which a formula correlating the readout to a specific force, was derived. Preliminary validation was successfully performed using the AbdoMANmodel, which showed a progressive rise in suture tension when the intra-abdominal pressure was artificially increased over time. Conclusion The implantable suture tension sensor appeared to be capable of recording real time changes in suture tension, and the. validation process of this sensor has been initiated. With the information from devices like this, a much better understanding of the issues at play in the development of incisional hernia can be gained.
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Affiliation(s)
- F.P.J. den Hartog
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
| | - Y. Yurtkap
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
| | - J. Vlot
- Department of Pediatric Surgery, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
| | - J.F. Lange
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
| | - P.J. Tanis
- Department of Surgery, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - G.J. Kleinrensink
- Department of Neuroscience, ErasmusMC, University Medical Center, Rotterdam, the Netherlands
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Voniatis C, Závoti O, Manikion K, Budavári B, Hajdu AJ. Fabrication of Mechanically Enhanced, Suturable, Fibrous Hydrogel Membranes. MEMBRANES 2023; 13:116. [PMID: 36676923 PMCID: PMC9867240 DOI: 10.3390/membranes13010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Poly(vinyl-alcohol) hydrogels have already been successfully utilised as drug carrier systems and tissue engineering scaffolds. However, lacking mechanical strength and suturability hinders any prospects for clinical and surgical applications. The objective of this work was to fabricate mechanically robust PVA membranes, which could also withstand surgical manipulation and suturing. Electrospun membranes and control hydrogels were produced with 61 kDa PVA. Using a high-speed rotating cylindrical collector, we achieved fibre alignment (fibre diameter: 300 ± 50 nm). Subsequently, we created multilayered samples with different orientations to achieve multidirectional reinforcement. Finally, utilising glutaraldehyde as a cross-linker, we created insoluble fibrous-hydrogel membranes. Mechanical studies were performed, confirming a fourfold increase in the specific loading capacities (from 0.21 to 0.84 Nm2/g) in the case of the monolayer samples. The multilayered membranes exhibited increased resistance from both horizontal and vertical directions, which varies according to the specific arrangement. Finally, the cross-linked fibrous hydrogel samples not only exhibited specific loading capacities significantly higher than their counterpart bulk hydrogels but successfully withstood suturing. Although cross-linking optimisation and animal experiments are required, these membranes have great prospects as alternatives to current surgical meshes, while the methodology could also be applied in other systems as well.
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Affiliation(s)
- Constantinos Voniatis
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
| | - Olivér Závoti
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
| | - Kenigen Manikion
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
| | - Bálint Budavári
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
| | - Angela Jedlovszky Hajdu
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, 1085 Budapest, Hungary
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Lesch C, Uhr K, Vollmer M, Raschidi R, Nessel R, Kallinowski F. Standardized suturing can prevent slackening or bursting suture lines in midline abdominal incisions and defects. Hernia 2022; 26:1611-1623. [PMID: 35997898 PMCID: PMC9684257 DOI: 10.1007/s10029-022-02659-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022]
Abstract
Purpose Incisional hernias often follow open abdominal surgery. A small-stitch–small-bite suture might close the incision durably. We analyzed specific details of this closure technique and assessed their influence on the closure stability. Methods The effects of cyclic loads, simulating coughs were investigated on a bench test. We prepared porcine bellies in the median line and bovine flanks parallel to the muscle fibers with 15 cm long incisions. Then we punched round or rhomboid defects with a diameter of 5–10 cm into the center of the incision. Monomax® 2–0 and Maxon® 1 and 2–0 were used as suture materials. We tested the durability of the closure with pressure impacts of 210 mmHg repeated 425 times. Throughout the experiments, we modified the suturing technique, the surgeon, the tissue tension, the defect size and shape and the suture diameter. Results Standardizing the suture technique improved the durability of the closure significantly. Any other variations showed minor influences after standardization. All incisions with round defects up to 7.5 cm width withstood 425 impacts using standardized suturing. Unstandardized sutures failed in all cases. When closing an incision with a 10 cm wide defect, the tissues ruptured frequently next to the suture line. We defined criteria to standardize this suturing technique. For the first time, we developed a suture factor related to the durability of a sutured tissue closure. We integrated the suture factor into the concept of biomechanically durable repairs. Conclusions Suturing the abdominal wall with a standardized suturing technique improves its durability significantly.
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Affiliation(s)
- C Lesch
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - K Uhr
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Vollmer
- Hamburg University of Technology, Biomechanics, Denickestrasse 15, 21073, Hamburg, Germany
| | - R Raschidi
- Department Allgemein- Und Viszeralchirurgie, Spital Walenstadt, St. Gallen, Switzerland
| | - R Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - F Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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A Simplified Abdominal Wall Model to Teach Complex Abdominal Wall Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4322. [PMID: 35702531 PMCID: PMC9187180 DOI: 10.1097/gox.0000000000004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
A simplified and functional abdominal wall model is necessary for surgical education. The utility of such a model encompasses medical student, resident, and fellow education. This is especially relevant in the fields of general surgery and plastic surgery. An abdominal wall model helps with a more complete understanding of abdomen access, hernia repair, and complex abdominal wall reconstruction. Although several models have been proposed, they are expensive and limitations exist due to access, costly repairs, maintenance, and part replacements. There is currently no consensus or widely adopted model used in surgical training programs. We present a simplified abdominal wall model that is inexpensive and easily reproducible.
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Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model. Hernia 2020; 24:1317-1324. [PMID: 32086634 PMCID: PMC7701069 DOI: 10.1007/s10029-020-02140-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/06/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. METHODS Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the 'AbdoMan'. A custom-made suture tension sensor was placed in the middle of the incision. RESULTS The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07-0.19) vs. large bites 0.57 N (IQR 0.23-0.92), p < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p < 0.038). No macroscopic tissue failure was seen during or after the experiments. CONCLUSION Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.
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Jourdan A, Soucasse A, Scemama U, Gillion JF, Chaumoitre K, Masson C, Bege T. Abdominal wall morphometric variability based on computed tomography: Influence of age, gender, and body mass index. Clin Anat 2020; 33:1110-1119. [PMID: 31889321 DOI: 10.1002/ca.23548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/15/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ventral hernia surgery does not usually account for the individuality of the abdominal wall anatomy. This could be both because medical imaging is rarely performed before surgery and because data on abdominal wall variability are limited. The objective of the present study was to perform an exhaustive morphometric analysis of abdominal wall components based on computed tomography (CT) scans. MATERIALS AND METHODS A retrospective study was performed on 120 abdominopelvic CT scans of clinically normal adults aged 18-86 years equally divided between women and men and into four age groups. Each abdominal wall muscle was evaluated in terms of area, thickness, shape ratio, fat infiltration, and aponeuroses width. The influence of age, gender, and body mass index (BMI) was investigated, as well as muscular asymmetry. RESULTS The abdominal wall muscle area represented 8.5 ± 2.5% of the abdominal area. The internal oblique muscle had the largest area, the rectus abdominis was the thickest, the transversus abdominis was the narrowest and had the smallest area. The width of the linea alba was 20.3 ± 12.0 mm. The evolution of the abdominal wall with age was quantified, as well as the large differences between the sexes and BMI groups, resulting in strong correlations and highlighting the specific pattern of the transversus abdominis. The asymmetry of the left and right muscle areas oscillated around 17%. CONCLUSIONS The various components of the abdominal wall have been precisely described. Knowledge of their variability could be used to enhance the planning of ventral hernia surgery or to develop numerical modeling of the abdominal wall.
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Affiliation(s)
- Arthur Jourdan
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - Andrea Soucasse
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - Ugo Scemama
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France
| | - Jean F Gillion
- Unité de Chirurgie Viscérale et Digestive, Hôpital Privé d'Antony, Antony, France
| | - Kathia Chaumoitre
- Department of Medical Imaging, Aix Marseille Univ, North Hospital, APHM, Marseille, France.,Anthropologie Biologique UMR 7268 ADES, Aix Marseille Univ, Marseille, France
| | - Catherine Masson
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France
| | - Thierry Bege
- Laboratoire de Biomécanique Appliquée, Aix Marseille Univ, IFSTTAR UMR T24, Marseille, France.,Department of General Surgery, Aix Marseille Univ, North Hospital, APHM, Marseille, France
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van Rooijen MMJ, Lange JF. Preventing incisional hernia: closing the midline laparotomy. Tech Coloproctol 2018; 22:623-625. [PMID: 30094713 PMCID: PMC6154121 DOI: 10.1007/s10151-018-1833-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/31/2018] [Indexed: 12/02/2022]
Affiliation(s)
- M M J van Rooijen
- Department of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Reply to Invited comment to the 'AbdoMAN': an artificial abdominal wall simulator for biomechanical studies on laparotomy closure techniques. C. Hollinsky. Hernia 2017; 21:999. [PMID: 29075959 DOI: 10.1007/s10029-017-1701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
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