Kallinowski Friedrich, Ludwig Yannique, Gutjahr Dominik, Gerhard Christian, Schulte-Hörmann Hannah, Krimmel Lena, Lesch Carolin, Uhr Katharina, Lösel Philipp, Voß Samuel, Heuveline Vincent, Vollmer Matthias, Görich Johannes, Nessel Regine
General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Heidelberg, Germany.
Front Surg. 2021 Oct 29;8:763957. doi: 10.3389/fsurg.2021.763957. eCollection 2021.
Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue. This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery. The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired. The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair.
疝修补术采用纺织网片加强腹壁。复发和疼痛表明网片与组织之间的结合薄弱。哪些生物力学因素能加强网片 - 组织界面，以及外科医生能否增强网片与组织之间的结合，仍是个问题。本研究通过动态载荷评估网片 - 组织界面的强度。自建的台架试验施加动态冲击。该试验模拟咳嗽。台架试验使用猪和牛的组织。组织质量、网片粘附性和固定强度影响固定力。这些影响被浓缩成一个公式以评估修补的耐久性。该公式应用于临床工作。重建的相对强度与个体的人腹壁相关。通过静息和瓦尔萨尔瓦动作时的计算机断层扫描，在手术前确定个体患者的组织质量。结果表明，在猪、牛和人体组织中观察到的生物力学参数在同一范围内。组织以不同模式失效。缝线在易损点松弛或断裂。加载持续时间和峰值载荷都会增加破坏。应力集中会提高失败率。力扭曲的局部区域会增加应力集中。疝修补术改善了应变水平。改进措施包括闭合缺损、使用更高动态间歇应变（DIS）等级的网片、增加网片重叠以及额外固定。外科医生可根据需要选择重建手术的安全边际。现在组织质量已被引入对压力相关冲击的临界和获得性抵抗力的概念中。可以根据现有系数设计持久的疝修补术。运用生物力学原理，外科医生可以将疼痛程度降至最低。在切口疝修补术中，有可能避免诸如疝复发等与网片相关的并发症。
