Measurement of the tensile strength of the ventral abdominal wall in comparison with scar tissue

“…A recent study [4] demonstrated that scar tissue is 3.7 N/mm 2 weaker than the linea alba leading to the conclusion that the midline should be reinforced to withstand at least 40 Newton/cm. As the currently available optimized material of meshes fulfils these requirements, the lower limit of tensile load-bearing capacity was set to 40 Newton for mesh fixation as well.…”

Section: Discussionmentioning

confidence: 96%

“…The required minimum stability was set to 40 Newton. This value had to be achieved because the load-bearing capacity of incisional tissue is about 30% less than that of the linea alba [4]. The costs of the fixation methods were also assessed.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, it is the most frequent long-term complication of this procedure [1][2][3]. This is not surprising because high tensile forces -caused by the external and internal oblique abdominal muscles and the transverse abdominal muscles -of up to 10 N/ mm 2 are exerted horizontally on the midline [4]. The rate of incisional hernia can be significantly reduced by mesh enhancement of the midline during closure of the abdominal wall, as shown by Gutiérrez [5]: they fixed the mesh by the onlay technique using single sutures.…”

Section: Introductionmentioning

confidence: 95%

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Prevention of incisional hernia by mesh implantation after median laparotomy: a preclinical trial

et al. 2010

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“…Unfortunately, there is limited data on the mechanical properties of the linea alba with current studies presenting conflicting results and varying experimental protocols [12][13][14][15][16]. A particular challenge is the aspect ratio of the linea alba (approximately 2:1), complicating tensile testing significantly.…”

Section: Introductionmentioning

confidence: 99%

Uniaxial and biaxial mechanical properties of porcine linea alba

Cooney

Moerman

Takaza

et al. 2015

Journal of the Mechanical Behavior of Biomedical Materials

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Trocar site hernia (or incisional hernia) is a severe complication post laparoscopic surgery that is commonly associated with the linea alba. However, the few studies on the mechanical properties of the linea alba in the literature appear contradictory, possible due to challenges with the physical dimensions of samples and variations in protocol. This study focuses on the tensile mechanical characterisation of the porcine linea alba, as determined by uniaxial and equi-load biaxial testing using image-based strain measurement methods. Results show that the linea alba demonstrated a non-linear elastic, anisotropic behaviour which is often observed in biological soft tissues. The transverse direction (parallel to fibres) was found to be approximately 8 times stiffer than the longitudinal (cross-fibre) direction under both uniaxial and equi-load biaxial loading. The equi-load biaxial tensile tests revealed that contraction could occur in the transverse direction despite increasing load, probably due to the anisotropy of the tissue. Optical surface marker tracking and digital image correlation methods were found to greatly improve the accuracy of stretch measurement, resulting in a 75% change in the apparent stiffness compared to using strain derived from machine cross-head displacement. Additionally, a finite element model of the experiments using a combination of an Ogden and fibre exponential power law model for the linea alba was implemented to quantify the effect of clamping and tissue dimensions (which are suboptimal for tensile testing) on the results. The preliminary model results were used to apply a correction factor to the uniaxial experimental data prior to inverse optimisation to derive best fit material parameters for the fibre reinforced Ogden model. Application of the model to the equi-load biaxial case showed some differences compared to the experimental data, suggesting a more complex anisotropic model may be necessary to capture biaxial behaviour. These results provide an improved assessment of the mechanical properties of the porcine linea alba for wound closure and other studies.

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Measurement of the tensile strength of the ventral abdominal wall in comparison with scar tissue

Cited by 83 publications

References 16 publications

Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair

Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair

Prevention of incisional hernia by mesh implantation after median laparotomy: a preclinical trial

Uniaxial and biaxial mechanical properties of porcine linea alba

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