TY  - CHAP
A1  - Bhattarai, Aroj
A1  - Staat, Manfred
ED  - Artmann, Gerhard
ED  - Temiz Artmann, Aysegül
ED  - Zhubanova, Azhar A.
ED  - Digel, Ilya
T1  - Mechanics of soft tissue reactions to textile mesh implants
T2  - Biological, Physical and Technical Basics of Cell Engineering
N2  - For pelvic floor disorders that cannot be treated with non-surgical procedures, minimally invasive surgery has become a more frequent and safer repair procedure. More than 20 million prosthetic meshes are implanted each year worldwide. The simple selection of a single synthetic mesh construction for any level and type of pelvic floor dysfunctions without adopting the design to specific requirements increase the risks for mesh related complications. Adverse events are closely related to chronic foreign body reaction, with enhanced formation of scar tissue around the surgical meshes, manifested as pain, mesh erosion in adjacent structures (with organ tissue cut), mesh shrinkage, mesh rejection and eventually recurrence. Such events, especially scar formation depend on effective porosity of the mesh, which decreases discontinuously at a critical stretch when pore areas decrease making the surgical reconstruction ineffective that further augments the re-operation costs. The extent of fibrotic reaction is increased with higher amount of foreign body material, larger surface, small pore size or with inadequate textile elasticity. Standardized studies of different meshes are essential to evaluate influencing factors for the failure and success of the reconstruction. Measurements of elasticity and tensile strength have to consider the mesh anisotropy as result of the textile structure. An appropriate mesh then should show some integration with limited scar reaction and preserved pores that are filled with local fat tissue. This chapter reviews various tissue reactions to different monofilament mesh implants that are used for incontinence and hernia repairs and study their mechanical behavior. This helps to predict the functional and biological outcomes after tissue reinforcement with meshes and permits further optimization of the meshes for the specific indications to improve the success of the surgical treatment.
Y1  - 2018
SN  - 978-981-10-7904-7
U6  - http://dx.doi.org/10.1007/978-981-10-7904-7_11
SP  - 251
EP  - 275
PB  - Springer
CY  - Singapore
ER  - 
TY  - CHAP
A1  - Bhattarai, Aroj
A1  - Frotscher, Ralf
A1  - Staat, Manfred
T1  - Computational Analysis of Pelvic Floor Dysfunction
T2  - Women's Health and Biomechanics
N2  - Pelvic floor dysfunction (PFD) is characterized by the failure of the levator ani (LA) muscle to maintain the pelvic hiatus, resulting in the descent of the pelvic organs below the pubococcygeal line. This chapter adopts the modified Humphrey material model to consider the effect of the muscle fiber on passive stretching of the LA muscle. The deformation of the LA muscle subjected to intra-abdominal pressure during Valsalva maneuver is compared with the magnetic resonance imaging (MRI) examination of a nulliparous female. Numerical result shows that the fiber-based Humphrey model simulates the muscle behavior better than isotropic constitutive models. Greater posterior movement of the LA muscle widens the levator hiatus due to lack of support from the anococcygeal ligament and the perineal structure as a consequence of birth-related injury and aging. Old and multiparous females with uncontrolled urogenital and rectal hiatus tend to develop PFDs such as prolapse and incontinence.
KW  - Pelvic muscle
KW  - Muscle fibers
KW  - Passive stretching
KW  - Pelvic floor dysfunction
Y1  - 2018
SN  - 978-3-319-71574-2
U6  - http://dx.doi.org/10.1007/978-3-319-71574-2_17
N1  - Lecture Notes in Computational Vision and Biomechanics, vol 29
SP  - 217
EP  - 230
PB  - Springer
CY  - Cham
ER  -