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Design of Abdominal Wall Hernioplasty Meshes Guided by Mechanobiology and the Wound Healing Response
Published in Jiro Nagatomi, Eno Essien Ebong, Mechanobiology Handbook, 2018
Shawn J. Peniston, Karen J.L. Burg, Shalaby W. Shalaby
The rectus sheath is divided by the posterior and anterior layer relative to the rectus abdominis muscle and is comprised of the aponeurosis from each layer of the triple flat abdominal muscles. The anterior layer of the rectus sheath is made up of primarily aponeurosis fiber from the external and internal oblique muscles and the posterior layer is comprised of aponeurosis fibers from the internal oblique and transversus muscles above the level of arcuate line. The arcuate line is generally located midway between the umbilicus and pubis and represents the transition zone in which the aponeurosis of the external oblique, the internal oblique, and the transversus abdominis muscles all pass anterior to the rectus muscle [39]. Below the arcuate line the posterior sheath of the rectus abdominis lacks strength as it is comprised of only transversalis fascia, areolar tissue, and peritoneum [39]. It should be noted that aponeurosis are like tendons or ligaments, with the major difference being that they originate from large flat muscles and thus take on the form of large, flat, thin sheets. Fascial layers on the other hand are considerably more extensible and primarily function to separate layers of tissue rather than provide load bearing structural support. For this reason the myopectineal orifice is susceptible to herniation.
The effects of the muscular contraction on the abdominal biomechanics: a numerical investigation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Piero G. Pavan, Silvia Todros, Paola Pachera, Silvia Pianigiani, Arturo N. Natali
This work is the first approach to abdomen mechanics including muscular contraction and represents an advancement compared with similar models proposed in the literature in which the active behavior of muscle fibers is not considered. Despite some simplifications, the computational approach underlines the relevance of including muscular contraction for a feasible investigation of the abdomen biomechanics. The approximation induced when neglecting the muscular contraction leads to an overestimation of abdominal wall deformation and membrane force on the fasciae, i.e. posterior rectus sheath and transversalis fascia. This aspect can be of interest since these structures are directly involved in surgical mesh fixation in intraperitoneal hernia repair. In conclusion, numerical results suggest focusing on experimental tests of the biomechanical behavior of abdomen under muscular active conditions, also as basis for a complete validation of the proposed model.