Abdomen; Aged; Aged, 80 and over; Biomechanics; Cadaver; Female; Humans; Middle Aged; Pelvic Organ Prolapse/physiopathology; Skin Physiological Phenomena; Tendons/physiology; Vagina/physiology
Abstract :
[en] INTRODUCTION AND HYPOTHESIS: despite minimal fundamental works, there is an increasing use of meshes in urogynecology. The concept is mainly based on experiences with abdominal wall surgery. We aimed to compare the biomechanical properties of vaginal tissue, abdominal aponeurosis, and skin. METHODS: samples from 11 fresh women cadavers without prolapse were collected. Uniaxial tension tests were performed and stress-strain curves were obtained. RESULTS: biomechanical properties of the vagina, aponeurosis, and skin differed significantly. The aponeurosis was much more rigid and less extendible than the vagina and skin. Vaginal tissue was less rigid but more extendible than skin. There was no difference between the vagina and skin at low strains (p = 0.341), but a highly significant difference at large strains (p = 0.005). CONCLUSIONS: skin and aponeurosis are not suited to predict vaginal tissue biomechanics. We should be cautious when transferring experiences from abdominal wall surgery to vaginal reconstructive surgery.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Gabriel, Boris
Rubod, Chrystele
Brieu, Mathias
Dedet, Bruno
DE LANDSHEERE, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
Delmas, Vincent
Cosson, Michel
Language :
English
Title :
Vagina, abdominal skin, and aponeurosis: do they have similar biomechanical properties?
KM Luber S Boero JY Choe 2001 The demographics of pelvic floor disorders: current observations and future projections Am J Obstet Gynecol 184 1496 1503 1:STN:280:DC%2BD3MzksV2nug%3D%3D 10.1067/mob.2001.114868 11408873
MD Barber MN Kuchibhatla CF Pieper RC Bump 2001 Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders Am J Obstet Gynecol 185 1388 1395 1:STN:280: DC%2BD3MnpslKisQ%3D%3D 10.1067/mob.2001.118659 11744914
B Gabriel D Denschlag H Göbel C Fittkow M Werner G Gitsch, et al. 2005 Uterosacral ligament in postmenopausal women with or without pelvic organ prolapse Int Urogynecol J 16 475 479 10.1007/s00192-005-1294-5
B Gabriel D Watermann K Hancke G Gitsch M Werner C Tempfer, et al. 2006 Increased expression of matrix metalloproteinase 2 in uterosacral ligaments is associated with pelvicorgan prolapse Int Urogynecol J 17 478 482 10.1007/s00192-005-0045-y
MH Kerkhof L Hendriks HAM Brölmann 2009 Changes in connective tissue in patients with pelvic organ prolapse-a review of the current literature Int Urogynecol J 20 461 474 1:STN:280:DC%2BD1M7otV2mtg%3D%3D 10.1007/s00192-008- 0737-1
M Alperin K Debes S Abramowitch L Meyn PA Moalli 2008 LOXL1 deficiency negatively impacts the biomechanical properties of the mouse vagina and supportive tissues Int Urogynecol J 19 977 986 10.1007/s00192-008-0561-7
JJ Bauer BA Salky IM Gelernt 1987 Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PFTE) Ann Surg 206 765 769 1:STN:280:DyaL1c%2Fns1Wksw%3D%3D 10.1097/00000658-198712000-00013 3689012
A Pans A Albert CM Lapière B Nusgens 2001 Biochemical study of collagen in adult groin hernias J Surg Res 95 107 113 1:CAS:528: DC%2BD3MXls1Wktg%3D%3D 10.1006/jsre.2000.6024 11162033
JS Afonso RM Jorge PS Martins MD Soldi OL Alves B Patricio, et al. 2009 Structural and thermal properties of polypropylene mesh used in treatment of stress urinary incontinence Acta Bioeng Biomech 11 27 33 20131747
C Rubod M Boukerrou M Brieu P Dubois M Cosson 2007 Biomechanical properties of vaginal tissue. Part 1: new experimental protocol J Urol 178 320 325 10.1016/j.juro.2007.03.040 17499792
M Mooney 1947 A theory of large elastic deformation J Appl Phys 1940 11 582 592
RS Rivlin 1948 Large elastic deformations of isotropic materials. I. Fundamental concepts. II. Some uniqueness theorems for pure homogenous deformations Philos Trans R Soc Lond Ser A: Math Phys Sci A240 459 490 10.1098/rsta.1948.0002
C Rubod M Boukerrou M Brieu J-C Clay P Dubois M Cosson 2008 Biomechanical properties of vaginal tissue: preliminary results Int Urogynecol J 19 811 816 10.1007/s00192-007-0533-3
MP Parente RM Jorge T Mascarenhas AA Fernandes JA Martins 2008 Deformation of the pelvic floor muscles during a vaginal delivery Int Urogynecol J 19 65 71 1:STN:280:DC%2BD2sjgtlOgsg%3D%3D 10.1007/s00192-007-0388-7
HP Dietz P Vancaillie M Svehla W Walsch AB Steensma TG Vancaillie 2003 Mechanical properties of urogynecologic implant materials Int Urogynecol J 14 239 243 1:STN:280:DC%2BD3svmvVansw%3D%3D 10.1007/s00192-003-1041-8
JS Afonso PALS Martins MJBC Girao RM Natal Jorge AJM Ferreira T Mascarenhas, et al. 2008 Mechanical properties of polypropylene mesh used in pelvic floor repair Int Urogynecol J 19 375 380 1:STN:280: DC%2BD1c%2FotlSmtw%3D%3D 10.1007/s00192-007-0446-1
J Neumeyer W Abdul-Wahab M Beer J Speethman D Groneberg C Groe-Siestrup 2007 Laboratory testing of suburethral mesh slings: a comparison of their static and dynamic properties Int Urogynecol J 18 Suppl 1 S111
H Krause M Bennet M Forwood J Goh 2008 Biomechanical properties of raw meshes used in pelvic floor reconstruction Int Urogynecol J 19 1677 1681 10.1007/s00192-008-0711-y
M Cosson E Lambaudi M Boukerrou P Lobry G Crépin A Ego 2004 A biomechanical study of the strength of vaginal tissues. Results on 16 post-menopausal patients presenting with genital prolapse Eur J Obstet Gynecol Reprod Biol 112 201 205 10.1016/S0301-2115(03)00333-6 14746960
GJ Ettema JT Goh MR Forwood 1998 A new method to measure elastic properties of plastic-viscoelastic connective tissue Med Eng Phys 20 308 314 1:STN:280:DyaK1czps1yktw%3D%3D 10.1016/S1350-4533(98)00026-5 9728682
JT Goh 2002 Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women Int Urogynecol J 13 76 79 1:STN:280: DC%2BD38zhtFynug%3D%3D 10.1007/s001920200019
P Martins E Pena B Calvo M Doblare T Mascarenhas RN Jorge, et al. 2010 Prediction of nonlinear elastic behaviour of vaginal tissue: experimental results and model formulation Comput Methods Biomech Biomed Eng 10.1080/10255840903208197
L Lei Y Song C RiQi 2007 Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women Int Urogynecol J 18 603 607 10.1007/s00192-006-0214-7
Haut RC (2002) Biomechanics of soft tissue. In: Nahum AM, Melvin JW (eds) Accidental injury. Biomechanics and prevention. Springer, New York, pp 236-238
M Cosson P Debodonance M Boukerrou MP Chauvet P Lobry G Crépin, et al. 2003 Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material? Int Urogynecol J 14 169 178 10.1007/s00192-003-1066-z
M Cosson M Boukerrou E Lambaudie P Lobry G Crépin A Ego 2003 Biomécanique de la réparation et résistance des tissus biologiques dans les cures de prolapsus: pourquoi utiliser des prothèses? J Gynécol Obstét Biol Reprod 32 329 337 1:STN:280: DC%2BD3szhtlWnuw%3D%3D
