TITLE:
Mechanical response of uterine tissue under the influence of hemostatic clips: A non-linear finite-element approach
AUTHORS:
Mark A. Nicosia, Donald A. Wood, Daniel Mazzucco
KEYWORDS:
Medical Device Design; Hemostasis; Finite Element Modeling; Tissue Modeling; Myometrial Tissue
JOURNAL NAME:
Journal of Biomedical Science and Engineering,
Vol.6 No.12A,
December
17,
2013
ABSTRACT: A
modeling strategy to predict the ability of surgical clips to achieve
mechanical hemostasis when applied to the cut edge of a thick and muscular
tissue is presented in this work. Although such a model may have broad utility
in the design of hemostatic clips and other surgical and wound closure
applications, our particular focus was on uterine closure following a Cesarean
delivery. Mechanical closure of a blood vessel, which is the first step in the
hemostatic process, is established when the compressive forces on the outer surface
of a blood vessel are sufficient to overcome the local blood pressure and
collapse the vessel. For thick tissue, forces applied to the tissue surface set
up a stress distribution within the tissue that, if sufficient to mechanically
close all vessels, will lead to cessation of local blood flow. The focus of the
current work was on utilization of a planar and nonlinear finite element model
to predict the pressure distribution within uterine tissue under the influence
of hemostatic clips. After experimental model validation with a polymer tissue
phantom, design curves were numerically developed, which consisted of the clip
force necessary to achieve hemostasis for a given thickness tissue as well as
the resulting deformed tissue thickness. Such curves could form the basis for a
preliminary clip design, which would provide initial design guidance before
more expensive experimental studies were required.