Resistance forces acting on suture needles

Understanding the resistance forces encountered by a suture needle during tissue penetration is important for the development of robotic surgical devices and virtual reality surgical simulators. Tensile forces applied to skin and tendon during suturing were measured. Fresh sheep achilles tendons were tensioned with a static load 4.9 N, 9.8 N or 19.6 N and sheepskin with 0.98 N, 2.9 N or 4.9 N static load. A straight 2/0 cutting suture needle in series with a load cell on a materials testing machine penetrated the tissue at 90 degrees with a velocity of 1, 5 or 10mm/s for each tissue tension (n=5). Continuous load versus displacement data was obtained and penetration load and stiffness were noted. The load versus displacement curve for skin during needle penetration demonstrated two characteristic peaks, corresponding to initial penetration and emergence of needle from the undersurface of the tissue. Increasing the tension within the tissue (skin and tendon) increased the amount of force required to penetrate the tissue with a suture needle (p<0.05). Needle displacement rate did not affect the resistance to needle penetration (p<0.05). This study provides a simple model for measuring force-feedback during needle penetration of soft tissues and is a good starting point for future studies of the penetration resistance properties of human tissues.     

Influence of needle insertion speed on backflow for convection-enhanced delivery

Fluid flow back along the outer surface of a needle (backflow) can be a significant problem during the direct infusion of drugs into brain tissues for procedures such as convection-enhanced delivery (CED). This study evaluates the effects of needle insertion speed (0.2 and 1.8 mm/s) as well as needle diameter and flow rate on the extent of backflow and local damage to surrounding tissues. Infusion experiments were conducted on a transparent tissue phantom, 0.6% (w/v) agarose hydrogel, to visualize backflow. Needle insertion experiments were also performed to evaluate local damage at the needle tip and to back out the prestress in the surrounding media for speed conditions where localized damage was not excessive. Prestress values were then used in an analytical model of backflow. At the higher insertion speed (1.8 mm/s), local insertion damage was found to be reduced and backflow was decreased. The compressive prestress at the needle-tissue interface was estimated to be approximately constant (0.812 kPa), and backflow distances were similar regardless of needle gauge (22, 26, and 32 gauge). The analytical model underestimated backflow distances at low infusion flow rates and overestimated backflow at higher flow rates. At the lower insertion speed (0.2 mm/s), significant backflow was measured. This corresponded to an observed accumulation of material at the needle tip which produced a gap between the needle and the surrounding media. Local tissue damage was also evaluated in excised rat brain tissues, and insertion tests show similar rate-dependent accumulation of tissue at the needle tip at the lower insertion speed. These results indicate that local tissue damage and backflow may be avoided by using an appropriate insertion speed.     

皮肤模型与微针穿刺性能评价的研究

微针阵列作为新型透皮给药技术,受到广泛关注。通常以刺入力、刺入率和刺入深度来评价微针刺入皮肤的程度和效率。皮肤是其性能评价的基础。皮肤的物理特性主要由角蛋白丝、胶原纤维、弹性纤维和皮下组织综合决定,并且从厚度、弹性、硬度和韧性等维度反映其对微针刺入的影响。机械的、渗透的、组织的和屏障的等皮肤模型被用于解读和模拟真实皮肤的该方面功能。同样,通过皮肤力学分析后建立的包括本构模型在内的各种皮肤力学模型也从物理维度解析皮肤的力学特征。真实皮肤具有复杂性,存在差异性大、不易获取和储存,以及伦理等问题,而皮肤模型可在一定程度上代替真实皮肤辅助微针递送系统设计、开发和性能评价。本文系统回顾分析了皮肤组织的物理特性、各种皮肤模型的制备及特点、真实皮肤和模拟皮肤在评价微针穿刺性能方面的应用,为开发及建立合适的皮肤模型提供借鉴。     

Reconstructed epidermis and full-thickness skin for absorption testing: influence of the vehicles used on steroid permeation

A protocol for percutaneous absorption studies has been validated, based on the use of reconstructed human epidermis (RHE) and aqueous solutions of test substances. However, it is often the case that it is more-complex formulations of drugs or chemicals which will make contact with the skin surface. To investigate whether RHE and the reconstructed full-thickness skin model (FT-model) can be used to predict uptake from formulations, we compared the permeation of hydrocortisone and testosterone when applied in emulsion form and as a solution containing the penetration enhancer, ethanol. Human and pig skin and a non-cornified alveolar model served as references. The results were compared with steroid release from the formulations. The permeation rates of the steroids were ranked as: alveolar model > RHE > FT-model, pig skin > human skin. In accordance with the rapid hydrocortisone release from the formulations, the permeation rates of this steroid exceeded those of testosterone. Only minor differences were observed when comparing the testosterone formulations, in terms of release and permeation. However, the ranking of the permeation of the hydrocortisone formulations was: solution > w/o emulsion > o/w emulsion, which permitted the elucidation of penetration enhancing effects, which is not possible with drug release studies. Differences in penetration were most obvious with native skin and reconstructed tissues, which exhibited a well-developed penetration barrier. In conclusion, RHE and skin preparations may be useful in the development of topical dermatics, and in the framework of hazard analysis of toxic compounds and their various formulations.     

无损光学法测量人胃粘膜/粘膜下层组织的光衰减特性

研究了人正常胃粘膜及粘膜下层组织对640 nm,690 nm,740 nm,790 nm,840 nm和890 nm波长的钛宝石激光的光衰减特性以及光学穿透深度,实验采用激光斜入射式空间分辨反射光和CCD探测器以及非线性拟合确定组织光学特性。结果表明:人正常胃粘膜及粘膜下层组织对六个波长的激光的有效衰减系数和光学穿透深度都是随着激光波长的变化而变化的。其有效衰减系数的最大值在640 nm,其值为1.12 mm-1,最小值在790 nm,其值为0.901 mm-1,最大差异在790 nm和890 nm之间,其值为19.9%,最小差异在690 nm和740nm之间,其值为2.83%。其光学穿透深度的最大值在790 nm,其值为1.11 mm,最小值在640 nm,其值为0.890 mm,最大差异在640 nm和790 nm之间,其值为24.7%,最小差异在690 nm和740 nm之间,其值为2.97%。     

Mechanics of solid tissue invasion by the mammalian pathogen Pythium insidiosum.

The relative significance of mechanical penetration versus the action of substrate-degrading enzymes during solid tissue invasion has not been established for any fungal disease. Pythium insidiosum is an oomycete fungus (or stramenopile) that causes a rare, but potentially lethal infection in humans and other mammalian hosts. Experiments with miniature strain gauges showed that single hyphal apices of this pathogen exert forces of up to 6.9 microN, corresponding to maximum pressures of 0.3 microN microm(-2) or MPa. Samples of cutaneous and subcutaneous tissue from fresh human cadavers displayed a mean strength (resistance to needle puncture) of 24 microN microm(-2), and a mean pressure of 30 microN microm(-2) was necessary to penetrate skin strips from slaughtered horses. These experiments demonstrate that P. insidiosum does not exert sufficient pressure to penetrate undamaged skin by mechanics alone, but must effect a decisive reduction in tissue strength by proteinase secretion.     

Depth profiling of gold nanoparticles and characterization of point spread functions in reconstructed and human skin using multiphoton microscopy

Multiphoton microscopy has become popular in studying dermal nanoparticle penetration. This necessitates studying the imaging parameters of multiphoton microscopy in skin as an imaging medium, in terms of achievable detection depths and the resolution limit. This would simulate real‐case scenarios rather than depending on theoretical values determined under ideal conditions. This study has focused on depth profiling of sub‐resolution gold nanoparticles (AuNP) in reconstructed (fixed and unfixed) and human skin using multiphoton microscopy. Point spread functions (PSF) were determined for the used water‐immersion objective of 63×/NA = 1.2. Factors such as skin‐tissue compactness and the presence of wrinkles were found to deteriorate the accuracy of depth profiling. A broad range of AuNP detectable depths (20–100 μm) in reconstructed skin was observed. AuNP could only be detected up to ～14 μm depth in human skin. Lateral (0.5 ± 0.1 μm) and axial (1.0 ± 0.3 μm) PSF in reconstructed and human specimens were determined. Skin cells and intercellular components didn't degrade the PSF with depth. In summary, the imaging parameters of multiphoton microscopy in skin and practical limitations encountered in tracking nanoparticle penetration using this approach were investigated. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Spatially resolved diffuse imaging for high‐speed depth estimation of jet injection

We investigate the use of spatially resolved diffuse imaging to track a fluid jet delivered at high speed into skin tissue. A jet injector with a short needle to deliver drugs beneath the dermis, is modified to incorporate a laser beam into the jet, which is ejected into ex vivo porcine tissue. The diffuse light emitted from the side and top of the tissue sample is recorded using high‐speed videography. Similar experiments, using a depth‐controlled fiber optic source, generate a reference dataset. The side light distribution is related to source depth for the controlled‐source experiments and used to track the effective source depth of the injections. Postinjection X‐ray images show agreement between the jet penetration and ultimate light source depth. The surface light intensity profile is parameterized with a single parameter and an exponential function is used to relate this parameter to source depth for the controlled‐source data. This empirical model is then used to estimate the effective source depth from the surface profile of the injection experiments. The depth estimates for injections into fat remain close to the side depth estimates, with a root‐mean‐square error of 1.1 mm, up to a source depth of 8 mm.      

Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues

The focus of the current work was to study how the geometric design of a single barbed monofilament suture effects its biomechanical behavior. Different cut angles and cut depths of barbs were prepared and tested in vitro for their tensile and tissue anchoring properties by means of a novel suture/tissue pullout test. Experiments were also performed using bovine tendon and porcine skin tissues. The experimental results revealed that since tendon tissue has a higher modulus than skin it needs a more rigid barb to penetrate and anchor the surrounding tissue. A cut angle of 150° and a cut depth of 0.18 mm are therefore recommended. On the other hand, for the softer skin tissue, a cut angle of 170° and a cut depth of 0.18 mm provides a more flexible barb that gives superior skin tissue anchoring. These findings confirm that the future development of barbed suture technology requires a detailed understanding of the biomechanical properties of the tissue in which they are to be used. This will lead to the future development of a range of tissue-specific barbed sutures.     

Measurement of subcutaneous tissue fluid pressure using a skin-cup method

We developed a new method for measuring tissue fluid pressure in subcutaneous tissue. Porous Teflon cylinders were permanently implanted subcutaneously into the inguinal area of 10 dogs, and after several weeks a skin concavity formed in the center of each of the cylinders. A small needle attached to a recording system was inserted into the free tissue fluid lining the concavity, and the tissue fluid pressure averaged -8.8 +/- 2.7 (SD) mmHg. Next, a hollow Plexiglas cup was placed over the concavity and glued to the skin. The air pressure in the skin cup was continually adjusted (using an electromechanical servo-control system) to pull the skin upward and to hold it perfectly flat across the upper ridge of the Teflon cylinder. The simultaneously recorded needle and cup pressures averaged -9.1 +/- 2.4 and -8.6 +/- 2.6 mmHg, respectively, during steady-state conditions with the skin in a flat position. Both pressures also responded appropriately to dynamic changes in tissue fluid pressure caused by increasing and decreasing the volume of the free tissue fluid. Because the skin was flat, the equivalences of pressures above and below the skin is consistent with the hypothesis that the skin was not tethered significantly to the underlying tissues and that cup pressure accurately estimates the tissue free fluid pressure.     

Experimental study of needle–tissue interaction forces: Effect of needle geometries,insertion methods and tissue characteristics

A thorough understanding of needle–tissue interaction mechanics is necessary to optimize needle design, achieve robotically needle steering, and establish surgical simulation system. It is obvious that the interaction is influenced by numerous variable parameters, which are divided into three categories: needle geometries, insertion methods, and tissue characteristics. A series of experiments are performed to explore the effect of influence factors (material samples n=5 for each factor) on the insertion force. Data were collected from different biological tissues and a special tissue-equivalent phantom with similar mechanical properties, using a 1-DOF mechanical testing system instrumented with a 6-DOF force/torque (F/T) sensor. The experimental results indicate that three basic phases (deformation, insertion, and extraction phase) are existent during needle penetration. Needle diameter (0.7–3.2 mm), needle tip (blunt, diamond, conical, and beveled) and bevel angle (10–85°) are turned out to have a great influence on insertion force, so do the insertion velocity (0.5–10 mm/s), drive mode (robot-assisted and hand-held), and the insertion process (interrupted and continuous). Different tissues such as skin, muscle, fat, liver capsule and vessel are proved to generate various force cures, which can contribute to the judgement of the needle position and provide efficient insertion strategy.     

The distribution and condition of soil phosphate under old permanent pasture

Summary The distribution and condition of soil phosphate under old permanent pasture on Tree Field at Cockle Park was investigated. Two cereal crops were then grown to estimate the residual value of the phosphatic dressings which had been applied over a long period of time.The total-phosphate content of Tree Field soil was found to be concentrated in the surface layers and to a lesser extent at depths of 36 inches. The total-phosphate contents of horizons between depths of 12 to 24 inches were relatively low. The penetration of the phosphatic fertilisers was found to be limited to the surface horizons.The availability of the phosphatic reserves differed in the surface layers of the plots. Plots which had received superphosphate or basic slag and lime had relatively large amounts of total phosphate in available form at these depths. Evidence of the possible utilisation of available phosphate by the original sward at a depth of 36 inches was found.The cropping potential of the plot which had received basic slag and lime was found to be superior to that of the remaining plots.     

Volume conduction models for surface EMG; confrontation with measurements

Volume conduction models are used to describe and explain recorded motor unit potentials (MUPs). So far it has remained unclear which factors have to be taken into account in a volume conduction model. In the present study, five different models are confronted with measured MUP distributions over the skin surface above the m. biceps brachii generated by MUs at different depths and recorded by small surface electrodes. All model simulations include fibres of finite length. The models differ in the size of the volume conductor (finite/infinite), the number of different layers (1, 2 or 3) and the conductivities of these layers (representing muscle, subcutaneous fat and skin). All measured and simulated MUPs contain a mainly negative propagating wave followed by a positive wave simultaneously present at all electrode positions. The magnitude of the different MUP components relative to each other and as a function of motor unit (MU) and electrode position differ between the models studied and the measurements. All simulated MUPs changed faster with observation distance than the measured MUPs. The three-layer model, in which muscle tissue was surrounded by a subcutaneous fat layer and by a layer of skin resulted in MUPs closest to the measured MUPs.     

Subcutaneous metastasis from transitional cell carcinoma of the bladder diagnosed by fine needle aspiration biopsy. A case report

BACKGROUND: Metastasis of transitional cell carcinoma (TCC) of the bladder to the skin and subcutaneous tissue is an uncommon finding. CASE: A 58-year-old man with a known case of high grade TCC of the bladder, presented with a right paraspinal mass. Clinically an abscess was suspected. Fine needle aspiration (FNA) showed many clusters and isolated malignant cells in an inflammatory background. The smears were diagnosed as positive for malignancy. CONCLUSION: It is essential to differentiate tumors metastatic to the skin and subcutaneous tissue from inflammatory lesions. FNA helped with the diagnosis in this case and prevented unnecessary biopsy.     

Inactivation Effects on Proteins in a Needle‐free Vaccine Injector

Needle‐free powder injectors using a supersonic gas jet to force powder particles into the skin are suitable devices for the reliable delivery of powdered vaccines into viable epidermis. The peculiarities of the injection mechanism lead to a more comfortable injection for the patient, but in return to an increase in the stress on the pharmaceutical formulation in comparison to conventional injections with needle and syringe. As a lot of the conceivable drugs for needle‐free powder injection, particularly protein vaccines, are very sensitive bio‐molecules with an extremely fragile molecular structure, their resilience to the potential molecule damaging processes during the actuation with the device and the preservation of their biological activity are the crucial factors. Therefore it was the central aim of this work to identify and investigate the reasons for the loss of biological activity. The imaginable responsible process steps were investigated separately and the amounts of activity loss related to them. The manufacture of the powder and the loading of the cassette containing the formulation are examined. Moreover, the effects of static pressure exposition, the stress occurring because of the particle transport through the injector device, inevitably accompanied by impacts and shear stress and the influence of the particle impact with the target, were the focus of this investigation. Furthermore, different formulations of protein in combination with pharmaceutical excipients well‐known for their protein stabilizing effects during the powder manufacture process were examined in regard to their potential suitability to protect protein against the stress occurring throughout the needle‐free injection.     

Tissue fluid pressure and flow during pneumatic compression in lymphedema of lower limbs

Background: Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs requires knowledge of how high external pressures should be applied manually or set in compression devices in order to generate tissue pressures high enough to move tissue fluid to nonswollen regions and to measure its flow rate. Methods: We measured tissue fluid pressure and flow in subcutaneous tissue of lymphedematous limbs stages II to IV at rest and during pneumatic compression under various pressures and inflation timing. An 8-chamber sequential compression device inflated to pressures 50-120?mmHg, for 50 sec each chamber, with no distal deflation, was used. Pressures were measured using a wick-in-needle and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb circumference using strain gauge plethysmography. Results: Before massage, in all stages of lymphedema, stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 and +10 mmHg and did not differ from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression reached 40-100 mmHg and were lower than those in inflated chambers. High pressure gradient through the skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal noncompressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30 ml per compression cycle, to reach in some cases 100 ml in the groin region. Conclusions: Tissue fluid pressures generated by a pneumatic device were found lower than in the compression chambers. The obtained results point to the necessity of applying high pressures and longer compression times to generate effective tissue fluid pressures and to provide enough time for moving the stagnant fluid.     

Electrical Impedance of Acupuncture Meridians: The Relevance of Subcutaneous Collagenous Bands

Background

The scientific basis for acupuncture meridians is unknown. Past studies have suggested that acupuncture meridians are physiologically characterized by low electrical impedance and anatomically associated with connective tissue planes. We are interested in seeing whether acupuncture meridians are associated with lower electrical impedance and whether ultrasound-derived measures – specifically echogenic collagenous bands - can account for these impedance differences.

Methods/Results

In 28 healthy subjects, we assessed electrical impedance of skin and underlying subcutaneous connective tissue using a four needle-electrode approach. The impedances were obtained at 10 kHz and 100 kHz frequencies and at three body sites - upper arm (Large Intestine meridian), thigh (Liver), and lower leg (Bladder). Meridian locations were determined by acupuncturists. Ultrasound images were obtained to characterize the anatomical features at each measured site. We found significantly reduced electrical impedance at the Large Intestine meridian compared to adjacent control for both frequencies. No significant decrease in impedance was found at the Liver or Bladder meridian. Greater subcutaneous echogenic densities were significantly associated with reduced impedances in both within-site (meridian vs. adjacent control) and between-site (arm vs. thigh vs. lower leg) analyses. This relationship remained significant in multivariable analyses which also accounted for gender, needle penetration depth, subcutaneous layer thickness, and other ultrasound-derived measures.

Conclusion/Significance

Collagenous bands, represented by increased ultrasound echogenicity, are significantly associated with lower electrical impedance and may account for reduced impedances previously reported at acupuncture meridians. This finding may provide important insights into the nature of acupuncture meridians and the relevance of collagen in bioelectrical measurements.     

The power of single and multibeam two-photon microscopy for high-resolution and high-speed deep tissue and intravital imaging

Two-photon microscopy is indispensable for deep tissue and intravital imaging. However, current technology based on single-beam point scanning has reached sensitivity and speed limits because higher performance requires higher laser power leading to sample degradation. We utilize a multifocal scanhead splitting a laser beam into a line of 64 foci, allowing sample illumination in real time at full laser power. This technology requires charge-coupled device field detection in contrast to conventional detection by photomultipliers. A comparison of the optical performance of both setups shows functional equivalence in every measurable parameter down to penetration depths of 200 microm, where most actual experiments are executed. The advantage of photomultiplier detection materializes at imaging depths >300 microm because of their better signal/noise ratio, whereas only charge-coupled devices allow real-time detection of rapid processes (here blood flow). We also find that the point-spread function of both devices strongly depends on tissue constitution and penetration depth. However, employment of a depth-corrected point-spread function allows three-dimensional deconvolution of deep-tissue data up to an image quality resembling surface detection.     

Interstitial potential during propagation in bathed ventricular muscle.

Theoretical simulations have suggested that interstitial potential (Vis) during action potential propagation affects measurements of the transmembrane action potential in bathed ventricular muscle. To evaluate the Vis experimentally, we obtained Vis and intracellular action potential (Vic) recordings at various depths in paced guinea pig papillary muscles bathed in oxygenated Tyrode's solution. The peak-to-peak amplitude and the maximum dV/dt (dV/dtmax) of the intrinsic downward deflection of the Vis recordings were determined. The transmembrane action potential (TM) was obtained by subtracting each Vis from the corresponding Vic recording, and measurements for the phase zero depolarization and action potential foot of the Vic were compared with the measurements for the TM. At penetration depths of approximately 54 microns, the amplitude and dV/dtmax of the Vis were 13 mV and -38 V/s. When the depth was increased to 200 microns, these parameters increased to 24 mV and -59 V/s (P less than 0.005), and when the depth was further increased to 390 microns, the parameters decreased to 16 mV and -38 V/s. Because of the Vis at the various depths, the Vic underestimated dV/dtmax of phase zero of the TM by 20-31%, which would reduce estimates of Na+ current obtained from dV/dt. Also, the Vic overestimated the time constant of the 2-8 mV foot of the action potential by 48-82%, which would reduce estimates of the "effective" membrane capacitance by 33-45%. These influences of the Vis on measurements may affect results of quantitative studies of the ventricular action potential.     

Mechanics of Solid Tissue Invasion by the Mammalian Pathogen Pythium insidiosum

The relative significance of mechanical penetration versus the action of substrate-degrading enzymes during solid tissue invasion has not been established for any fungal disease. Pythium insidiosum is an oomycete fungus (or stramenopile) that causes a rare, but potentially lethal infection in humans and other mammalian hosts. Experiments with miniature strain gauges showed that single hyphal apices of this pathogen exert forces of up to 6.9 μN, corresponding to maximum pressures of 0.3 μN μm⁻² or MPa. Samples of cutaneous and subcutaneous tissue from fresh human cadavers displayed a mean strength (resistance to needle puncture) of 24 μN μm⁻², and a mean pressure of 30 μN μm⁻² was necessary to penetrate skin strips from slaughtered horses. These experiments demonstrate that P. insidiosum does not exert sufficient pressure to penetrate undamaged skin by mechanics alone, but must effect a decisive reduction in tissue strength by proteinase secretion.