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Lesch et al. Mini-invasive Surg 2023;7:25 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.31

Original Article Open Access

Cyclic pulse loads pave the road to the GRIP

concept in abdominal wall reconstruction

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1
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Carolin Lesch 1 , Yannique Ludwig , Fabio Kugel , Katharina Uhr , Matthias Vollmer , Regine Nessel ,
Friedrich Kallinowski 1
1
General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany.
2
Hamburg University of Technology, Biomechanics, Hamburg 21073, Germany.
3
General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn 74078, Germany.
Correspondence to: Dr.Carolin Lesch, General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im
Neuenheimer Feld 410, Heidelberg 69120, Germany. E-mail: carolin.lesch@stud.uni-heidelberg.de; carolesch@gmx.de
How to cite this article: Lesch C, Ludwig Y, Kugel F, Uhr K, Vollmer M, Nessel R, Kallinowski F. Cyclic pulse loads pave the road
to the GRIP concept in abdominal wall reconstruction. Mini-invasive Surg 2023;7:25. https://dx.doi.org/10.20517/2574-
1225.2023.31
Received: 31 Mar 2023 First Decision: 2 Jun 2023 Revised: 13 Jun 2023 Accepted: 4 Jul 2023 Published: 10 Jul 2023
Academic Editor: Luca Gordini Copy Editor: Lin He Production Editor: Lin He

Abstract
Aim: Durable reconstruction of the abdominal wall needs to be assessed in a lifelike experimental setting and
consider the reconstructed abdominal wall as a coherent compound. Our aim was to evaluate broader possibilities
in preclinical testing and to deepen the understanding of the biomechanical influences.

Methods: We developed a test bench that allows studying a compound under cyclic, repetitive loads. Pulse loads
transmit energy to the abdominal wall repeatedly. The amount of energy is related to the load characteristics. We
used porcine bellies with a round central (5 cm) defect. They were bridged in a sublay position with Cicat
®
Dynamesh . Further defects, located in an additional incision, were sutured in a standardized small-bite technique.
We varied the number of loads, the maximum peak pressure, the pressure plateau length, and the impact area size.

Results: Increasing the peak pressure by 30 mmHg lowers the durability by about 20 %. Prolonging the plateau
phase led to a significant durability decrease. During the first 100 dynamic intermittent strain (DIS) impacts, the
major tissue deformation and the majority of failures occur. Beyond the 425th DIS impact, about 10 % more
failures occur. Increasing elongation and deformation of the tissue raise the likelihood of failure.

Conclusion: If the compound does not establish a strain-stable condition during the period of plastic deformation,
failure occurs. The outcome does not only depend on the reconstruction technique but also on the external

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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