Surrogates, which precisely simulate nonlinear mechanical properties of the human skin at different body sites, would be indispensable for biomechanical testing applications, such as estimating the accurate load response of skin implants and prosthetics to study the biomechanics of static and dynamic loading conditions on the skin, dermatological and sports injuries, and estimating the dynamic load response of lethal and nonlethal ballistics. To date, human skin surrogates have been developed mainly with materials, such as gelatin and polydimethylsiloxane (PDMS), based on assumption of simplified mechanical properties, such as an average elastic modulus (estimated through indentation tests), and Poisson’s ratio. In addition, pigskin and cowhides, which have widely varying mechanical properties, have been used to simulate human skin. In the current work, a novel elastomer-based material system is developed, which precisely mimics the nonlinear stress–stretch behavior, elastic modulus at high and low strains, and fracture strengths of the natural human skin at different body sites. The manufacturing and fabrication process of these skin surrogates are discussed, and mechanical testing results are presented.

Soft tissues in general exhibit anisotropic mechanical behavior, which varies in three dimensions based on the location of the tissue in the body. In the past, there have been few attempts to numerically model tissue anisotropy using composite-based formulations (involving fibers embedded within a matrix material). However, so far, tissue anisotropy has not been modeled experimentally. In the current work, novel elastomer-based soft composite materials were developed in the form of experimental test coupons, to model the macroscopic anisotropy in tissue mechanical properties. A soft elastomer matrix was fabricated, and fibers made of a stiffer elastomer material were embedded within the matrix material to generate the test coupons. The coupons were tested on a mechanical testing machine, and the resulting stress-versus-stretch responses were studied. The fiber volume fraction (FVF), fiber spacing, and orientations were varied to estimate the changes in the mechanical responses. The mechanical behavior of the soft composites was characterized using hyperelastic material models such as Mooney-Rivlin’s, Humphrey’s, and Veronda-Westmann’s model and also compared with the anisotropic mechanical behavior of the human skin, pelvic tissues, and brain tissues. This work lays the foundation for the experimental modelling of tissue anisotropy, which combined with microscopic studies on tissues can lead to refinements in the simulation of localized fiber distribution and orientations, and enable the development of biofidelic anisotropic tissue phantom materials for various tissue engineering and testing applications.

Pelvic organ prolapse (POP) is an abnormality of the female pelvic anatomy due to events, such as multiple child births, menopause, and morbid obesity, which may lead to weakening of the pelvic floor striated muscles and smooth musculo-connective tissues. POP leads to dropping of the pelvic organs, namely, the bladder, uterus, and rectum into the vaginal canal and eventual protrusion, causing vaginal pain, pressure, difficulty emptying the bladder and rectum, and sexual dysfunction. Each year, close to 300,000 POP surgeries are performed in the U.S., out of which more than 60% of patients may face relapse conditions. A closer look into the problem reveals that POP surgery failures may be attributed mainly to the lack of understanding among medical practitioners on the mechanics of prolapse. In the literature, there have been attempts in the engineering community to understand prolapse using phenomenological computational modeling. This paper reviews the development and study of these numerical models, aimed at understanding the mechanics of POP. The various computational challenges related to geometry creation, material modeling, finite-element (FE) modeling, and boundary conditions (BCs) will be discussed and significant future research directions will also be highlighted in this review.

Suturing is an acquired skill and is based on a surgeon's experience. To date, no two sutures are the same with respect to the type of knot, tension or suture material. With advancement in medical technologies, robotic suturing is becoming more and more important to operate on complex and difficult to reach internal surgical sites. While it is very difficult to translate a surgeon's suturing expertise to an automated environment, computational models could be employed to estimate baseline suture force requirements for a given wound shape, size, and suture material, which could be subsequently processed by a robot. In literature, there have been few attempts to characterize wound closure and suture mechanics using simple 2D and 3D computational models. Single and multiple skin layers (epidermis, dermis, and hypodermis) and tissues with different wound geometries, and sizes have been simulated under simple wound flap displacements to estimate suture force requirements. An extensive review of this literature on computational modeling of wound suture would provide valuable insights into the areas in which further research work is required. Discussion of various computational challenges in modeling sutures in numerical environment will help in better understanding the roadblocks, and the required advancements in suture modeling

The calcaneal fat pad is a major load bearing component of the human foot due to daily gait activities such as standing, walking, and running. Heel and arch pain pathologies such as plantar fasciitis, which over one third of the world population suffers from, is a consequent effect of calcaneal fat pad damage. Also, fat pad stiffening and ulceration has been observed due to diabetes mellitus. To date, the biomechanics of fat pad damage is poorly understood due to the unavailability of live human models (because of ethical and biosafety issues) or biofidelic surrogates for testing. This also precludes the study of the effectiveness of preventive custom orthotics for foot pain pathologies caused due to fat pad damage. The current work addresses this key gap in the literature with the development of novel biofidelic surrogates， which simulate the in vivo and in vitro compressive mechanical properties of a healthy calcaneal fat pad. Also, surrogates were developed to simulate the in vivo mechanical behavior of the fat pad due to plantar fasciitis and diabetes. A four-part elastomeric material system was used to fabricate the surrogates, and their mechanical properties were characterized using dynamic and cyclic load testing. Different strain (or displacement) rates were tested to understand surrogate behavior due to high impact loads. These surrogates can be integrated with a prosthetic foot model and mechanically tested to characterize the shock absorption in different simulated gait activities, and due to varying fat pad material property in foot pain pathologies (i.e., plantar fasciitis, diabetes, and injury). Additionally, such a foot surrogate model, fitted with a custom orthotic and footwear, can be used for the experimental testing of shock absorption characteristics of preventive orthoses.

Skin injury is the most common type of injury, which manifests itself in the form of wounds and cuts. A minor wound repairs itself within a short span of time. However, deep wounds require adequate care and sometime clinical interventions such as surgical suturing for their timely closure and healing. In literature, mechanical properties of skin and other tissues are well known. However, the anisotropic behavior of wounded skin has not been studied yet, specifically with respect to localized overstraining and possibilities of rupture. In the current work, the biomechanics of common skin wound geometries were studied with a biofidelic skin phantom, using uniaxial mechanical testing and Digital Image Correlation (DIC). Global and local mechanical properties were investigated, and possibilities of rupture due to localized overstraining were studied across different wound geometries and locations. Based on the experiments, a finite element (FE) model was developed for a common elliptical skin wound geometry. The fidelity of this FE model was evaluated with simulation of uniaxial tension tests. The induced strain distributions and stress-stretch responses of the FE model correlated very well with the experiments (R² > 0.95). This model would be useful for prediction of the mechanical response of common wound geometries, especially with respect to their chances of rupture due to localized overstraining. This knowledge would be indispensable for pre-surgical planning, and also in robotic surgeries, for selection of appropriate wound closure techniques, which do not overstrain the skin tissue or initiate tearing.