Tubiana staging system based on a digit’s total extension deficit [51, 52].
\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
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In light of the current trends and popularity of herbal medicine, cultural/societal differences and perception, and the relationship with modern healthcare this book presents selected topics to ensure that necessary information on herbal medicine in healthcare is provided. Apart from clarifying certain important complexities and misconceptions on herbal medicine, a general overview of herbal medicine, uses of herbs in the management of diseases, plant secondary metabolites, analytical techniques, applications in stem cell research, use as leads for conventional drug compound development, and research and development of herbal medicines for healthcare are among the major discussions in this book.",isbn:"978-1-78984-783-3",printIsbn:"978-1-78984-782-6",pdfIsbn:"978-1-83881-386-4",doi:"10.5772/intechopen.69412",price:139,priceEur:155,priceUsd:179,slug:"herbal-medicine",numberOfPages:314,isOpenForSubmission:!1,isInWos:1,hash:"b70a98c6748d0449a6288de73da7b8d9",bookSignature:"Philip F. Builders",publishedDate:"January 30th 2019",coverURL:"https://cdn.intechopen.com/books/images_new/6302.jpg",numberOfDownloads:29522,numberOfWosCitations:2,numberOfCrossrefCitations:29,numberOfDimensionsCitations:68,hasAltmetrics:1,numberOfTotalCitations:99,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 23rd 2017",dateEndSecondStepPublish:"June 13th 2017",dateEndThirdStepPublish:"September 9th 2017",dateEndFourthStepPublish:"December 8th 2017",dateEndFifthStepPublish:"February 6th 2018",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,editors:[{id:"182744",title:"Dr.",name:"Philip",middleName:null,surname:"Builders",slug:"philip-builders",fullName:"Philip Builders",profilePictureURL:"https://mts.intechopen.com/storage/users/182744/images/5533_n.jpg",biography:"Dr. Philip Fafowora Builder is a Nigerian born on 12th February 1968 in Ibadan. He attended Baptist Day Primary School Jos and Command Secondary School Jos, Plateau State Nigeria. He obtained the Bachelor of Pharmacy degree (B. Pharm.) from the University of Jos, in 1991 and, Master of Pharmacy (M. Pharm) and Doctor of Philosophy (Ph. D- Pharmaceutics) degrees from University of Nigeria, Nsukka, Enugu State, Nigeria in 1997 and 2008 respectively. He worked as a research fellow in the Department of Pharmaceutical Technology and Raw Materials Development (NIPRD), Abuja, Nigeria from 2002 to 2016. His is currently an Associate Professor and the Head of Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Kaduna State University, Kaduna State, Nigeria. He has published several research articles and review papers in many peer review journals as well as book chapters. He has also received several academic awards among which are: Best Graduating Student Forensic Pharmacy, University of Jos, Nigeria 1991; University of Nigeria Vice Chancellor’s Price for Best Ph. D Student, Department of Pharmaceutics, 2008. His areas of research interest are: development of novel biopolymers for drug delivery, dosage form design of conventional drugs and herbal medicines, nano-particulate drug delivery systems, stability and quality assessment of herbal medicines and conventional drugs.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"991",title:"Herbalism",slug:"herbalism"}],chapters:[{id:"62180",title:"Introductory Chapter: Introduction to Herbal Medicine",doi:"10.5772/intechopen.78661",slug:"introductory-chapter-introduction-to-herbal-medicine",totalDownloads:1258,totalCrossrefCites:1,totalDimensionsCites:2,signatures:"Philip F. 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Dupuytren’s disease is one of the most common pathologies diagnosed in the field of hand surgery. It is a fibroproliferative disease of the palmar fascia characterized by flexion contractures of the digits and involves an abnormal production of type III collagen. The disease has a unique history with origins dating back to the Vikings and has been studied extensively since. However, despite ongoing research the etiology of the disease remains unclear but likely results from a complex interaction between genetics and environmental risk factors. Patients classically present with palpable palmar nodules and cords leading to gradual, progressive loss of function. The disease can potentially lead to debilitating flexion contractures of the digits and affect activities of daily living. The disease is a clinical diagnosis and only requires further testing to exclude other pathologies. There is no cure for Dupuytren’s disease and treatment methods remain palliative. Patients with mild disease can be observed for disease progression while patients with more severe disease may be treated with a variety of procedures or surgeries. Recently, clinical procedures including collagenase injections and percutaneous needle fasciotomy (PNF) have been utilized to successfully treat select patients. Still, surgery remains the preferred method of treating Dupuytren’s contractures for most surgeons. A variety of surgical techniques have been described utilizing different types of incisions to either incise or excise disease fascia and correct contractures. Surgery has yielded successful outcomes in regaining extension of the involved digits and improving function of the hand, however, it is not without risks. Complications related to infection, wound healing, and neurovascular injuries have been reported. In addition, despite successful treatment following surgery some patients experience recurrence of their contracture. Further research has focused on methods of successfully treating Dupuytren’s disease while reducing complications and recurrence. This chapter will provide a thorough description of Dupuytren disease from its history and pathophysiology to clinical management as well as highlight research related to patient outcomes.
\nDupuytren’s disease is a condition of the hand with a unique history. Its origin is linked to the Viking population and likely spread throughout Northern Europe as the Vikings conquered and acquired lands in the ninth through thirteenth century. For this reason, it has since been given the colloquial name, “Viking disease.” The Viking’s 300-year conquest lead to many settlements in which their descendants lived and bred with native populations, leading to the spread of Dupuytren’s disease to many northern European nationalities [1, 2]. Naturally, as time progressed and more conquests occurred, the disease spread to the shores of North America, and is now found throughout the world.
\nEarly evidence of diseases mimicking Dupuytren’s has been noted in historical texts. The “Curse of the MacCrimmons” is a tale of seventeenth century Scotland in which Clan MacCrimmons was cursed with a “bent finger,” leaving them unable to play their bagpipes [2, 3]. The Catholic Church sign of benediction has even been postulated to depict an early church priest with Dupuytren’s disease [2, 4]. Whaley and Elliot describe early Icelandic stories of the twelfth and thirteenth century possibly describing accounts of Dupuytren’s disease dating back to the ninth century and include the treatment of one case by a procedure resembling a palmar fasciotomy [5].
\nIn 1831, the French surgeon and namesake to the disease Baron Guillaume Dupuytren gave a lecture on the “permanent retractions of the flexed fingers” [6]. Other surgeons have also been credited with describing conditions believed to be caused by Dupuytren’s disease, including: Felix Platter in 1680, Henry Cline, Jr. in 1808, and Sir Astley Cooper in 1818 [2]. Elliot discusses a “Cline’s contracture” as an earlier description of Dupuytren’s disease [7]. MacFarlane reports Platter may have been the first to publish a description of Dupuytren’s disease as early as 1614 [2]. Despite possible earlier accounts, Dupuytren maintains the namesake of the disease to this day. Dupuytren finished his career as chief surgeon at the Hôtel de Dieu in Paris, and his name appears in at least 12 other diseases and instruments, cementing his legacy in the medical field [1].
\nDupuytren’s disease is often considered a “disease of the north,” in to its northern European origins. Various studies into the prevalence of Dupuytren’s disease demonstrate its northern roots, showing Norway, Scotland, and Iceland with some of the highest prevalence when compared to more southern nations [8, 9, 10]. Today, Dupuytren’s disease can be seen in all types of patients; however, there are specific subsets of the population at in increased risk of developing the disease.
\nDupuytren’s disease is most prominent in Northern European white males, especially greater than 40 years old. A study in the Netherlands reports a prevalence as high as 22% in the general population [11]. The study also demonstrated a propensity for older populations with ages 50–55 displaying a 4.9% prevalence, while those 76–80 years old having a prevalence of 52.6%. Men were also affected disproportionately more than women (26.4 vs. 18.6%). The prevalence in the US has been shown to approach 7.3% when including self-reported symptoms [12]. Other epidemiological studies show a male to female ratio in the US of 1.7:1 which approaches 1:1 with increasing age [13]. Dupuytren’s disease has been linked to both genetic and environmental factors, both of which contribute to the prevalence in patient populations throughout the world.
\nThe genetic component of Dupuytren’s disease has been a topic of interest for many years. A study by Burge et al. found that the prevalence of Dupuytren’s in Norwegian individuals over 60 years old reaches 30%, indicating a familial component in like populations [14]. They also suggested an autosomal dominant inheritance pattern with variable penetrance based on pedigree analysis. Multiple heritable patterns have been hypothesized, but there is no clear consensus on a mode of transmission. It is possible the disease does not carry a simple inheritance pattern, but rather follows a more complex method similar to heart disease and diabetes. Ling et al. performed a study examining the family members of patients with Dupuytren’s disease, and found that 53% of men and 33% of women over the age of 60 in the family had signs of the disease [15]. In a clinical study, patients with a family history of Dupuytren’s disease had a 6-year earlier onset of disease compared to patients without a family history [16]. There was also increased disease severity in terms of the number of affected digits and degree of contracture in patients with a family history. Both of these findings suggest patients with a family history of Dupuytren’s disease develop a more severe and earlier onset of disease. Research has also investigated specific genes linked to the development of Dupuytren’s, including the gene for TGF-β1. However, studies implicating TGF- β1 with Dupuytren’s disease have been inconclusive [17]. The genetic predisposition of Dupuytren’s disease is complex and further research is needed to elicit a clear relationship between genetics and disease manifestation.
\nDespite Dupuytren’s genetic tendencies, multiple patients with no familial history of the disease are affected every year. Certain environmental factors have been associated with the development of Dupuytren’s disease including smoking, alcohol use, diabetes, manual labor, and previous trauma. Hindocha et al. identified additional risk factors in developing Dupuytren’s and included frozen shoulder, epilepsy, and a high lipid profile [16]. There are many environmental risk factors associated with Dupuytren’s disease; however, smoking, alcohol, diabetes mellitus, and previous trauma are the most well-established factors cited in current literature.
\nThere is a high prevalence of patients with Dupuytren’s disease who smoke cigarettes. A study found 76.5% of Dupuytren’s patients were smokers, while only 37.2% of the control group were smokers [18]. Another study examined 222 patients undergoing surgery to treat a Dupuytren’s contracture and found smoking was strongly associated with Dupuytren’s requiring surgical intervention (OR 2.8, 95% CI 1.5–5.2) [19]. The pathogenesis of Dupuytren’s disease from smoking is likely related to its impact on circulation. Cigarette smoking affects the small blood vessels causing microangiopathies, resulting in reduced blood flow to the distal extremities including the hands. The microvascular impairment from smoking is believed to contribute to the development of the Dupuytren’s disease. Smoking induced hypoxia of distal extremities leads to PDGF release, triggering endothelial and fibroblast activation resulting in increased collagen synthesis [8]. These vascular changes associated with smoking and collagen synthesis may contribute to the pathogenesis of Dupuytren’s. Overall, smoking is a modifiable risk factor that likely increases one’s risk of developing Dupuytren’s disease.
\nThough the role of alcohol is not clearly identified, it has been shown to be a risk factor for the development of Dupuytren’s disease. One study suggested alcoholic consumption leads to impaired liver function, and in turn altered palmar fat composition which could as a trigger for developing Dupuytren’s [20]. Heavy drinking was found to be more common in a study of Dupuytren’s patients awaiting surgery, and another study reported alcohol was the second most important risk factor after age in developing the disease [20, 21]. Additional studies suggest that alcoholics have a higher prevalence of Dupuytren’s disease compared to non-alcoholics (28 vs. 22%, respectively) [22]. Though associations have been documented, further research is needed in identifying the role of alcohol as a modifiable risk factor for developing Dupuytren’s disease.
\nMultiple studies have identified a relationship between Dupuytren’s disease and diabetes, but there is no clear evidence its pathophysiology. Noble et al. reported a 42% incidence of Dupuytren’s disease in adult diabetics and suggested Dupuytren’s severity is usually more mild and affecting the middle finger in diabetics [23]. In addition, 13% of 134 patients with Dupuytren’s disease were found to have elevated glucose levels, suggesting elevated blood glucose levels may influence development of Dupuytren’s disease. In another study, the proportion of German diabetics with Dupuytren’s disease was only slightly higher than that of the normal population (11% compared to about 7%) [24]. Another study however, showed the prevalence of the disease in diabetic patients was as high as 32% [25]. Though the prevalence of DD in diabetics has been studied in various subpopulations, a consensus on the relationship between Dupuytren’s disease and diabetes mellitus has not been reached. Further research is needed to demonstrate a true mechanism of pathogenesis between Dupuytren’s disease and diabetes.
\nDupuytren himself first proposed previous trauma as a risk factor for developing the disease [26]. The progression of Dupuytren’s disease resembles normal physiologic healing and based on a patient’s risk factors, trauma may initiate a cascade of events leading to an aberrant healing response. It is unclear whether the development of disease is related to a single injury or rather multiple insults over time, but studies have reported the development of Dupuytren’s near the site of previous penetrating injuries [27]. Other studies have linked previous hand surgery such as carpal tunnel and trigger finger release to the development of Dupuytren’s disease [22, 25, 28, 29].
\nThe association between Dupuytren’s disease and epilepsy or anticonvulsants and has been reported. Lund et al. recorded a 50% prevalence of Dupuytren’s in male patients with epilepsy and 25% in females [30]. Another study identified an overall prevalence of Dupuytren’s disease in 37% of epileptics [31]. Critchley et al. reported a 56% incidence of Dupuytren’s disease in chronic epileptic patients and an associated increased in disease with duration of epilepsy and possibly related to the administration of the anticonvulsant phenobarbital [32]. The effect of phenobarbital on DD was analyzed in a 2011 study, in which a dose-dependent fibrotic effect was seen with phenobarbital use. Though these studies demonstrate a relationship between epilepsy and phenobarbital use in DD, other studies have found no direct correlation to antiepileptic drugs [33, 34].
\nManuel labor consisting of continued and repetitive hand use has also been proposed as a risk factor for developing Dupuytren’s disease. Lucas et al. reported the effect of personal and occupation exposures on the development of the disease and reported men who developed the disease had the highest exposure to biomechanical, vibration, and manual work [35]. After adjusting for personal risk factors, manual labor and the handling of vibratory tools had the strongest association with Dupuytren’s disease. Another study examining the effect of weekly hand transmitted vibration on the development of Dupuytren’s disease concluded the risk of developing Dupuytren’s contracture is more than double in men with increasing amounts of hand-transmitted vibration [34]. In addition, handwork for at least 30 years has also been reported as a possible risk factor in the development of Dupuytren’s disease [35].
\nA thorough understanding of anatomy is crucial to understanding Dupuytren’s disease and its progression. Dupuytren’s disease is a fibroproliferative disorder affecting the palmar aponeurosis, one of the three zones within the palmar fascial complex. The subcutaneous palmar aponeurosis is a continuation of the palmaris longus tendon, extending superficially to the palmaris brevis muscle and into the palmar surface. The palmar aponeurosis can be divided into three layers according to orientation: longitudinal, vertical, and transverse. The longitudinal fibers extend to the phalanges where they bifurcate and terminate as three separate insertions. The superficial layer inserts into the dermis and the deep layer inserts into the flexor and extensor mechanisms. The middle layer of the longitudinal fibers travel vertically next to the metacarpophalangeal (MCP) joint capsule forming spiral bands. Vertical fibers of the palmar aponeurosis include the superficial Grapow fibers, which anchor the skin to the aponeurosis, and the septa of Legueu and Juvara, which create fibro-osseous compartments to allow passage of flexor tendons, neurovascular bundles, and lumbrical muscles. Transverse fibers of the palmar aponeurosis include the transverse ligament and the natatory ligament.
\nDupuytren’s disease is characterized by the transformation of normal, palmar fascial bands into fibrotic, contracted tissue called cords. Different manifestations and stages of the disease are dependent on the anatomical bands that are affected. Early disease often affects the superficial Grapow fibers, forming thickened skin in the affected area. Pretendinous cords are the most common and result in skin dimpling and MCP contracture. The spiral cord consists of the middle pretendinous band, spiral band, lateral digital sheet, and Grayson ligament result in MCP and proximal interphalangeal (PIP) contracture and can also be accompanied with a medially displaced neurovascular bundle [36]. Other cords that can form include the central and lateral cords which can lead to a combination of PIP or distal inter-phalangeal (DIP) contractures while natatory cords can lead to web space contractures.
\nThe pathophysiology of Dupuytren’s is similar to the normal connective tissue healing process. However, there are aspects of the Dupuytren’s process that differ and contribute to its pathogenesis. In Dupuytren’s there is an increased number of myofibroblasts producing type 3 collagen, a change in biochemical composition of the fascia, as well as an abundance of cytokines and prostaglandins contribute to the pathogenesis. An immune mediated component of the disease has also been proposed and researched. Luck et al. describes three distinct microscopic phases of Dupuytren’s disease [37]. The first stage is called the proliferative phase, and is characterized by increased fibroblast presence and proliferation in fascial bands, forming a nodule. On a cellular level, these nodules represent the accumulation of myofibroblasts, collagen, and extracellular matrix components within the palmar fascia, resulting in fibrotic, adherent lesions that decrease mobility of the joint. In this stage, there can be as high as a fortyfold increase in the amount of proliferating fibroblasts [38]. The active or “involutional” phase is dominated by myofibroblasts, which contain myofibrillar bundles in the cytoplasm, allowing them to contract and draw tissue together. These muscle-like fibers align in the direction of stress [38, 39]. The residual phase is characterized by the disappearance of a nodule, and appearance of cords. The acellular cord causes shortening of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint and producing the classic contracted appearance of Dupuytren’s disease. In the late phase, there is commonly impaired range of motion of the effected digit, and nerve damage and vascular insufficiency can occasionally be seen.
\nMyofibroblasts are contractile cells that are α-smooth muscle actin positive and contribute to the contracture present in Dupuytren’s disease. During the early phase of disease, myofibroblasts become densely packed in the palmar aponeurosis and produce an increased type 3/type 1 collagen ratio. The accumulation of fibroblasts and type III collagen creates the characteristic early nodule. This abundant type 3 collagen production is similar to connective tissue scar formation, and may or may not contribute to the pathophysiology of Dupuytren’s disease [40]. The source of myofibroblasts in Dupuytren’s disease remains unclear. Some argue that the fibroblast-myofibroblasts transformation is induced by local ischemia and hypoxia.
\nBiochemical changes to the palmar fascia may contribute to the development of Dupuytren’s disease. These changes include increased glycosaminoglycan content, increased hydroxylysine content, and increased reducible crosslinks found in affected palmar aponeuroses [40]. Myofibroblasts found in the palmar fascia produce fibronectin, a glycoprotein thought to encourage cell-cell and cell-extracellular matrix adherence [41, 42]. This contributes to the thickening of the palmar fascia seen in the disease. Dermatan sulfate has been found to be two fold greater in tissue affecting by Dupuytren’s and is known to affect collagen organization, deposition rate, and maintenance of fibers [43]. The same study also demonstrated an increased heparin sulfate composition in patients with Dupuytren’s, which has been shown to play a role in cell recognition, adhesion, growth control, and angiogenesis. Research has also shown a change in the architecture of the palmar fascia in Dupuytren’s patients. Compared to normal fascia, fascia in Dupuytren’s patients has more hydroxyl-lysino-hydroxy-norleucine crosslinking which was absent in normal tissue [44, 45]. It is unclear how this increased crosslinking component contributes to the severity of disease.
\nMany studies have pointed to the role of growth factors and cytokines in the pathogenesis of Dupuytren’s disease. An increased production of IL-1α and IL-1β is seen in Dupuytren’s palmar fascia. These cytokines are involved in proinflammatory processes including local fibroblast proliferation, which can potentially contribute to the active stage of Dupuytren’s disease [46]. There is also an increase in bFGF which contributes to fibroblast growth and proliferation, and increased TGF-β, which contributes to collagen synthesis and fibroblast chemotaxis [46]. The study concluded that increased release of cytokines and growth factors relative to normal reparative tissue may suggest a locally driven fibroblast proliferation contributing to the development of Dupuytren’s disease. Research has also demonstrated prostaglandins PGE2 and PGF2α play a role in contractility of smooth muscle associated with myofibroblasts [44, 47]. This contractile influence on myofibroblasts is thought to contribute to the contraction of tissue late in the disease. The source of these prostaglandins are possibly from microcirculation and perinodular fat, as nodules are highly vascularized and fatty.
\nStudies have suggested an immune mediated response in the pathophysiology of Dupuytren’s disease. Mayerl et al. describe abundant accumulation of immune cells in Dupuytren’s tissue, including mononuclear CD3+, CD4+ > CD8+, and primarily a Th1 mediated response [39]. These clusters of immune cells were found around blood vessels in the area, suggesting the fibroproliferation exists in Dupuytren’s may be due to microvascular damage mediated by the immune system. Further research is required to determine the relationship of Dupuytren’s to an immune mediated response.
\nA thorough history and physical exam is necessary to accurately diagnose Dupuytren’s disease, which has a classic presentation. It is important to assess risk factors including family history, northern European descent, smoking, alcohol use, history of diabetes mellitus, or previous trauma to the hand in order to gain a broader picture of the patients’ presentation. In many cases, disease is bilateral with one hand affected more than the other so it important to evaluate both hand. The ring finger is the most commonly affected digit followed by the small, middle, index, and thumb [48]. Other fibroproliferative diseases have been associated with Dupuytren’s disease and include Garrod’s nodes, Ledderhose disease, and Peyronie’s disease. Garrod’s nodes, also called knuckle pads, can be visualized on the dorsal PIP joints and are subcutaneous nodules that histologically portray myofibroblasts proliferation. Ledderhose is a fibrosis of the plantar fascia and Peyronie’s disease is an inflammation and scarring of the tunica albuginea of the penis. Rayan et al. described three phases to Dupuytren’s disease clinical presentation: the early, intermediate, and late phases [49]. These three phases provide a good framework to assess the patient’s disease status, and each phase is characterized by distinct aspects of the disease.
\nEarly disease is characterized by skin dimpling, puckering, and pitting, usually on the medial aspect of the palm. These changes can lead to the patient seeking medical attention, however are also easily ignored by some patients. A Dupuytren’s patient population study suggests that approximately 11% of Dupuytren’s disease patients seek attention from their physician with a chief complaint of skin changes on the palm [12]. Physical exam during the early phase of disease can confirm these skin changes upon inspection. Pitting of skin on the medial palm of the hand is a good indication of developing Dupuytren’s disease. Palpation reveals thickening and dimpling of the skin around the effected joint. The underlying fat on the medial palm becomes fibrotic near the distal palmar crease. Active range of motion (ROM) and strength testing in early disease will reveal no limitations, though more severe skin adhesions can lead to a slight decrease in mobility and function of the affected digits in some patients.
\nThe appearance of Dupuytren’s nodules and cords signifies the intermediate phase of disease. Nodule formation is often one of the first patient complaints and occurs during intermediate stages of the disease. Approximately 42% of patients with Dupuytren’s disease present to the office due to a nodule [12]. Nodules most commonly form proximal to the palmar crease overlying the metacarpophalangeal joint of the affected digit, and encompass the superficial layers of the palmar and digital fascia. Sometimes digital nodules are seen at the base of the proximal interphalangeal joint. Though often painless, larger nodules can cause pain when they exert pressure on underlying flexor tendons. Painful, chronic nodules are more indicative of intrinsic joint disease and rheumatoid arthritis, and must be differentiated from a Dupuytren’s disease nodule. After the appearance of a nodule, a pathologic cord may form within the palmar fascia. Approximately 12% of patients seek will seek care following development of a cord [12]. Nodules often regresses, but in some cases can be present simultaneously with Dupuytren’s cords. Initial cords are often unnoticeable and blend in with the underlying connective tissue, but over time, they become thick and resemble subcutaneous tendon-like structures upon inspection (\nFigure 1\n). Palpation reveals an immobile, thickened cord. Cord formation is extremely variable in terms of location. The most common cords arise in the palm, and include peritendinous, natatory, and vertical cords arising from their respective bands in the palmar fascia. Digital cords frequently seen include central and spiral cords. Active and passive ROM testing during the intermediate disease will often reveal no limitations in patients with nodules, but as cords form patients will begin to lose extension of the involved joint.
\nA patient with Dupuytren’s cords leading to contractures and affecting the bilateral small and ring fingers.
Late disease is defined by contraction of cords and the classic “bent finger” appearance of Dupuytren’s disease (\nFigure 2\n). Approximately 10% of Dupuytren’s disease patients will present during the late stage of the disease complaining of a permanent bent finger [12]. Contracture of the MCP joint often occurs before the PCP joint. Contractures often lead to difficulties in activates of daily living and patients will report difficulties with chores, washing, putting a hand in a pocket, and handshakes. Inspection and palpation will reveal a contracted, fibrotic cord. Both active and passive finger extension of the effected finger will likely be impaired, the extent of which is determined by severity of disease. Pain with ROM is rarely reported and if present should prompt further evaluation. The table top test was described in 1982 by Hueston and is specific to a Dupuytren’s diagnosis and has been used to stage disease progression [50]. The test involves placing the patient’s hand on a tabletop with the palmar side down. The test is positive if the patient cannot flatten the hand against the table and is indicative of the late phase of the disease.
\nA patient with Dupuytren’s PIP joint contracture with a flexion contracture of approximately 100°.
The degree of extension deficit is taken into account when staging Dupuytren’s disease. The adapted Tubiana staging system is the most common method of classifying the progression of Dupuytren’s disease (\nTable 1\n) [51, 52].
\n\nDupuytren’s disease is a clinical diagnoses based on a patient’s history and physical exam. Its hallmark features consist of an indolent, progressive course characterized by palmar skin changes, painless nodules, and fibrotic cords leading to flexion contractures of the digits. Patients presenting with later findings of the disease consisting of fibrotic cords and contracted digits are more clearly diagnosed. Conversely, patients presenting with earlier features of Dupuytren’s disease such as painless nodules may not be as easily distinguished from other diseases. Stenosing tenosynovitis, also known as a trigger finger, and soft tissue tumors may be mistaken for Dupuytren’s disease. Stenosing tenosynovitis can be differentiated from Dupuytren’s by tenderness over the A1 pulley with symptomatic locking or triggering of the digit and often no ROM deficit. Soft tissue masses typically do not present with skin thickening and pitting as seen in Dupuytren’s disease. In addition, Dupuytren’s nodules are often fixed to the skin and palmar fascia. Early Dupuytren’s disease may be difficult to distinguish from diabetic cheiroarthropathy, however, involvement of multiple digits and a waxy appearance of the skin are clues to distinguish diabetic cheiroarthropathy. Other pathologies that may present with some features similar to Dupuytren’s disease include: ulnar claw, rheumatoid arthritis, Volkmann’s contracture, and camptodactyly. Radiographs should be considered in patients presenting with a history of trauma to rule out a fracture or dislocation. Further diagnostic imaging such as MRI may be considered in special cases to rule out suspicion of other disease processes, but is not required to diagnose Dupuytren’s disease. A thorough history and physical exam is key to accurately diagnosing Dupuytren’s disease.
\nDespite the recent advances in understanding the pathophysiology of Dupuytren’s disease the treatment options remain palliative and not curative. Non-operative treatment is recommended in patients with isolated disease without contractures and in patients with mild contractures without significant interference with activities of daily living. Observation is a reasonable non-operative option for many patients with early disease and minimal symptoms. Studies have estimated about 50.8% of patients with palpable nodules will progress to developing cords after 8 years from diagnosis, and of these only 17% will develop contractures meeting criteria for surgical intervention [53].
\nSurgery is the mainstay treatment for Dupuytren’s contractures. However, non-operative interventions continue to be pursued as an alternative option to surgical intervention. Splinting and physical therapy have mostly been utilized as a post-operative intervention to prevent recurrence. Critics of splinting and physical therapy often express concern it may worsen the contracture if the contractile tissue is not first removed. In vitro studies have reported mechanical loads increase TGF-beta expression and thus enhance fibroblast contraction [54]. Few clinical studies have investigated orthosis or therapy as a non-operative intervention. Larocerie-Salgado et al. reported patients with mild PIP joint contractures had an average improvement of 14.6° (SD 5.1°) after wearing a volar hand-based extension splint at night and utilizing hand exercises and massage [55]. Another study comparing tension and compression orthosis worn for 20 hours per day reported significant improvement in the total active extension (TAE) of a digit in both groups compared to baseline TAE [56]. Overall there is minimal evidence regarding therapy and orthosis usage. There may be some benefit in preventing progression of a contracture in an isolated digit, but the possible benefit may be minimal and outweighed by interference of the splint and necessity for prolonged periods of daily use.
\nIntralesional triamcinolone injections have also been proposed to deter the progression of Dupuytren’s disease. Steroid treatment in Dupuytren’s is linked to its effectiveness in reducing hypertrophic scars and keloids by degrading insoluble collagen. Ketchum and Donahue reported resolution of Dupuytren nodules in patients with mild disease (<15° joint contracture) after an average of three 60-120 mg triamcinolone injections spaced out over 6 weeks [57]. However, 50% experienced recurrence of disease and either underwent further injections or surgery. Other studies have utilized triamcinolone in patients with nodules but without flexion contractures and have demonstrated better outcomes with only a 6% recurrence at 5 years [58]. The high recurrence rates and complications including skin atrophy, transient erythema, depigmentation and tendon rupture have minimized the use of steroid injections in Dupuytren’s disease [57, 58].
\nNon-operative treatment has recently expanded to include office-based procedures to provide patients with Dupuytren’s contractures an alternative to surgery or treat patients unable to tolerate surgery. Percutaneous needle fasciotomy and collagenase injections are two clinic procedures that have recently gained popularity. Zhao et al. reported these two minimally invasive techniques comprised 14% of all procedures for Dupuytren’s in 2007, but have more recently risen to 39% of all procedures [59].
\nPercutaneous needle fasciotomy (PNF) utilizes a 25-gauge needle as a scalpel to incise the contracted cord at different levels while the digit is manually straightened. Prior to the procedure the dermis is injected with a local anesthetic to reduce pain and is followed by range of motion (ROM) exercises aimed at preventing recurrence of the cord. As described by Eaton, needle fasciotomy has four requirements including a contracture caused by a palpable cord, redundant skin, and a cooperative patient [60]. The benefits of the procedure include a low complication rate, early return of motion, and avoidance of surgery. Zhou et al. reported a complication rate of 5.2% after fasciotomy compared with 24.3% in a group undergoing limited fasciectomy [61]. However, PNF had a higher rate of recurrence at long-term follow-up. Van Rijssen et al. have reported recurrence rates following PNF as high as 63% at 3 years and 84.9% at 5-year follow-up [62]. Patients older than 75 years old with mild disease had the lowest rate of recurrence at 5 years. In general, PNF is a reasonable option for older patients who have developed a mild contracture due to a palpable cord and are well-informed of the recurrence risk but prefer a minimally invasive option.
\nCollagenase injections were first approved for Dupuytren’s contractures in 2010 by the United States Food and Drug Administration and are currently approved for the treatment of two Dupuytren’s contracted joints in the same hand. Collagenase injections deliver an enzyme isolated from Clostridium histolyticum which is responsible for lysing the collagen in a contracted cord. After injection, the patient returns within 1–3 days for manipulation to straighten the digit. Hurst et al. reported good results following up to 3 injections with 64% of patients experiencing 0–5° of full flexion with no recurrence 90 days after treatment [63]. Common adverse events of collagenase included swelling, pain, bruising, tenderness, and pruritis. Complications related to tendon ruptures, skin atrophy, and complex regional pain syndrome (CRPS) are rare and have been reported in less 1% of patients [63, 64]. Recurrence rates following collagenase have been closely studied as well. Van beek et al. reported 2-year recurrence rates (>20-degree worsening) following one or more injections were 28.2 and 62.1% for MCP and PIP joints, respectively [65]. Peimer et al. reported 47% of successfully treated patients experience recurrence (>20° worsening) within 5-years following collagenase injections with PIP joints having a higher degree of recurrence at 66 versus 39% among MCP joints [64]. Collagenase injections provide a good treatment option for patients with a palpable cord causing a contracture.
\nOperative treatment of Dupuytren’s disease is offered in patient with contractures of >30° at the MCP joint and any functionally bothersome PIP contracture. The goal of surgical treatment is to return full extension of the involved digits via various surgical techniques involving either incising or excising the diseased fascia. Dupuytren originally described an open palmar fasciotomy technique in 1831 and this was later popularized in 1964 by McCash et al. as the open-palm technique [6, 66]. The open-palm technique involved a transverse incision across the distal palmar crease followed by incising any Dupuytren cords. Multiple surgical methods have since been described and include open fasciotomy, segmental fasciectomy, limited fasciectomy, and dermofasciectomy. These techniques range from being minimally invasive to radical excision of the diseased tissue. It is important to consider the severity of contractures, extent of correction, and risk factors for recurrence in addition to protecting soft tissues when choosing the optimal surgical treatment. Surgery is ultimately an elective form of treatment and should prompt a conversation with patients regarding the risk and benefits of surgery as well as their functional goals.
\nProper handling of soft tissue is a key principle of surgical treatment of Dupuytren’s contractures. Adequate exposure of the cord must be balanced with protecting the neurovascular bundles, providing adequate wound coverage, limiting the risk of skin necrosis, and avoiding secondary contractures from longitudinal scarring. Multiple skin incisions have been described to address these issues and include: transverse incisions in the palm and digit, a Bruner incision, a Bruner incision with V-Y advancement flaps, curved incisions, and a longitudinal incision closed with z-plasties (\nFigure 3\n). Midline incisions provide the benefit of potentially avoiding the neurovascular bundles, however, Dupuytren’s disease distorts regular anatomy and can tether the cord toward the midline. Curved or zig-zag incisions help avoid secondary contractures from longitudinal scars. Despite the many variations in incisions, the Bruner incision seems to be the most commonly used.
\nThe figure outlines types of incisions and closures options for treating Dupuytren’s disease. Thumb: longitudinal incision with z-plasty closure. Index finger: Brunner incision. Middle finger: curvilinear incision. Index finger: V-Y incision. Small finger: transverse incisions utilized in the McCash open palm technique.
Skin closure is another important aspect of treating Dupuytren’s disease. The open-palm technique described by McCash left the skin incisions open to decrease hematoma formation and allowed for secondary healing with good results [66]. Today, most incisions are closed primarily, however, increased skin tension after closure has been correlated with elevated recurrence rate (\nFigure 4\n). Citron and Hearnden randomized patients undergoing fasciotomies and reported a 50% recurrence rate in the group with transverse incisions closed primarily compared with a 15% rate in patients with longitudinal incisions with a z-plasty closure [67]. Another study compared Bruner’s incision with direct closure to a longitudinal incision with a z-plasty closure for fasciectomy and reported no difference between the two methods [68]. Special attention should be given to skin tension during closure and a transpositional flap such as a z-plasty should be utilized if needed.
\nA post-operative image of a patient after a limited fasciectomy for a Dupuytren’s contracture of the small and ring finger. The Brunner’s incision was closed primarily with nylon sutures.
Open fasciotomy includes a variety of surgical techniques for treating Dupuytren’s contractures by incising the contracted cord without removing the diseased fascia. Many of the modern fasciotomy techniques are modifications of the methods originally described by Dupuytren and McCash et al. [6, 66]. Various types of incisions may be utilized to access the cord, but once the cord is visualized and incised, the digit is extended until straight. In some cases, additional incisions may be required at different levels along the cord in order to fully extend the digit. Unlike PNF, an open fasciotomy procedure provides the benefit of direct visualization to protect neurovascular structures and can often be accomplished through small incisions. In addition, it minimizes the potential morbidity sometimes seen in other techniques which excise the diseased fascia. Still, excision techniques are often preferred over an open fasciotomy for their ability to remove the diseased fascia which may aid in preventing regrowth of the cord and recurrence. This may be particularly true in patients with severe contractures. Stewart et al. retrospectively reviewed a series of patients who had open fasciotomies and reported a reoperation rate of 13.2% at 46 months with patients who initially required three level fasciotomies having worse recurrence [69]. Another study assessed 16 patients with Tubiana stage III and IV contractures and reported a higher recurrence rate of 37.5% at 5–8 year follow-up [70].
\nFasciectomy is the most common surgical treatment for Dupuytren’s contractures. The technique is based on the concept that the remaining diseased fascia may proliferate and lead to recurrence. Multiple methods of fasciectomies have been described and range from a segmental fasciectomy, where a portion of the fascial cord is removed, to a radical fasciectomy where skin and diseased fascia are excised. A segmental fasciectomy is usually completed through small incisions where segments of the cord are excised until the finger straightens. No attempt is made to removal the complete cord. The most widely used technique is a limited fasciectomy and is considered the gold standard in the operative treatment of Dupuytren’s contractures (\nFigure 5\n). The technique involves carefully exposing the diseased fascia from its proximal to distal end and excising it from the surrounding soft tissue (\nFigure 6\n). It differs from a radical fasciectomy by removing only the diseased fascia and leaving normal fascia, subcutaneous tissue, and the dermis intact. Radical fasciectomy advocated by McIndie and Beare involved extensive removal of nearby tissue and skin and required a skin graft [71]. However, the technique largely fell out of favor due to a higher complication rate without a reduction in recurrence. A dermatofasciectomy is similar to a limited fasciectomy but involves excising the overlying skin and often requires a skin graft for coverage. Advocates of this technique report disease-forming cells may be left in the overlying soft tissue leading to recurrence and selectively use it in patients at higher risk for recurrence. Despite the variety of techniques, fasciectomies require meticulous dissection to avoid injuring neurovascular bundles which may be displaced by a contracted cord. In addition, maintaining hemostasis is important to prevent hematoma formation which can compromise healing. Overall, fasciectomies offer the benefit of removing more diseased fascia but are accompanied by increased morbidity related to a more extensive exposure.
\nAn intraoperative image of a patient undergoing a limited fasciectomy for a Dupuytren’s contracture of the small finger. A Brunner’s incision was utilized to exposed the disease tissue. The Dupuytren’s cord is being elevated by the forceps.
An intraoperative image of a patient undergoing a limited fasciectomy for a Dupuytren’s contracture of the ring finger. (A) A Brunner’s incision was utilized to exposed the disease tissue. The longitudinal band of the palmar aponeurosis is being elevated. (B) The diseased fascia was meticulously elevated from proximal to distal. (C) The diseased fascia after removal from the digit.
Most surgeons utilize some form of rehabilitation to prevent further contractures and maintain ROM. After surgery, patients are typically immobilized in an extension-based splint for 2–3 days. Wounds are closely monitored following surgery to ensure adequate healing and to identify any barriers to healing such as infection, hematoma, or skin necrosis. Patients are often referred to a hand therapist within the first week of surgery for wound care, scar management, range of motion exercises, and splinting techniques to prevent contracture formation. A variety of splinting protocols and types of orthoses have been described. In general, protocols may involve static or dynamic splinting and be utilized at different periods of the day. Despite the widespread use of post-operative splinting, studies have found no strong evidence they are effecting in preventing loss of extension or recurrence. Collis et al. randomized patients to night time extension orthoses and hand therapy or hand therapy alone and reported no differences between the two groups in terms of active ROM or hand function [72]. A similar study found night time splinting offered no benefit in terms of ROM and function at 1 year after surgery and recommended splinting should only be utilized when extension deficits occur [73]. Overall, less invasive procedures allow for earlier rehabilitation and a shorter recovery period. In addition, wound healing often dictates how fast a patient can progress following surgery. A segmental aponeuroectomy may involve a 2–3 week recovery period whereas a fasciectomy may involve a much longer recovery period.
\nOverall, surgery is an effective method of treating Dupuytren’s contractures and improving patients’ hand function. In a survey of over 1100 patients who underwent surgical treatment 75% reported almost full or full correction of their contracture [74]. Zyluk et al. reported patients had significantly improved hand function as measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire after undergoing a subtotal fasciectomy [75]. In addition, patient’s experienced a significant improvement in the total loss of extension from an average of 80 to 10°. Another study prospectively evaluated 90 patients undergoing a fasciectomy for a 60-degree or more deficit in total active extension and reported 81% patient satisfaction with function, 87% reaching functional ROM, and significantly improved DASH scores at 1 year follow up [76].
\nFurther analysis of surgical treatment has lead authors to identify certain characteristic associated with better outcomes. Patients with MCP contractures are more likely to achieve full intra-operative correction (Donaldson). However, correction of PIP contractures has a stronger correlation to improved hand function when compared with correction of the MCP joint [77]. Surgical treatment has focused on PIP contractures to maximize intra-operative correction and improve functional outcomes. Surgeons have tried releasing the PIP capsule with a fasciectomy to improve PIP correction, but there is no strong data to support whether it is effective [78]. Zyluk et al. reported younger patients had a significantly greater functional improvement after surgery as measured by the DASH score [75]. Studies have also cited the extent of preoperative deformity, incomplete correction, and multiple involved digits as factors affecting post-operative functional outcomes [75, 78, 79, 80].
\nDespite multiple studies reporting good outcomes after surgery, there are limited randomized studies comparing outcomes after different operative techniques. Ullah et al. found no difference in ROM or recurrence in 79 patients randomized to either direct closure with z-plasty or firebreak skin grafting after a fasciectomy, however, patients with skin grafting had an increased incidence of hypoesthesia [81]. Van Rijssen et al. randomized patients to percutaneous needle fasciotomy and limited fasciectomy and reported the PNF group was significantly higher recurrence rate (76.8 vs. 20.9%, p < 0.001) and lower VAS satisfaction scores (6.2 vs. 8.3, p < 0.001) [62]. Further prospective, randomized studies reporting functional outcomes, complications, and recurrence rates are necessary to recommend any surgical procedure.
\nRecurrence of a Dupuytren’s contracture is a common event even after successful initial treatment. A systematic review analyzed 51 studies and reported recurrence rates ranged from 0 to 71% [82]. Furthermore, recurrence rates are difficult to assess as there is considerable variation in the criteria used to define recurrence. Some authors report the presence of any diseased tissue after treatment while others include only contractures necessitating re-operation. More recently, studies have tended to define recurrence as a 20–30° loss of extension in a successfully treated digit. A recent randomized study defined recurrence as a 20° reduction of total passive extension in a successfully treated digit and reported a 20.9% 5-year recurrence rate after limited fasciectomy [62].
\nMultiple studies have focused on identifying factors which may predispose patients to recurrence. The dramatic variability of recurrence rates may be due to the heterogeneity of the presentation of Dupuytren’s itself, as many patients may have more aggressive biology associated with “Dupuytren’s diathesis”, whereas others may have more mild disease. Dupuytren diathesis is a term coined by Hueston describing certain characteristics related to severe disease and increased recurrence [83]. Hindocha modified the criteria to include the following features within a Northern European population: male sex, <50 years old, bilateral disease, affected parent or sibling, and presence of Garrod’s nodes and reported patients with all 5 features had a recurrence rate of 71% [84]. However, other studies have failed to demonstrate a significant correlation with recurrence among all 5 diathesis criteria. Van Rijssen reported only older age was found to delay recurrence after PNF and limited fasciectomy [62]. PIP joint contractures have an elevated recurrence rate after surgery compared to the MCP joint. Donaldson et al. reported 34.2% of fully corrected PIP joints experienced at least some loss of correction compared with 12.2% of MCP joints [80]. Patients with severe preoperative PIP contractures greater than 60°, incomplete correction, and poor post-operative compliance had significantly worse recurrence [78].
\nSurgical management of recurrent disease is challenging as anatomic landmarks and tissue plans become difficult to distinguish. There is currently limited data regarding the preferred surgical treatment. Roush and Stern compared dermatofasciectomy with a skin graft, interphalangeal joint arthrodesis, and fasciectomy with local flaps among 19 patients with recurrence after a prior surgery [85]. The fasciectomy cohort was the only group to significantly maintain total active motion at final follow-up, but all three groups had similar patient reported outcomes. It is important patients are aware of the risk of recurrence prior to their initial surgery and personal factors which may increase their likelihood of recurrence.
\nDespite good outcomes after surgical treatment of Dupuytren’s contractures surgery is not without complications. A 20 year systematic review of complications by Denkler et al. reported an average major complication risk of 15% with complication rates ranging from 3.6 to 39.1% [86]. Specific complications after limited fasciectomy included the following: wound healing problems, 22.9%; flare reaction, 9.9%; complex region pain syndrome, 5.5%; nerve injury, 3.4%; infection, 2.4%; hematoma, 2.1%; and digit artery injury, 2%. Severe complications include tendon rupture or loss of the digit but are extremely rare. Patients with severe flexion contractures are more at risk of experiencing a complication [87]. Smoking and diabetes, however, has not been identified as an increased risk factor for wound healing problems after surgery [88]. Patients undergoing revision surgery for recurrence are most at risk for complications, especially neurovascular injuries due to scar tissue and loss of anatomic landmarks. Neurovascular injuries have been reported as high as 10 times more common in revision surgeries for recurrence [86].
\nDupuytren’s disease is a unique fibroproliferative disorder of palmar fascia likely resulting from a complex interplay of genetic and environmental factors. Despite extensive research, its etiology remains unclear and treatment methods remain palliative. Observation is an acceptable form of treatment for mild disease and patients with low functional status. Collagenase injections and percutaneous fasciectomy are becoming more common as an initial treatment method for patients with isolated disease and a palpable cord. Surgical indications typically include a flexion contracture of >30° at the MCP joint and 10–15° at the PIP joint but are also influenced by patients’ functional goals. Limited fasciectomy is the preferred method of surgical treatment by most surgeons. However, there is insufficient high quality evidence comparing different methods of treatment. In general, starting with a less invasive treatment is a reasonable approach; the recurrence rate may be higher, but patients will benefit from a quicker rehabilitation and a lower complication rate. Limited fasciectomy can then be reserved for more severe disease, initial treatment failures, or recurrence. PIP contractures, however, may benefit from earlier intervention due to their impact on function, increased likelihood of incomplete correction, and higher recurrence rate. Overall, surgery is an effective treatment for Dupuytren’s contractures but complications can occur especially related to wound healing, and many patients experience recurrence. Further research is still needed to compare treatment modalities and determine appropriate indications.
\nSynthetic cellular foam materials have been developed in the late 1940s of the last century, whereas mass production of polymeric, mostly polyurethane, foams started a decade later [1]. There is a large variety of application of these materials, ranging from lightweight structures to insulation, thermal, acoustical, filtering applications, etc. [2, 3]. Consistently, about 10% of the annual production of polymers is dedicated to produce foams, highlighting both technological and market importance of these materials. As shown in Figure 1, cellular foams have also attracted a still increasing attention of the researchers over the past 50 year or so, totaling over 6300 papers. Equally increasing interest is manifested by industrial researcher, and in line with the technological importance of these materials, the ratio of published patents/patent applications to the published documents is about 25. It is important to evidence that when the term “acoustic” is added to the previous search, the total drops by about 90%, and most importantly, the above quoted ratio increases up to 87, despite the fact that cellular foams, particularly those with open cells, are widely employed as acoustic insulators [4]. Clearly, despite the technological and market importance of these materials as acoustic insulators, the acoustic aspects and performances of these materials have sparingly been addressed in the scientific literature.
Results of Scopus search using combination of the indicated keywords. Totals of documents/patens published in 1970–2019 period are also reported (search conducted in December 2019, the lines are used only as eye-guide). Figure adapted from [15].
Among the cellular foam materials, polyurethane foams are widely employed, especially in the building sector [5], due to their quite low thermal conductivity (0.022–0.028 W/(m K)), which makes them one of the materials of choice in the applications that require effective and lightweight insulation. In the recent years, circular economy has become a priority in EU countries. Consistently, recycling of waste into industrial products has become an important issue [6]. As far as foam materials are concerned, whereas elastomers or similar waste residues could be effectively recycled in a polyurethane foaming process or even bio-based binders to form efficient acoustics absorbers [7, 8], reutilization of glass and ceramic waste generally employs high-energy-demanding production process [9, 10, 11], often leading to foam materials to be employed as insulators. An important class of materials, difficult to be recycled, is represented by composites such as fiber-reinforced thermoset polymers, used in a wide range of industrial application, from automotive to industrial, transportation and naval sectors, etc. [12, 13]. Due to landfill restrictions, thermal (energetic recovery, recovery of fibers/chemicals), mechanical (filler materials), and chemical (solvolysis) routes are underdevelopment, yet their industrial applications still represent a burden, both economic and technical [13]. Recently, we have developed a novel process to recover glass and fiberglass waste via low-temperature foaming process using natural alginate-based foaming agent as a novel route leading to sustainable insulating materials, with interesting acoustic absorption properties [14, 15]. An interesting aspect of this research was linked to the applicability and the limitation of literature acoustic models when used to describe the behavior to this novel cellular type of materials. Specifically, the focus is made on the interconnection between the material properties as obtained from the microstructural characterization and the parameters of Johnson-Champoux-Allard (JCA) acoustic model (tortuosity, viscous characteristic length, thermal characteristic length, porosity, and flow resistivity) [16, 17].
Due to their intensive use as insulating materials, thermal properties of cellular foams have been investigated quite intensively [18], and a number of models was reported, first of these date back to the 1930s of the last century [19]. Here we summarize only some of the models adopted.
Placido et al. [19] developed a predictive model which considers that heat transfer takes place by both conductions through solid skeleton and included gas and by radiation across the whole layer. The radiation is attenuated by material microstructures, via scattering and absorption phenomena. As for the contribution of the free convection the heat transfer, it is generally considered negligible due to the very small pore size so that the Raleigh number is much less than the critical value [20, 21].
The one-dimensional thermal conduction occurring in a continuum layer is regulated by the Fourier law:
where qc is the flux of the thermal conduction (W/m2), λ is the thermal conductivity (W/(m K)), T is the temperature (K), and x is the thickness (m). The thermal conductivity in foams results as the sum of bulk thermal conductivity and gas one (
where qr is the flux of the thermal radiation (W/m2) and λr is the radiative conductivity (W/(m K)) as follows:
where
As per the conservation law, the final heat flux and the final conductivity will be
For the radiative part, Cunsolo et al. [22] analyzed several analytical methodologies, concluding that those procedures provide results that are less reliable than numerical ones. This difference is basically caused by porosity modeling, while cell size distribution may not affect final outcomes.
Mendes et al. [23] predict the effective thermal conductivity by means of finite volume methods, taking into account both regular cells and real ones.
Klett et al. [24] demonstrated the paramount effect of rigid skeleton compared to included gas.
Öchsner et al. [18] provided a very comprehensive analysis of thermal property simulation and prediction of porous media, highlighting the difference in approaches both from analytical and numerical point of view. Furthermore, they explain how there are three main theoretical approaches:
Field approach, where the Laplace equation is solved taking into consideration the microstructure of the system and the influence of the structural elements in the linear propagation of the flux
Resistor approach, where the bulk and gaseous phases are considered like parallel parts which are assumed to be thermal resistors to flux propagation
Phase averaging, where the effective thermal conductivity is obtained by averaging the constituting phases
Many models were built on cells micro–macro structures like Pande et al. [25] focusing on the heat flow propagation direction [26] or on cell distribution [27].
The Monte Carlo approach is used several time in order to compute temperature profiles where there are randomly shaped borders with varying boundary conditions [28].
Yüksel [29] presented a comprehensive review of measurement methods for the determination of thermal conductivity of materials highlighting how for porous ones only heat flow meter and guarded hot plate are useful to this aim.
As indicated above, the acoustic behavior of cellular foams, which is the focus of this work, received less attention compared to thermal applications. The acoustic efficiency of the foams can be easily understood when the principles of sound absorption are considered [30, 31]. The incident sound energy (
Clearly, as illustrated in Figure 2, in in order to minimize transmitted energy, both absorption and reflection must be maximized for our material.
Scheme of sound energy interaction with a sold: energy conservation [32].
Sound absorption occurs in porous materials essentially via three mechanisms, i.e., (i) interaction of air molecules which vibrate and interact with the pore walls; (ii) air compression and expansion in the pores induced by the entering sound wave, resulting in sound energy transformation into heat; and (iii) vibration and resonance of pore walls [16, 32, 33]. Clearly, all the three mechanisms involve the air located within the pores and its motion that lead to transformation and dissipation of the original sound energy.
From a material point of view, sound absorption coefficient (α) is used to quantify the efficiency of the porous sound absorption materials, which can be measured by impedance tube or reverberation chamber by considering its definition in terms of energy:
Sound absorption coefficient can be calculated if the surface impedance (Zs) is known according to Eq. (8):
where the term ρ0c0, respectively, density and speed of sound, represents the impedance of the air.
The aspects of energy dissipation are associated mainly with viscoelastic phenomena that occur within the rigid material and in the interface between it and the fluid in motion. For this reason, the material can be considered biphasic and can be effectively modeled with the Biot theory [34, 35, 36]. Therefore, foams can be defined by an equivalent fluid that features an equivalent density and equivalent bulk modulus according to the following equation:
where
Consequently, a large number of impedance predictive models for obtaining the sound absorption coefficient have been published [16, 30, 38, 39, 40], which can be grossly divided into two groups: empirical and theoretical. The empirical methods were initially developed by applying regression methods to large sets of experimental measurements which clearly links them to the specific material considered [39]. Theoretical methods are based on the physics of the sound propagation in the materials (phenomenological methods) and, desirably, include relationships between microstructure and macroscopic properties [41, 42]. This, in fact, has been the case for polyurethane foams, which, however, typically present a regular and well-defined structure, as exemplified in Figure 3. For such materials, the tetrakaidecahedra unit cells, Kelvin cell, which represents packing of equal-sized objects together to fill space with minimal surface area, can effectively be applied to describe the foam microstructure [41, 43, 44]. This bottom-up approach therefore seems limited to specific materials with a very precise and defined morphology of the cells.
SEM pictures of two samples of polyurethane (PU) foam and the relationship with the derived model tetrakaidecahedron unit cell (Kelvin cell) of the PU structure (adapted from [44]). Notice the continuity of the cell microstructure across the figure that includes two samples.
Thus, a general approach typically employs a semi-phenomenological model.
For the frequency domain, Johnson et al. [45] proposed a model with arbitrary cell shape of the porous material, while Champoux and Allard [46] derived a model that includes the thermal effects inside the porous medium.
At present, the Johnson-Champoux-Allard model appears as the most effective and reliable model to predict frequency behavior throughout the audible range [39]. This model depends on the following parameters:
Flow resistivity σ (N s m−4)
Porosity
Tortuosity
Viscous characteristic length Λ (μm)
Thermal characteristic length Λ’ (μm)
The JCA model has been further modified by researchers with the aim of improving some aspects: Pannetton [47] considered aspects related to the limp frame, and further modification was incorporated in the Kino’s models [48]. To our knowledge, successful application of these models is essentially limited to “simple” foams, such as polyurethane ones, as above quoted.
Foams consist mainly of air interrupted by a very thin solid matrix that constitutes the air cells, which leads to broadband sound absorption properties.
Composite-made foams as those here investigated present a complex structure where the alginate matrix is loaded with the glass-containing powder and thus represents a new class of sustainable materials. Given their composite microstructure, it is of strong interest to assess whether traditional numerical acoustic procedures can be effectively used for describing and forecasting their properties.
In the following paragraphs, the acoustic procedures employed in the present chapter are described. The use of the chosen analytical models is justified by the fact that there are the most used and simple predicting equations found in literature. Thus, an attempt to understand if they could work also with complex foams is important. For detailed description of the experimental details, we refer the reader to our recent publication [15]. The results of this procedures performed on the innovative cellular foams here employed are described in the next section.
From an analytical point of view, the JCA model parameter, i.e., flow resistivity (σ), porosity (
where
For air flow resistivity, the most used model is Tarnow’s one [50]:
where
The acoustic model parameters were calculated form Eqs. (10)–(14) using experimental data (SEM measurements, etc.) and then employed as input values for the transfer matrix method (TMM) [51] calculation of the acoustic absorption coefficient.
As discussed above, the measurement of the above quoted fluid-phase parameters may be difficult to be obtained and time-consuming. The inverse identification methods fit the acoustical experimental data obtained in a standing wave tube to, i.e., acoustic absorption coefficient as a function of frequency, to calculate the fluid-phase parameters.
Accordingly, the five parameters related to the fluid phase were determined by applying an inversion procedure algorithm described in [52, 53] to experimental laboratory acoustic measurements.
The fitting of the experimental data is based on a nonlinear best-fit approach implemented in the ICT_MAA software (
TMM was used to implement a Johnson-Champoux-Allard model. The general scheme of the TM method is depicted in Figure 4 where the matrix approach allows introduction of dedicated models according the needed and contemporarily solved.
Optimization TMM functional scheme.
Eq. (15) reports the general analytical expression for TMM which is normally considered as a two-dimensional problem which considers the impact of a flat acoustic wave on the surface of a structure consistent of two or more layers:
The vector V(S1) contains the variables that define the acoustic indicators (pressure, stresses, velocity, etc.) applied to the surface S1, whereas the vector V(S2) contains the same variables for the surface S2. The matrix T is a function of the physical and mechanical parameters associated with each specific layer.
Accordingly, the transfer matrix [T] models the transmission of sound waves through the layered structure. The dimension of the matrix is a function of the type of the layer, i.e., solid, fluid, poroelastic, or viscoelastic.
Assuming hard-wall boundary condition, i.e., the layered structure being immersed in a semi-infinite fluid on both sides, the complex reflection coefficient can be defined as follows:
where Z0 = ρ0c0 represents the characteristic impedance of the fluid calculated my multiplying the density ρ0 and speed of sound c0.
and
D1 and D2 matrices are obtained from a complete matrix D (combination of transfer matrix of each layer, coupling matrices, and proper boundary conditions) and
Generally speaking, cellular foams being porous materials find a large variety of applications, irrespectively of their nature, wherever a lightweight porous material is needed [3], applications as thermal and acoustic insulators being perhaps those most important [54]. Ceramic or glass foam synthesis is traditionally carried out by three routes: (i) replica technique, (ii) use of sacrificial template, and (iii) use of direct foaming agents [2, 55]. There is a common strategy for the first two routes of preparing a precursor of the porous structures at a low temperature. This can be achieved either by impregnation of a “spongelike” material or by using sacrificial particles incorporated in the precursor network. In a subsequent heating step, the sacrificial material is removed, leaving the porous cellular microstructure. In principle this allows to design a specific porous network in the low-temperature synthesis step, which then creates a specific skeleton leading to the porous network during the calcination step. Accordingly, porous structures, ranging from microporous and/or mesoporous to macroporous, could be synthesized [56]. Concerning the third route, the foaming agent is added to the starting mixture. Upon calcination, this agent decomposes generating gas bubbles in the melted material, thus creating the porous structure upon cooling [2, 55]. Typical industrially employed foaming agents are carbonates, particularly in the production of ceramic- and glass-based foams [57].
As stated in the introduction section, there is an increasing attention to the sustainability of material production, and effectively, acoustical sustainable materials, either natural or made from recycled materials, are quite often a valid alternative to traditional synthetic materials [58, 59]. However, the reutilization of glass and ceramic waste generally employs high-energy-demanding production process [9, 10, 11], which clearly impacts the sustainability of this route. Furthermore, the use of sacrificial reagents for the synthesis as stated above, clearly contradicts the principles of sustainable chemistry, whereas there is an increasing need for sustainability of both processes and products [60].
We have recently reported synthesis of open-cell foams based on room temperature co-gelling of alginates with glass waste as a viable and sustainable process for production of glass-based cellular. Alginates biopolymers have been used mostly in biomedical applications [61, 62], but recently different applications have been reported, e.g., fire retardants and insulation materials [63], membranes [64], and fuel cell applications [65]. The synthesis of these materials generally implies formation of a gel structure as the “foaming” principle. The gen consists of a continuous solid porous network with pores filled with a fluid, water in our case. Removal of the liquid from the gel to achieve the porous solid causes a significant collapse of pores due to liquid surface tension, particularly high in the case of water, leading to the so-called xerogels where more than 80–90% of pores initially present collapse. Accordingly, to conserve the gel porous structure, water removal must be carried avoiding the liquid–gas interphase. Under supercritical conditions there is no interface between the liquid and gaseous phase; thus, during removal of the fluid, pore collapse is prevented, obtaining high surface products called aerogels [66]. Similarly, sublimation does not imply liquid surface tension, and using freeze-drying technique, the so-called cryogels are obtained [67]. Notably directional freezing was used for the synthesis of cryogels [68, 69], and even alginate gels could be prepared with either isotropic or anisotropic pore structure according to the freeze-drying conditions [70].
Since our interest was focused on eco-efficient glass/fiberglass recycling methodologies [14, 71], the use of alginates, i.e., a natural product, represents a route to improve the greenness of the process. We showed that alginates effectively incorporate recycled glass powders in the gelation step. When these materials are subjected to freeze-drying, open-cell foam structures are formed. Since we were interested in the influence of the coarse foam structure on the acoustic properties, we do not add other bonding agents such as aggregators and plasticizers [72, 73, 74, 75], which could confer either flexibility of rigidity to our composite materials. However, we can anticipate that even if the specimens are flexible [76], we do not find significant variation of sound absorption properties in the range of frequencies here investigated. Last but not least, even if freeze drying is considered an energy-demanding unit operation, the comparison of the gelation process with the high-temperature industrial foaming processes showed this process being competitive, less energy-demanding, and cost-effective.
Three samples A, B, and C were prepared containing, respectively, 10 and 20% w/v of glass powders and 20% w/v of fiberglass (see Refs. [14, 71] for details of the syntheses). Recycling fiberglass is difficult and costly being a thermoset composite [13, 77]. In contrast when added in the gel synthesis, they contribute in the creation of the pore structure, leading to a possible, environmentally friendly, recycle route. Figure 5 shows the microstructure of the samples: macroporous open-cell morphology is observed for all the samples, confirming the efficiency of the proposed methodology for preparing cellular foams. As shown in Figure 5(a1, b1, and c1), taken at higher magnifications, both glass and fiberglass are well dispersed and engulfed within the cell walls made of the alginate polymer.
SEM micrographs: (a) sample A 50×, (a1) details of sample A 50×, evidencing some of the glass powder inclusions; (b) sample B 50×, (b1) details of sample B 2500× evidencing some of the glass powder inclusions; (c) sample C 50×, (c1) details of sample C 500× evidencing some of the fiberglass inclusions. Figure adapted from [15].
A perusal of Figure 5(a–c) reveals a net change of the shape and alignment of the pores upon varying the nature of the glass-containing materials and its amount (compare also Table 2). Samples A and B feature mostly cells of a quadratic/rectangular form. When the amount of glass powder is increased from 10 to 20% w/v, the orientation of the cells is favored and their dimensions increase. Using fiberglass (sample C), unoriented cells are formed with larger pores compared to sample B. Table 1 summarizes both the microstructure and mechanical properties of the samples, including the reference rock wool.
Sample | A | B | C | Rock wool |
---|---|---|---|---|
Pore medium area (mm2) | 0.011 | 0.019 | 0.074 | |
Standard deviation (mm2) | 0.011 | 0.009 | 0.033 | |
Radius mean value (μm) | 29 | 38 | 75 | |
Porosity | 0.85 | 0.91 | 0.93 | |
Density (kg/m3) | 186 | 201 | 250 | 150 |
EC (MPa) | 5.2 | 4.2 | 3.4 | 1.0 |
Standard deviation (MPa) | 0.6 | 0.3 | 0.1 | 0.1 |
Microstructure and properties of the alginate foams: average area and radius of the foam pores, density, and compression modulus.
Table adapted from [15].
Particle size distribution (PSD) curves were measured on the starting glass and fiberglass powders reported in Ref. [15] which provide some insight into this change of microstructure. The glass powder consists of smaller particles compared to fiberglass: the PSD peaks at ca. 8 μm which increases to ca. 128 μm for the fiberglass. Consistently, submillimeter fiber particles, indicated by arrows, are clearly detected in the SEM micrographs reported in Figure 5(c). This change of powder morphology is even more important by considering the particle number (PN) distribution: about 90% of the glass particles are smaller than 4 μm, whereas for an equal percentage, the dimension increases to ca. 60 μm in the case of the fiberglass powder.
The process conditions strongly affect freeze-drying synthesis since directional freezing of the ice particles can be easily achieved leading to novel morphologies such as monoliths [69, 78]. This technique can be widely applied, and also alginate-based gels were produced in an anisotropic form [70]. Ordinary freezing conditions were employed for the synthesis, which suggest that this effect should not be operative in our case. It is well-known that during the crystallization of ice, both solute and suspended particles/gels are segregated from the ice crystals. This may generate an ice-templating effect where the morphology of the material is dictated by the crystallized solvent [79]. A large number of small particles favors heterogeneous nucleation providing a large number of nucleation centers [80, 81]. The large amount of small particles in the glass-containing samples A and B increase the ice front velocity promoting formation of a columnar morphology [82], accounting for the morphology detected by SEM. Sample C contains much less small particles, and the rate of nucleation decreases compared to that of particle growth (ice crystallization). This generates an isotropic pattern of the open cells in sample C. The large pore dimension is in line with the higher particle size of the fiberglass compared to glass materials [79, 80].
Thus, the crystallization conditions and the particle distribution in the starting waste material appear to represent factors capable of directing the microstructure leading to distinct cell morphology and dimension. This is an important aspect as the aim of the study is to find correlation between the microstructure and acoustic properties of these materials.
The data reported in Table 1 show clear trends for the density and the compression modulus which can be correlated with the dimension of the open cells. For a fixed volume, the higher the pore area, the lower the number of cells, which means that the density increases in the sequence samples A, B and C and the opposite occurs for the compression modulus. Data for a rock wool sample are also included in Table 1, as a standard sample for the acoustic studies.
In this section the results of the acoustic performance and application of the different procedures to model the acoustic performance of these novel materials are discussed, first using the analytical procedure to calculate the model parameters and then using the TMM approach.
Experimentally measured acoustic absorption coefficient for the samples A, B, and C are reported in Figure 6. Samples A and B show comparable shape of the curves where sample B features better global sound-absorbing properties compared to A: the highest absorption coefficient observed for sample B is 0.998 at 2190 Hz. Sample C features a maximum of absorption at about 2100 Hz followed by a slow decline, at variance with samples A and B where a rapid decline is observed. Clearly, different morphologies of sample C compared to A and B lead to different acoustic properties. For comparison, a reference rock wool sample features a nearly linear increase of the sound absorption coefficient with a maximum value of ca. 0.85 at 2900 Hz.
Sound absorption coefficient as a function of frequency: analytical model (calculated with TMM) vs experimental values obtained for rock wool, samples A, B, and C and sample A using modified tortuosity Eq. (19). Figure adapted from [15].
As highlighted above, the application of the analytical model by calculating the JCA parameters using Eqs. (10)–(14) was one of the important aspects of this study. The question is, are the widely employed state-of-the-art parameter formulations applicable to a novel type of material?
To answer this question, we report, for the sake of conciseness, only the result obtained for sample A, but equivalent results have been obtained for samples B and C [15].
In the first instance, in order to model the sound absorption coefficient, the five parameters were calculated according to Eqs. (10)–(14) using the measured densities and the dimensions of the cells evaluated from the SEM micrographs (Table 2). As perusal of the data reported in Table 2 reveals a close similarity of the calculated parameters notwithstanding the dissimilarity in their nature and morphology. This demonstrates that the analytical model is not suitable for this kind of cellular foam microstructure.
Material | Flow resistivity (Eq. (14)) (σ) ((N s) m−4) | Porosity (Eq. (10)) (ϕ) (–) | Tortuosity (Eq. (11)) ( | Tortuosity (Eq. (19)) ( | Viscous characteristic length (Eq. (12)) (Λ) (μm) | Thermal characteristic length (Eq. (13)) (Λ’) (μm) |
---|---|---|---|---|---|---|
A | 24,428 | 0.92 | 1.07 | 2.89 | 31 | 57 |
Rock wool | 27,289 | 0.93 | 1.06 | 31 | 57 |
Analytical model results: flow resistivity, porosity (
The frequency trends of the sound absorption coefficient, which were calculated using these parameters as input for the TMM procedure, are shown in Figure 6.
The results (Figure 6) show that the analytical model procedure as implemented using Eqs. (10)–(14) cannot be reliably applied to the complex foam structures, at variance with the rock wool sample which is properly modeled. The observation is in line with the above reported comments on the limits of the applicability of this methodology to fibrous materials [48, 50].
The above presented microstructural data show that the morphology and dimensions of the foam cells depend on the addition of the glass-containing powders. Since the powder is incorporated into the walls of the cells, increasing its amount will result in an extension of the free path for the wave propagating within the material itself. As a consequence, a modification of the tortuosity parameter is expected. For this reason, we consider the tortuosity factor as calculated by Eq. (11), developed for fibrous like materials, to inadequately describe this type of novel material. Notice that a modification of the tortuosity parameter changes the sound absorption leaving the thickness of the material unchanged.
Eq. (19), which is obtained by modifying the formulation of Archie for the tortuosity [83], is therefore proposed as a partial modification of Eq. (11). Eq. (19) is able to provide a reliable fit, up to 2500 Hz, as shown in Figure 6, because this model depends only on the open porosity:
The exponent of the open porosity in Eq. (19) is calculated by a curve-fitting procedure of all measured results. The value of the tortuosity calculated using Eq. (19) is included in Table 2 for material A. As shown in Figure 6 (modified model), using the modified tortuosity parameter (
Accordingly, an important finding of this part of this study is the demonstration of the necessity of adapting the analytical calculation of the parameters for the JCA model to the specific material analyzed. In this case the predictive value of the tortuosity clearly appears strictly related to the nature of the sample. Accordingly, the “traditional” analytical model will not be considered further.
As discussed in the preceding section, the modeling of the acoustic properties of porous materials requires to determine physical parameters of the porous solid, namely, airflow resistivity, open porosity, tortuosity, and viscous and thermal characteristic lengths [84]. In the recent years, an inversion method can be applied which consists in a best-fit procedure of the experimental acoustic data to provide all these parameters as the output has become a popular methodology [52]. Such an approach could successfully be applied to a number of different types of porous materials [38]. This is exemplified in Figure 7 which reports the comparison between the measured and calculated trends for a free inversion of the rock wool sample.
Comparison of modeled and measured values for rock conditions and wool using parameters obtained from the free inversion procedure. Figure adapted from [15].
The picture reported in Figure 7 clearly suggests the effectiveness of this procedure since the modeled data visibly better fit the experimental data compared to the analytical model reported in Figure 6. As discussed in Section 4, the final goal of the modeling procedures is to acquire a predictive capacity and, most importantly, the capability to properly correlate the microstructure of the investigated material with its sound-absorbing capacity [42]. This clearly would open new horizons for the material development by trying to develop correlations between the synthesis conditions and material properties [44]. In this respect, it important to recall that the inversion procedure involves a best fit of an experimental curve using a number of parameters, 5 for the JCA model, which can increase up to 8, according to the model considered [30, 85].
The inversion procedure algorithm was therefore applied to the experimental acoustic measurements using three different approaches: in the first one, no restriction has been applied to the inverse procedure. In the second one, restrictions were applied to the values obtained from the modified analytical model. The limitations were applied in terms of upper and lower limits of the flow resistivity (σ) within which the inverse procedure can fit. In the third one, the thermal characteristic length (Λ’) value was imposed based on the experimental data (pore radius in Table 2) in the inverse procedure. The choice of these restrictions is motivated by the fact that these parameters are those usually experimentally measured in, respectively, acoustic and material science studies.
Figure 8 compares the experimental sound-absorbing coefficient and the complex impedance for the three materials with the calculated, ones using TMM, vs frequency. A quite good agreement between the fitted and experimental curves is found, unrestricted fitting giving the best result for sample A.
Comparison of modeled and measured values for sample A using parameters obtained from the inversion procedure, using free inversion, restricted analytical model values and imposing the measured Λ’ value: absorbing coefficient vs frequency and complex impedance. Figure adapted from [15].
To properly assess the goodness of fit, an attempt was performed using standard deviation calculated as reported in Eq. (20):
The calculated values and standard deviation of the calculated α from the experimental values assuming that the latter represent the average value, being an average of three measurements in the range 200–3000 Hz, are reported in Table 3.
Material | Flow resistivity (σ) ((N s) m−4) | Porosity (ϕ) (–) | Tortuosity ( | Viscous characteristic length (Λ) (μm) | Thermal characteristic length (Λ’) (μm) | Standard deviationa (σ) |
---|---|---|---|---|---|---|
I. Fitting with no restriction | ||||||
A | 17,744 | 0.87 | 6.78 | 91 | 194 | 0.0142 |
II. Fitting using restricted method (based on analytical model) | ||||||
A | 59,676 | 0.81 | 4.34 | 53 | 53 | 0.0251 |
III. Fitting using experimental pore dimension | ||||||
A | 59,181 | 0.82 | 2.88 | 29 | 29 | 0.0323 |
Parameters obtained from inverse procedure using different fitting approaches.
Standard deviation of the calculated α from the experimental values assuming that the latter represent the average value of three experiments in the range 200–3000 Hz.
Table adapted from [15].
The values of the calculated deviation shows (i) minor effects of the restriction on the parameters on the goodness of fit upon variation of the fitting procedure, (ii) unrestricted fit is slightly better than those restricted, and (iii) samples A and B are much better fitted than sample C (compare full data in Ref. [15]). As for the latter aspect, this could be related to the irregular pore morphology sample C. Accordingly, the fitting procedure, based on an idealized structure, fits better regular structures compared to those irregular.
Let us now discuss the four sets of parameter derived by the above described procedures (Tables 2 and 3), which were used to calculate the TMM-based forecast of the sound adsorption capability and compared with the experimental data (Figure 8).
At first, we observe that by either restricting the inverse fitting procedure or using the parameters calculated in the modified analytical model or imposing the measured Λ’ value, the calculated TMM profile fits slightly worse the experimental data compared to those obtained by the unrestricted inverse method.
However, it is important to consider that the derived ϕ, α, Λ and Λ’ parameters should be properly related to the real microstructure of foam materials, which should help to discriminate the proper fitting model among of the four considered.
For this purpose, Figure 9 compares the obtained acoustic parameters for the four sets expressed in terms of relative percentages. For the scope of this paper, we limit the analysis to sample A, being sufficient to provide relevant considerations and insights. For a full comparison of the three samples, we refer the reader to our original paper [15].
Comparison of modeled JCA values for sample A with modified analytical, the inversion techniques: values are expressed as % of the maximum value observed for each material/parameter. Figure adapted from [15].
A perusal of Figure 9 immediately reveals that the “free fit” inverse method computes significantly different values for the
To be noticed is that the calculated tortuosity (
It is worth to remind that conventional materials such as lightweight, fibrous materials (e.g., fiberglass and rock wool) and reticulated foams (e.g., polyurethane and melamine open-cell foams) typically feature porosity and tortuosity very close to unity. In contrast, our and other materials feature tortuosity factors well above unity [38].
The modified analytical methods and fixed Λ’ value inverse procedure show a good agreement for ϕ e α parameters, whereas no method accurately estimates the value of the Λ’ parameter. Our data indicate that this parameter should be measured experimentally using SEM or an equivalent technique to get a reliable result. This observation highlights direct link between the parameters used in the material science and those used in acoustics.
Both the analytical model and the free inverse fitting (Table 3) lead to a low value of the σ parameter compared to the other methods. This however may be explained by the fact that a sensitivity analysis [52] revealed that variation of this parameter scarcely affected the goodness of fit.
The pore geometry is associated with viscous and thermal characteristic lengths [45], the average size of the foam cells being correlated to the thermal characteristic length (Λ’). As for the characteristic viscose length Λ, this parameter, albeit linked to pore geometry, can hardly be derived from the microstructural characterization, whereas its influence is important since narrowing the interconnections between the foam cells, blocks the fluid movement and transition, resulting in improved sound absorption characteristics. As for the similarity of the thermal and viscous characteristic length values, the complex foam cells of our materials feature a parallelepiped interconnected geometry which appears consistent with the similarity of the two parameters.
A novel class of sustainable innovative acoustic insulation materials has been described in the present paper. The use of a natural alginate-based gelling agent allows efficient incorporation of waste glass and fiberglass powders. The analysis of the microstructure indicates a strong sensitivity of the pore morphology, on particle dimensions of the doping powder and its amount. The formation of oriented regular cell patterns was attributed to the presence of a large amount of small particles that favors heterogeneous nucleation of ice formation leading to mono-dimensional freezing process. Consistently, using coarse particles produces at comparable doping powder loading an unoriented cellular sample morphology.
Five different forecasting methods including traditional analytical, a modified analytical with a new proposed equation, and inverse procedures were employed to determine the JCA parameters related to the sound-absorbing properties of foam materials. TMM to assess the reliability of the different procedures in comparison to the experimental performance.
The analytical modeling of the JCA parameters, namely, tortuosity, viscous characteristic length, thermal characteristic length, porosity, and flow resistivity showed some limitations of the applicability of the traditional equation, because they are strongly related to fibrous materials rather than foams and a new equation for the determination of the tortuosity was proposed and validated against experimental data using TMM calculation and inverse parameter determination.
The use of the inverse determination of the physical parameters allowed to provide an insight between the materials’ properties and acoustic performance: consistent with SEM microstructural analysis indicated comparable foam properties for materials A and B, material C being somewhat different, a situation well consistent with the acoustic performance. As in fact, the sound-absorbing performance depends on cell shape and dimension identified by the thermal lengths. Thus, using the same foaming agent with different doping powders leads to different sound absorption trends: volcano-shaped for materials A and B with glass powder and flat for material C with fiberglass inclusions, as the decline of the sound absorption being less important. The effects of cell orientation impact the acoustic properties as the unoriented cell morphology leads to enhanced sound absorption capacity compared to the samples with more regular and oriented morphology.
An important warning arises from the present data which is the fact that unrestricted fitting may lead to a reliable acoustic profile, corresponding to a local minimum that, however, may not have a physical relationship with the materials properties, e.g., pore morphology. As a matter of fact, the performed sensitivity analysis indicated tortuosity as a factor that heavily affects the fit, which may easily lead physically unreliable values for the other parameters.
Finally, it has been clearly shown that the “traditional” analytical model for determination of JCA parameters cannot be a priori applied to these novel materials due to their complex structure: modification of the calculation of the tortuosity was necessary, and a new equation for the determination of the tortuosity is proposed that has been assessed; the results of the inverse procedure, using the thermal characteristic length derived from the SEM micrographs as imposed parameter, well agree with the modified analytical model. The use of measured values of thermal characteristic length in the inverse procedure is recommended in order to obtain physically reliable results related to the real microstructure. Thus, a direct link between the materials science property and acoustics has been established.
This work was financed by “Klimahouse and energy production” in the framework of the programmatic-financial agreement with the Autonomous Province of Bozen-Bolzano of Research Capacity Building, which is gratefully acknowledged.
The authors want to thank Gianluca Turco (Department of Medicine, Surgery and Health Sciences, University of Trieste) for SEM pictures and Andrea Travan (Department of Life Science, University of Trieste) for help in foam production and characterization. Paolo Bonfiglio of Materiacustica srl is gratefully acknowledged for his precious advices.
M.C. developed the research. M.C. elaborated acoustic data, numerical simulation, and acoustic inversions; G.K.d’A. synthetized and characterized the foam samples and performed acoustic measurements with M.C. and J.K. J.K. overviewed the research. M.C., G.K.d’A., and J.K. wrote the paper.
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
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\n\nA Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
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\n\n3.1. ERRATUM
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