From in vitro to in vivo: Diverse applications of kirigami technology in medical devices

Abstract

Kirigami, as a paper-cutting art, has developed into an innovative design and manufacture strategy with the support of material diversity and modern manufacturing technology. Combining the mechanical, electrical, and magnetic properties of materials, carefully designed geometric shapes can significantly improve mechanical flexibility, two-dimensional and three-dimensional reconfiguration, and functionality. This paper focuses on medical devices, and reviews the pattern design, deformation characteristics, function realization and diversified applications of advanced kirigami technology in this field. And the design influencing factors, basic deformation mechanism and various fabrication methods of kirigami are also discussed. Medical devices are mainly classified by in vitro and in vivo applications, with different functions such as monitoring, power supply, and treatment as sub-categories. At the same time, the application potential of kirigami-based smart devices in medical applications and the auxiliary role of simulation technology in design are discussed. On this basis, the challenges and prospects of the research and development in the field of medical health inspired by kirigami are summarized and prospected.

Keywords: In vitro and in vivo medical devices; Kirigami; Smart technology.

Graphical abstract

Fig. 1

The Overview of the induced mechanisms, pattern preparation methods and applications of kirigami metamaterials. Inner circle: 2D/3D induced deformation mechanisms of kirigami. Middle circle: preparation methods of different kirigami patterns, including tool cutting, mold casting, 3D printing, photolithography, laser cutting. etc. Reproduced with permission [58]. Copyright 2020, IEEE. Reproduced with permission [59]. Copyright 2023, The Authors. Reproduced with permission [60]. Copyright 2023, AIP Publishing. Reproduced with permission [61]. Copyright 2023, Wiley. Reproduced with permission [62]. Copyright 2020, American Chemical Society. Reproduced with permission [63]. Copyright 2019, American Chemical Society. Outer circle: current and potential applications of different kirigami shapes in the medical field, including protection, monitoring, curing, soft robots, etc. Reproduced with permission [21]. Copyright 2020, Springer Nature. Reproduced with permission [64]. Copyright 2024, Elsevier. Reproduced with permission [26]. Copyright 2024, Elsevier. Reproduced with permission [65]. Copyright 2024, The Authors. Reproduced with permission [18]. Copyright 2022, Wiley. Reproduced with permission [66]. Copyright 2019, The Authors.

Fig. 2

Kirigami-based 3D deformations formed by stretching buckling from parallel cutting and center-symmetric cutting patterns. (a) 3D structures formed by the stretching buckling of linear pattern. Reproduced with permission [71]. Copyright 2015, The Authors. (b) The effect of different sizes and arrangements of linear cuts on the 3D reconstruction outcome. Reproduced with permission [57]. Copyright 2024, Elsevier. (c) Folded wall structures formed after adding small cuts at the ends of incisions and subsequent reconstruction. Reproduced with permission [78]. Copyright 2023, The Authors. (d) Pop-up angle structures formed by replacing linear cuts with V-shaped cuts during reconstruction. Reproduced with permission [21]. Copyright 2020, Springer Nature. (e) Concentric circular arc patterns, (f) spiral line patterns, and (g) circumferential arrays of linear patterns forming 3D pyramidal structures through stretching-induced buckling. Reproduced with permission [93]. Copyright 2021, Wiley. Reproduced with permission [94]. Copyright 2020, Optical Society of America. Reproduced with permission [95] Copyright 2023, Elsevier.

Fig. 3

Kirigami-based 3D deformations under the mechanisms of compressive buckling and combined folding. (a–d) Micro-nano scale kirigami patterns and their 3D structures formed by compressive buckling. Reproduced with permission [96]. Copyright 2015, National Academy of Sciences. (e, f) The design of different creases on the same specimen and the resulting 3D structures from deformation. (g, h) 3D structures formed by adding pre-creased patterns and folding based on kirigami technology. Reproduced with permission [107]. Copyright 2016, The Authors. (i) Application of kirigami metamaterials combined with folding techniques in drug delivery. Reproduced with permission [10]. Copyright 2012, Elsevier.

Fig. 4

Kirigami-based 2D deformation formed by the rotation of common units and programmable units. (a) The design of the Y-shaped cutting pattern and its reconfigured structure maintaining good compliance and adhesion under pressing. Reproduced with permission [124]. Copyright 2021, American Chemical Society. (b) The design of the orthogonal cutting pattern and experimental photos of reconfigured deformation under negative Poisson's ratio performance. Reproduced with permission [128]. Copyright 2023, Elsevier. (c) Kinematic relationships between triangular cells under Y-shaped cutting. (d) Kinematic relations between square cells under orthogonal cutting. (e) The design of programmable rotating unit based on the orthogonal cutting pattern. (f) 2D surface structure formed by rotating the programmable kirigami pattern. Reproduced with permission [30]. Copyright 2023, Springer Nature.

Fig. 5

The effect of material mechanical properties on 2D deformation. (a) PLCL polymer material with a self-achievable ultra-high stretch of 1600 %. Reproduced with permission [143]. Copyright 2023, The Authors. (b) Schematic illustration of the tensile deformation of an elastic material with parallel cutting patterns. (c) 2D deformation of parallel-cut PVA composite soft material under stretching and compression on the skin surface. Reproduced with permission [59]. Copyright 2023, The Authors. (d) 2D deformation of parallel-cut hydrogel with good 2D surface performance under skin and joint bending. Reproduced with permission [61]. Copyright 2023, Wiley.

Fig. 6

Kirigami-based wearable health monitoring devices. (a) Modified paper-based sensor with parallel linear cutting patterns for real-time, continuous monitoring of physiological signals. Reproduced with permission [151]. Copyright 2023, Elsevier. (b) Fabric patch with Y-shaped cutting patterns to maintain conformal contact between the electrodes and skin for monitoring EMG signals. Reproduced with permission [168]. Copyright 2024, The Authors. (c) Stretchable BS made from Cu foil and PEEK film, along with a high-sensitivity compression BS for monitoring respiratory depth. Reproduced with permission [169]. Copyright 2024, Elsevier. (d, e) PVDF composites with different kirigami patterns for monitoring repetitive joint motion, effectively addressing the bending issues of joints. Reproduced with permission [170,171]. Copyright 2024, The Authors.

Fig. 7

Kirigami-based monitoring devices with highly elastic materials. (a) SBMR on a PDMS substrate sensing different signals in 2D and 3D modes, demonstrating high stability and durability. Reproduced with permission [174]. Copyright 2024, Wiley. (b) PDMS integrated with LIG electrodes is highly sensitive to small skin deformations, capable of monitoring signals during various movements. Reproduced with permission [175]. Copyright 2024, American Chemical Society. (c) Rubber composite film with a centrosymmetric L-shaped pattern, exhibiting a maximum electrical response of 24.6V and enabling precise human posture monitoring. Reproduced with permission [91]. Copyright 2023, The Authors.

Fig. 8

Kirigami-based wearable power supply devices. (a) The design of the battery with the orthogonal cutting pattern, and capacitance retention after cyclic stretching of the battery with the parallel cutting pattern. Reproduced with permission [128]. Copyright 2023, Elsevier. (b) FS-TENG design with parallel cutting pattern and its energy output. Reproduced with permission [184]. Copyright 2021, American Chemical Society. (c) K-HENG design with parallel cutting pattern and its power transmission performance. Reproduced with permission [185]. Copyright 2022, Wiley. (d) Kirigami capacitor design with serpentine pattern and its excellent electromechanical stability. Reproduced with permission [156]. Copyright 2024, Elsevier.

Fig. 9

Kirigami-based temperature-controlled therapeutic devices. (a) Infrared thermal images of a heater with parallel cutting patterns under various strains and worn on the wrist, along with the maximum temperatures achievable in different configurations. Reproduced with permission [195]. Copyright 2024, The Authors. (b) Design of a heater with Y-shaped cutting patterns and its conformal attachment to the wrist for temperature control adjustments. Reproduced with permission [196]. Copyright 2025, Royal Society of Chemistry. (c) Design of a multilayer kirigami material composite electrothermal device and its electrothermal effects at different bending degrees, along with infrared thermal images of it conformally attached to the arm. Reproduced with permission [197]. Copyright 2024, Zhejiang University Press.

Fig. 10

Other kirigami-based invitro therapeutic devices. (a) Design of a rigid brace with parallel patterns and the stretching experiment and FEA (Finite Element Analysis) diagram of kirigami spring components. Reproduced with permission [198]. Copyright 2023, The Authors. (b, c) Design of drug-loaded microneedle patches with parallel patterns and their therapeutic effects. Reproduced with permission [7]. Copyright 2024, The Authors. Reproduced with permission [199]. Copyright 2024, Elsevier. (d) Design of smart dressing with parallel patterns and its therapeutic effects. Reproduced with permission [200]. Copyright 2023, Elsevier.

Fig. 11

Kirigami-based implantable health monitoring devices. (a) The design of the bio-probe with parallel linear cutting pattern and its monitoring ECoG signals from the mouse. Reproduced with permission [204]. Copyright 2017, Wiley. (b) The design of the doughnut-shaped kirigami probe and its monitoring of EMG signals from the mouse hindlimb. Reproduced with permission [205]. Copyright 2019, Wiley. (c) The design of the electrode patch with the Y-shaped cutting pattern and its monitoring of sensory signals from mouse tactile stimulation. Reproduced with permission [206]. Copyright 2023, The Authors. (d) The intervention device integrating a kirigami soft robot and sensor for wireless monitoring of GERD, and the movement form of the soft robot. Reproduced with permission [85]. Copyright 2023, American Chemical Society.

Fig. 12

Kirigami-based implantable power supply devices. (a) The design of the kirigami piezoelectric device with a parallel linear cutting pattern and its voltage output when applied to the surface of a pig heart. Reproduced with permission [209]. Copyright 2019, The Authors. (b) The design of the energy harvester for a pacemaker and its voltage output when implanted in a pig heart. Reproduced with permission [149]. Copyright 2020, Wiley.

Fig. 13

Kirigami-based Implantable Therapeutic Devices. (a) The kirigami-based SMP is restructured from a cylindrical shape into a Y-shaped structure to expand narrowed bifurcated blood vessels. Reproduced with permission [219]. Copyright 2022, Wiley. (b) By combining cutting and folding, structural reconstruction can be achieved via balloon expansion for fracture treatment. Reproduced with permission [214]. Copyright 2020, The Authors. (c–e) Patches with different kirigami patterns can well adapt to the surface of the heart and brain, controlling cell movement through electrical and optical stimulation for disease treatment. Reproduced with permission [215]. Copyright 2018, The Authors. Reproduced with permission [217]. Copyright 2024, Wiley. Reproduced with permission [216]. Copyright 2019, IEEE.(f) Kirigami stent for drug delivery is restructured to form protruding angles, and CT scan images of the stent inside the esophagus. Reproduced with permission [86]. Copyright 2021, Springer Nature.

Fig. 14

Kirigami sensors for human-machine interaction. (a) AgNWs/PI composite film sensor with orthogonal cutting patterns used for controlling a quadrotor drone. Reproduced with permission [63]. Copyright 2019, American Chemical Society. (b) Flexible core-sheath fiber sensor with concentric arc patterns used for controlling a robotic arm. Reproduced with permission [232]. Copyright 2021, Elsevier. (c) Hydrogel sensor with V-shaped parallel cutting patterns used for underwater robotic arm operations. Reproduced with permission [61]. Copyright 2023, Wiley. (d) PEDOT:PSS electrode sensor with parallel cutting patterns enabling synchronized gameplay of the Snake game. Reproduced with permission [59]. Copyright 2023, The Authors. (e) Liquid-metal electrode sensor with orthogonal cutting patterns developed for an intelligent dialing communication system. Reproduced with permission [233]. Copyright 2022, American Chemical Society.

Fig. 15

Kirigami-based grippers. (a) Cross-shaped and chrysanthemum-shaped bistable grippers. Reproduced with permission [22]. Copyright 2023, Wiley. (b) Soft grippers based on stretching and compressive buckling. Reproduced with permission [234]. Copyright 2024, The Authors. (c) Thermally actuated grippers based on stretching buckling. Reproduced with permission [235]. Copyright 2024, IOP.

Fig. 16

Kirigami-based flexible locomotion robots. (a) Design of flexible actuators with snake-like patterns and assembly of multiple actuators to form a crawling robot. Reproduced with permission [246]. Copyright 2021, Mary Ann Liebert, Inc. (b) Snake-inspired soft robot driven by a single pneumatic actuator and using V-shaped cutting pattern skin. Reproduced with permission [79]. Copyright 2018, The Authors. (c) Earthworm-inspired soft robot driven by three pneumatic actuators and using trapezoidal cutting pattern skin. Reproduced with permission [83]. Copyright 2019, IEEE. (d) Soft robot with a U-shaped cutting pattern, capable of setting crawling paths by altering the magnetic field. Reproduced with permission [247]. Copyright 2023, The Authors. (e) Magnetic thin plate robot with orthogonal cutting patterns, capable of carrying a load twice its own weight. Reproduced with permission [140]. Copyright 2023, The Authors. (f) Magnetic-tile robot with trapezoidal cutting patterns, capable of towing a load 90 times its own weight. Reproduced with permission [85]. Copyright 2023, American Chemical Society. (g) Soft robot assembled with magnetic discs and orthogonal cut rubber, enabling multi-directional movement. Reproduced with permission [60]. Copyright 2023, AIP Publishing.

Fig. 17

Simulation performance studies based on Kirigami technology. (a) Optimization design of the notch tip structure using Midas NFX. Reproduced with permission [157]. Copyright 2023, The Authors. (b) Research on the deformation effects of different grippers using ANSYS. Reproduced with permission [234]. Copyright 2024, IEEE. (c, d) Investigation of the deformation effects of kirigami metamaterials using COMSOL. Reproduced with permission [146]. Copyright 2023, The Authors. Reproduced with permission [196]. Copyright 2024, Royal Society of Chemistry. (e) Study of the potential distribution in kirigami metamaterials using COMSOL. Reproduced with permission [169]. Copyright 2024, Elsevier. (f) Analysis of the deformation effects of soft robots using ABAQUS. Reproduced with permission [60]. Copyright 2023, AIP Publishing. (g) Optimization design of the notch hinge structure using ABAQUS. Reproduced with permission [139]. Copyright 2022, Wiley. (h) Machine learning assisted design of 3D kirigami metamaterials. Reproduced with permission [259]. Copyright 2022, The Authors.