Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Polypropylene (PP) large pore size nets have been most widely used implants for hernia repair. Nevertheless, the growth of bacteria within PP mesh pores after operation is a major reason of hernia recurrence. Secondly, pre-operative prophylaxis during mesh implantation has failed due to the hydrophobic nature of PP meshes. Herein, chitosan cross-linked and levofloxacin HCl incorporated, antimicrobial PP mesh devices were prepared using citric acid as a bio-based and green cross-linking agent. The inert PP mesh fibers were surface activated using O2 plasma treatment at low pressure. Then, chitosan of different molecular weights (low and medium weight) were cross-linked with O2 plasma activated surfaces using citric acid. Scanning electron microscopy (SEM), energy dispersive X-ray (EDX) spectroscopy, and Fourier transform infrared (FTIR) spectroscopy confirmed that chitosan was cross-linked with O2 plasma-treated PP mesh surfaces and formed a thin layer of chitosan and levofloxacin HCl on the PP mesh surfaces. Moreover, antimicrobial properties of chitosan and levofloxacin HCl-coated PP meshes were investigated using an agar plate release method. The coated PP meshes demonstrated excellent antimicrobial inhibition zone up to 10 mm. Thus, modified PP meshes demonstrated sustained antimicrobial properties for six continuous days against Staphylococcus aureus (SA) and Escherichia coli (EC) bacteria.

Polydopamine-Inspired Surface Modification of Polypropylene Hernia Mesh Devices via Cold Oxygen Plasma: Antibacterial and Drug Release Properties

Mesh infection is a major complication of hernia surgery after polypropylene (PP) mesh implantation. Modifying the PP mesh with antibacterial drugs is an effective way to reduce the chance of infection, but the hydrophobic characteristic of PP fibers has obstructed the drug adhesion. Therefore, to prepare antimicrobial PP mesh with a stable drug coating layer and to slow the drug release property during the hernia repair process has a great practical meaning. In this work, PP meshes were coated by bio-inspired polydopamine (PDA), which can load and release levofloxacin. PP meshes were activated with cold oxygen plasma and then plasma activated PP fibers were coated with PDA. The PDA coated meshes were further soaked in levofloxacin. The levofloxacin loaded PP meshes demonstrate excellent antimicrobial properties for 6 days and the drug release has lasted for at least 24 h. Moreover, a control PP mesh sample without plasma treatment was also prepared, after coating with PDA and loading levofloxacin. The antimicrobial property was sustained only for two days. The maximum inhibition zone of PDA coated meshes with and without plasma treatment was 12.5 and 9 mm, respectively. On all accounts, the modification strategy can facilely lead to long-term property of infection prevention.

Controlled Levofloxacin Release and Antibacterial Properties of β-Cyclodextrins-Grafted Polypropylene Mesh Devices for Hernia Repair

Mesh infection is a major complication of hernia repair. After knitted mesh implantation, bacteria can grow within textile structures causing infection. In this work, polypropylene (PP) mesh devices were two-step grafted with hexamethylene diisocyanate (HDI) and β⁻cyclodexrins (CD) and then loaded with suitable antimicrobial levofloxacin HCL for hernia mesh-infection prevention. First, oxygen plasma was able to create surface roughness, then HDI was successfully grafted onto PP fiber surfaces. Afterwards, CD was covalently grafted onto the HDI treated PP meshes, and levofloxacin HCL (LVFX) was loaded into the CD cavity of the modified meshes. The modified devices were evaluated for sustained antibiotic properties and drug-release profiles in a phosphate buffer, and sustained drug release was observed between interfaces of meshes and aqueous environment. The antibiotic-loaded PP mesh samples demonstrated sustained antibacterial properties for 7 and 10 days, respectively, against both Gram-negative and Gram-positive bacteria. The CD-captured levofloxacin HCL showed burst release after 6 h but later exhibited sustained release for the next 48 h. Among all samples, the modified mesh LVFX-6 was more stable and showed more sustained drug release and could be employed in future clinical applications.

Preparation and Characterization of Antibacterial Polypropylene Meshes with Covalently Incorporated β-Cyclodextrins and Captured Antimicrobial Agent for Hernia Repair

Polypropylene (PP) light weight meshes are commonly used as hernioplasty implants. Nevertheless, the growth of bacteria within textile knitted mesh intersections can occur after surgical mesh implantation, causing infections. Thus, bacterial reproduction has to be stopped in the very early stage of mesh implantation. Herein, novel antimicrobial PP meshes grafted with β-CD and complexes with triclosan were prepared for mesh infection prevention. Initially, PP mesh surfaces were functionalized with suitable cold oxygen plasma. Then, hexamethylene diisocyanate (HDI) was successfully grafted on the plasma-activated PP surfaces. Afterwards, β-CD was connected with the already HDI reacted PP meshes and triclosan, serving as a model antimicrobial agent, was loaded into the cyclodextrin (CD) cavity for desired antibacterial functions. The hydrophobic interior and hydrophilic exterior of β-CD are well suited to form complexes with hydrophobic host guest molecules. Thus, the prepared PP mesh samples, CD-TCL-2 and CD-TCL-6 demonstrated excellent antibacterial properties against Staphylococcus aureus and Escherichia coli that were sustained up to 11 and 13 days, respectively. The surfaces of chemically modified PP meshes showed dramatically reduced water contact angles. Moreover, X-ray diffractometer (XRD), differential scanning calorimeter (DSC), and Thermogravimetric (TGA) evidenced that there was no significant effect of grafted hexamethylene diisocyanate (HDI) and CD on the structural and thermal properties of the PP meshes.