Efficacy of hyaluronic acid and hydroxyethyl starch in preventing adhesion following endoscopic sinus surgery

Design of an electrospun tubular construct combining a mechanical and biological approach to improve tendon repair

Hand tendon injuries represent a major clinical problem and might dramatically diminish a patient's life quality. In this study, a targeted solution for flexor tendon repair was developed by combining a mechanical and biological approach. To this end, a novel acrylate-endcapped urethane-based polymer (AUP) was synthesized and its physico-chemical properties were characterized. Next, tubular repair constructs were developed using electrospinning of the AUP material with incorporated naproxen and hyaluronic acid (i.e. anti-inflammatory and anti-adhesion compounds, respectively), and with a tubular braid as mechanical reinforcement. Tensile testing of the repair constructs using ex vivo sheep tendons showed that the developed repair constructs fulfilled the required mechanical properties for tendon repair (i.e. minimal ultimate stress of 4 MPa), with an ultimate stress of 6.4 ± 0.6 MPa. Moreover, in vitro biological assays showed that the developed repair tubes and the incorporated bioactive components were non-cytotoxic. In addition, when equine tenocytes and mesenchymal stem cells were co-cultured with the repair tubes, an increased production of collagen and non-collagenous proteins was observed. In conclusion, this novel construct in which a mechanical approach (fulfilling the required mechanical properties) was combined with a biological approach (incorporation of bioactive compounds), shows potential as flexor tendon repair application. Graphical abstract.

Flexor tendon repair using a reinforced tubular, medicated electrospun construct

A reinforced tubular, medicated electrospun construct was developed for deep flexor tendon repair. This construct combines mechanical strength with the release of anti-inflammatory and anti-adhesion drugs. In this study, the reinforced construct was evaluated using a rabbit model. It was compared to its components (a tubular, medicated electrospun polymer without reinforcement and a tubular braid as such) on the one hand to a modified Kessler suture as a control group. Forty New Zealand rabbits were randomly divided into two groups. Surgery was performed in the second and fourth deep flexor tendons of one hind paw of the rabbits in the two groups using four repair techniques. Biomechanical tensile testing and macroscopic and histological evaluations were performed at 3 and 8 weeks postoperatively. A two-way analysis of variance with pairwise comparisons revealed that the three experimental surgical techniques (a reinforced tubular medicated electrospun construct, tubular-medicated construct, and tubular braid as such) showed similar strength as that of a modified Kessler suture repair, which was characterized by a mean load at ultimate failure of 19.85 N (standard deviation [SD] 5.29 N) at 3 weeks and 18.15 N (SD 8.01 N) at 8 weeks. Macroscopically, a significantly different adhesion pattern was observed at the suture knots, either centrally or peripherally, depending on the technique. Histologically, a qualitative assessment showed good to excellent repair at the tendon repair site, irrespective of the applied technique. This study demonstrates that mechanical and biological repair strategies for flexor tendon repair can be successfully combined.

Design and development of a reinforced tubular electrospun construct for the repair of ruptures of deep flexor tendons

This research aims at developing a more potent solution for deep flexor tendon repair by combining a mechanical and biological approach. A reinforced, multi-layered electrospun tubular construct is developed, composed of three layers: an inner electrospun layer containing an anti-inflammatory component (Naproxen), a middle layer of braided monofilament as reinforcement and an outer electrospun layer containing an anti-adhesion component (hyaluronic acid, HA). In a first step, a novel acrylate endcapped urethane-based precursor (AUP) is developed and characterized by measuring molar mass, acrylate content and thermo-stability. The AUP material is benchmarked against commercially available poly(ε-caprolactone) (PCL). Next, the materials are processed into multi-layered, tubular constructs with bio-active components (Naproxen and HA) using electrospinning. In vitro assays using human fibroblasts show that incorporation of the bio-active components is successful and not-cytotoxic. Moreover, tensile testing using ex vivo sheep tendons prove that the developed multi-layered constructs fulfill the required strength for tendon repair (i.e. 2.79-3.98 MPa), with an ultimate strength of 8.56 ± 1.92 MPa and 8.36 ± 0.57 MPa for PCL and AUP/PCL constructs respectively. In conclusion, by combining a mechanical approach (improved mechanical properties) with the incorporation of bio-active compounds (biological approach), this solution shows its potential for application in deep flexor tendon repair.

Cornstarch-based wound dressing incorporated with hyaluronic acid and propolis: In vitro and in vivo studies

The unique physicochemical and functional characteristics of starch-based biomaterials and wound dressings have been proposed for several biomedical applications. Film dressings of cornstarch/hyaluronic acid/ ethanolic extract of propolis (CS/HA/EEP) were prepared by solvent-casting and characterized by attenuated total reflectance/Fourier transform infrared spectroscopy, scanning electron microscopy, gas chromatography/mass spectrometry, light transmission, opacity measurements, EEP release, equilibrium swelling, and in vitro and in vivo evaluations. The CS/HA/0.5%EEP film dressing exhibited higher antibacterial activity against Staphylococcus aureus (2.08 ± 0.14 mm), Escherichia coli (2.64 ± 0.18 mm), and Staphylococcus epidermidis (1.02 ± 0.15 mm) in comparison with the CS, CS/HA, and CS/HA/0.25%EEP films. Also, it showed no cytotoxicity for the L929 fibroblast cells. This wound dressing could effectively accelerate the wound healing process at Wistar rats' skin excisions. These results indicate that enrichment of cornstarch wound dressings with HA and EEP can significantly enhance their potential efficacy as wound dressing material.