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Fischer NG, Aparicio C. Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants. Bioact Mater 2022; 18:178-198. [PMID: 35387164 PMCID: PMC8961425 DOI: 10.1016/j.bioactmat.2022.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.
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Affiliation(s)
- Nicholas G. Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
- Division of Basic Research, Faculty of Odontology, UIC Barcelona – Universitat Internacional de Catalunya, C/. Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), C/. Baldiri Reixac 10-12, 08028, Barcelona, Spain
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Kjellin P, Danielsson K, Håkansson J, Agrenius K, Andersson T, Stenlund P. Biomechanical and histomorphometric evaluation of skin integration on titanium and PEEK implants with different surface treatments. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:68. [PMID: 36178551 PMCID: PMC9525375 DOI: 10.1007/s10856-022-06687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/22/2022] [Indexed: 05/14/2023]
Abstract
Percutaneous implants are frequently affected by bacterial growth at the skin-implant interface. Integration between implant and surrounding skin is important to prevent bacteria from spreading to the underlying tissue. The standard method to evaluate skin-implant integration is by histomorphometry on samples which have been placed in tissue grown in vivo or ex vivo. In this study, a biomechanical method was developed and evaluated. The integration of implants into porcine skin was studied in an ex vivo model, where pig skin samples were cultivated in a nutrient solution. Cylindrical shaped implants, consisting of polyether ether ketone (PEEK) and titanium (Ti) with different surface treatments, were implanted in the skin tissue and the skin was grown in nutrient solution for 2 weeks. The implants were then extracted from the implantation site and the mechanical force during extraction was measured as a quantitative assessment of skin-implant integration. Implants from each group were also processed for histomorphometry and the degree of epidermal downgrowth (ED) and tissue to implant contact (TIC) was measured. A higher mean pullout force was observed for the PEEK implants compared to the Ti implants. Applying nanosized hydroxyapatite (HA) on Ti and PEEK increased the pullout force compared to uncoated controls, 24% for machined and 70% for blasted Ti, and 51% for machined PEEK. Treatment of Ti and PEEK with nanosized zirconium phosphate (ZrP) did not increase the pullout force. The histomorphometry analysis showed correlation between ED and pullout force, where the pullout force was inversely proportional to ED. For TIC, no significant differences were observed between the groups of same material (i.e. Ti, Ti+HA, Ti+ZrP, and PEEK, PEEK + HA, PEEK + ZrP), but it was significantly higher for PEEK compared to Ti. Scanning electron microscopy analysis was done on samples before and after the pullout tests, showing that the ZrP coating was unaffected by the 2 week ex vivo implantation and pullout procedure, no dissolution or detachment of the coating was observed. For the HA coating, a loss of coating was seen on approximately 5% of the total surface area of the implant. Graphical abstract.
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Affiliation(s)
- Per Kjellin
- Promimic AB, AstraZeneca BioventureHub, SE, 43183, Mölndal, Sweden.
| | - Karin Danielsson
- Promimic AB, AstraZeneca BioventureHub, SE, 43183, Mölndal, Sweden
| | - Joakim Håkansson
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
- Department of Laboratory Medicine, Institute of Biomedicine, Gothenburg University, SE, 40530, Göteborg, Sweden
| | - Karin Agrenius
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
| | - Therese Andersson
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
| | - Patrik Stenlund
- Department of Methodology, Textile and Medical Technology, RISE Research Institutes of Sweden, SE, 50115, Borås, Sweden
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3
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Carboxymethyl Dextran-Based Nanomicelle Coatings on Microarc Oxidized Titanium Surface for Percutaneous Implants: Drug Release, Antibacterial Properties, and Biocompatibility. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9225647. [PMID: 35865662 PMCID: PMC9296324 DOI: 10.1155/2022/9225647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Bacterial contamination and biofilm formation onpercutaneous implants can lead to device failure and be life-threatening. To solve this issue, we constructed a carboxymethyl dextran- (CMD-) based nanomicelle antibacterial coating on the microarc-oxidized titanium (MAO-Ti) surface (described in the supplementary file). The self-assembled CMD-based nanomicelles and octadecylamine (ODA) were developed as a drug carrier and loaded with minocycline (MC). The characterization and stability of the MC-loaded nanomicelles were determined. The surface roughness, hydrophilicity, and drug release property of the coatings were also investigated. Our findings showed that the cross-linked MC-loaded nanomicelles (MC@(ODA-CMD)CL) were more stable than the uncross-linked nanomicelles. Moreover, MC@(ODA-CMD)CL was successfully incorporated into the pores of MAO-Ti, which significantly increased the surface hydrophilicity of the coatings without influencing their surface roughness. In addition, the coatings demonstrated a sustained release time of 360 h, with a cumulative release rate reaching 86.6%. Staphylococcus aureus (S. aureus) was used to determine the antibacterial properties of the coatings, and human skin fibroblasts were seeded on them to investigate their biocompatibility. The results showed that the coatings significantly reduced the number of adhesive S. aureus and promoted the viability, adhesion, and morphology of the human skin fibroblasts compared to smooth titanium (S-Ti) sheets. In conclusion, MC-loaded CMD-based nanomicelles coated on MAO-Ti surface (MC@(ODA-CMD)CL-Ti) demonstrated sustained-release properties, excellent antibacterial properties and biocompatibility, and promising potential as coatings for percutaneous implants.
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4
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Sartori M, Borsari V, Maglio M, Brogini S, Bragonzoni L, Zaffagnini S, Fini M. Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials. Biomater Sci 2021; 9:7008-7023. [PMID: 34549759 DOI: 10.1039/d1bm00707f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.
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Affiliation(s)
- Maria Sartori
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Veronica Borsari
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Melania Maglio
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Silvia Brogini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Laura Bragonzoni
- University of Bologna - Department for Life Quality Studies, Bologna, Italy
| | - Stefano Zaffagnini
- IRCCS - Istituto Ortopedico Rizzoli, II Orthopaedic and Traumatologic Clinic, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Milena Fini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
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Pitkin M, Cassidy C, Shevtsov MA, Jarrell JR, Park H, Farrell BJ, Dalton JF, Childers WL, Kistenberg RS, Oh K, Klishko AN, Prilutsky BI. Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface. Mil Med 2021; 186:688-695. [PMID: 33499499 PMCID: PMC7832823 DOI: 10.1093/milmed/usaa445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/04/2020] [Accepted: 11/16/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The three major unresolved problems in bone-anchored limb prosthetics are stable, infection-free integration of skin with a percutaneous bone implant, robust skeletal fixation between the implant and host bone, and a secure interface of sensory nerves and muscles with a prosthesis for the intuitive bidirectional prosthetic control. Here we review results of our completed work and report on recent progress. MATERIALS AND METHODS Eight female adult cats received skin- and bone-integrated pylon (SBIP) and eight male adult cats received SBIP-peripheral neural interface (PNI) pylon into the right distal tibia. The latter pylons provided PNI for connection between a powered sensing transtibial prosthesis and electrodes in residual soleus muscle and on residual distal tibial nerve. If signs of infection were absent 28-70 days after implantation, cats started wearing a passive prosthesis. We recorded and analyzed full-body mechanics of level and slope locomotion in five cats with passive prostheses and in one cat with a powered sensing prosthesis. We also performed histological analyses of tissue integration with the implants in nine cats. Four pigs received SBIPs into the left hindlimb and two pigs-into the left forelimb. We recorded vertical ground reaction forces before amputation and following osseointegration. We also conducted pullout postmortem tests on the implanted pylons. One pig received in dorsum the modified SBIPs with and without silver coating. RESULTS Six cats from the SBIP groups had implant for 70 days. One cat developed infection and did not receive prosthesis. Five cats had pylon for 148 to 183 days, showed substantial loading of the prosthesis during locomotion (40.4% below presurgery control), and demonstrated deep ingrowth of skin and bone tissue into SBIP (over 60%). Seven of eight cats from the SBIP-PNI group demonstrated poor pylon integration without clinical signs of infection. One cat had prosthesis for 824 days (27 months). The use of the bidirectionally controlled prosthesis by this animal during level walking demonstrated increased vertical loading to nearly normal values, although the propulsion force was significantly reduced. From the study on pigs, it was found that symmetry in loading between the intact and prosthetic limbs during locomotion was 80 ± 5.5%. Skin-implant interface was infection-free, but developed a stoma, probably because of the high mobility of the skin and soft tissues in the pig's thigh. Dorsal implantation resulted in the infection-free deep ingrowth of skin into the SBIP implants. CONCLUSIONS Cats with SBIP (n = 5) and SBIP-PNI (n = 1) pylons developed a sound interface with the residuum skin and bone and demonstrated substantial loading of prosthetic limb during locomotion. One animal with SBIP developed infection and seven cats with SBIP-PNI demonstrated poor bone integration without signs of infection. Future studies of the SBIP-PNI should focus on reliability of integration with the residuum. Ongoing study with pigs requires decreasing the extra mobility of skin and soft tissues until the skin seal is developed within the SBIP implant.
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Affiliation(s)
- Mark Pitkin
- Poly-Orth International, Sharon, MA, 02067, USA
| | | | - Maxim A Shevtsov
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences, Laboratory of Biomedical Nanotechnologies, Petersburg, 194064, Russia
- Department of Biotechnology, First Pavlov State Medical University of St. Petersburg, Petersburg, 197022, Russia
| | - Joshua R Jarrell
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Hangue Park
- Department of Electrical & Computer Engineering. Texas A&M University, College Station, TX, 77843, USA
| | - Brad J Farrell
- Department of Physical Therapy, Georgia State University, Atlanta, GA, 30302, USA
| | - John F Dalton
- Georgia Hand, Shoulder & Elbow, Atlanta, GA, 30309, USA
| | - W Lee Childers
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA
| | - Robert S Kistenberg
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Kyunggeune Oh
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Alexander N Klishko
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Boris I Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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6
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Shevtsov M, Gavrilov D, Yudintceva N, Zemtsova E, Arbenin A, Smirnov V, Voronkina I, Adamova P, Blinova M, Mikhailova N, Galibin O, Akkaoui M, Pitkin M. Protecting the skin-implant interface with transcutaneous silver-coated skin-and-bone-integrated pylon in pig and rabbit dorsum models. J Biomed Mater Res B Appl Biomater 2020; 109:584-595. [PMID: 32935912 DOI: 10.1002/jbm.b.34725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Implant-associated soft tissue infections at the skin-implant interface represent the most frequent complications in reconstructive surgery and lead to implant failures and revisions. Titanium implants with deep porosity, called skin-and-bone-integrated-pylons (SBIP), allow for skin ingrowth in the morphologically natural direction, thus restoring a reliable dermal barrier and reducing the risk of infection. Silver coating of the SBIP implant surface using physical vapor deposition technique offers the possibility of preventing biofilm formation and exerting a direct antimicrobial effect during the wound healing phase. In vivo studies employing pig and rabbit dorsum models for assessment of skin ingrowth into the pores of the pylon demonstrated the safety of transcutaneous implantation of the SBIP system. No postoperative complications were reported at the end of the follow-up period of 6 months. Histological analysis proved skin ingrowth in the minipig model without signs of silver toxicity. Analysis of silver release (using energy dispersive X-ray spectroscopy) in the model of intramedullary-inserted silver-coated SBIP in New Zealand rabbits demonstrated trace amounts of silver after 3 months of in-bone implantation. In conclusion, selected temporary silver coating of the SBIP implant surface is powerful at preventing the periprosthetic infections without imparing skin ingrowth and can be considered for clinical application.
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Affiliation(s)
- Maxim Shevtsov
- Department of Radiation Immuno-Oncology, Center for Translational Cancer Research Technische Universität München (TranslaTUM), Klinikum Rechts der Isar, Munich, Germany.,Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia.,Department of Pediatric Neurosurgery, Almazov National Medical Research Centre, Russian Polenov Neurosurgical Institute, St. Petersburg, Russia.,Laboratory of Biomedical Cell Technologies, Far Eastern Federal University, Vladivostok, Russia
| | - Dmitriy Gavrilov
- Federal State Budgetary Institution "Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht" of the Ministry of Labour and Social Protection of the Russian Federation, St. Petersburg, Russia
| | - Natalia Yudintceva
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Elena Zemtsova
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Andrei Arbenin
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Vladimir Smirnov
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | | | - Polina Adamova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - Miralda Blinova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Nataliya Mikhailova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Oleg Galibin
- Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia
| | | | - Mark Pitkin
- Tufts University, Boston, Massachusetts, USA.,Poly-Orth International, Sharon, Massachusetts, USA
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7
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Lindsay C, Ruppert D, Abumoussa S, Dahners L, Weinhold P. Benefits of additive manufacturing and micro and nano surface texture modifications on mechanical strength and infection resistance of skin-implant interfaces in rats. J Biomater Appl 2020; 34:1193-1200. [PMID: 32041456 DOI: 10.1177/0885328220903961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christopher Lindsay
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David Ruppert
- Joint Department of Biomedical Engineering, University of North Carolina / North Carolina State University, Chapel Hill / Raleigh, NC, USA
| | - Sam Abumoussa
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Laurence Dahners
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Weinhold
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Joint Department of Biomedical Engineering, University of North Carolina / North Carolina State University, Chapel Hill / Raleigh, NC, USA
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8
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Pawar DRL, Jeyapalina S, Bachus KN. Evaluation of soft-tissue response around laser microgrooved titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2020; 108:2031-2040. [PMID: 31889421 DOI: 10.1002/jbm.b.34543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/25/2019] [Accepted: 12/08/2019] [Indexed: 01/27/2023]
Abstract
Percutaneous devices are prone to epidermal downgrowth and sinus tract formation, which can serve as a nidus for bacterial colonization and increase the risk of peri-prosthetic infection. A laser microgrooved topography has been shown to limit gingival epidermal downgrowth around dental implants. However, the efficacy of this laser microgrooved topography to limit epidermal downgrowth around nongingival percutaneous devices is yet to be investigated. In this study, devices with a porous-coated subdermal component and a percutaneous post were designed and manufactured. The proximal 2 mm section of the percutaneous post were left smooth, or were textured with either a porous coating, or with the laser microgrooved topography. The smooth and porous topographies served as controls. The devices were tested in a hairless guinea pig back model, where 18 animals were randomly assigned into three groups, with each group receiving one implant type (n = 6/group). Four weeks postimplantation, the devices with surrounding soft-tissues were harvested and processed for histological analyses. Results indicated that the laser microgrooved topography failed to prevent epidermal downgrowth (23 ± 4%) around percutaneous posts in this model. Furthermore, no significant differences (p = 0.70) in epidermal downgrowth were present between the three topographies, with all the groups exhibiting similar measures of downgrowth. Overall, these findings suggest that the laser microgrooved topography may not halt downgrowth around percutaneous devices for dermal applications.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
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9
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Trent A, Van Dyke ME. Development and characterization of a biomimetic coating for percutaneous devices. Colloids Surf B Biointerfaces 2019; 182:110351. [DOI: 10.1016/j.colsurfb.2019.110351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/19/2019] [Accepted: 07/06/2019] [Indexed: 02/05/2023]
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10
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Bennett BT, Beck JP, Papangkorn K, Colombo JS, Bachus KN, Agarwal J, Shieh JF, Jeyapalina S. Characterization and evaluation of fluoridated apatites for the development of infection-free percutaneous devices. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 100:665-675. [DOI: 10.1016/j.msec.2019.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/30/2018] [Accepted: 03/07/2019] [Indexed: 12/15/2022]
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11
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Jeyapalina S, Mitchell SJ, Agarwal J, Bachus KN. Biomimetic coatings and negative pressure wound therapy independently limit epithelial downgrowth around percutaneous devices. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:71. [PMID: 31183809 DOI: 10.1007/s10856-019-6272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/25/2019] [Indexed: 06/09/2023]
Abstract
Biomimetic material coatings and negative pressure wound therapy (NPWT) have been shown independently to limit the epithelial downgrowth rates in percutaneous devices. It was therefore hypothesized that these techniques, in combination, could further limit the clinically observed epithelial downgrowth around these devices. In this study, we evaluated the efficacy of two biomimetic coatings, collagen and hydroxyapatite (HA), to prevent downgrowth when used with continuous NPWT. Using an established single-stage surgical protocol, collagen (n = 10) and HA (n = 10) coated devices were implanted subdermally on the back of hairless guinea pigs. Five animals from each group were subjected to continuous ~90 mmHg NPWT. Four weeks post-implantation, animals were sacrificed, and the devices and surrounding tissues were harvested, processed, and downgrowth was computed and compared to historical porous titanium coated controls. Data showed a significant reduction in downgrowth in NPWT treated animals (p ≤ 0.05) when compared to the untreated porous titanium controls. HA coated devices, without the NPWT treatment, also showed significantly decreased downgrowth compared to the untreated porous titanium controls.
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Affiliation(s)
- Sujee Jeyapalina
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA.
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
| | - Saranne J Mitchell
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA
- Orthopaedic Research Laboratory, University of Utah Orthopaedic Center, Salt Lake City, UT, 84108, USA
- Department of Bioengineering, University of Utah Salt Lake City, Salt Lake City, UT, 84112, USA
| | - Jayant Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Kent N Bachus
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA.
- Orthopaedic Research Laboratory, University of Utah Orthopaedic Center, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah Salt Lake City, Salt Lake City, UT, 84112, USA.
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12
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Jeyapalina S, Colombo JS, Beck JP, Agarwal JP, Schmidt LA, Bachus KN. Epidermal growth factor receptor genes are overexpressed within the periprosthetic soft-tissue around percutaneous devices: A pilot study. J Biomed Mater Res B Appl Biomater 2019; 108:527-537. [PMID: 31074946 DOI: 10.1002/jbm.b.34409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022]
Abstract
Epidermal downgrowth around percutaneous devices produce sinus tracts, which then accumulate bacteria becoming foci of infection. This mode to failure is epidermal-centric, and is accelerated by changes in the chemokines and cytokines of the underlying periprosthetic granulation tissue (GT). In order to more fully comprehend the mechanism of downgrowth, in this 28-day study, percutaneous devices were placed in 10 Zucker diabetic fatty rats; 5 animals were induced with diabetes mellitus II (DM II) prior to the surgery and 5 animals served as a healthy, nondiabetic cohort. At necropsy, periprosthetic tissues were harvested, and underwent histological and polymerase chain reaction (PCR) studies. After isolating GTs from the surrounding tissue and extracting ribonucleic acids, PCR array and quantitative-PCR (qPCR) analyses were carried-out. The PCR array for 84 key wound-healing associated genes showed a five-fold or greater change in 31 genes in the GTs of healthy animals compared to uninjured healthy typical skin tissues. Eighteen genes were overexpressed and these included epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR). Thirteen genes were underexpressed. When GTs of DM II animals were compared to healthy animals, there were 8 genes overexpressed and 25 genes underexpressed; under expressed genes included EGF and EGFR. The qPCR and immunohistochemistry data further validated these observations. Pathway analysis of genes up-regulated 15-fold or more indicated two, EGFR and interleukin-10, centric clustering effects. It was concluded that EGFR could be a key player in exacerbating the epidermal downgrowth, and might be an effective target for preventing downgrowth.
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Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - John S Colombo
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,The School of Dentistry, University of Utah School of Medicine, Salt Lake City, Utah
| | - James P Beck
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Linda A Schmidt
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kent N Bachus
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
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13
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Pawar DRL, Jeyapalina S, Hafer K, Bachus KN. Influence of negative pressure wound therapy on peri-prosthetic tissue vascularization and inflammation around porous titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2019; 107:2091-2101. [PMID: 30629801 DOI: 10.1002/jbm.b.34302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/20/2018] [Accepted: 12/01/2018] [Indexed: 01/11/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) has been shown to limit downgrowth around percutaneous devices in a guinea pig model. However, the influence of NPWT on peri-prosthetic tissue characteristics leading to limited downgrowth is still unclear. In order to investigate this, 12 CD hairless rats were assigned into two groups, NPWT and Untreated (n = 6/group). Each animal was implanted with a porous coated titanium percutaneous device and was dressed with a gauze and semi-occlusive base dressing. Post-surgery, animals in the NPWT Group received a regimen of NPWT treatment (-70 to -90 mmHg). After 4 weeks, tissue was collected over the device and stained with CD31 and CD68 to quantify blood vessel density and inflammation, respectively. The device with the surrounding tissue was also collected to quantify downgrowth. NPWT treatment led to a 1.6-fold increase in blood vessel densities compared to untreated tissues (p < 0.05). NPWT treatment also resulted in half the downgrowth as the Untreated Group, although not statistically significant (p = 0.19). Additionally, the results showed a trend toward increased CD68 cell densities in the NPWT Group compared to the Untreated Group (p = 0.09). These findings suggest that NPWT may influence wound healing responses in percutaneous devices by increasing blood vessel densities, limiting downgrowth and potentially increasing inflammation. Overall, NPWT may enhance tissue vascularity around percutaneous devices, especially in patients with impaired wound healing. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2091-2101, 2019.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Kelli Hafer
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
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14
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Pather S, Vertriest S, Sondergeld P, Ramis MA, Frossard L. Load characteristics following transfemoral amputation in individuals fitted with bone-anchored prostheses: a scoping review protocol. ACTA ACUST UNITED AC 2018; 16:1286-1310. [PMID: 29894396 DOI: 10.11124/jbisrir-2017-003398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
REVIEW QUESTION The main purpose of this scoping review is to characterize loading information applied on the residuum of individuals with transfemoral amputation fitted with an osseointegrated fixation for bone-anchored prostheses.The objectives of this scoping review are: i) to map the scope of loading variables, and ii) to report the range of magnitude of loads that has been directly measured using a portable kinetic recording apparatus fitted at the distal end of the residuum during rehabilitation exercises, standardized and unscripted activities of daily living, and adverse events.The specific review questions are.
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Affiliation(s)
- Shanthan Pather
- School of Chemistry, Physics and Mechanical Engineering, Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
| | - Sofie Vertriest
- Department of Physical and Rehabilitation Medicine, University Hospital, Ghent, Belgium
| | - Peter Sondergeld
- Library, Queensland University of Technology, Brisbane, Australia
| | - Mary-Anne Ramis
- CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
| | - Laurent Frossard
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
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15
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Pawar DRL, Mitchell SJ, Jeyapalina S, Hawkes JE, Florell SR, Bachus KN. Peri-prosthetic tissue reaction to discontinuation of negative pressure wound therapy around porous titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2018; 107:564-572. [PMID: 29732684 DOI: 10.1002/jbm.b.34148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Abstract
Negative pressure wound therapy (NPWT) has been reported to limit epithelial downgrowth, one of the failure mechanisms of percutaneous devices. In a previous study, when NPWT was applied for 4 weeks (NPWT Group) to porous coated titanium percutaneous devices, downgrowth (5 ± 4%; mean ± one SD) was significantly reduced compared to untreated controls (Untreated Group) (16 ± 6%; p ≤ 0.01). However, it was unclear whether this beneficial effect was sustained when NPWT was discontinued. In order to test this, porous coated titanium percutaneous devices were implanted into 6 hairless guinea pigs. Post-surgery, animals received 4 weeks of NPWT treatment followed by 4 weeks of no treatment (Discontinued Group). At necropsy, the devices and surrounding tissues were harvested and processed. Quantitative downgrowth measurements and qualitative analyses of tissue characteristics were performed, and compared to historical controls (NPWT and Untreated Groups). The Discontinued Group, at 8 weeks, had significantly more downgrowth than the NPWT Group at 4 weeks (23 ± 3% vs. 5 ± 4%; p ≤ 0.01). At 8 weeks, the Discontinued Group qualitatively appeared to exhibit reduced numbers of blood vessels and increased degree of fibrosis compared to the NPWT Group at 4 weeks. This study suggests that NPWT will only be an effective treatment for limiting downgrowth if used continuously. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 564-572, 2019.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Saranne J Mitchell
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Jason E Hawkes
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Scott R Florell
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
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16
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Jeyapalina S, Beck JP, Agarwal J, Bachus KN. A 24-month evaluation of a percutaneous osseointegrated limb-skin interface in an ovine amputation model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:179. [PMID: 28980174 DOI: 10.1007/s10856-017-5980-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
Percutaneous osseointegrated (OI) prostheses directly connect an artificial limb to the residual appendicular skeleton via a permanently implanted endoprosthesis with a bridging connector that protrudes through the skin. The resulting stoma produces unique medical and biological challenges. Previously, a study using a large animal amputation model indicated that infection could be largely prevented, for at least a 12-month period, but the terminal epithelium continued to downgrow. The current study was undertaken to test the longer-term efficacy of this implant construct to maintain a stable skin-implant interface for 24 months. Using the previously successful amputation and implantation surgical procedure, a total of eight sheep were fitted with a percutaneous OI prosthesis. Two animals were removed from the study due to early complications. Of the remaining six sheep, one (16.7%) became infected at 15-months post-implantation and five remained infection-free for the intended 24 months. The histological data of the remaining animals further confirmed the grossly observable epithelial downgrowth. Albeit a receding interface, it was clear that all animals that survived to the end of the study had residual fibrous soft-tissue ingrowth into, and debris within, the exposed titanium porous-coated surface. Overall, the data demonstrated that the porous coated subdermal barrier offered initial protection against infection. However, the fibrous skin attachment was continuously lysed over time by the down-growing epithelium.
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Affiliation(s)
- Sujee Jeyapalina
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, UT, 84112, USA
| | - James Peter Beck
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA
| | - Jayant Agarwal
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kent N Bachus
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
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17
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Overton JA, Cooke DF, Goldring AB, Lucero SA, Weatherford C, Recanzone GH. Improved methods for acrylic-free implants in nonhuman primates for neuroscience research. J Neurophysiol 2017; 118:3252-3270. [PMID: 28855286 DOI: 10.1152/jn.00191.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022] Open
Abstract
Traditionally, head fixation devices and recording cylinders have been implanted in nonhuman primates (NHP) using dental acrylic despite several shortcomings associated with acrylic. The use of more biocompatible materials such as titanium and PEEK is becoming more prevalent in NHP research. We describe a cost-effective set of procedures that maximizes the integration of headposts and recording cylinders with the animal's tissues while reducing surgery time. Nine rhesus monkeys were implanted with titanium headposts, and one of these was also implanted with a recording chamber. In each case, a three-dimensional printed replica of the skull was created based on computerized tomography scans. The titanium feet of the headposts were shaped, and the skull thickness was measured preoperatively, reducing surgery time by up to 70%. The recording cylinder was manufactured to conform tightly to the skull, which was fastened to the skull with four screws and remained watertight for 8.5 mo. We quantified the amount of regression of the skin edge at the headpost. We found a large degree of variability in the timing and extent of skin regression that could not be explained by any single recorded factor. However, there was not a single case of bone exposure; although skin retracted from the titanium, skin also remained adhered to the skull adjacent to those regions. The headposts remained fully functional and free of complications for the experimental life of each animal, several of which are still participating in experiments more than 4 yr after implant.NEW & NOTEWORTHY Cranial implants are often necessary for performing neurophysiology research with nonhuman primates. We present methods for using three-dimensional printed monkey skulls to form and fabricate acrylic-free implants preoperatively to decrease surgery times and the risk of complications and increase the functional life of the implant. We focused on reducing costs, creating a feasible timeline, and ensuring compatibility with existing laboratory systems. We discuss the importance of using more biocompatible materials and enhancing osseointegration.
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Affiliation(s)
| | - Dylan F Cooke
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Adam B Goldring
- Center for Neuroscience, University of California, Davis, California
| | - Steven A Lucero
- Department of Biomedical Engineering, University of California, Davis, California; and
| | - Conor Weatherford
- Center for Neuroscience, University of California, Davis, California
| | - Gregg H Recanzone
- Center for Neuroscience, University of California, Davis, California.,Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California
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18
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Shao J, Kolwijck E, Jansen JA, Yang F, Walboomers XF. Animal models for percutaneous-device-related infections: a review. Int J Antimicrob Agents 2017; 49:659-667. [DOI: 10.1016/j.ijantimicag.2017.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 01/05/2023]
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19
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Wang J, Wu G, Liu X, Sun G, Li D, Wei H. A decomposable silica-based antibacterial coating for percutaneous titanium implant. Int J Nanomedicine 2017; 12:371-379. [PMID: 28123297 PMCID: PMC5229168 DOI: 10.2147/ijn.s123622] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although percutaneous titanium implants have become one of the best choices as retainers in the facial defects, peri-implantitis still occurs at a significant rate. This unwanted complication occurs due to adhesion of bacteria and subsequent biofilm formation. To solve this problem, we have developed a novel antibiotic nanodelivery system based on self-decomposable silica nanoparticles. In this study, silica-gentamycin (SG) nanoparticles were successfully fabricated using an innovative one-pot solution. The nanoparticles were incorporated within a gelatin matrix and cross-linked on microarc-oxidized titanium. To characterize the SG nanoparticles, their particle size, zeta potential, surface morphology, in vitro drug release, and decomposition process were sequentially evaluated. The antibacterial properties against the gram-positive Staphylococcus aureus, including bacterial viability, antibacterial rate, and bacteria morphology, were analyzed using SG-loaded titanium specimens. Any possible influence of released gentamycin on the viability of human fibroblasts, which are the main component of soft tissues, was investigated. SG nanoparticles from the antibacterial titanium coating continuously released gentamycin and inhibited S. aureus growth. In vitro investigation showed that the obtained nanodelivery system has good biocompatibility. Therefore, this design can be further investigated as a method to prevent infection around percutaneous implants.
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Affiliation(s)
- Jia Wang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an
| | - Guofeng Wu
- Department of Prosthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing
| | - Xiangwei Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Guanyang Sun
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an
| | - Dehua Li
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Hongbo Wei
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, People’s Republic of China
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20
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Calliess T, Bartsch I, Haupt M, Reebmann M, Schwarze M, Stiesch M, Pfaffenroth C, Sluszniak M, Dempwolf W, Menzel H, Witte F, Willbold E. In vivo comparative study of tissue reaction to bare and antimicrobial polymer coated transcutaneous implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 61:712-9. [DOI: 10.1016/j.msec.2015.12.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 12/03/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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21
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Mitchell SJ, Jeyapalina S, Nichols FR, Agarwal J, Bachus KN. Negative pressure wound therapy limits downgrowth in percutaneous devices. Wound Repair Regen 2016; 24:35-44. [PMID: 26487170 PMCID: PMC4805517 DOI: 10.1111/wrr.12373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/17/2015] [Indexed: 11/27/2022]
Abstract
Maintenance of a soft tissue seal around percutaneous devices is challenged by the downgrowth of periprosthetic tissues-a gateway to potential infection. As negative pressure wound therapy (NPWT) is used clinically to facilitate healing of complex soft tissue pathologies, it was hypothesized that NPWT could limit downgrowth of periprosthetic tissues. To test this hypothesis, 20 hairless guinea pigs were randomly assigned into four groups (n = 5/group). Using a One-Stage (Groups 1 and 3) or a Two-Stage (Groups 2 and 4) surgical procedure, each animal was implanted with a titanium-alloy subdermal device porous-coated with commercially pure, medical grade titanium. Each subdermal device had a smooth titanium-alloy percutaneous post. The One-Stage procedure encompassed insertion of a fully assembled device during a single surgery. The Two-Stage procedure involved the implantation of a subdermal device during the first surgery, and then three weeks later, insertion of a percutaneous post. Groups 1 and 2 served as untreated controls and Groups 3 and 4 received NPWT. Four weeks postimplantation of the post, the devices and surrounding tissues were harvested, and histologically evaluated for downgrowth. Within the untreated control groups, the Two-Stage surgical procedure significantly decreased downgrowth (p = 0.027) when compared with the One-Stage procedure. Independent of the surgical procedures performed, NPWT significantly limited downgrowth (p ≤ 0.05) when compared with the untreated controls.
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Affiliation(s)
- Saranne J. Mitchell
- Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Orthopaedic Research Laboratory, Research Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Bioengineering, University of Utah Salt Lake City, Utah
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Orthopaedic Research Laboratory, Research Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Bioengineering, University of Utah Salt Lake City, Utah
| | - Francesca R. Nichols
- Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Orthopaedic Research Laboratory, Research Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Jayant Agarwal
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kent N. Bachus
- Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Orthopaedic Research Laboratory, Research Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Bioengineering, University of Utah Salt Lake City, Utah
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