Research of a novel biodegradable surgical staple made of high purity magnesium

Biodegradable high-nitrogen iron alloy anastomotic staples: In vitro and in vivo studies

For gastrointestinal anastomosis, metallic biodegradable staples have a broad application potential. However, both magnesium and zinc alloys have relatively low strength to withstand the repeated peristalsis of the gastrointestinal tract. In this study, we developed a novel kind of biodegradable high-nitrogen iron (HN-Fe) alloy wires (0.23 mm), which were fabricated into the staples. The tensile results showed that the ultimate tensile strength and elongation of HN-Fe wires were 1023.2 MPa and 51.0 %, respectively, which was much higher than those of other biodegradable wires. The degradation rate in vitro of HN-Fe wires was slightly higher than that of pure Fe wires. After 28 days of immersion, the tensile strength of HN-Fe wires remained not less than 240 MPa, meeting the clinical requirements. Furthermore, sixteen rabbits were enrolled to conduct a comparison experiment using HN-Fe and clinical Ti staples for gastroanastomosis. After 6 months of implantation, a homogeneous degradation product layer on HN-Fe staples was observed and no fracture occurred. The degradation rate of HN-Fe staples in vivo was significantly higher than that in vitro, and they were expected to be completely degraded in 2 years. Meanwhile, both benign cutting and closure performance of HN-Fe staples ensured that all the animals did not experience hemorrhage and anastomotic fistula during the observation. The anastomosis site healed without histopathological change, inflammatory reaction and abnormal blood routine and biochemistry, demonstrating good biocompatibility of HN-Fe staples. Thereby, the favorable performance makes the HN-Fe staples developed in this work a promising candidate for gastrointestinal anastomosis.

Study on Mechanical Properties and Degradation Behavior of Magnesium Alloy Vascular Clip

The Mg alloy vascular clip has biodegradability and good biocompatibility, which can improve the convenience and safety of clinical application. However, the Mg alloy vascular clip also has some disadvantages, such as an unreasonable structure design and a degradation rate which is too fast. In this study, the process of clamping blood vessels with a biodegradable Mg alloy (Mg-Zn-Nd-Zr and Mg-Zn-Nd) general V-type vascular clip was simulated by finite element simulation software (Abaqus). A new type of vascular clip, the P-type vascular clip, was analyzed and investigated through simulation. The differences between Mg alloy vascular clips of V-type and P-type were analyzed by finite element simulation. In addition, the effects of Zr element on the mechanical properties and corrosion resistance of P-type vascular clips were also investigated to improve the mechanical stability. The results show that during the V-type vascular clip closure of Mg-Zn-Nd-Zr alloy, this clip has some problems, such as uneven distribution of blood vessel stress, crevices in blood vessels and stress concentration. The improved P-type vascular clip has uniform closure, and there is no gap in the blood vessel, which can effectively avoid stress concentration. The improved P-type vascular clip is well closed and can effectively avoid stress concentration. The corrosion resistance of the Mg-Zn-Nd-Zr alloy P-type clip was better than that of the Mg-Zn-Nd alloy P-type clip (degradation rate of 2.02 mm/y and 2.61 mm/y on the 7th day, respectively). Mg-Zn-Nd-Zr alloy The P-type vascular clip remained closed even on the 7th day, which could meet the requirements of clinical application.

Cellulose-based bioabsorbable and antibiotic coated surgical staple with bioinspired design for efficient wound closure

The quest to design a flawless wound closure system began long ago and is still underway. Introducing surgical staples is one of the most significant breakthroughs in this effort. In this work, we developed a biodegradable surgical staple to meet the optimal wound closure system criteria and other clinical requirements, such as radiography compatibility and secondary infection prevention. To meet these requirements, a naturally derived cellulose acetate (CA) fiber-reinforced poly-(l-lactic acid) (PLLA) composite was synthesized, and its physicochemical properties were determined using several characterizations such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC) and Universal testing machine (UTM), etc. Taking cues from the Mantis's foreleg, a novel staple design was implemented and verified using Finite Element Analysis (FEA). The CA + PLLA staples were fabricated using melt-casted/3D-printing processes. The staples exhibited excellent biodegradation in both wound and physiological microenvironments with sufficient puncturing strength and later closed the wound's edges mechanically. In addition, the CA + PLLA staples also exhibit metal-like ductility properties to withstand horizontal skin tensions during the healing process. Further, the staples are coated with an antibiotic to combat infections effectively to provide better healing.

Zinc-based subcuticular absorbable staples: An in vivo and in vitro study

A zinc-nutrient element alloy (Zn-1.0Cu-0.5Ca) was developed into subcuticular absorbable staples (SAS) as a robust alternative to the commercially available poly(l-lactide-co-glycolide) (PLGA) SAS for the first time. The fixation properties of the Zn SAS were measured via pull-out tests and in-situ lap-shear pull-out test comparatively against the PLGA SAS. The Zn SAS exhibited fixation force of 18.9±0.2 N, which was over three times higher than that of PLGA SAS (5.5±0.1 N). The Zn SAS was used to close incision wounds in a SD rat model for biodegradability and biocompatibility characterisation at 1, 4 and 12 weeks. The Zn SAS showed uniform degradation behaviour after in vivo implantation at the average rate of 198±54, 112±28, and 70±24 μm/y after 1, 4, and 12 weeks, which reduced the fixation force to 16.8±1.1 N, 15.4±0.9 N, 12.7±0.7 N, respectively. These findings showed the potential of the Zn SAS for the closure of heavy loading and slowing healing tissues. The Zn SAS enabled successful closure and healing of the incision wound, similar to the PLGA staples. However, the slow long-term degradation rate of the Zn SAS may lead to unnecessary implant retention. In addition, the alloy SAS resulted in higher local foreign body responses due to their stiffness. Reducing the implant cross-section profile and applying low stiffness and a corrosion-accelerating coating are suggested as possible approaches to reduce post-service implant retention and improve the biocompatibility of the Zn SAS. STATEMENT OF SIGNIFICANCE: This work reports the fabrication of the first metallic subcuticular absorbable staples (SAS) made from Zn-Cu-Ca alloy for skin wound closure applications. The Zn-based SAS were characterised in vitro and in vivo (SD rat model) for biodegradability, fixation properties, biocompatibility and inflammatory responses, which were compared against the commercially available PLGA-based SAS. The Zn-based SAS provided a secure attachment of the full-thickness wounds on SD rats and allowed successful healing during the 12-week service period. In addition, the in vitro results showed that the Zn-based SAS provided more than three times higher fixation strength than the commercial PLGA, indicating the potential of the Zn-based SAS for load-bearing wound closure application.

A biodegradable magnesium surgical staple for colonic anastomosis: In vitro and in vivo evaluation

Staplers have been widely used in the clinical treatment of gastrointestinal reconstruction. However, the current titanium (Ti) staple will remain in the human body permanently, resulting in some adverse effects. In this study, we developed a type of biodegradable staple for colonic anastomosis using 0.3 mm diameter magnesium (Mg) alloy wires. The wire surface was modified by micro-arc oxidation treatment (MAO) and then coated with poly-l-lactic acid (PLLA) to achieve a moderate degradation rate matching the tissue healing process. The results of tensile tests on isolated porcine colon tissue anastomosed by Mg and Ti staples showed that the anastomotic property of Mg staples was almost equal to that of Ti staples. The in vitro degradation tests indicated the dual-layer coating effectively enhanced the corrosion resistance and maintained the tensile force of the coated staple stable after 14-day immersion in the simulated colonic fluid (SCF). Furthermore, 24 beagle dogs were employed to conduct a comparison experiment using Mg-based and clinical Ti staples for 90-day implantation by ent-to-side anastomosis of the colon. The integrated structure of Mg-based staples was observed after 7 days and completely degraded after 90 days. All animals did not have anastomotic leakage and stenosis, and 12 dogs with Mg-based staples fully recovered after 90 days without differences in visceral ion levels and other side effects. The favorable performance makes this Mg-based anastomotic staple an ideal candidate for colon reconstruction.

Zinc-nutrient element based alloys for absorbable wound closure devices fabrication: Current status, challenges, and future prospects

The need for the development of load-bearing, absorbable wound closure devices is driving the research for novel materials that possess both good biodegradability and superior mechanical characteristics. Biodegradable metals (BMs), namely: magnesium (Mg), zinc (Zn) and iron (Fe), which are currently being investigated for absorbable vascular stent and orthopaedic implant applications, are slowly gaining research interest for the fabrication of wound closure devices. The current review presents an overview of the traditional and novel BM-based intracutaneous and transcutaneous wound closure devices, and identifies Zn as a promising substitute for the traditional materials used in the fabrication of absorbable load-bearing sutures, internal staples, and subcuticular staples. In order to further strengthen Zn to be used in highly stressed situations, nutrient elements (NEs), including calcium (Ca), Mg, Fe, and copper (Cu), are identified as promising alloying elements for the strengthening of Zn-based wound closure device material that simultaneously provide potential therapeutic benefit to the wound healing process during implant biodegradation process. The influence of NEs on the fundamental characteristics of biodegradable Zn are reviewed and critically assessed with regard to the mechanical properties and biodegradability requirements of different wound closure devices. The opportunities and challenges in the development of Zn-based wound closure device materials are presented to inspire future research on this rapidly growing field.

Laser machined micropatterns as corrosion protection of both hydrophobic and hydrophilic magnesium

Magnesium and its alloys are promising candidate materials for medical implants because they possess excellent biocompatibility and mechanical properties comparable to bone. Furthermore, secondary surgical operations for removal could be eliminated due to magnesium's biodegradability. However, magnesium's degradation rate in aqueous environments is too high for most applications. It has been reported that hydrophobic textured surfaces can trap a surface gas layer which acts as a protective barrier against corrosion. However, prior studies have not investigated separately the role of the texture and hydrophobic treatments on magnesium corrosion rates. In this study, pillar-shaped microstructure patterns were fabricated on polished high purity magnesium surfaces by ablation with a picosecond laser. Some micropatterned samples were further processed by stearic acid modification (SAM). Micropatterned surfaces with SAM had hydrophobic properties with water droplet contact angles greater than 130°, while the micropatterned surfaces without SAM remained hydrophilic. The corrosion properties of textured and smooth magnesium surfaces in saline solution were investigated using electrochemical impedance spectroscopy (EIS) and optical microscopy. Corrosion rates on both hydrophobic and hydrophilic laser machined surfaces were reduced ∼90% relative to polished surfaces. Surprisingly, corrosion rates were similar for both hydrophobic and hydrophilic surfaces. Indirect evidence of local alkalization near microstructures was found and was hypothesized to stabilize the Mg(OH)₂ layer, thereby inhibiting corrosion on hydrophilic surfaces. This is different than the corrosion resistance mechanism for superhydrophobic surfaces which makes use of gas adhesion at the liquid solid interface. These results suggest additional processing to render the magnesium hydrophobic is not necessary since it does not significantly enhance the corrosion resistance beyond what is conferred by micropatterned textures.

Multifunctional Magnesium Anastomosis Staples for Wound Closure and Inhibition of Tumor Recurrence and Metastasis

Biodegradable magnesium (Mg) implants spontaneously releasing therapeutic agents against tumors are an intriguing therapeutic approach for both tissue repair and tumor treatment. Anastomotic staples are extensively used for wound closure after surgical resection in patients with colorectal tumors. However, the safety of Mg anastomosis implants for intestinal closure and the effect of tumor suppression remain elusive. Here, we used a high-purity Mg staple to study these issues. Based on the results, we found that it has the potential to heal wounds produced after colorectal tumor resection while inhibiting relapse of residual tumor cells in vitro and in vivo. After implantation of Mg staples for 7 weeks in rabbits, the intestinal wound gradually healed with no adverse effects such as leakage or inflammation. Furthermore, the implanted Mg staples inhibit the growth of colorectal tumor cells and block migration to normal organs because of the increased concentration of Mg ions and released hydrogen. Such an antitumor effect is further confirmed by the in vitro cell experiments. Mg significantly induces apoptosis of tumor cells as well as inhibits cell growth and migration. Our work presents a feasible therapeutic opinion to design Mg anastomotic staples to perform wound healing and simultaneously release tumor suppressor elements in vivo to decrease the risk of tumor recurrence and metastasis.

The effect of enzymes on the in vitro degradation behavior of Mg alloy wires in simulated gastric fluid and intestinal fluid

With an upsurge of biodegradable metal implants, the research and application of Mg alloys in the gastrointestinal environment of the digestive tract have been of great interest. Digestive enzymes, mainly pepsin in the stomach and pancreatin in the small intestine, are widespread in the gastrointestinal tract, but their effect on the degradation of Mg alloys has not been well understood. In this study, we investigated the impacts of pepsin and pancreatin on the degradation of Mg-2Zn alloy wires. The results showed that the pepsin and pancreatin had completely different even the opposite effects on the degradation of Mg, although they both affected the degradation product layer. The degradation rate of Mg wire declined with the addition of pepsin in simulated gastric fluid (SGF) but rose with the addition of pancreatin in simulated intestinal fluid (SIF). The opposite trends in degradation rate also resulted in completely different degradation morphologies in wires surface, where the pitting corrosion in SGF was inhibited because of the physical barrier effect of pepsin adsorption. In contrast, the adsorption of pancreatin affected the integrity of magnesium hydrogen phosphate film, causing a relatively uneven degraded surface. These results may help us to understand the role of different digestive enzymes in the degradation of magnesium and facilitate the development and clinical application of magnesium alloy implanted devices for the digestive tract.

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The pepsin in SGF and pancreatin in SIF have opposite effects on the degradation rate of Mg.

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Both enzymes can adsorb on the surface of Mg wire and affect the formation of the degradation layer.

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The physical barrier effect of pepsin adsorption retarded the pitting corrosion and corrosion rate in SGF.

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Adsorbed pancreatin affected the integrity of the products layer in SIF, resulting in an accelerated corrosion rate.

Biodegradable magnesium-based biomaterials: An overview of challenges and opportunities

As promising biodegradable materials with nontoxic degradation products, magnesium (Mg) and its alloys have received more and more attention in the biomedical field very recently. Having excellent biocompatibility and unique mechanical properties, magnesium-based alloys currently cover a broad range of applications in the biomedical field. The use of Mg-based biomedical devices eliminates the need for biomaterial removal surgery after the healing process and reduces adverse effects induced by the implantation of permanent biomaterials. However, the high corrosion rate of Mg-based implants leads to unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. To overcome these limitations, alloying Mg with suitable alloying elements and surface treatment come highly recommended. In this area, open questions remain on the behavior of Mg-based biomaterials in the human body and the effects of different factors that have resulted in these challenges. In addition to that, many techniques are yet to be verified to turn these challenges into opportunities. Accordingly, this article aims to review major challenges and opportunities for Mg-based biomaterials to minimize the challenges for the development of novel biomaterials made of Mg and its alloys.

The influence of Ca and Cu additions on the microstructure, mechanical and degradation properties of Zn-Ca-Cu alloys for absorbable wound closure device applications

Novel ternary Zn-Ca-Cu alloys were studied for the development of absorbable wound closure device material due to Ca and Cu's therapeutic values to wound healing. The influence of Ca and Cu on the microstructure, mechanical and degradation properties of Zn were investigated in the as-cast state to establish the fundamental understanding on the Zn-Ca-Cu alloy system. The microstructure of Zn-0.5Ca-0.5Cu, Zn-1.0Ca-0.5Cu, and Zn0.5Ca-1.0Cu is composed of intermetallic phase CaZn13 distributed within the Zn-Cu solid solution. The presence of CaZn13 phase and Cu as solute within the Zn matrix, on the one hand, exhibited a synergistic effect on the grain refinement of Zn, reducing the grain size of pure Zn by 96%; on the other hand, improved the mechanical properties of the ternary alloys through solid solution strengthening, second phase strengthening, and grain refinement. The degradation properties of Zn-Ca-Cu alloys are primarily influenced by the micro-galvanic corrosion between Zn-Cu matrix and CaZn13 phase, where the 0.5% and 1.0% Ca addition increased the corrosion rate of Zn from 11.5 μm/y to 19.8 μm/y and 29.6 μm/y during 4 weeks immersion test.

Regulatory science for hernia mesh: Current status and future perspectives

Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.

In vitro and in vivo studies of biodegradable Zn-Li-Mn alloy staples designed for gastrointestinal anastomosis

Zn-0.8 wt.% Li-0.1 wt.% Mn wire with the diameter of 0.3 mm was fabricated and further processed into gastrointestinal staple, and its in vitro and in vivo biodegradation behavior and biocompatibility were studied systematically. The experimental Zn-Li-Mn alloy staple could deform from the original U-shape to B-shape without fracture, indicating its good mechanical property. Due to the residual stress concentration caused by anastomosis deformation, the feet and leg arc part of the staple were more prone to degradation. The Zn-Li-Mn alloy staple sustained integrity after immersion in Hanks' solution and simulated gastric fluid (SGF) for 28 days, and the degradation rate in SGF was about 4 times of that in Hanks' solution. Furthermore, Zn-Li-Mn alloy staples were utilized for gastrointestinal anastomosis in pig models, with clinically-used titanium alloy staples as a comparison. No anastomotic leakage and severe inflammation were observed after operation. The Zn-Li-Mn alloy staple maintained mechanical integrity within 8 weeks' implantation. The gastrointestinal tissue healed after 12 weeks, and no obvious side effects were detected during the whole implantation period, demonstrating the good biocompatibility of Zn-Li-Mn alloy staple. Thus, Zn-Li-Mn alloy staple fabricated in this work displayed the promising potential in the gastrointestinal anastomosis.

In vivo evaluation of bending strengths and degradation rates of different magnesium pin designs for oral stapler

Magnesium alloys have been potential biodegradable implants in the areas of bone, cardiovascular system, gastrointestinal tract, and so on. The purpose of this study is to evaluate Mg-2Zn alloy degradation as a potential suture material. The study included Sprague-Dawley (SD) rats in vivo. In 24 male SD rats, tests in the leg muscle were conducted using traditional surgical incision and insertion of magnesium alloys of different designs into the tissue. The material degradation topography, elemental composition, and strength of the pins were analyzed. This paper explores magnesium pins with different cross-sectional shapes and diameters to establish a suitable pin diameter and shape for use as an oral stapler, which must have a good balance of degradation rate and strength. The results showed there were good bending strengths over different degradation periods in groups with diameters of 0.8 mm and 0.5 mm, and no significantly different bending strength between the groups of triangle and round cross-section shapes with same diameter of 0.3 mm, although the degradation rate still needs to be improved.

Effect of strain on degradation behaviors of WE43, Fe and Zn wires

The biodegradable metallic devices undergo stress/strain-induced corrosion when they are used for load-bearing applications. The stress/strain induced-corrosion behavior causes differences in corrosion rate, corrosion morphology, strain distribution and mechanical performance of the devices. One representative example is the biodegradable stent. Biodegradable stents undergo complex inhomogeneous deformation that can cause dramatic non-uniform stent degradation, resulting in stress concentration and stents failure. The degradation of biodegradable devices requires special attention to the mutual effect between the applied strain and degradation. The quantitative relationship between strain and corrosion of the sample alloys (WE43, Fe and Zn), selected from three typical biodegradable metals, is firstly investigated and compared in this study. The in vitro degradation and the strength retention of WE43, Fe and Zn wires were investigated under different elastic and plastic strain levels ranging from 0.1% to 30%. The results indicated that the applied strain could bring down the corrosion potential, increase corrosion current and accelerate the degradation of three biodegradable metals. Specifically, remarkable enhanced localized corrosion was observed for plastic strained WE43 compared with those with elastic strains. This localized corrosion morphology significantly accelerated the strength decline at first, while the differences diminished with longer immersion period. Fe and Zn exhibited increased degradation with plastic strain applications than those under elastic strains. However, the degradation was not further increased with the increasing magnitude of plastic strains. Moreover, the bended wires were subcutaneously implanted in the dorsal aspect of the rats and the effect of bending deformation on in vitro and in vivo degradation of three metallic wires were also compared. The U-bended WE43 wires suffered more severe in vitro degradation at the stress concentrated region. Surprisingly, the early fracture of the undeformed regions was observed in the in vivo test. In conclusion, the corrosion rate, corrosion morphology and mechanical properties of WE43, Fe and Zn was sensitive to magnitude of the applied strains. The quantification results provided new insights into understanding the strain-dependent corrosion of three biodegradable metals both in vitro and in vivo. STATEMENT OF SIGNIFICANCE: Biodegradable implants are subjected to various mechanical environment during the deployment and subsequent physiological activity. It is necessary to have a clear understanding of the effects of the applied stress on degradation. This study addresses the quantitative effects of applied strain/stress on the in vitro and in vivo degradation of three typical biodegradable metals (Mg, Fe and Zn). These quantification results provide new insights into understanding the strain-induced corrosion of three metals.

The mechanical property and corrosion resistance of Mg-Zn-Nd alloy fine wires in vitro and in vivo

Titanium and its alloy are commonly used as surgical staples in the reconstruction of intestinal tract and stomach, however they cannot be absorbed in human body, which may cause a series of complications to influence further diagnosis. Magnesium and its alloy have great potential as surgical staples, because they can be degraded in human body and have good mechanical properties and biocompatibility. In this study, Mg-2Zn-0.5Nd (ZN20) alloy fine wires showed great potential as surgical staples. The ultimate tensile strength and elongation of ZN20 alloy fine wires were 248 MPa and 13%, respectively, which could be benefit for the deformation of the surgical staples from U-shape to B-shape. The bursting pressure of the wire was about 40 kPa, implying that it can supply sufficient mechanical support after anastomosis. Biochemical test and histological analysis illustrated good biocompatibility and biological safety of ZN20 alloy fine wire. The residual tensile stress formed on the outside of ZN20 fine wire during drawing would accelerate the corrosion. The second phase had a negative influence on corrosion property due to galvanic corrosion. The corrosion rate in vitro was faster than that in vivo due to the capsule formed on the surface of ZN20 alloy fine wire.

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The mechanical property of ZN20 wire can ensure the anastomosis smoothly.

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Peeling of was the mainly corrosion behavior of ZN20 wire in simulated intestinal fluid.

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The attachment of fibroblasts and macrophages caused corrosion rate in vivo decrease.

Novel zinc alloys for biodegradable surgical staples

BACKGROUND

The development of biodegradable surgical staples is desirable as non-biodegradable Ti alloy staples reside in the human body long after wound healing, which can cause allergic/foreign-body reactions, adhesion, or other adverse effects. In order to develop a biodegradable alloy suitable for the fabrication of surgical staples, we hypothesized that Zn, a known biodegradable metal, could be alloyed with various elements to improve the mechanical properties while retaining biodegradability and biocompatibility. Considering their biocompatibility, Mg, Ca, Mn, and Cu were selected as candidate alloying elements, alongside Ti, the main material of clinically available surgical staples.

AIM

To investigate the in vitro mechanical properties and degradation behavior and in vivo safety and feasibility of biodegradable Zn alloy staples.

METHODS

Tensile and bending tests were conducted to evaluate the mechanical properties of binary Zn alloys with 0.1–6 wt.% Mg, Ca, Mn, Cu, or Ti. Based on the results, three promising Zn alloy compositions were devised for staple applications (wt.%): Zn-1.0Cu-0.2Mn-0.1Ti (Zn alloy 1), Zn-1.0Mn-0.1Ti (Zn alloy 2), and Zn-1.0Cu-0.1Ti (Zn alloy 3). Immersion tests were performed at 37 °C for 4 wk using fed-state simulated intestinal fluid (FeSSIF) and Hank's balanced salt solution (HBSS). The corrosion rate was estimated from the weight loss of staples during immersion. Nine rabbits were subjected to gastric resection using each Zn alloy staple, and a clinically available Ti staple was used for another group of nine rabbits. Three in each group were sacrificed at 1, 4, and 12 wk post-operation.

RESULTS

Additions of ≤1 wt.% Mn or Cu and 0.1 wt.% Ti improved the yield strength without excessive deterioration of elongation or bendability. Immersion tests revealed no gas evolution or staple fracture in any of the Zn alloy staples. The corrosion rates of Zn alloy staples 1, 2, and 3 were 0.02 mm/year in HBSS and 0.12, 0.11, and 0.13 mm/year, respectively, in FeSSIF. These degradation times are sufficient for wound healing. The degradation rate is notably increased under low pH conditions. Scanning electron microscopy and energy dispersive spectrometry surface analyses of the staples after immersion indicated that the component elements eluted as ions in FeSSIF, whereas corrosion products were produced in HBSS, inhibiting Zn dissolution. In the animal study, none of the Zn alloy staples caused technical failure, and all rabbits survived without complications. Histopathological analysis revealed no severe inflammatory reaction around the Zn alloy staples.

CONCLUSION

Staples made of Zn-1.0Cu-0.2Mn-0.1Ti, Zn-1.0Mn-0.1Ti, and Zn-1.0Cu-0.1Ti exhibit acceptable in vitro mechanical properties, proper degradation behavior, and in vivo safety and feasibility. They are promising candidates for biodegradable staples.

Translational status of biomedical Mg devices in China

Magnesium (Mg) and its alloys as temporary medical implants with biodegradable and properly mechanical properties have been investigated for a long time. There are already three kinds of biodegradable Mg implants which are approved by Conformite Europeene (CE) or Korea Food and Drug Administration (KFDA), but not China Food and Drug Administration (CFDA, now it is National Medical Products Administration, NMPA). As we know, Chinese researchers, surgeons, and entrepreneurs have tried a lot to research and develop biodegradable Mg implants which might become other new approved implants for clinical applications. So in this review, we present the representative Mg implants of three categories, orthopedic implants, surgical implants, and intervention implants and provide an overview of current achievement in China from academic publications and Chinese patents. We would like to provide a systematic way to translate Mg and its alloy implants from experiment designs to clinical products.

Biodegradable Surgical Staple Composed of Magnesium Alloy

Currently, surgical staples are composed of non-biodegradable titanium (Ti) that can cause allergic reactions and interfere with imaging. This paper proposes a novel biodegradable magnesium (Mg) alloy staple and discusses analyses conducted to evaluate its safety and feasibility. Specifically, finite element analysis revealed that the proposed staple has a suitable stress distribution while stapling and maintaining closure. Further, an immersion test using artificial intestinal juice produced satisfactory biodegradable behavior, mechanical durability, and biocompatibility in vitro. Hydrogen resulting from rapid corrosion of Mg was observed in small quantities only in the first week of immersion, and most staples maintained their shapes until at least the fourth week. Further, the tensile force was maintained for more than a week and was reduced to approximately one-half by the fourth week. In addition, the Mg concentration of the intestinal artificial juice was at a low cytotoxic level. In porcine intestinal anastomoses, the Mg alloy staples caused neither technical failure nor such complications as anastomotic leakage, hematoma, or adhesion. No necrosis or serious inflammation reaction was histopathologically recognized. Thus, the proposed Mg alloy staple offers a promising alternative to Ti alloy staples.

The Prospects for Biodegradable Zinc in Wound Closure Applications

Zinc is identified as a promising biodegradable metal along with magnesium and iron. In the last 5 years, considerable progress is made on understanding the mechanical properties, biodegradability, and biocompatibility of zinc and its alloys. A majority of these studies have focused on using zinc for absorbable cardiovascular and orthopedic device applications. However, it is likely that zinc is also suitable for other biomedical applications. In this work, the prospects for zinc in the fabrication of wound closure devices such as absorbable sutures, staples, and surgical tacks are critically assessed, with the aim of inspiring future research on biodegradable Zn for this medical application.

Fabrication, microstructure, and properties of a biodegradable Mg-Zn-Ca clip

An Mg-Zn-Ca alloy biodegradable clip was fabricated by combining hot extrusion and blanking processing. Microstructure evolution was investigated by optical microscopy and electron backscattering diffraction and the occlusion properties of Mg-Zn-Ca alloy clip were evaluated in vitro and in vivo. It was found that the as-extruded Mg-Zn-Ca alloy exhibited a typical fiber microstructure. After blanking, the basal texture intensity increased because of the work hardening effect. Subsequent annealing treatment of the blanking clip can significantly weaken the texture while improving the ductility of the Mg-Zn-Ca alloy. It was found that Mg-Zn-Ca clips can maintain closure performance for 2 weeks in in vitro immersion tests while in vivo tests indicated that the Mg-3Zn-0.2Ca alloy clips fabricated by this preparation processing successfully occluded the blood vessels. These results suggest that the developed Mg-3Zn-0.2Ca alloy clip is a suitable candidate for biodegradable soft tissue fixation devices such as surgical clips. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1741-1749, 2019.

High-Purity Magnesium Staples Suppress Inflammatory Response in Rectal Anastomoses

Magnesium-based materials are promising biodegradable implants, although the impact of magnesium on rectal anastomotic inflammation is poorly understood. Thus, we investigated the inflammatory effects of high-purity Mg staples in rectal anastomoses by in vivo luciferase reporter gene expression in transgenic mice, hematoxylin-eosin staining, immunohistochemistry, and Western blotting. As expected, strong IL-1β-mediated inflammation and inflammatory cell infiltration were observed 1 day after rectal anastomoses were stapled with high-purity Mg or Ti. However, inflammation and inflammatory cell infiltration decreased more robustly 4-7 days postoperation in tissues stapled with high-purity Mg. This rapid reduction in inflammation was confirmed by immunohistochemical analysis of IL-6 and TNF-α. Western blot also suggested that the reduced inflammatory response is due to suppressed TLR4/NF-κB signaling. In contrast, MCP-1, uPAR, and VEGF were abundantly expressed, in line with the notion that expression of these proteins is regulated by feedback between the VEGF and NF-κB pathways. In vitro expression of MCP-1, uPAR, and VEGF was also similarly high in primary rectal mucosal epithelial cells exposed to extracts from Mg staples, as measured by antibody array. Collectively, the results suggest that high-purity Mg staples suppress the inflammatory response during rectal anastomoses via TLR4/NF-κB and VEGF signaling.

In vivo and in vitro assessment of the biocompatibility and degradation of high-purity Mg anastomotic staples

Titanium (Ti) staples are not biodegradable, and anastomotic complications related to Ti staples are reported frequently. In the present study, the biocompatibility and degradation behavior of high-purity magnesium (HP Mg) staples with the small intestine were investigated. HP Mg staples did not affect the relative growth rate, cell cycle and apoptosis of primary rectal mucosal epithelial cells (IEC-6) in vitro. At one, two and three days after immersion in intestinal juice, the weight of the 30 rinsed HP Mg staples reduced by 7.5 ± 1.6, 10.6 ± 2.2 and 13.5 ± 2.1 mg, respectively, and those in the Hanks' solution reduced by 3.9 ± 0.8, 6.1 ± 1.2 and 7.1 ± 2.4 mg. Extracts of HP Mg staples were bio-safe for IEC-6, and the corrosion rate of HP staples was faster in the small intestinal juice than in the Hanks' solution. In the in vivo experiments, the small intestine of the minipigs was anastomosed by HP Mg and Ti staples. HP Mg staples neither affected important bio-chemical parameters nor induced serious inflammation or necrosis in the anastomosis tissues. The residual weight of a HP Mg staples (0.81 ± 0.13 mg) was 89.7% of the original weight (9 ± 0.09 mg) one month after surgery. The in vivo corrosion rate for one HP Mg staple was determined to be∼0.007 ± 0.001 mm·month^-1. The preliminary results of the biocompatibility and degradation of high-purity Mg anastomotic staples are promising, and further studies will be initiated to study in more detail.