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Pérez-Köhler B, Benito-Martínez S, García-Moreno F, Rodríguez M, Pascual G, Bellón JM. Antibacterial polypropylene mesh fixation with a cyanoacrylate adhesive improves its response to infection. Surgery 2021; 170:507-515. [PMID: 33612292 DOI: 10.1016/j.surg.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antibacterial meshes for hernia repair seek to avoid infection in the patient. As these biomaterials are especially prone to bacteria settling at their sutured borders, this study examines whether the use of a cyanoacrylate tissue adhesive could improve mesh behavior at the fixation zones. METHODS First, antibacterial polypropylene meshes were prepared by soaking in 0.05% chlorhexidine, and the response of n-hexyl cyanoacrylate to contamination with Staphylococcus aureus ATCC25923 was assessed in vitro. Then, in a preclinical model, partial defects (5 x 3 cm) were created in the abdominal wall of 18 New Zealand White rabbits and repaired with mesh to establish the following 3 study groups: (1) mesh without chlorhexidine fixed with cyanoacrylate, (2) antibacterial mesh fixed with sutures, and (3) antibacterial mesh fixed with cyanoacrylate (n = 6 each). The implants were inoculated with 106 CFU/mL of S aureus. At 14 days after surgery, bacterial adhesion to the implant and its integration within host tissue were determined through microbiological, histological and immunohistochemical procedures. RESULTS As observed in vitro, the cyanoacrylate gave rise to a 1.5-cm bacteria-free margin around the prosthetic mesh. In vivo, the tissue adhesive prevented bacterial adhesion to the fixation zones, reducing infection of chlorhexidine-free meshes and optimizing the efficacy of the antibacterial meshes compared with those fixed with sutures. CONCLUSION These findings indicated that cyanoacrylate fixation does not affect mesh integration into the host tissue. Likewise, the antibacterial behavior and tissue response of a chlorhexidine-treated polypropylene mesh is improved when cyanoacrylate is used for its fixation.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain; Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Selma Benito-Martínez
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Francisca García-Moreno
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Marta Rodríguez
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain; Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
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Woodmansey EJ, Roberts CD. Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds. Int Wound J 2018; 15:1025-1032. [PMID: 30117675 PMCID: PMC7949668 DOI: 10.1111/iwj.12969] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022] Open
Abstract
Antimicrobial resistance is an ever-increasing global concern, with the era of untreatable infection becoming a reality. Wound care is no exception, with increasing issues of antibiotic-resistant infections across different wound types and care settings. Antibiotic resistance and stewardship have been the priority for most strategic interventions so far; however, in wound care, alternative or supplementary strategies using antiseptics should be considered. Antiseptics such as silver can provide effective cidal activity across a broad range of wound pathogens, assuming they are used at the correct level for an appropriate duration. Evidence summarised in this manuscript suggests that effective antiseptics, such as nanocrystalline silver, have an increasing body of evidence in support of their use to minimise transmission of antibiotic-resistant organisms as part of institutional infection control procedures and, in addition, through appropriate early use and stewardship on local wound infections, in conjunction with local procedures, to minimise the need for systemic antibiotic therapy. Engagement, alignment, and collaboration between wound care professionals and wider related teams and governments on antimicrobial stewardship, and the potential role of antiseptics within this, will help to generate further evidence for such interventions in the fight against antimicrobial-resistant infections in wound care.
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Affiliation(s)
- Emma J. Woodmansey
- Clinical Scientific and Medical AffairsSmith & Nephew Advanced Wound ManagementHullUK
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Westcott JM, Crockett L, Qiu F, Berg TG. Effect of skin coverage method following subcuticular suturing on wound infection rates at cesarean delivery. J Matern Fetal Neonatal Med 2016; 30:2003-2005. [DOI: 10.1080/14767058.2016.1236082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jill M. Westcott
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, USA and
| | - Libby Crockett
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, USA and
| | - Fang Qiu
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Teresa G. Berg
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, USA and
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Application time for postoperative wound dressing following breast augmentation with implants: study protocol for a randomized controlled trial. Trials 2015; 16:19. [PMID: 25623237 PMCID: PMC4311490 DOI: 10.1186/s13063-014-0529-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/19/2014] [Indexed: 11/08/2022] Open
Abstract
Background Breast augmentation with silicone implants is one of the most frequently performed cosmetic surgeries worldwide. Surgical site infection (SSI) remains an important complication of this procedure. One of the most important risk factors for SSI is the presence of microorganisms on the skin surrounding the wound. Guidelines by the Centers for Disease Control (CDC) recommend that surgical wounds be covered with a sterile dressing for 24 to 48 hours. However, a recent study showed that the application of a dressing for six days after breast reduction reduced wound colonization by coagulase-negative staphylococci. Methods/Design A randomized clinical trial was designed to assess two protocols of postoperative wound care to determine how the application duration of the postoperative dressing influences wound colonization in patients undergoing breast augmentation with silicone implants. Women aged between 18 and 60 years who are candidates for breast augmentation with silicone implants will be randomly allocated to group I (n = 48), in which the dressing will be removed on the first postoperative day, or group II (n = 48), in which the dressing will be removed on the sixth postoperative day. Cutaneous colonization will be assessed by cultures of samples of skin flora taken from the wound region. The incidence of SSI, using standardized CDC criteria, and the perceptions of patients towards the dressing will be secondary outcomes. Discussion An important component of SSI prevention is to minimize all possible risk factors, and the application of postoperative dressing plays a key role in this endeavor. The results of this clinical trial may help to standardize postoperative wound care after breast augmentation with silicone implants. Trial registration This trial was registered on 12 March 2012 with ClinicalTrials.gov (identifier: NCT01553604).
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Wagner K, Friedrich S, Stang C, Bley T, Schilling N, Bieda M, Lasagni A, Boschke E. Initial phases of microbial biofilm formation on opaque, innovative anti-adhesive surfaces using a modular microfluidic system. Eng Life Sci 2013. [DOI: 10.1002/elsc.201200035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Katrin Wagner
- Institute of Food Technology and Bioprocess Engineering; Technische Universität Dresden; Dresden Germany
| | - Sandra Friedrich
- Institute of Food Technology and Bioprocess Engineering; Technische Universität Dresden; Dresden Germany
| | - Carolin Stang
- Institute of Food Technology and Bioprocess Engineering; Technische Universität Dresden; Dresden Germany
| | - Thomas Bley
- Institute of Food Technology and Bioprocess Engineering; Technische Universität Dresden; Dresden Germany
| | - Niels Schilling
- Fraunhofer Institute for Material and Beam Technology IWS; Dresden Germany
| | - Matthias Bieda
- Fraunhofer Institute for Material and Beam Technology IWS; Dresden Germany
| | - Andrés Lasagni
- Fraunhofer Institute for Material and Beam Technology IWS; Dresden Germany
| | - Elke Boschke
- Institute of Food Technology and Bioprocess Engineering; Technische Universität Dresden; Dresden Germany
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