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He P, Wang D, Zheng R, Wang H, Fu L, Tang G, Shi Z, Wu Y, Yang G. An antibacterial biologic patch based on bacterial cellulose for repair of infected hernias. Carbohydr Polym 2024; 333:121942. [PMID: 38494213 DOI: 10.1016/j.carbpol.2024.121942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
Infection-associated complications and repair failures and antibiotic resistance have emerged as a formidable challenge in hernia repair surgery. Consequently, the development of antibiotic-free antibacterial patches for hernia repair has become an exigent clinical necessity. Herein, a GBC/Gel/LL37 biological patch (biopatch) with exceptional antibacterial properties is fabricated by grafting 2-Methacryloyloxyethyl trimethylammonium chloride (METAC), a unique quaternary ammonium salt with vinyl, onto bacterial cellulose (GBC), followed by compounding with gelatin (Gel) and LL37. The GBC/Gel/LL37 biopatch exhibits stable swelling capacity, remarkable mechanical properties, flexibility, and favorable biocompatibility. The synergistic effect of METAC and LL37 confers upon the GBC/Gel/LL37 biopatch excellent antibacterial efficacy against Staphylococcus aureus and Escherichia coli, effectively eliminating invading bacteria without the aid of exogenous antibiotics in vivo while significantly reducing local acute inflammation caused by infection. Furthermore, the practical efficacy of the GBC/Gel/LL37 biopatch is evaluated in an infected ventral hernia model, revealing that the GBC/Gel/LL37 biopatch can prevent the formation of visceral adhesions, facilitate the repair of infected ventral hernia, and effectively mitigate chronic inflammation. The prepared antibacterial GBC/Gel/LL37 biopatch is very effective in dealing with the risk of infection in hernia repair surgery and offers potential clinical opportunities for other soft injuries, exhibiting considerable clinical application prospects.
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Affiliation(s)
- Pengyu He
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Dawei Wang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Ruizhu Zheng
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hao Wang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Lina Fu
- College of Medicine, Huanghuai University, Zhumadian, Henan 463000, China; Zhumadian Central Hospital, Zhumadian, Henan 463000, China
| | - Guoliang Tang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Zhijun Shi
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, Hubei, China.
| | - Guang Yang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
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Tang F, Miao D, Huang R, Zheng B, Yu Y, Ma P, Peng B, Li Y, Wang H, Wu D. Double-Layer Asymmetric Porous Mesh with Dynamic Mechanical Support Properties Enables Efficient Single-Stage Repair of Contaminated Abdominal Wall Defect. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307845. [PMID: 38408735 DOI: 10.1002/adma.202307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/08/2024] [Indexed: 02/28/2024]
Abstract
Contamination tolerance and long-term mechanical support are the two critical properties of meshes for contaminated abdominal wall defect repair. However, biological meshes with excellent pollution tolerance fail to provide bio-adaptive long-term mechanical support due to their rapid degradation. Here, a novel double-layer asymmetric porous mesh (SIS/PVA-EXO) is designed by simple and efficient in situ freeze-thaw of sticky polyvinyl alcohol (PVA) solution on the loosely porous surface of small intestinal submucosal decellularized matrix (SIS), which can successfully repair the contaminated abdominal wall defect with bio-adaptive dynamic mechanical support through only single-stage surgery. The exosome-loaded degradable loosely porous SIS layer accelerates the tissue healing; meanwhile, the exosome-loaded densely porous PVA layer can maintain long-term mechanical support without any abdominal adhesion. In addition, the tensile strength and strain at break of SIS/PVA-EXO mesh change gradually from 0.37 MPa and 210% to 0.10 MPa and 385% with the degradation of SIS layer. This unique performance can dynamically adapt to the variable mechanical demands during different periods of contaminated abdominal wall reconstruction. As a result, this SIS/PVA-EXO mesh shows an attractive prospect in the treatment of contaminated abdominal wall defect without recurrence by integrating local immune regulation, tissue remodeling, and dynamic mechanical supporting.
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Affiliation(s)
- Fuxin Tang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dongtian Miao
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Rongkang Huang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Bingna Zheng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P.R. China
| | - Yang Yu
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Pengwei Ma
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Binying Peng
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Yong Li
- Department of General Surgery (Gastrointestinal Surgery), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dingcai Wu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
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Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
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Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
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Montazerian H, Davoodi E, Baidya A, Badv M, Haghniaz R, Dalili A, Milani AS, Hoorfar M, Annabi N, Khademhosseini A, Weiss PS. Bio-macromolecular design roadmap towards tough bioadhesives. Chem Soc Rev 2022; 51:9127-9173. [PMID: 36269075 PMCID: PMC9810209 DOI: 10.1039/d2cs00618a] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Emerging sutureless wound-closure techniques have led to paradigm shifts in wound management. State-of-the-art biomaterials offer biocompatible and biodegradable platforms enabling high cohesion (toughness) and adhesion for rapid bleeding control as well as robust attachment of implantable devices. Tough bioadhesion stems from the synergistic contributions of cohesive and adhesive interactions. This Review provides a biomacromolecular design roadmap for the development of tough adhesive surgical sealants. We discuss a library of materials and methods to introduce toughness and adhesion to biomaterials. Intrinsically tough and elastic polymers are leveraged primarily by introducing strong but dynamic inter- and intramolecular interactions either through polymer chain design or using crosslink regulating additives. In addition, many efforts have been made to promote underwater adhesion via covalent/noncovalent bonds, or through micro/macro-interlock mechanisms at the tissue interfaces. The materials settings and functional additives for this purpose and the related characterization methods are reviewed. Measurements and reporting needs for fair comparisons of different materials and their properties are discussed. Finally, future directions and further research opportunities for developing tough bioadhesive surgical sealants are highlighted.
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Affiliation(s)
- Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, Los Angeles, California 90024, USA.
| | - Elham Davoodi
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, Los Angeles, California 90024, USA.
- Multi-Scale Additive Manufacturing Lab, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Avijit Baidya
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
| | - Maryam Badv
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, USA
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, USA
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Reihaneh Haghniaz
- Terasaki Institute for Biomedical Innovation, Los Angeles, Los Angeles, California 90024, USA.
| | - Arash Dalili
- School of Engineering, University of British Columbia, Kelowna, British Columbia V1V 1V7, Canada
| | - Abbas S Milani
- School of Engineering, University of British Columbia, Kelowna, British Columbia V1V 1V7, Canada
| | - Mina Hoorfar
- School of Engineering, University of British Columbia, Kelowna, British Columbia V1V 1V7, Canada
- School of Engineering and Computer Science, University of Victoria, Victoria, British Columbia V8P 3E6, Canada
| | - Nasim Annabi
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, Los Angeles, California 90024, USA.
| | - Paul S Weiss
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, USA.
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, USA
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, USA
- Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, USA
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Hajimohammadi K, Makhdoomi K, Zabihi RE, Parizad N. Treating post-renal transplant surgical site infection with combination therapy: a case study. ACTA ACUST UNITED AC 2021; 30:478-483. [PMID: 33876694 DOI: 10.12968/bjon.2021.30.8.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical site infection (SSI) is one of the most common and debilitating complications of surgery. The risk of SSI rises if the patient has underlying health-related risk factors. This article reports on the complicated case of 61-year-old female with a history of obesity and diabetes. She was diagnosed with end-stage renal disease (ESRD) and had been receiving haemodialysis since 2012. She underwent a kidney transplant and developed a multidrug-resistant Pseudomonas aeruginosa SSI following surgery. She experienced delayed wound healing with a partially dehisced incision. Despite conventional wound care, there was no progress in wound healing. The authors combined sharp debridement, irrigation and antibiotic therapy with a silver-containing antimicrobial dressing for 1 month. Her SSI improved significantly and she returned to theatre for wound closure. The patient recovered well and was discharged from the hospital after suture removal. Wound care professionals can use combination therapies to manage SSIs effectively and reduce patient and healthcare costs.
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Affiliation(s)
- Kazem Hajimohammadi
- Wound Manager, Imam Khomeini Teaching Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Khadijeh Makhdoomi
- Nephrologist, Associate Professor, Nephrology and Kidney Transplant Research Center, Urmia University of Medical Science, Urmia, Iran
| | - Roghayeh Esmaeili Zabihi
- Lecturer, Department of Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Science, Urmia, Iran
| | - Naser Parizad
- Assistant Professor, Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
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Shin CS, Cabrera FJ, Lee R, Kim J, Ammassam Veettil R, Zaheer M, Adumbumkulath A, Mhatre K, Ajayan PM, Curley SA, Scott BG, Acharya G. 3D-Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2003778. [PMID: 33325594 DOI: 10.1002/adma.202003778] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold, the inflammatory response can be modulated, and the visceral adhesion formations and postsurgical complications can be minimized. The bioscaffold is fabricated by 3D-bioprinting of an in situ phosphate crosslinked poly(vinyl alcohol) polymer. In vivo efficacy of the bioscaffold is evaluated in a rat ventral hernia model. In vivo proinflammatory cytokine expression analysis and histopathological analysis of the tissues have confirmed that the bioscaffold acts as an inflammation trap and captures the proinflammatory cytokines secreted at the implant site and effectively modulates the local inflammation without the need for exogenous anti-inflammatory agents. The bioscaffold is very effective in inhibiting visceral adhesions formation and minimizing postsurgical complications.
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Affiliation(s)
- Crystal S Shin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fernando J Cabrera
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Richard Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - John Kim
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Remya Ammassam Veettil
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mahira Zaheer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Aparna Adumbumkulath
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Kirti Mhatre
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Pulickel M Ajayan
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Steven A Curley
- Oncology Institute, Christus Health Institute, 910 East Houston St., Suite 270, Tyler, TX, 75702, USA
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ghanashyam Acharya
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
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