Recent Advances in Tissue Adhesives for Clinical Medicine

A biguanide chitosan-based hydrogel adhesive accelerates the healing of bacterial-infected wounds

The development of tissue adhesives with good biocompatibility and potent antimicrobial properties is crucial for addressing the high incidence of surgical site infections in emergency and clinical settings. Herein, an injectable hydrogel adhesive composed of chitosan biguanidine (CSG), oxidized dextran (ODex) and tannin (TA) was synthesized primarily through Schiff-base reactions, hydrogen bonding, and electrostatic interactions. TA was introduced into the CSG/ODex hydrogel to prepare a physicochemically double cross-linked hydrogel. The hydrogel formulation incorporating 2 wt% TA (CSG/ODex-TA2) exhibited rapid gelation, moderate mechanical properties, good tissue adhesion, and sustained release behavior of TA. Both in vitro and in vivo studies demonstrated that CSG/ODex-TA2 showed significantly enhanced adhesion and antibacterial effectiveness compared to the CSG/ODex hydrogel and commercial fibrin glue. Leveraging the positive charge of CSG, the CSG/ODex-TA2 hydrogel demonstrated a strong contact antibacterial effect, while the sustained release of TA provided diffusion antibacterial capabilities. By integrating contact and diffusion antibacterial mechanisms into the hydrogel, a promising approach was developed to boost antibacterial efficiency and accelerate the healing of wounds infected with methicillin-resistant Staphylococcus aureus (MRSA). The CSG/ODex-TA2 hydrogel has excellent biocompatibility, hemostatic properties, and antibacterial capabilities, making it a promising candidate for improving in vivo wound care and combating bacterial infections.

An Environmentally Stable, Biocompatible, and Multilayered Wound Dressing Film with Reversible and Strong Adhesion

Reversible adhesives for wound care improve patient experiences by permitting reuse and minimizing further tissue injury. Existing reversible bandages are vulnerable to water and can undergo unwanted deformation during removal and readdressing procedures. Here, a biocompatible, multilayered, reversible wound dressing film that conforms to skin and is waterproof is designed. The inner layer is capable of instant adhesion to various substrates upon activation of the dynamic boronic ester bonds by water; intermediate hydrogel layer and outer silicone backing layer can enhance the dressing's elasticity and load distribution for adhesion, and the silicone outer layer protects the dressing from exposure to water. The adhesive layer is found to be biocompatible with mouse skin. Skin injuries on the mouse skin heal more rapidly with the film compared to no dressing controls. Evaluations of the film on skin of freshly euthanized minipigs corroborate the findings in the mouse model. The film remains attached to skins without delamination despite subjecting to various degrees of deformation. Exposure to water softens the film to allow removal from the skin without pulling any hair off. The multilayered design considers soft mechanics in each layer and will offer new insights to improve wound dressing performance and patient comfort.

Effect of Silica Nanoparticle Treatment on Adhesion between Tissue-like Substrates and In Vivo Skin Wound Sealing

Silica nanoparticles are innovative solutions of surgical glue that can readily adhere to various tissue-like substrates without the need for time-consuming chemical reactions or ultraviolet irradiation. Herein, 10 nm-sized silica nanoparticle (SiNP10) treatment exhibited maximum adhesion strength in the porcine heart tissue model, which was approximately 7.15 times higher than that of the control group of non-treatment. We assessed the effects of silica nanoparticle treatment on in vivo skin wounds by scoring tissue adhesion and inflammation using histological images. Compared to the commercial cyanoacrylate skin adhesive (Dermabond), suppression of inflammatory cytokine levels in the incision wound skin was observed. We further quantified the expression of angiogenic growth factors and connective tissue formation-related proteins. On day 5 after wound closing treatment, the expression levels of PDGF-BB growth factor were significantly higher in SiNP10 treatment (0.64 ± 0.03) compared to Dermabond (0.07 ± 0.05). This stimulated angiogenesis and connective tissue formation in the skin of the incision wound may be associated with the promoting effects of SiNP10 treatment on wound closure and tissue adhesion.

Octyl-2-cyanoacrylate Tissue Adhesive Closure Versus Subcuticular Suture for Post-Auricular Incisions

BACKGROUND

Skin closure techniques in otolaryngology vary based on surgeon preference and wound site. Octyl-2-Cyanoacrylate may be a safe, rapid, and cost-effective option for post-site closure.

AIM

This randomized controlled trial study aimed to compare Octyl-2-Cyanoacrylate and conventional subcuticular sutures in ear surgeries, assessing wound closure results in both case and control groups.

METHODS

This prospective, randomized, controlled, single-blind study was conducted at Ohud Hospital from May 2021 to May 2022. Ear surgery and cochlear implantation in patients were examined, and each group was randomly assigned to receive Dermabond TM and deep layer subcuticular sutures closure. Incisions were assessed at various time points, including 3 weeks, 6 weeks, 6 months, and 1 year post-surgery. The patient and observer Scar Assessment Scale was used, and two independent ear surgeons used the Stony Brook Scar Evaluation Scale for initial scar assessment.

RESULTS

This study involved 126 ear surgery and cochlear implantation patients randomized to use cyanoacrylate tissue adhesive or subcuticular suture for port site closure. The study found that tissue adhesive (OCA) was faster and more efficient than standard sutures, saving an average of 12 min per incision in each ear. Incision cosmesis showed immediate results and significant differences, and patient satisfaction with OCA wound closure was higher than standard sutures.

CONCLUSION

The findings confirmed that cyanoacrylate tissue adhesive significantly reduced the time needed for skin closure during ear surgery and showed immediate cosmetic improvements without any documented instances of bleeding, hematoma, infection, or wound separation.

LEVEL OF EVIDENCE

This is a randomized controlled trial, it follows Level 2 of evidence. Randomized trial or observational study with dramatic effects Laryngoscope, 134:4036-4041, 2024.

Biocompatible polymer-based micro/nanorobots for theranostic translational applications

Recently, micro/nanorobots (MNRs) with self-propulsion have emerged as a promising smart platform for diagnostic, therapeutic and theranostic applications. Especially, polymer-based MNRs have attracted huge attention due to their inherent biocompatibility and versatility, making them actively explored for various medical applications. As the translation of MNRs from laboratory to clinical settings is imperative, the use of appropriate polymers for MNRs is a key strategy, which can prompt the advancement of MNRs to the next phase. In this review, we describe the multifunctional versatile polymers in MNRs, and their biodegradability, motion control, cargo loading and release, adhesion, and other characteristics. After that, we review the theranostic applications of polymer-based MNRs to bioimaging, biosensing, drug delivery, and tissue engineering. Furthermore, we address the challenges that must be overcome to facilitate the translational development of polymeric MNRs with future perspectives. This review would provide valuable insights into the state-of-the-art technologies associated with polymeric MNRs and contribute to their progression for further clinical development.

Breaking the boundaries of wound closure: A novel polyurethane tissue adhesive with enhanced healing properties

Over the past few decades, there have been advancements in the development of high-performance tissue adhesives as alternatives to traditional sutures and staples for rapid and effective wound closure post-surgery. While tissue adhesives offer advantages such as ease of use, short application time, and minimal tissue damage, they also face challenges related to biocompatibility, biodegradability, and adhesive strength. In this study, L-lysine diisocyanate (LDI) and trimethylolpropane (TMP) were utilized as the primary raw materials to produce a prepolymer terminated with NCO, resulting in the development of a new biocompatible polyurethane tissue adhesive (TMP-LDI). Additionally, SiO2 nanoparticles were incorporated into the prepolymer, significantly enhancing the adhesive strength of the TMP-LDI tissue adhesive through the "nanobridging effect," achieving a strength of 170.4 kPa. Furthermore, the SiO2/TMP-LDI tissue adhesive exhibited satisfactory temperature change during curing and degradation performance. In vitro and in vivo studies demonstrated that SiO2/TMP-LDI exhibited good biocompatibility, efficient hemostasis, antimicrobial properties, and the ability to promote wound healing. This research presents a novel approach for the development of tissue adhesives with superior adhesive performance.

Moldable Tissue-Sealant Hydrogels Composed of In Situ Cross-Linkable Polyethylene Glycol via Thiol-Michael Addition and Carbomers

Moldable tissue-sealant hydrogels were developed herein by combining the yield stress fluidity of a Carbomer and in situ cross-linking of 3-arm PEG-thiol (PEG-SH) and 4-arm PEG-acrylate (PEG-AC). The Carbomer was mixed with each PEG oligomer to form two aqueous precursors: Carbomer/PEG-SH and Carbomer/PEG-AC. The two hydrogel precursors exhibited sufficient yield stress (>100 Pa) to prevent dripping from their placement on the tissue surface. Moreover, these hydrogel precursors exhibited rapid restructuring when the shear strain was repeatedly changed. These rheological properties contribute to the moldability of these hydrogel precursors. After mixing these two precursors, they were converted from yield-stress fluids to chemically cross-linked hydrogels, Carbomer/PEG hydrogel, via thiol-Michael addition. The gelation time was 5.0 and 11.2 min at 37 and 25 °C, respectively. In addition, the Carbomer/PEG hydrogels exhibited higher cellular viability than the pure Carbomer. They also showed stable adhesiveness and burst pressure resistance to various tissues, such as the skin, stomach, colon, and cecum of pigs. The hydrogels showed excellent tissue sealing in a cecum ligation and puncture model in mice and improved the survival rate due to their tissue adhesiveness and biocompatibility. The Carbomer/PEG hydrogel is a potential biocompatible tissue sealant that surgeons can mold. It was revealed that the combination of in situ cross-linkable PEG oligomers and yield stress fluid such as Carbomer is effective for developing the moldable tissue sealant without dripping of its hydrogel precursors.

Recent Advances in the Degradability and Applications of Tissue Adhesives Based on Biodegradable Polymers

In clinical practice, tissue adhesives have emerged as an alternative tool for wound treatments due to their advantages in ease of use, rapid application, less pain, and minimal tissue damage. Since most tissue adhesives are designed for internal use or wound treatments, the biodegradation of adhesives is important. To endow tissue adhesives with biodegradability, in the past few decades, various biodegradable polymers, either natural polymers (such as chitosan, hyaluronic acid, gelatin, chondroitin sulfate, starch, sodium alginate, glucans, pectin, functional proteins, and peptides) or synthetic polymers (such as poly(lactic acid), polyurethanes, polycaprolactone, and poly(lactic-co-glycolic acid)), have been utilized to develop novel biodegradable tissue adhesives. Incorporated biodegradable polymers are degraded in vivo with time under specific conditions, leading to the destruction of the structure and the further degradation of tissue adhesives. In this review, we first summarize the strategies of utilizing biodegradable polymers to develop tissue adhesives. Furthermore, we provide a symmetric overview of the biodegradable polymers used for tissue adhesives, with a specific focus on the degradability and applications of these tissue adhesives. Additionally, the challenges and perspectives of biodegradable polymer-based tissue adhesives are discussed. We expect that this review can provide new inspirations for the design of novel biodegradable tissue adhesives for biomedical applications.

Molecular Crowding: The History and Development of a Scientific Paradigm

It is now generally accepted that macromolecules do not act in isolation but "live" in a crowded environment, that is, an environment populated by numerous different molecules. The field of molecular crowding has its origins in the far 80s but became accepted only by the end of the 90s. In the present issue, we discuss various aspects that are influenced by crowding and need to consider its effects. This Review is meant as an introduction to the theme and an analysis of the evolution of the crowding concept through time from colloidal and polymer physics to a more biological perspective. We introduce themes that will be more thoroughly treated in other Reviews of the present issue. In our intentions, each Review may stand by itself, but the complete collection has the aspiration to provide different but complementary perspectives to propose a more holistic view of molecular crowding.

Biochemical and biomechanical characterization of an autologous protein-based fibrin sealant for regenerative medicine

Accidental events or surgical procedures usually lead to tissue injury. Fibrin sealants have proven to optimize the healing process but have some drawbacks due to their allogeneic nature. Autologous fibrin sealants present several advantages. The aim of this study is to evaluate the performance of a new autologous fibrin sealant based on Endoret®PRGF® technology (E-sealant). One of the most widely used commercial fibrin sealants (Tisseel®) was included as comparative Control. E-sealant´s hematological and biological properties were characterized. The coagulation kinetics and the microstructure were compared. Their rheological profile and biomechanical behavior were also recorded. Finally, the swelling/shrinkage capacity and the enzymatic degradation of adhesives were determined. E-sealant presented a moderate platelet concentration and physiological levels of fibrinogen and thrombin. It clotted 30 s after activation. The microstructure of E-sealant showed a homogeneous fibrillar scaffold with numerous and scattered platelet aggregates. In contrast, Control presented absence of blood cells and amorphous protein deposits. Although in different order of magnitude, both adhesives had similar rheological profiles and viscoelasticity. Control showed a higher hardness but both adhesives presented a pseudoplastic hydrogel nature with a shear thinning behavior. Regarding their adhesiveness, E-sealant presented a higher tensile strength before cohesive failure but their elastic stretching capacity and maximum elongation was similar. While E-sealant presented a significant shrinkage process, Control showed a slight swelling over time. In addition, E-sealant presented a high enzymatic resorption rate, while Control showed to withstand the biodegradation process in a significant way. E-sealant presents optimal biochemical and biomechanical properties suitable for its use as a fibrin sealant with regenerative purposes.

A nature-inspired multifunctional adhesive for cartilage tissue-biomaterial integration

Surgical adhesives play a crucial role in tissue integration and repair, yet their application in wet conditions has been severely limited by inadequate adhesive strength and subpar biocompatibility. Furthermore, tissue adhesives have rarely been reported in cartilage tissue repair. In this study, a three-armed dopamine-modified hyaluronic acid derivative adhesive was prepared to function as a bio-inspired adhesive in moist environments. To meet the clinical requirements for cartilage tissue adhesion, we studied its chemical structure, including microscopic morphology, adhesion properties with materials and tissues, in vivo degradation rules, and biological evaluation. The OGMHA8-DOPA adhesive with the optimal aldehyde substitution degree and dopamine-grafting rate was determined by analyzing the experimental conditions. SEM results revealed that the cartilage tissue adhered to a porous interconnected structure. The excellent biocompatibility of the material not only facilitated chondrocyte adhesion but also supported their proliferation on its surface. Animal experiments have demonstrated that this material has no observable inflammatory response or incidence of fibrous capsule formation. The degradation timeline of the material extends beyond the duration of two weeks. The dopamine-modified adhesive exhibited a tight interfacial binding force between the biomaterial and cartilage tissue and excellent biocompatibility in watery tissue, revealing its potential for application in cartilage tissue repair and minimally invasive surgery.

Manipulating mechanical properties of PEG-based hydrogel nanocomposite: A potential versatile bio-adhesive for the suture-less repair of tissue

Multifunctional bio-adhesives with tunable mechanical properties are obtained by controlling the orientation of anisotropic particles in a blend of fast-curing hydrogel with an imposed capillary flow. The suspensions' microstructural evolution was monitored by the small-angle light scattering (SALS) method during flow up to the critical Péclet number (Pe≈1) necessary for particle orientation and hydrogel crosslinking. The multifunctional bio-adhesives were obtained by combining flow and UV light exposure for rapid photo-curing of PEGDA medium and freezing titania rods' ordered microstructures. Blending the low- and high-molecular weight of PEGDA polymer improved the mechanical properties of the final hydrogel. All the hydrogel samples were non-cytotoxic up to 72 h after cell culturing. The system shows rapid blood hemostasis and promotes adhesive and cohesive strength matching targeted tissue properties with an applicating methodology compatible with surgical conditions. The developed SALS approach to optimize nanoparticles' microstructures in bio-adhesive applies to virtually any optically transparent nanocomposite and any type of anisotropic nanoparticles. As such, this method enables rational design of bio-adhesives with enhanced anisotropic mechanical properties which can be tailored to potentially any type of tissue.

Multifunctional chitosan-based gel sponge with efficient antibacterial, hemostasis and strong adhesion

Developing wound dressings with solid adhesive properties that enable efficient, painless hemostasis and prevent wound infection remain a huge challenge. Herein, the tris(hydroxymethyl) methyl glycine-modified chitosan derivative (CTMG) was prepared and freeze-dried after simply adjusting the concentration of CTMG to obtain the chitosan-based gel sponge with desired multi-hollow structure, special antibacterial and biocompatibility. The adhesion strength on porcine skin was impressive up to 113 KPa, much higher than fibrin glue. It can withstand the pressure that far exceeds blood pressure. CTMG exhibits bacteriostatic abilities as demonstrated in a bacteriostatic assay, and alongside biocompatibility, as shown in cytotoxicity and hemolytic assays. Moreover, CTMG gel sponge showed hemostatic properties in both in vivo and in vitro hemostasis experiments. During an experiment on liver hemorrhage in rats, CTMG gel sponge proved to be more effective in controlling bleeding than other hemostatic sponges available on the market, indicating its promising hemostatic properties. CTMG gel sponge possesses the potential to function as a wound dressing and hemostatic material, making it suitable for various clinical applications.

Natural polymer-based bioadhesives as hemostatic platforms for wound healing

Medical adhesives are advanced but challenging alternatives to wound closure and repair, especially in mitigating uncontrolled hemorrhage. Ideal hemostatic adhesives need to meet good biocompatibility and biodegradability, adequate mechanical strength, and strong tissue adhesion functionality under wet and dynamic conditions. Considering these requirements, natural polymers such as polysaccharide, protein and DNA, attract great attention as candidates for making bioadhesives because of their distinctive physicochemical performances and biological properties. This review systematically summarizes the advances of bioadhesives based on natural polysaccharide, protein and DNA. Various physical and chemical cross-linking strategies have been introduced for adhesive synthesis and their hemostatic applications are introduced from the aspect of versatility. Furthermore, the possible challenges and future opportunities of bioadhesives are discussed, providing insights into the development of high-performance hemostatic materials.

A Customizable Proteinic Bioadhesive Patch with Water-Switchable Underwater Adhesiveness, Adjustable Biodegradability, and Modifiable Stretchability for Healing Diverse Internal Wounds

Customizable bioadhesives for individual organ requirements, including tissue type and motion, are essential, especially given the rise in implantable medical device applications demanding adequate underwater adhesion. While synthetic bioadhesives are widely used, their toxicity upon degradation shifts focus to biocompatible natural biomaterials. However, enhancing the adhesive strengths of these biomaterials presents ongoing challenges while accommodating the unique properties of specific organs. To address these issues, three types of customized underwater bioadhesive patches (CUBAPs) with strong, water-responsive adhesion and controllable biodegradability and stretchability based on bioengineered mussel adhesive proteins conjugated with acrylic acid and/or methacrylic acid are proposed. The CUBAP system, although initially nonadhesive, shows strong underwater adhesion upon hydration, adjustable biodegradation, and adequate physical properties by adjusting the ratio of poly(acrylic acid) and poly(methacrylic acid). Through ex vivo and in vivo evaluations using defective organs and the implantation of electronic devices, the suitability of using CUBAPs for effective wound healing in diverse internal organs is demonstrated. Thus, this innovative CUBAP system offers strong underwater adhesiveness with tailored biodegradation timing and physical properties, giving it great potential in various biomedical applications.

Injectable, Antibacterial, and Hemostatic Tissue Sealant Hydrogels

Hemorrhage and bacterial infections are major hurdles in the management of life-threatening surgical wounds. Most bioadhesives for wound closure lack sufficient hemostatic and antibacterial properties. Furthermore, they suffer from weak sealing efficacy, particularly for stretchable organs, such as the lung and bladder. Accordingly, there is an unmet need for mechanically robust hemostatic sealants with simultaneous antibacterial effects. Here, an injectable, photocrosslinkable, and stretchable hydrogel sealant based on gelatin methacryloyl (GelMA), supplemented with antibacterial zinc ferrite (ZF) nanoparticles and hemostatic silicate nanoplatelets (SNs) for rapid blood coagulation is nanoengineered. The hydrogel reduces the in vitro viability of Staphylococcus aureus by more than 90%. The addition of SNs (2% w/v) and ZF nanoparticles (1.5 mg mL-1 ) to GelMA (20% w/v) improves the burst pressure of perforated ex vivo porcine lungs by more than 40%. Such enhancement translated to ≈250% improvement in the tissue sealing capability compared with a commercial hemostatic sealant, Evicel. Furthermore, the hydrogels reduce bleeding by ≈50% in rat bleeding models. The nanoengineered hydrogel may open new translational opportunities for the effective sealing of complex wounds that require mechanical flexibility, infection management, and hemostasis.

Bioadhesives with Antimicrobial Properties

Bioadhesives with antimicrobial properties enable easier and safer treatment of wounds as compared to the traditional methods such as suturing and stapling. Composed of natural or synthetic polymers, these bioadhesives seal wounds and facilitate healing while preventing infections through the activity of locally released antimicrobial drugs, nanocomponents, or inherently antimicrobial polers. Although many different materials and strategies are employed to develop antimicrobial bioadhesives, the design of these biomaterials necessitates a prudent approach as achieving all the required properties including optimal adhesive and cohesive properties, biocompatibility, and antimicrobial activity can be challenging. Designing antimicrobial bioadhesives with tunable physical, chemical, and biological properties will shed light on the path for future advancement of bioadhesives with antimicrobial properties. In this review, the requirements and commonly used strategies for developing bioadhesives with antimicrobial properties are discussed. In particular, different methods for their synthesis and their experimental and clinical applications on a variety of organs are reviewed. Advances in the design of bioadhesives with antimicrobial properties will pave the way for a better management of wounds to increase positive clinical outcomes.

Nanotechnology development in surgical applications: recent trends and developments

This paper gives a detailed analysis of nanotechnology's rising involvement in numerous surgical fields. We investigate the use of nanotechnology in orthopedic surgery, neurosurgery, plastic surgery, surgical oncology, heart surgery, vascular surgery, ophthalmic surgery, thoracic surgery, and minimally invasive surgery. The paper details how nanotechnology helps with arthroplasty, chondrogenesis, tissue regeneration, wound healing, and more. It also discusses the employment of nanomaterials in implant surfaces, bone grafting, and breast implants, among other things. The article also explores various nanotechnology uses, including stem cell-incorporated nano scaffolds, nano-surgery, hemostasis, nerve healing, nanorobots, and diagnostic applications. The ethical and safety implications of using nanotechnology in surgery are also addressed. The future possibilities of nanotechnology are investigated, pointing to a possible route for improved patient outcomes. The essay finishes with a comment on nanotechnology's transformational influence in surgical applications and its promise for future breakthroughs.

Biological and Adhesive Properties of an Autologous Protein-Based Fibrin Sealant for Ophthalmological Applications

Purpose

The aim of this study was to evaluate the biological and adhesive properties of a new autologous sealant based on plasma rich in growth factors (PRGF), named E-Sealant.

Methods

Conventional PRGF and a commercial fibrin sealant (Tisseel) were included as controls. The hematological and protein content of E-Sealant was determined. Its bioactivity and biocompatibility were tested for human keratocytes (HKs). To evaluate its adhesion and regenerative capacity, E-Sealant was used on an animal model of conjunctival autograft surgery and compared to Tisseel.

Results

E-Sealant presented a high growth factor content with levels similar to those of conventional PRGF. E-Sealant induced proliferative and migratory activity on HK cells equivalent to PRGF. Although autologous membranes induced the proliferation of HKs, cells cultured over Tisseel did not adhere nor proliferate. HK cells showed increased number and flattened morphology over PRGF and E-Sealant compared to scarce and round-shape cells detected in Tisseel. Conjunctival autograft glued with E-Sealant adhered successfully, whereas Tisseel application formed irregular clots. During follow-up, both adhesives showed good integration and no dehiscence. However, Tisseel-treated samples presented slightly increased hemorrhage and inflammation. In contrast to Tisseel, E-Sealant-treated autografts presented a continuous layer of non-keratinized stratified squamous epithelium. Inflammatory infiltrates were minimal in E-Sealant-treated conjunctiva, whereas the Tisseel group showed noticeable immune reactions. Unlike Tisseel-treated grafts, E-Sealant presented low immunoreactivity for smooth muscle actin (SMA), suggesting decreased fibrotic tissue formation.

Conclusions

E-Sealant presents optimal biological and adhesive properties suitable for use as an ophthalmic glue, with regenerative purposes superior to commercial fibrin sealants.

Translational Relevance

Our study analyzed the characterization and biological activity of a new autologous fibrin sealant in ocular surface cells and in an animal model in which the adhesive and regenerative properties of the fibrin sealant were evaluated.

Sea squirt-inspired bio-derived tissue sealants

Sea squirts' or tunicates' bodies are composed of cellulose nanofibers and gallol- functionalized proteins. These sea creatures are known to heal their injuries under seawater by forming crosslinks between gallols and functional groups from other proteins in their bodies. Inspired by their wound healing mechanism, herein, we have developed a tissue sealant using zein (a plant-based protein) and tannic acid (gallol-containing polyphenol). Except for fibrin- based sealants, most commercial surgical adhesives, and sealants available today are derived from petroleum products that compromise their biodegradability. They often have complicated and multi-step synthesis processes that ultimately affect their affordability. To overcome this challenge, we ensured that these sea squirt-inspired tissue sealants are bio-based, easily synthesized, and low-cost. The sealants were studied on their own and with a food-grade enzyme transglutaminase. The adhesion performances of the sealants were found to be higher than physiological pressures in seven out of nine different tissue substrates studied here. Their performance was also better than or on par with the FDA-approved fibrin sealant Tisseel. Ex vivo models demonstrate instant sealing of leaking wounds in less than a minute. The sealants were not only cytocompatible but also showed complete wound healing on par with sutures and Tisseel when applied in vivo on skin incisions in rats. Overall, these sea squirt-inspired bio-based sealants show great potential to replace currently available wound closure methods.

Closure of Long Surgical Incisions with Hemostatic Tissue Adhesive in a Porcine Skin Model

OBJECTIVE

Skin adhesives offer many advantages over traditional wound-closure devices. Recently, the current research group reported on tissue adhesives composed of natural polymers (gelatin and alginate), which are biocompatible with mechanical properties suitable for tissue adhesion. The objective of the present study was to conduct clinical and histologic assessment of this hemostatic bioadhesive in the healing of long skin incisions (≥4 cm) in comparison with traditional and commercially available methods.

METHODS

Researchers created 24 long incisions on the ventral side of two domestic pigs to compare four different treatment modalities: two topical bioadhesives based on gelatin and alginate combined with the hemostatic agent kaolin, nylon sutures, and commercial tissue adhesive N-butyl-2-cyanoacrylate. The bioadhesive compounds were spread on the incision surface and then mixed either manually or with a double-headed syringe. After 14 days, clinical and histologic measurements were performed to evaluate the healing phase of the wounds.

RESULTS

The bioadhesive formulation that contained a relatively low crosslinker concentration demonstrated superior results to the formulation that contained a standard crosslinker concentration. However, no significant statistical differences were observed compared with the control incisions (sutures and commercial adhesive N-butyl-2-cyanoacrylate). This was verified by immunohistochemical analysis for epithelial integrity and scar formation as well as by clinical assessment.

CONCLUSIONS

This newly developed bioadhesive demonstrated suitable properties for the closure of long incisions in a porcine skin model.

Re-Assemblable, Recyclable, and Self-Healing Epoxy Resin Adhesive Based on Dynamic Boronic Esters

Thermosetting adhesives are commonly utilized in various applications. However, covalent cross-linked networks prevent thermosetting adhesives from being re-assembled, which necessitates higher machining precision. Additionally, the primary raw materials used in adhesive preparation are derived from non-renewable petroleum resources, which further constrain adhesive development. In this study, a recyclable adhesive was developed by incorporating dynamic boronic esters into epoxy resin derived from soybean oil. The successful synthesis of epoxidized soybean oil and boronic esters was confirmed through the analysis of proton nuclear magnetic resonance spectra and differential scanning calorimetry results. Swelling tests and tensile curves demonstrated the presence of covalently cross-linked networks. Self-healing and reprocessing experiments indicated that the cross-linked network topology could be re-assembled under mild conditions.

Synthetic Pressure Sensitive Adhesives for Biomedical Applications

Pressure sensitive adhesives are components of everyday products found in homes, offices, industries, and hospitals. Serving the general purpose of fissure repair and object fixation, pressure sensitive adhesives indiscriminately bind surfaces, as long as contact pressure is administered at application. With that being said, the chemical and material properties of the adhesive formulation define the strength of a pressure sensitive adhesive to a particular surface. Given our increased understanding of the viscoelastic material requirements as well as the intermolecular interactions at the binding interface required for functional adhesives, pressure sensitive adhesives are now being explored for greater use. New polymer formulations impart functionality and degradability for both internal and external applications. This review highlights the structure-property relationships between polymer architecture and pressure sensitive adhesion, specifically for medicine. We discuss the rational, molecular-level design of synthetic polymers for durable, removable, and biocompatible adhesion to wet surfaces like tissue. Finally, we examine prevalent challenges in biomedical wound closure and the new, innovative strategies being employed to address them. We conclude by summarizing the progress of current research, identifying additional clinical opportunities, and discussing future prospects.

Cyanoacrylate Tissue Adhesives Compared With Sutures on Facial and Neck Wounds: A Meta-analysis

Objective

To compare the effectiveness between cyanoacrylate tissue adhesives (CTAs) and sutures for skin closure on the face and neck.

Data Sources

Embase, Medline, Scopus, Central, Web of Science.

Review Methods

Randomized controlled trials comparing CTAs versus sutures for skin closure on the face and neck were included. Primary outcomes were cosmetic outcomes. Secondary outcomes were scar depth, scar width, pain, closure time, cost, and adverse events. Subgroup analyses were performed by wound locations, type of CTAs, type of sutures, age groups, and type of wounds. Physicians and patients evaluated the cosmetic outcomes.

Results

Eighteen studies (1020 patients) were included. CTAs offered better cosmetic outcomes by Wound Registry Scale at ≤1 month (physician: mean difference [MD]: -1.50, 95% confidence interval, CI: -2.42 to -0.58). The cosmetic outcomes assessed by Visual Analog Scale were comparable at >1 to ≤3 months (physicians: standard mean difference [SMD], -0.01, 95% CI, -0.25 to 0.23, patients: SMD, -0.02, 95% CI, -0.84 to 0.79). The cosmetic outcomes by the Patient and Observer Scar Assessment Scale favored sutures at >3 to 12 months (physician: MD 4.26, 95% CI, 2.02-6.50). Subgroup analyses revealed no differences. CTAs offered less scar depth, scar width, pain, closure time, and total cost of closure. Adverse events were similar.

Conclusion

Based on the wound healing process, the cosmetic outcomes exhibited a favorable inclination toward CTAs at <1 month while demonstrating comparable results between CTAs and sutures at >1 to ≤3 months. Subsequently, sutures exhibited superior cosmetic outcomes compared to CTAs at >3 to 12 months.

Adhesive and self-healing materials for central nervous system repair

The central nervous system (CNS) has a limited ability to regenerate after a traumatic injury or a disease due to the low capacity of the neurons to re-grow and the inhibitory environment formed in situ. Current therapies include the use of drugs and rehabilitation, which do not fully restore the CNS functions and only delay the pathology progression. Tissue engineering offers a simple and versatile solution for this problem through the use of bioconstructs that promote nerve tissue repair by bridging cavity spaces. In this approach, the choice of biomaterial is crucial. Herein, we present recent advances in the design and development of adhesive and self-healing materials that support CNS healing. The adhesive materials have the advantage of promoting recovery without the use of needles or sewing, while the self-healing materials have the capacity to restore the tissue integrity without the need for external intervention. These materials can be used alone or in combination with cells and/or bioactive agents to control the inflammation, formation of free radicals, and proteases activity. We discuss the advantages and drawbacks of different systems. The remaining challenges that can bring these materials to clinical reality are also briefly presented.

Bone adhesive materials: From bench to bedside

Biodegradable bone adhesives represent a highly sought-after type of biomaterial which would enable replacement of traditional metallic devices for fixation of bone. However, these biomaterials should fulfil an extremely large number of requirements. As a consequence, bone-adhesive biomaterials which meet all of these requirements are not yet commercially available. Therefore, this comprehensive review provides an extensive overview of the development of bone adhesives from a translational perspective. First, the definition, classification, and chemistry of various types of bone adhesives are highlighted to provide a detailed overview of this emerging class of biomaterials. In this review we particularly focused studies which describe the use of materials that are capable of gluing two pieces of bone together within a time frame of minutes to days. Second, this review critically reflects on i) the experimental conditions of commonly employed adhesion tests to assess bone adhesion and ii) the current state-of-the-art regarding their preclinical and clinical applicability.

Dual crosslinked injectable protein-based hydrogels with cell anti-adhesive properties

Currently, one of the most severe clinical concerns is post-surgical tissue adhesions. Using films or hydrogel to separate the injured tissue from surrounding tissues has proven the most effective method for minimizing adhesions. Therefore, by combining dual crosslinking with calcium ions (Ca²⁺) and tetrakis(hydroxymethyl) phosphonium chloride, we were able to create a novel, stable, robust, and injectable dual crosslinking hydrogel using albumin (BSA). This dual crosslinking has preserved the microstructure of the hydrogel network during the degradation process, which contributes to the hydrogel's mechanical strength and stability in a physiological situation. At 60% strain, compressive stress was 48.81 kPa obtained. It also demonstrated excellent self-healing characteristics (within 25 min), tissue adhesion, excellent cytocompatibility, and a quick gelling time of 27 ± 6 s. Based on these features, the dual crosslinked injectable hydrogels might find exciting applications in biomedicine, particularly for preventing post-surgical adhesions.

Adhesive hydrogels in osteoarthritis: from design to application

Osteoarthritis (OA) is the most common type of degenerative joint disease which affects 7% of the global population and more than 500 million people worldwide. One research frontier is the development of hydrogels for OA treatment, which operate either as functional scaffolds of tissue engineering or as delivery vehicles of functional additives. Both approaches address the big challenge: establishing stable integration of such delivery systems or implants. Adhesive hydrogels provide possible solutions to this challenge. However, few studies have described the current advances in using adhesive hydrogel for OA treatment. This review summarizes the commonly used hydrogels with their adhesion mechanisms and components. Additionally, recognizing that OA is a complex disease involving different biological mechanisms, the bioactive therapeutic strategies are also presented. By presenting the adhesive hydrogels in an interdisciplinary way, including both the fields of chemistry and biology, this review will attempt to provide a comprehensive insight for designing novel bioadhesive systems for OA therapy.

An Instant Underwater Tissue Adhesive Composed of Catechin-Chondroitin Sulfate and Cholesterol-Polyethyleneimine

Due to the safety issue and poor underwater adhesion of current commercially available bioadhesives, they are hard to apply to in vivo physiological environments and more diverse medical use conditions. In this study, a novel and facile bioadhesive for underwater medical applications are designed based on the coacervation of electrostatic interactions and hydrophobic interactions, with the introduction of catechin as a provider of catechol moieties for adhesion to surrounding tissues. The orange-colored bio-adhesive, named PcC, is generated within seconds by mixing catechin-modified chondroitin sulfate and cholesterol chloroformate-modified polyethyleneimine with agitation. In vitro mechanical measurements prove that this novel PcC bio-adhesive is superior in underwater adhesion performance when applied to cartilage. Animal experiments in a rat mastectomy model and rat cartilage graft implantation model demonstrate its potential for diverse medical purposes, such as closing surgical incisions, reducing the formation of seroma, and tissue adhesive applied in orthopedic or cartilage surgery.

Dual action of a tyrosinase-mesoporous silica nanoparticle complex for synergistic tissue adhesion

Bridging biological tissues for immediate adhesion and long-term sustainability was accomplished using a combination of mesoporous silica nanoparticles (MSNs) and tyrosinase. Tyrosinase-loaded MSNs provided rapid physical adsorption, while tyrosinase within MSNs induced enzymatic chemical bond gluing of tissues. This synergistic strategy has robust potential in tissue adhesives for clinical settings.

Composition, host responses and clinical applications of bioadhesives

Bioadhesives are medical devices used to join or seal tissues that have been injured or incised. They have been classified into tissue adhesives, sealants, and hemostatic agents. Bioadhesives such as FloSeal®, CoSeal®, BioGlue®, Evicel®, Tisseel®, Progel™ PALS, and TissuGlu® have been commercialized and used in clinical setting. They can be formulated with natural or synthetic components or a combination of both including albumin, glutaraldehyde, chitosan, cyanoacrylate, fibrin and thrombin, gelatin, polyethylene glycol (PEG), along with urethanes. Each formulation has intrinsic properties and has been developed and validated for a specific application. This review article briefs the mechanisms by which bioadhesives forms adhesion to tissues and highlights the correlation between bioadhesives composition and their potential host responses. Furthermore, clinical applications of bioadhesives and their application-driven requirements are outlined.

Rapid Ultratough Topological Tissue Adhesives

Tissue adhesives capable of achieving strong and tough adhesion in permeable wet environments are useful in many biomedical applications. However, adhesion generated through covalent bond formation directly with the functional groups of tissues (i.e., COOH and NH2  groups in collagen), or using non-covalent interactions can both be limited by weak, unstable, or slow adhesion. Here, it is shown that by combining pH-responsive bridging chitosan polymer chains and a tough hydrogel dissipative matrix one can achieve unprecedented ultratough adhesion to tissues (>2000 J m-2 ) in 5-10 min without covalent bond formation. The strong non-covalent adhesion is shown to be stable under physiologically relevant conditions and strongly influenced by chitosan molecular weight, molecular weight of polymers in the matrix, and pH. The adhesion mechanism relies primarily on the topological entanglement between the chitosan chains and the permeable adherends. To further expand the applicability of the adhesives, adhesion time can be decreased by dehydrating the hydrogel matrix to facilitate rapid chitosan interpenetration and entanglement (>1000 J m-2  in ≤1 min). The unprecedented adhesive properties presented in this study open opportunities for new strategies in the development of non-covalent tissue adhesives and numerous bioapplications.

Medical Adhesives and Their Role in Laparoscopic Surgery—A Review of Literature

Laparoscopic surgery is undergoing rapid development. Replacing the traditional method of joining cut tissues with sutures or staples could greatly simplify and speed up laparoscopic procedures. This alternative could undoubtedly be adhesives. For decades, scientists have been working on a material to bond tissues together to create the best possible conditions for tissue regeneration. The results of research on tissue adhesives achieved over the past years show comparable treatment effects to traditional methods. Tissue adhesives are a good alternative to surgical sutures in wound closure. This article is a review of the most important groups of tissue adhesives including their properties and possible applications. Recent reports on the development of biological adhesives are also discussed.

Solution structure of recombinant Pvfp-5β reveals insights into mussel adhesion

Some marine organisms can resist to aqueous tidal environments and adhere tightly on wet surface. This behavior has raised increasing attention for potential applications in medicine, biomaterials, and tissue engineering. In mussels, adhesive forces to the rock are the resultant of proteinic fibrous formations called byssus. We present the solution structure of Pvfp-5β, one of the three byssal plaque proteins secreted by the Asian green mussel Perna viridis, and the component responsible for initiating interactions with the substrate. We demonstrate that Pvfp-5β has a stably folded structure in agreement with the presence in the sequence of two EGF motifs. The structure is highly rigid except for a few residues affected by slow local motions in the µs-ms time scale, and differs from the model calculated by artificial intelligence methods for the relative orientation of the EGF modules, which is something where computational methods still underperform. We also show that Pvfp-5β is able to coacervate even with no DOPA modification, giving thus insights both for understanding the adhesion mechanism of adhesive mussel proteins, and developing of biomaterials.

A double crosslinking adhesion mechanism for developing tough hydrogel adhesives

Tough hydrogel adhesives that consist of a robust gel network and can strongly adhere to wet tissues have shown great promise as the next generation of bioadhesives. While a variety of chemistries can be utilized to construct the tough gel network, the covalent conjugation methods for tissue adhesion are still limited. Here we report, for the first time, the use of side product-free amine-thiolactone chemistry which initiates a double crosslinking adhesion mechanism to develop tough gel adhesives. Thiolactone groups can conjugate with tissue-surface amines via a ring-opening reaction. The resultant thiol end groups can be further crosslinked into disulfide linkages, enabling the formation of a robust and stable adhesion layer. The thiolactone-bearing tough hydrogel composed of methacrylate-modified gelatin, acrylic acid, and thiolacone acrylamide exhibited good biocompatibility and mechanical properties, and strong adhesion to various types of engineering solids and tissues. We also demonstrated its ability to function as a tissue sealant and drug depot. The novel adhesion mechanism will diversify future design of bioadhesives for hemostasis, drug delivery, tissue repair, and other applications. STATEMENT OF SIGNIFICANCE: Tough hydrogel adhesives with excellent tissue-adhesive and mechanical properties have demonstrated tremendous promise for hemostasis, tissue repair, and drug delivery applications. However, the covalent chemistry for tissue adhesion has been limited, which narrows the choice of materials for the design of bioadhesives and may pose a safety concern. Here, for the first time, we report the use of side product-free amine-thiolactone chemistry, which involves a double crosslinking adhesion mechanism, for developing tough hydrogel adhesives. We demonstrate that thiolactone-bearing tough hydrogels exhibit favorable biocompatibility and mechanical properties, and superior adhesion to both engineering solids and tissues. Our new adhesion technology will greatly facilitate future development of advanced bioadhesives for numerous biomedical applications.

Applications of Electrospun Drug-Eluting Nanofibers in Wound Healing: Current and Future Perspectives

Wounds are a consequence of disruption in the structure, integrity, or function of the skin or tissue. Once a wound is formed following mechanical or chemical damage, the process of wound healing is initiated, which involves a series of chemical signaling and cellular mechanisms that lead to regeneration and/or repair. Disruption in the healing process may result in complications; therefore, interventions to accelerate wound healing are essential. In addition to mechanical support provided by sutures and traditional wound dressings, therapeutic agents play a major role in accelerating wound healing. The medicines known to improve the rate and extent of wound healing include antibacterial, anti-inflammatory, and proliferation enhancing agents. Nonetheless, the development of these agents into eluting nanofibers presents the possibility of fabricating wound dressings and sutures that provide mechanical support with the added advantage of local delivery of therapeutic agents to the site of injury. Herein, the process of wound healing, complications of wound healing, and current practices in wound healing acceleration are highlighted. Furthermore, the potential role of drug-eluting nanofibers in wound management is discussed, and lastly, the economic implications of wounds as well as future perspectives in applying fiber electrospinning in the design of wound dressings and sutures are considered and reported.

Tissue Adhesives in Reconstructive and Aesthetic Surgery—Application of Silk Fibroin-Based Biomaterials

Tissue adhesives have been successfully used in various kind of surgeries such as oral and maxillofacial surgery for some time. They serve as a substitute for suturing of tissues and shorten treatment time. Besides synthetic-based adhesives, a number of biological-based formulations are finding their way into research and clinical application. In natural adhesives, proteins play a crucial role, mediating adhesion and cohesion at the same time. Silk fibroin, as a natural biomaterial, represents an interesting alternative to conventional medical adhesives. Here, the most commonly used bioadhesives as well as the potential of silk fibroin as natural adhesives will be discussed.

Strong and bioactive bioinspired biomaterials, next generation of bone adhesives

The bone adhesive is a clinical requirement for complicated bone fractures always articulated by surgeons. Applying glue is a quick and easy way to fix broken bones. Adhesives, unlike conventional fixation methods such as wires and sutures, improve healing conditions and reduce postoperative pain by creating a complete connection at the fractured joint. Despite many efforts in the field of bone adhesives, the creation of a successful adhesive with robust adhesion and appropriate bioactivity for the treatment of bone fractures is still in its infancy. Because of the resemblance of the body's humid environment to the underwater environment, in the latest decades, researchers have pursued inspiration from nature to develop strong bioactive adhesives for bone tissue. The aim of this review article is to discuss the recent state of the art in bone adhesives with a specific focus on biomimetic adhesives, their action mechanisms, and upcoming perspective. Firstly, the adhesive biomaterials with specific affinity to bone tissue are introduced and their rational design is studied. Consequently, various types of synthetic and natural bioadhesives for bone tissue are comprehensively overviewed. Then, bioinspired-adhesives are described, highlighting relevant structures and examples of biomimetic adhesives mainly made of DOPA and the complex coacervates inspired by proteins secreted in mussel and sandcastle worms, respectively. Finally, this article overviews the challenges of the current bioadhesives and the future research for the improvement of the properties of biomimetic adhesives for use as bone adhesives.

Biodegradable polyaspartamide-g-C18 /DOPA/GLY-NEO nano-adhesives for wound closure/healing with antimicrobial activity

This study was focused on the development of biodegradable nano-adhesives with efficient sealing and antibiotic effects for wound healing. Biodegradable polyaspartamide (PASPAM) was grafted with several functional groups to implement diverse roles-octadecylamine (C₁₈ ) for nano-aggregate formation, dopamine (DOPA) for adhesive function, neomycin (NEO) for inhibition of bacterial infection. Specifically, NEO was conjugated to PASPAM with a pH-sensitive glycine (GLY) linker for targeted delivery on the acidic wound site. About 60% of the drug was ramteleased at pH 6.0, while about 22% was released at pH 7.4, showing the faster drug release pattern of nano-adhesives in the acidic environment. The C₁₈ /DOPA/GLY-NEO-g-PASPAM nano-adhesives showed the bacterial viability higher than 70% at pH 7.4, but about 40% at pH 6.0. The wound breaking strength of the polymer-treated skin was much higher than that of the bare skin. According to the in vivo wound healing test using a mouse model, C₁₈ /DOPA/GLY-NEO-g-PASPAM nano-adhesives showed much faster healing performance than sutures. From those results, C₁₈ /DOPA/GLY-NEO-g-PASPAM nano-adhesives are expected to be utilized as effective adhesives that promote the wound healing with inhibition of bacterial infection.

The tick and I: Parasite-host interactions between ticks and humans

Ticks, particularly hard ticks (Ixodidae), which are among the most important vectors of dangerous infectious agents, feed on their hosts for extended periods of time. With this lifestyle, numerous adaptations have evolved in ticks and their hosts, the pharmacological importance of which is increasingly being recognized. Many bioactive substances in tick saliva are being considered as the basis of new drugs. For example, components of tick cement can be developed into tissue adhesives or wound closures. Analgesic and antipruritic salivary components inhibit histamine or bradykinin, while other tick-derived molecules bind opioid or cannabinoid receptors. Tick saliva inhibits the extrinsic, intrinsic, or common pathway of blood coagulation with implications for the treatment of thromboembolic diseases. It contains vasodilating substances and affects wound healing. The broad spectrum of immunomodulatory and immunosuppressive effects of tick saliva, such as inhibition of chemokines or cellular immune responses, allows development of drugs against inflammation in autoimmune diseases and/or infections. Finally, modern vaccines against ticks can curb the spread of serious infections. The medical importance of the complex tick-host interactions is increasingly being recognized and translated into first clinical applications. Using selected examples, an overview of the mutual adaptations of ticks and hosts is given here, focusing on their significance to medical advance.

Cyanoacrylate Securement in Neonatal PICC Use: A 4-Year Observational Study

BACKGROUND

Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant.

PURPOSE

This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments.

METHOD AND SETTING

This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar.

RESULTS

The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type.

IMPLICATIONS FOR PRACTICE AND RESEARCH

In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.

The use of tissue sealant in reducing urethrocutaneous fistula event following hypospadias repair: A systematic review and meta-analysis

Background

One of the most frequent complications following hypospadias repair is urethrocutaneous fistula (UCF) event. Tissue sealant has been introduced as a means to reduce UCF. However, reports regarding its benefits are varied. Thus, we initiated a systematic review and meta-analysis to investigate its role in reducing UCF following hypospadias repair.

Methods

We completed a systematic search through the Embase, MEDLINE, and Scopus databases for studies assessing postoperative complications in hypospadias patients undergoing urethroplasty with and without tissue sealant. Cochrane risk of bias 2 (RoB 2) tool was used to assess the quality of randomized clinical trials (RCTs), while the observational studies were assessed with Newcastle-Ottawa Scale. The primary outcome analyzed in this study was UCF, while secondary outcomes consisted of postoperative complications such as edema, infection, and wound dehiscence that increases the risk of UCF formation, measured using odds ratio (OR) with a 95% confidence interval (CI).

Results

Six eligible studies comprising three RCTs and three non-randomized studies were included. Patients undergoing hypospadias repair with tissue sealant had lower UCF events (OR = 3.27; 95% CI 1.92–5.58; p < 0.0001). Likewise other post-operative complications, tissue sealant group had a lower rate of edema (OR = 2.29; 95% CI 1.38–3.78; p = 0.001) and infection (OR = 3.87; 95% CI 1.55–9.70; p = 0.004). The difference in wound dehiscence was insignificant between the groups (OR = 2.08; 95% CI 0.21–20.55; p = 0.53).

Conclusion

Tissue sealant can reduce UCF events following hypospadias repair as well as edema and infection that increases the risk of UCF formation.

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Tissue sealant can reduce UCF events following hypospadias repair.

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Edema and infection increase the risk of UCF formation.

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Tissue sealant provides a watertight surgical anastomosis right after application.

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Tissue sealant can resist hydrostatic pressure of urine at the surgical suture line.

Adhesion advances: from nanomaterials to biomimetic adhesion and applications

The field of adhesion has revealed a significant impact on numerous applications such as wound healing, drug delivery, electrically conductive adhesive, dental adhesive, and wood industry. Nanotechnology has continued to be the primary means to achieve adhesion. Among them, biological systems based on the unique structure of the nano-levels have developed excellent adhesion capabilities after billions of years of evolution and natural selection. Therefore, the research on bionic adhesion inspired by biological systems has gradually emerged. This review firstly focuses on the mechanism of adhesion, and secondly reports the effects of different nanomaterials on adhesion properties. Then based on the structure of mussels, geckos, tree frogs, octopuses, and other organisms, the research progress of biomimetic nanotechnology to achieve adhesion is summarized. Finally, the applications, challenges, and future directions of nanotechnology in new adhesive materials are provided.

Novel Application of Photo-Crosslinked Urocanic-Acid-Modified Chitosan in Corneal Wounds

In the last few years, the use of tissue adhesives in corneal perforation has gained immense popularity in clinical practices. The present study aimed to devise a new application of urocanic-acid-modified chitosan (CS) with methylene blue (MB) as a photosensitizer for the development of a photo-crosslinked tissue adhesive. In particular, the curing time was controlled with the aid of a 650 nm red diode. Under the same irradiation condition, the mechanical properties were tuned using the photosensitizer at different concentrations. In vitro tests revealed that the gel was ductile and biocompatible. The application of the gel to a perforated cornea model stopped the leakage of aqueous humor, immediately after the gel was photo-crosslinked. The blue appearance of the gel provided high precision when applied to corneal wounds. Importantly, the crosslinked gel became transparent within 24 h, owing to the dissipation of MB from tears, and the gel spontaneously sloughed off without artificial removal. Altogether, the study reported the development of a novel photo-crosslinkable urocanic-acid-modified CS gel that exhibited significant potential to be utilized in the healing of corneal perforation.

In situ forming hydrogel recombination with tissue adhesion and antibacterial property for tissue adhesive

In situ forming hydrogels with strong adhesive strength and antibacterial activity are of great interest to serve as tissue adhesive in fields like wound dressing and mass hemorrhage. In this study, hybrid hydrogel (GOHA) based on gelatin and oxidized hyaluronic acid was developed and endowed with excellent mechanical strength and tissue adhesion. According to our results, GOHA hydrogel exhibits a fast gelation time of around 60 s, robust compression strength of 223.43 ± 24.28 kPa, and strong adhesion of 14.33 ± 0.78 kPa to porcine skin, which is much higher than that of commercial fibrin glue (around 1.00 kPa). Meanwhile, through the loading of levofloxacin, obvious antibacterial activity can be obtained for wider applications. Notably, it would not compromise the hemocompatibility and cytocompatibility in vitro. In summary, this kind of hybrid hydrogel shows great potential as tissue adhesive in biomedical fields.