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Ghalayani Esfahani A, Sartori M, Bregoli C, Fiocchi J, Biffi CA, Tuissi A, Giavaresi G, Presentato A, Alduina R, De Luca A, Cabrini A, De Capitani C, Fini M, Gruppioni E, Lavorgna M, Ronca A. Bactericidal Activity of Silver-Doped Chitosan Coatings via Electrophoretic Deposition on Ti 6Al 4V Additively Manufactured Substrates. Polymers (Basel) 2023; 15:4130. [PMID: 37896373 PMCID: PMC10610813 DOI: 10.3390/polym15204130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Prosthetic reconstruction can serve as a feasible alternative, delivering both functional and aesthetic benefits to individuals with hand and finger injuries, frequent causes of emergency room visits. Implant-related infections pose significant challenges in arthroplasty and osteosynthesis procedures, contributing to surgical failures. As a potential solution to this challenge, this study developed a new class of silver (Ag)-doped chitosan (CS) coatings via electrophoretic deposition (EPD) on osseointegrated prostheses for infection therapy. These coatings were successfully applied to additively manufactured Ti6Al4V ELI samples. In the initial phase, the feasibility of the composite coating was assessed using the Thermogravimetric Analysis (TGA) and Attenuated Total Reflection (ATR) techniques. The optimized structures exhibited impressive water uptake in the range of 300-360%. Codeposition with an antibacterial agent proved effective, and scanning electron microscopy (SEM) was used to examine the coating morphology. Biologically, CS coatings demonstrated cytocompatibility when in direct contact with a fibroblast cell line (L929) after 72 h. When exposed to the Staphylococcus epidermidis strain (ATCC 12228), these coatings inhibited bacterial growth and biofilm formation within 24 h. These findings underscore the significant potential of this approach for various applications, including endoprostheses like hip implants, internal medical devices, and transcutaneous prostheses such as osseointegrated limb prosthetics for upper and lower extremities.
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Affiliation(s)
- Arash Ghalayani Esfahani
- Institute for Polymers, Composites and Biomaterials (IPCB), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (A.C.); (C.D.C.); (M.L.); (A.R.)
| | - Maria Sartori
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, Italy; (M.S.); (G.G.); (A.D.L.)
| | - Chiara Bregoli
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (C.B.); (J.F.); (C.A.B.); (A.T.)
| | - Jacopo Fiocchi
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (C.B.); (J.F.); (C.A.B.); (A.T.)
| | - Carlo Alberto Biffi
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (C.B.); (J.F.); (C.A.B.); (A.T.)
| | - Ausonio Tuissi
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (C.B.); (J.F.); (C.A.B.); (A.T.)
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, Italy; (M.S.); (G.G.); (A.D.L.)
| | - Alessandro Presentato
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Bd. 16, 90128 Palermo, Italy; (A.P.); (R.A.)
| | - Rosa Alduina
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Bd. 16, 90128 Palermo, Italy; (A.P.); (R.A.)
| | - Angela De Luca
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, Italy; (M.S.); (G.G.); (A.D.L.)
| | - Alessia Cabrini
- Institute for Polymers, Composites and Biomaterials (IPCB), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (A.C.); (C.D.C.); (M.L.); (A.R.)
| | - Cristina De Capitani
- Institute for Polymers, Composites and Biomaterials (IPCB), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (A.C.); (C.D.C.); (M.L.); (A.R.)
| | - Milena Fini
- Scientific Directorate, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136 Bologna, Italy;
| | - Emanuele Gruppioni
- INAIL Centro Protesi, Via Rabuina 14, Vigorso di Budrio, 40054 Bologna, Italy;
| | - Marino Lavorgna
- Institute for Polymers, Composites and Biomaterials (IPCB), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (A.C.); (C.D.C.); (M.L.); (A.R.)
| | - Alfredo Ronca
- Institute for Polymers, Composites and Biomaterials (IPCB), National Research Council (Consiglio Nazionale delle Ricerche) (CNR), Via Gaetano Previati, 1/E, 23900 Lecco, Italy; (A.C.); (C.D.C.); (M.L.); (A.R.)
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Bregoli C, Stacchiotti F, Fiocchi J, Ferrari R, Biffi CA, Morellato K, Gruppioni E, Tuissi A. A biomechanical study of osseointegrated patient-matched additively manufactured implant for treatment of thumb amputees. Med Eng Phys 2023; 118:104019. [PMID: 37536840 DOI: 10.1016/j.medengphy.2023.104019] [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: 04/12/2023] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
Thumb amputations leads to 50 % loss in hand functionality. To date, silicone vacuum prosthesis and autologous transplantation are the most adopted treatment solutions: nevertheless, vacuum prostheses lack in stability and cause skin issue and surgical treatment is not always accepted by patients. Osseointegrated implants were demonstrated to enhance stability, restore osseoperception and increase the time of prosthesis use. Thumb amputations present varying stump sizes: a standard size implant cannot address specificity of each patient, while a patient matched solution can meet surgeon requirements, by geometrical features of implant. The fixture presented in the current paper is the first additively manufactured patient matched osseointegrated implant for the treatment of thumb amputees. The current work aims to verify and validate a predictive finite element model (FEM) for mechanical strength of the presented fixture. FEM was demonstrated to correctly evaluate the mechanical strength of patient matched device. Minimum strength requirements were calculated in different core diameters: FEM were experimentally validated. Safety factor of 1.5 was guaranteed. Finally, considerations on performance of the prototype were carried out by means of insertion tests in Sawbones and axial pull-out force assessment. Cadaver tests to evaluate the entire procedure and production process are ongoing.
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Affiliation(s)
- Chiara Bregoli
- CNR ICMATE, National Research Council, Unit of Lecco, Via Previati 1/e, 23900, Lecco, Italy.
| | - Federico Stacchiotti
- Istituto di BioRobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, italy
| | - Jacopo Fiocchi
- CNR ICMATE, National Research Council, Unit of Lecco, Via Previati 1/e, 23900, Lecco, Italy
| | - Rubens Ferrari
- Istituto di BioRobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, italy
| | - Carlo Alberto Biffi
- CNR ICMATE, National Research Council, Unit of Lecco, Via Previati 1/e, 23900, Lecco, Italy
| | - Kavin Morellato
- INAIL Centro Protesi, via Rabuina 14, Vigorso di Budrio, 40054, Bologna, Italy
| | - Emanuele Gruppioni
- INAIL Centro Protesi, via Rabuina 14, Vigorso di Budrio, 40054, Bologna, Italy
| | - Ausonio Tuissi
- CNR ICMATE, National Research Council, Unit of Lecco, Via Previati 1/e, 23900, Lecco, Italy
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Shi J, Sun Y, Han Y, Chai M, Liu H, Wang J. A finite element analysis on the biomechanical performance of implant-retained finger prostheses designed for Asians. J Plast Reconstr Aesthet Surg 2022; 75:4048-4053. [DOI: 10.1016/j.bjps.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/19/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
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Bregoli C, Biffi CA, Morellato K, Gruppioni E, Primavera M, Rampoldi M, Lando M, Adani R, Tuissi A. Osseointegrated Metallic Implants for Finger Amputees: A Review of the Literature. Orthop Surg 2022; 14:1019-1033. [PMID: 35524645 PMCID: PMC9163974 DOI: 10.1111/os.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
Digital trauma amputations and digital agenesis strongly affect the functionality and aesthetic appearance of the hand. Autologous reconstruction is the gold standard of treatment. Unfortunately, microsurgical options and transplantation procedures are not possible for patients who present contraindications or refuse to undergo transplantation from the toe (e.g. toe‐to‐thumb transplantation). To address these issues, osseointegrated finger prostheses are a promising alternative. The functional assessments registered during follow‐up confirmed the promising outcomes of osseointegrated prostheses in the treatment of hand finger amputees. This review outlines (a) a detailed analysis of osseointegrated finger metallic components of the implants, (b) the surgical procedures suggested in the literature, and (c) the functional assessments and promising outcomes that demonstrate the potential of these medical osseointegrated devices in the treatment of finger amputees.
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Affiliation(s)
- Chiara Bregoli
- Unit of Lecco, CNR ICMATE, National Research Council, Lecco, Italy
| | | | | | | | - Matteo Primavera
- Hand and Reconstructive Surgery Unit, Centro Traumatologico Ortopedico A. Alesini, Rome, Italy
| | - Michele Rampoldi
- Hand and Reconstructive Surgery Unit, Centro Traumatologico Ortopedico A. Alesini, Rome, Italy
| | - Mario Lando
- Department of Hand surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Ausonio Tuissi
- Unit of Lecco, CNR ICMATE, National Research Council, Lecco, Italy
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Bettlach CR, Gibson E, Daines JM, Payne ER, Vuong LN, Merrill CM, Pet MA. The stigma of digital amputation: a survey of amputees with analysis of risk factors. J Hand Surg Eur Vol 2022; 47:461-468. [PMID: 34496665 DOI: 10.1177/17531934211044642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36-64) was similar to the mean value of the normal population. Younger age, a worker's compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation.Level of evidence: III.
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Affiliation(s)
- Carrie Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Ella Gibson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - John M Daines
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Emma R Payne
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Linh N Vuong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Corinne M Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
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Li AT, Shepherd A, Gray SJ, Slattery P, Bruscino-Raiola F. Comparative outcome analysis of osseointegrated reconstruction and replantation for digital amputations. J Hand Surg Eur Vol 2022; 47:453-460. [PMID: 34278813 DOI: 10.1177/17531934211030752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients.Level of evidence: IV.
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Affiliation(s)
- Andrew T Li
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela Shepherd
- Department of Occupational Therapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Steven J Gray
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Philip Slattery
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Frank Bruscino-Raiola
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
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