2-Octyl-Cyanoacrylate Mesh Dressings for Total Joint Arthroplasty: Dressing Design Influences Risks of Wound Complications

INTRODUCTION

Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty (TJA). Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between two similar systems.

METHODOLOGY

An eighteen-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty (THA) and 212 total knee arthroplasty (TKA) cases from four attending surgeons at one institution that used one of two dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator.

RESULTS

Wound complications (3.2 versus 7.6%; X2 = 3.86; df = 1; P = 0.049), early periprosthetic joint infections (PJI) (0 versus 2.8%; X2 = 7.63; df = 1; P = 0.006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X2 = 6.39; df = 1; P = 0.011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (SSI) (0.7 versus 0%; X2 = 1.06; df = 1; P = 0.302) or allergy rates (3.3 versus 4.1%; X2 = 0.12; df = 1; P = 0.655) between Mesh A and B.

CONCLUSION

We observed significantly different performance in wound complications, early postoperative PJI, and 90-day reoperation between the two designs. Having the accelerator in the applicator rather than on the mesh patch, may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal.

A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case-Control Study

Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures.

Closed-loop recyclable plastics from poly(ethyl cyanoacrylate)

Ethyl cyanoacrylate is a highly reactive monomer that has been used nearly exclusively to make Super Glue and related fast-setting adhesives. Here, we describe transformation of this highly abundant, readily available monomer into a closed-loop recyclable plastic that could supplant currently used (and often unrecycled/unrecyclable) plastics, such as poly(styrene). We report polymerization conditions, plastic-processing methods, and plastic-recycling protocols for poly(ethyl cyanoacrylate) plastics that make the Super Glue monomer a viable starting material for a next generation of closed-loop recyclable plastics. The processes described are scalable, and the plastics can be recycled in a closed-loop process with >90% yields, even when combined with a heterogeneous mixture of other types of plastic.

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.

Biodegradable and Biocompatible Adhesives for the Effective Stabilisation, Repair and Regeneration of Bone

Bone defects and complex fractures present significant challenges for orthopaedic surgeons. Current surgical procedures involve the reconstruction and mechanical stabilisation of complex fractures using metal hardware (i.e., wires, plates and screws). However, these procedures often result in poor healing. An injectable, biocompatible, biodegradable bone adhesive that could glue bone fragments back together would present a highly attractive solution. A bone adhesive that meets the many clinical requirements for such an application has yet to be developed. While synthetic and biological polymer-based adhesives (e.g., cyanoacrylates, PMMA, fibrin, etc.) have been used effectively as bone void fillers, these materials lack biomechanical integrity and demonstrate poor injectability, which limits the clinical effectiveness and potential for minimally invasive delivery. This systematic review summarises conventional approaches and recent developments in the area of bone adhesives for orthopaedic applications. The required properties for successful bone repair adhesives, which include suitable injectability, setting characteristics, mechanical properties, biocompatibility and an ability to promote new bone formation, are highlighted. Finally, the potential to achieve repair of challenging bone voids and fractures as well as the potential of new bioinspired adhesives and the future directions relating to their clinical development are discussed.

Characteristics of Suture Materials Used in Oral Surgery: Systematic Review

BACKGROUND

The aim of this review was to evaluate the most used suture materials with regards to their inflammatory response, their bacterial adhesion, and their physical properties when used to close oral wounds.

METHODS

Four databases (PubMed, Scopus, Dentistry & Oral Sciences, and OVID) were searched to retrieve relevant studies from January 1, 2000, to January 31, 2020.

RESULTS

Out of the 269 articles, only 13 studies were selected as they were relevant and met the systematic review's protocol. These studies showed that almost all suture materials studies (catgut, polyglycolic acid [PGA] sutures, nylon, expanded polytetrafluoroethylene, and silk sutures) caused bacterial adherence and tissue reaction. In nylon and chromic catgut, the number of bacteria accumulated was lowest. Silk and nylon were found to be more impacted than catgut and PGA in terms of physical characteristics such as tensile strength. PGA, on the other hand, was said to be the most susceptible to knot unwinding.

CONCLUSIONS

Following an oral surgical operation, all sutures revealed varied degrees of irritation and microbial accumulation. Nonresorbable monofilament synthetic sutures, however, exhibited less tissue response and less microbial accumulation.

Photocurable GelMA Adhesives for Corneal Perforations

The current treatments for the management of corneal and scleral perforations include sutures and adhesives. While sutures are invasive, induce astigmatism and carry a risk of infection, cyanoacrylate glues are toxic, proinflammatory and form an opaque and rough surface that precludes vision. Consequently, the clinical need for a fast curing and strong tissue adhesive with minimised cytotoxicity and host inflammation remains unmet. In this paper, we engineer a gelatine methacryloyl (GelMA) adhesive that can be crosslinked in situ within 2 min using UV or visible light and a riboflavin (RF)/sodium persulfate (SPS) system. Optical coherence tomography (OCT) images demonstrated that the flowable GelMA adhesive could completely fill corneal wounds and restore the ocular curvature by forming a smooth contour on the ocular surface. Further, ex vivo studies in porcine eyes showed that GelMA bioadhesives exhibited burst pressures that were comparable to cyanoacrylates (49 ± 9 kPa), with the hydrogels exhibiting a transmittance (90%), water content (85%) and storage modulus (5 kPa) similar to the human cornea. Finally, using human dermal fibroblasts, we showed that our GelMA adhesive was non-toxic and could effectively support cell adhesion and proliferation. Taken together, the adhesive’s performance, injectability and ease of administration, together with gelatin’s availability and cost-effectiveness, make it a potential stromal filler or sealant for corneal and conjunctival applications.

Biomaterial-based treatments for the prevention of preterm birth after iatrogenic rupture of the fetal membranes

Minimally invasive interventions to ameliorate or correct fetal abnormalities are becoming a clinical reality. However, the iatrogenic premature preterm rupture of the fetal membranes (FMs) (iPPROM), which may result in...

Prevention of pulmonary air leaks using a biodegradable tissue-adhesive fiber sheet based on Alaska pollock gelatin modified with decanyl groups

Tissue adhesives have been widely used in surgery to treat pulmonary air leaks. However, conventional adhesives have poor interfacial strength under wet conditions. To overcome this clinical problem, we modified Alaska pollock-derived gelatin to include decanyl (C10) groups (C10-ApGltn) and used electrospinning to create a tissue-adhesive fiber sheet (AdFS). C10-AdFS showed higher burst strength when adhering to porcine pleura compared with a sheet of original ApGltn (Org-ApGltn). Hematoxylin-eosin-stained sections after burst experiments reveal that a dense C10-AdFS layer remained on the surface of the porcine pleura. The effect of the degree of C10 modification of ApGltn on the burst strength was evaluated. ApGltn with a C10 modification ratio of 13 mol% amino groups (13C10-AdFS) exhibited the highest burst strength. Furthermore, from ex vivo experiments with extracted rat lung, 13C10-AdFS exhibited a higher burst strength (41 cm H₂O) than Org-AdFS. The decanyl groups in 13C10-AdFS interacted with the hydrophobic proteins and the lipid bilayers of the cells, resulting in the high interfacial strength between 13C10-AdFS and the pleura. Moreover, 13C10-AdFS samples implanted subcutaneously in the backs of rats were completely degraded within 21 days without any severe inflammation. These results show that 13C10-AdFS is a promising adhesive material for the treatment of pulmonary air leaks.

Polymeric Tissue Adhesives

Polymeric tissue adhesives provide versatile materials for wound management and are widely used in a variety of medical settings ranging from minor to life-threatening tissue injuries. Compared to the traditional methods of wound closure (i.e., suturing and stapling), they are relatively easy to use, enable rapid application, and introduce minimal tissue damage. Furthermore, they can act as hemostats to control bleeding and provide a tissue-healing environment at the wound site. Despite their numerous current applications, tissue adhesives still face several limitations and unresolved challenges (e.g., weak adhesion strength and poor mechanical properties) that limit their use, leaving ample room for future improvements. Successful development of next-generation adhesives will likely require a holistic understanding of the chemical and physical properties of the tissue-adhesive interface, fundamental mechanisms of tissue adhesion, and requirements for specific clinical applications. In this review, we discuss a set of rational guidelines for design of adhesives, recent progress in the field along with examples of commercially available adhesives and those under development, tissue-specific considerations, and finally potential functions for future adhesives. Advances in tissue adhesives will open new avenues for wound care and potentially provide potent therapeutics for various medical applications.

Photocurable platelet rich plasma bioadhesives

Closure of wounds with tissue adhesives has many advantages over sutures, but existing synthetic adhesives are toxic and have poor workability. Blood-derived adhesives display complete resorption but have adhesion too weak for reliable wound dressings. We propose a semi-synthetic design that combines the positive attributes of synthetic and blood-derived tissue adhesives. PAMAM-g-diazirine (PDz) is a rapidly gelling bioadhesive miscible in both aqueous and organic solvents. PDz blended with platelet-rich plasma (PRP) forms PDz/PRP composite, a semi-synthetic formulation that combines PDz's wet tissue adhesion with PRP's potent wound healing properties. Light-activated PDz/PRP bioadhesive composite has similar elasticity to soft tissues and behaves as an induced hemostat-an unmet clinical need for rapid wound dressings. PDz/PRP composite applied to in-vivo full-thickness wounds observed a 25% reduction in inflammation, as assessed by the host-cell response.

Ex-vivo mechanical sealing properties and toxicity of a bioadhesive patch as sealing system for fetal membrane iatrogenic defects

Preterm prelabor rupture of membranes (PPROM) is the most frequent complication of fetal surgery. Strategies to seal the membrane defect created by fetoscopy aiming to reduce the occurrence of PPROM have been attempted with little success. The objective of this study was to evaluate the ex-vivo mechanical sealing properties and toxicity of four different bioadhesives integrated in semi-rigid patches for fetal membranes. We performed and ex-vivo study using term human fetal membranes to compare the four integrated patches composed of silicone or silicone-polyurethane combined with dopaminated-hyaluronic acid or hydroxypropyl methylcellulose (HPMC). For mechanical sealing properties, membranes were mounted in a multiaxial inflation device with saline, perforated and sealed with the 4 combinations. We measured bursting pressure and maximum pressure free of leakage (n = 8). For toxicity, an organ culture of membranes sealed with the patches was used to measure pyknotic index (PI) and lactate dehydrogenase (LDH) concentration (n = 5). All bioadhesives achieved appropriate bursting pressures, but only HPMC forms achieved high maximum pressures free of leakage. Concerning toxicity, bioadhesives showed low PI and LDH levels, suggesting no cell toxicity. We conclude that a semi-rigid patch coated with HPMC achieved ex-vivo sealing of iatrogenic defects in fetal membranes with no signs of cell toxicity. These results warrant further research addressing long-term adhesiveness and feasibility as a sealing system for fetoscopy.

Biomaterials in Gastroenterology: A Critical Overview

In spite of the large diversity of diagnostic and interventional devices associated with gastrointestinal endoscopic procedures, there is little information on the impact of the biomaterials (metals, polymers) contained in these devices upon body tissues and, indirectly, upon the treatment outcomes. Other biomaterials for gastroenterology, such as adhesives and certain hemostatic agents, have been investigated to a greater extent, but the information is fragmentary. Much of this situation is due to the paucity of details disclosed by the manufacturers of the devices. Moreover, for most of the applications in the gastrointestinal (GI) tract, there are no studies available on the biocompatibility of the device materials when in intimate contact with mucosae and other components of the GI tract. We have summarized the current situation with a focus on aspects of biomaterials and biocompatibility related to the device materials and other agents, with an emphasis on the GI endoscopic procedures. Procedures and devices used for the control of bleeding, for polypectomy, in bariatrics, and for stenting are discussed, particularly dwelling upon the biomaterial-related features of each application. There are indications that research is progressing steadily in this field, and the establishment of the subdiscipline of "gastroenterologic biomaterials" is not merely a remote projection. Upon the completion of this article, the gastroenterologist should be able to understand the nature of biomaterials and to achieve a suitable and beneficial perception of their significance in gastroenterology. Likewise, the biomaterialist should become aware of the specific tasks that the biomaterials must fulfil when placed within the GI tract, and regard such applications as both a challenge and an incentive for progressing the research in this field.

Bioadhesives for internal medical applications: A review

Bioadhesives such as tissue adhesives, hemostatic agents, and tissue sealants have gained increasing popularity in different areas of clinical operations during the last three decades. Bioadhesives can be categorized into internal and external ones according to their application conditions. External bioadhesives are generally applied in topical medications such as wound closure and epidermal grafting. Internal bioadhesives are mainly used in intracorporal conditions with direct contact to internal environment including tissues, organs and body fluids, such as chronic organ leak repair and bleeding complication reduction. This review focuses on internal bioadhesives that, in contrast with external bioadhesives, emphasize much more on biocompatibility and adhesive ability to wet surfaces rather than on gluing time and intensity. The crosslinking mechanisms of present internal bioadhesives can be generally classified as follows: 1) chemical conjugation between reactive groups; 2) free radical polymerization by light or redox initiation; 3) biological or biochemical coupling with specificity; and 4) biomimetic adhesion inspired from natural phenomena. In this review, bioadhesive products of each class are summarized and discussed by comparing their designs, features, and applications as well as their prospects for future development.

STATEMENT OF SIGNIFICANCE

Despite the emergence of numerous novel bioadhesive formulations in recent years, thus far, the classification of internal and external bioadhesives has not been well defined and universally acknowledged. Many of the formulations have been proposed for treatment of several diseases even though they are not applicable for such conditions. This is because of the lack of a systematic standard or evaluation protocol during the development of a new adhesive product. In this review, the definition of internal and external bioadhesives is given for the first time, and with a focus on internal bioadhesives, the criteria of an ideal internal bioadhesive are adequately discussed; this is followed by the review of recently developed internal bioadhesives based on different gluing mechanisms.

Skin Protectants Made of Curable Polymers: Effect of Application on Local Skin Temperature

Objective: To measure the skin temperature after application of a new skin protectant intended for incontinence-associated dermatitis (IAD), compared with a commercial product with an analogous cyanoacrylate-based chemistry.

Approach: Twelve healthy human volunteers received an application of the new product on one thigh and of the comparator on the other thigh. An infrared camera using ThermaCAM™ software imaged the skin and measured the temperature at the skin surface over time to characterize the thermal cure profile induced by the products on the skin.

Results: The new product led to a drop in skin surface temperature (endothermic reaction), whereas the commercial product displayed an exotherm and a slight rise in skin surface temperature.

Innovation: Cyanoacrylate-based chemistries come in various formulations, differing in the side chains and additives used. They are liquid monomers that polymerize after application, and this polymerization is accompanied by an exothermic reaction that can be perceived as an unpleasant warming sensation, especially on compromised skin. A new formulation was designed to mitigate this rise in temperature.

Conclusion: The new skin protectant may potentially be more comfortable for IAD patients, since it causes a drop in skin surface temperature instead of a rise during the curing process that follows application.

A Bio Polymeric Adhesive Produced by Photo Cross-Linkable Technique

The advantages of photo polymerization methods compared to thermal techniques are: rapid cure reactions, low energy demands, solvent free requirements and room temperature use. In order to form a macromer, polycaprolactone (PCL) was cross-linked via ultraviolet power with 2-isocyanatoethyl methacrylate. Different methods of characterization were carried out: estimation of swelling capacity, adhesive capacity (using aminated substrates), surface energy (by contact angle), and attenuated total reflectance Fourier transform infrared. In addition to these experiments, we carried out dynamical mechanical thermal analysis, thermogravimetry and thermorphology characterizations of PCL. Thus, it has been concluded that the prepared macromer could be transformed into membranes that were effective as a medical adhesive. The degree of cross linking has been estimated using two different techniques: swelling of the samples and photo cross linking of the samples with different periods of irradiation at relatively high UV-power (600 mW/cm²).