Chitosan-Coated Surgical Sutures Prevent Adherence and Biofilms of Mixed Microbial Communities

A multifunctional surgical suture with electroactivity assisted by oligochitosan/gelatin-tannic acid for promoting skin wound healing and controlling scar proliferation

Surgical wound closure is accomplished most frequently with sutures, optimally proceeding rapidly and without complication. However, surgical sutures can trigger foreign body reactions and incite abnormal collagen deposition. Sustained inflammation can result in abnormal wound healing with hypertrophic scar formation. Therefore, evolution of suture material to inhibit inflammation and scar formation is of great clinical significance. In the present study, commercial 3-0 PPDO [poly(p-dioxanone)] suture was used as the base material and modified by adding two layers: a drug-loaded layer and an electroactive layer. The former layer was curcumin (Cur) encapsulated by PLGA [poly (lactic-co-glycolic acid)] and the latter layer was composed of oligochitosan-gelatin/tannic acid/polypyrrole (OCS-GE/TA/PPy). The multifunctional sutures, named S@LC@CGTP, had desirable sustained-drug release properties in vitro where Cur could be released for 8 days due to the action of PLGA. The three-dimensional network structure of OCS-GE/TA ensured S@LC@CGTP against surface cracking and maintained electrical. Furthermore, using an in vivo experiment, S@LC@CGTP could attenuate inflammation and promote scar-free wound healing according to suppression of infiltrating inflammatory cells, down-regulation of TGF-β1 and collagen type I expression, and improved collagen arrangement. Cumulatively, we indicated that S@LC@CGTP suture material has great potential to facilitate optimal, nearly scarless healing of surgical incisions.

Bioinspired, Robust, and Absorbable Cellulose Nanofibrils/Chitosan Filament with Remarkable Cytocompatibility and Wound Healing Properties

Surgical threads are of great importance to prevent wound infection and accelerate tissue healing in surgical treatment. Cellulose nanofibrils (CNF) and chitosan (CS) are attracting increasing attention to be employed as biomedicine materials due to their nontoxicity, cytocompatibility, and biodegradability. However, a robust and absorbable cellulose-based surgical thread has not been explored. Therefore, in this work, a bioinspired CNF/CS composite thread containing 5% cationic polyacrylamide (CPAM) by the mass of CS was prepared, and the obtained CNF/CS-5C thread exhibited excellent mechanical properties and low swelling ratio in water due to the high cross-link degree. Especially, the tensile strength (1877 ± 107 MPa) of this thread was much higher than that of most reported CNF-based threads. Meanwhile, compared with commercial silk and Vicryl surgical threads, the CNF/CS-5C thread exhibited better in vitro cytocompatibility toward endothelial and fibroblast cells and lower inflammatory response in vivo to subcutaneous tissues of rats. In addition, the obtained thread could be regarded as a promising absorbable suture, which exhibited excellent wound healing performances in vivo. Therefore, the prepared absorbable thread will open a new window to prepare novel and advanced cellulose-based threads for medical applications.

Advances, challenges, and prospects for surgical suture materials

As one of the long-established and necessary medical devices, surgical sutures play an essentially important role in the closing and healing of damaged tissues and organs postoperatively. The recent advances in multiple disciplines, like materials science, engineering technology, and biomedicine, have facilitated the generation of various innovative surgical sutures with humanization and multi-functionalization. For instance, the application of numerous absorbable materials is assuredly a marvelous progression in terms of surgical sutures. Moreover, some fantastic results from recent laboratory research cannot be ignored either, ranging from the fiber generation to the suture structure, as well as the suture modification, functionalization, and even intellectualization. In this review, the suture materials, including natural or synthetic polymers, absorbable or non-absorbable polymers, and metal materials, were first introduced, and then their advantages and disadvantages were summarized. Then we introduced and discussed various fiber fabrication strategies for the production of surgical sutures. Noticeably, advanced nanofiber generation strategies were highlighted. This review further summarized a wide and diverse variety of suture structures and further discussed their different features. After that, we covered the advanced design and development of surgical sutures with multiple functionalizations, which mainly included surface coating technologies and direct drug-loading technologies. Meanwhile, the review highlighted some smart and intelligent sutures that can monitor the wound status in a real-time manner and provide on-demand therapies accordingly. Furthermore, some representative commercial sutures were also introduced and summarized. At the end of this review, we discussed the challenges and future prospects in the field of surgical sutures in depth. This review aims to provide a meaningful reference and guidance for the future design and fabrication of innovative surgical sutures. STATEMENT OF SIGNIFICANCE: This review article introduces the recent advances of surgical sutures, including material selection, fiber morphology, suture structure and construction, as well as suture modification, functionalization, and even intellectualization. Importantly, some innovative strategies for the construction of multifunctional sutures with predetermined biological properties are highlighted. Moreover, some important commercial suture products are systematically summarized and compared. This review also discusses the challenges and future prospects of advanced sutures in a deep manner. In all, this review is expected to arouse great interest from a broad group of readers in the fields of multifunctional biomaterials and regenerative medicine.

Smart Design of Sensor-Coated Surgical Sutures for Bacterial Infection Monitoring

Virtually, all implantable medical devices are susceptible to infection. As the main healthcare issue concerning implantable devices is the elevated risk of infection, different strategies based on the coating or functionalization of biomedical devices with antiseptic agents or antibiotics are proposed. In this work, an alternative approach is presented, which consists of the functionalization of implantable medical devices with sensors capable of detecting infection at very early stages through continuous monitoring of the bacteria metabolism. This approach, which is implemented in surgical sutures as a representative case of implantable devices susceptible to bacteria colonization, is expected to minimize the risk of worsening the patient's clinical condition. More specifically, non-absorbable polypropylene/polyethylene (PP/PE) surgical sutures are functionalized with conducting polymers using a combination of low-pressure oxygen plasma, chemical oxidative polymerization, and anodic polymerization, to detect metabolites coming from bacteria respiration. Functionalized suture yarns are used for real-time monitoring of bacteria growth, demonstrating the potential of this strategy to fight against infections.

Review: Application of chitosan and its derivatives in medical materials

Chitin is a natural polymeric polysaccharide extracted from marine crustaceans, and chitosan is obtained by removing part of the acetyl group (usually more than 60 %) in chitin's structure. Chitosan has attracted wide attention from researchers worldwide due to its good biodegradability, biocompatibility, hypoallergenic and biological activities (antibacterial, immune and antitumor activities). However, research has shown that chitosan does not melt or dissolve in water, alkaline solutions and general organic solvents, which greatly limits its application range. Therefore, researchers have carried out extensive and in-depth chemical modification of chitosan and prepared a variety of chitosan derivatives, which have expanded the application field of chitosan. Among them, the most extensive research has been conducted in the pharmaceutical field. This paper summarizes the application of chitosan and chitosan derivatives in medical materials over the past five years.

Applications of Chitosan in Surgical and Post-Surgical Materials

The continuous advances in surgical procedures require continuous research regarding materials with surgical applications. Biopolymers are widely studied since they usually provide a biocompatible, biodegradable, and non-toxic material. Among them, chitosan is a promising material for the development of formulations and devices with surgical applications due to its intrinsic bacteriostatic, fungistatic, hemostatic, and analgesic properties. A wide range of products has been manufactured with this polymer, including scaffolds, sponges, hydrogels, meshes, membranes, sutures, fibers, and nanoparticles. The growing interest of researchers in the use of chitosan-based materials for tissue regeneration is obvious due to extensive research in the application of chitosan for the regeneration of bone, nervous tissue, cartilage, and soft tissues. Chitosan can serve as a substance for the administration of cell-growth promoters, as well as a support for cellular growth. Another interesting application of chitosan is hemostasis control, with remarkable results in studies comparing the use of chitosan-based dressings with traditional cotton gauzes. In addition, chitosan-based or chitosan-coated surgical materials provide the formulation with antimicrobial activity that has been highly appreciated not only in dressings but also for surgical sutures or meshes.

Transition metal complex laminated bioactive implant alleviates Methicillin Resistant Staphylococcus aureus virulence

Orthopedic implant infections cause a serious threat after implantation. The major source of implant infection is biofilms which are highly tolerant to antibiotics due to the presence of rigid biofilm matrix. Hence to overcome biofilm mediated implant infections, we developed a novel antibiofilm agent, palladium (II) thiazolinyl picolinamide complex (Pd(II)-E). From our study, it was found that Pd(II)-E have profound biofilm inhibition activity and also reduced various virulence factors of Methicillin resistant Staphylococcus aureus (MRSA) including slime synthesis, Phenol soluble modulin (PSM) mediated spreading, Exopolysaccharides production and staphyloxanthin synthesis. Further, Pd(II)-E was coated over the titanium plates which was confirmed using EDX (Energy Dispersive X-Ray) analysis. The Pd(II)-E coated plates were able to prevent the biofilm formation on them which was evident under a Scanning electron microscope (SEM) and several virulent genes were found to be downregulated in the biofilms on the coated titanium plates which confirmed by qPCR. From our findings, it was found that Pd(II)-E coated titanium implants would be an effective alternate approach for preventing biofilm mediated implant infections.

Synthesis of a new chitosan-p-tert-butylcalix[4]arene polymer as adsorbent for toxic mercury ion

In this paper, we have synthesized a novel chitosan-p-tert-butylcalix[4]arene polymer (CCP) as a highly efficient adsorbent for mercury ion (Hg²⁺) removal from water. In fact, a lower rim diamine derivative of p-tert-butylcalix[4]arene has been cross-linked with chitosan chain by carbonyl diimidazole (CDI) as the linker. CDI forms a urea linkage between calix[4]arene diamine derivative and amine groups of the chitosan polymeric chain. The structure and properties of the new polymer were characterized by Fourier transform infrared spectroscopy, X-ray diffraction and scanning electron microscope. Also, the adsorption capacity of CCP was studied towards Hg²⁺ in aqueous medium by inductively coupled plasma-optical emission spectrometry. Interestingly, the results showed a considerable adsorption capacity for CCP in comparison with chitosan. Therefore, CCP can be introduced as a promising adsorbent for the elimination of Hg²⁺ from wastewaters. Moreover, because of the conformity of adsorption kinetic with pseudo-second-order kinetic models, it can be concluded that chemical adsorption has an important role between functional groups on CCP polymer and Hg²⁺ ions. In addition, according to Freundlich isotherm, the CCP surface was heterogeneous with different functional groups.

Bioactivity of Chitosan-Based Particles Loaded with Plant-Derived Extracts for Biomedical Applications: Emphasis on Antimicrobial Fiber-Based Systems

Marine-derived chitosan (CS) is a cationic polysaccharide widely studied for its bioactivity, which is mostly attached to its primary amine groups. CS is able to neutralize reactive oxygen species (ROS) from the microenvironments in which it is integrated, consequently reducing cell-induced oxidative stress. It also acts as a bacterial peripheral layer hindering nutrient intake and interacting with negatively charged outer cellular components, which lead to an increase in the cell permeability or to its lysis. Its biocompatibility, biodegradability, ease of processability (particularly in mild conditions), and chemical versatility has fueled CS study as a valuable matrix component of bioactive small-scaled organic drug-delivery systems, with current research also showcasing CS’s potential within tridimensional sponges, hydrogels and sutures, blended films, nanofiber sheets and fabric coatings. On the other hand, renewable plant-derived extracts are here emphasized, given their potential as eco-friendly radical scavengers, microbicidal agents, or alternatives to antibiotics, considering that most of the latter have induced bacterial resistance because of excessive and/or inappropriate use. Loading them into small-scaled particles potentiates a strong and sustained bioactivity, and a controlled release, using lower doses of bioactive compounds. A pH-triggered release, dependent on CS’s protonation/deprotonation of its amine groups, has been the most explored stimulus for that control. However, the use of CS derivatives, crosslinking agents, and/or additional stabilization processes is enabling slower release rates, following extract diffusion from the particle matrix, which can find major applicability in fiber-based systems within ROS-enriched microenvironments and/or spiked with microbes. Research on this is still in its infancy. Yet, the few published studies have already revealed that the composition, along with an adequate drug release rate, has an important role in controlling an existing infection, forming new tissue, and successfully closing a wound. A bioactive finishing of textiles has also been promoting high particle infiltration, superior washing durability, and biological response.