Advances, challenges, and prospects for surgical suture materials

Collagen-mediated in situ mineralization-enhanced biomimetic bone tissue engineering scaffolds

Oriented poly(lactic acid) (PLA) fiber bone tissue engineering scaffolds are often limited by factors including poor material hydrophilicity and weak osteogenic activity. The introduction of in situ mineralization can address these issues, but it requires the assistance of hydrophilic materials to achieve optimal performance. Collagen, a nature-based ECM component, was adopted because it can enhance hydrophilicity, encourage cell adhesion, and biomimetrically induce mineralization, according to recent studies of ECM-mimicking scaffolds. Therefore, this study proposes a collagen-mediated in situ mineralization-enhanced scaffold design aimed at improving the hydrophilicity and osteogenic potential of oriented fiber scaffolds. Collagen (5-10 wt%) and phosphate-containing solutions (59.6 mM) were added to a PLA matrix, and scaffolds were electrospun at 12 kV. Subsequently, the scaffolds underwent in situ mineralization in a calcium ion-containing solution (101 mM), leading to the formation of calcium phosphate within the scaffold structure. The experimental results show that the introduction of collagen effectively promoted the formation of in situ mineralization, enhanced the hydrophilicity of the scaffold, and maintained good fiber orientation. The scaffolds exhibited significant mechanical anisotropy, with the Young's modulus parallel to the fiber direction reaching 5 MPa, which is 25 times greater than that in the direction perpendicular to the fibers. In vitro studies with rat bone marrow mesenchymal stem cells showed a 2.4-fold increase in osteogenic differentiation, as assessed by alkaline phosphatase activity. Micro-CT analysis showed that the increase of BV/TV was 3.26 times higher when compared to that of control scaffolds, while histological analysis revealed mature bone tissue formation characterized by well-organized collagen fibers. Overall, the present study describes a novel strategy of collagen-mediated in situ mineralization, first integrating enhanced hydrophilicity, mechanical anisotropy, and biomimetic bone-like properties to address major limitations associated with the current oriented fiber scaffolds.

Use of a zipline skin closure device in gastroenterological surgery: a multicenter randomized controlled trial assessing wound infection incidence, operation time, and cosmesis

Subcuticular sutures, which are effective and cosmetically advantageous in gastroenterological surgery, are time-consuming and heavily dependent on the surgeon's technical expertise. This study aims to evaluate whether Zipline skin closure could be an alternative to subcuticular sutures in gastroenterological surgery. A multicenter randomized controlled trial (UMIN000048169) was conducted on 76 patients who underwent elective gastroenterological surgery. The patients were randomized to either the Zipline group (N = 35) or the subcuticular suture group (N = 41). Primary outcomes included skin closure time and secondary outcomes included postoperative wound complications and cosmetic results, assessed 6 months post-surgery, using the Stony Book Scar Evaluation Scale (SBSES). The Zipline group demonstrated significantly shorter closure times than the suture group (median: 438 s [406-526] vs. 575 s [537-638]; p = 0.003). This difference was more pronounced for incisions > 55 mm (median:399 s [307-533] vs. 605 s [493-736]; p = 0.001). No significant differences were observed in wound infection rates (5.7% vs. 2.4%; p = 0.46) or SBSES scores (median: 4.0 [4.0-5.0] vs. 4.0 [3.0-5.0; p = 0.82) between the two groups. The Zipline device reduced the skin closure time in gastroenterological surgery significantly, particularly for large incisions, without compromising wound healing or cosmetic outcomes. These findings suggest that the Zipline system may be a viable alternative to traditional subcuticular sutures in gastroenterological procedures, potentially promoting operating room efficiency without compromising surgical quality or patient outcomes.

Conductive Antibacterial Silk Sutures for Combating Surgical Site Infections via Electrically Controlled Drug Release

Current antibacterial sutures for preventing surgical site infections (SSIs) face challenges including suboptimal drug utilization efficiency and uncontrolled burst release. To address these limitations, an antibacterial conductive suture with an electrically controlled drug release system is developed in this study. Polypyrrole (PPy) doped with tannic acid (TA) is in situ polymerized on the surface of silk sutures precoated with chitosan/gelatin (CS/GE), designated as PCG-SS. The PCG-SS exhibits excellent conductivity, enabling voltage-dependent regulation of TA release. At -0.6 V applied potential, PPy underwent electrochemical reduction with decreased positive charge density, enabling maximal TA release; conversely, at +0.4 V, PPy attained an oxidized state with enhanced positive charges, strengthening electrostatic adsorption of anionic TA and achieving 80% suppression of drug elution. Under -0.6 V stimulation, the antibacterial rates of PCG-SS against S. aureus and E. coli exceeded 90%. This work successfully validated that a PPy-based drug-controlled release system can effectively formulate drug release programs, providing new insights into the study of electronically controlled drug delivery systems.

Osteogenic surgical sutures for tendon traction and fixation: A model of achilles tendon sleeve avulsion

Currently, the repair of Achilles tendon sleeve avulsion is a challenge due to their limited research and particularly difficult treatment. In tendon repair surgery, the construction of bone tunnels is required for the suspensory fixation of ruptured tendon by sutures. However, due to the biologically inert of commonly used tendon sutures, postoperative fixation instability, bone tunnel enlargement, and even tendon reconstruction failure can easily occur under stressful conditions. In this study, core-spun nanoyarns containing β-tricalcium phosphate (β-TCP) were prepared by electrospinning to serve as surgical sutures for tendon traction and fixation. The suture of 6 core-spun nanoyarns spun again into one strand had stronger mechanical properties, which could effectively pull the tendon. The silk fibroin micron yarn of the suture core layer and the polycaprolactone/silk fibroin/β-TCP nanofibers of the shell layer demonstrated favorable biocompatibility, which facilitated cell adhesion and expression in the tendon and bone. In the repair surgery of the Achilles tendon sleeve avulsion in rabbits, compared with non-degradable and high mechanical properties commercial sutures, the β-TCP in the nanofibers of sutures could induce osteogenesis, thereby reducing the gap in the bone tunnel and preventing enlargement of the bone tunnel. In conclusion, the suture could weave the ruptured tendon, fix the tendon to the bone, promote the formation of new bone in the bone tunnel, avoid the instability of the existing commercial sutures to the bone tunnel, and ultimately improve the success rate of tendon repair surgery. STATEMENT OF SIGNIFICANCE: Nowadays, there is very limited research on the Achilles tendon sleeve avulsion model. This model presents challenges due to inadequate tendon tissue in the calcaneus for direct repair and insufficient bone tissue on the avulsed tendon for fixation. The incidence of this model is low, but treatment once it occurs is particularly difficult. In this study, we proposed to compound osteogenesis-promoting β-TCP materials onto nanoyarns to prepare surgical sutures that could weave the ruptured tendon, fix the tendon to the bone, induce osteogenesis, and reduce the gap in the bone tunnel, thus avoiding the instability of the existing commercial sutures in the bone tunnel, and ultimately improving the success rate of the surgery.

Self-reinforced silk nanofibrils networks enable ultrafine fibroin monofilament sutures applied in minimally invasive surgery

Superfine recycled regenerated silk fibroin (RRSF) monofilament sutures are designed to minimize surgical incisions, prevent scar formation, and facilitate precise suturing in cosmetic and plastic surgeries. However, balancing fineness and strength remains a challenge because the RRSF extraction process disrupts the hierarchical structure of natural silk fibers, leading to suboptimal mechanical properties. This study employed mechanical peeling and grinding to exfoliate β-sheets-rich silk fibroin nanofibrils (SFNF), which served as homologous reinforcing materials uniformly dispersed in the RRSF spinning system. Water-soluble, biocompatible polyvinyl alcohol (PVA) was introduced to enhance ductility. The fiber underwent extensive water immersion stretching to produce ultrafine fibers and foster a highly oriented internal self-reinforcing SFNF network structure. Monofilament surgical sutures were successfully fabricated following surface coating with chitosan. Our results showed that with 0.1 wt% SFNF and a stretching multiplier of 2.5, the tensile strength of the fibers increased by 33 % compared to those without SFNF. Fluorescence staining confirmed the presence of highly oriented SFNF networks within the fibers. Mechanical simulations validated the pronounced reinforcement effect of this network structure. The sutures, measuring 39.38 μm in diameter and exhibiting a tensile strength of 0.31 N, met USP standards for 9-0 surgical sutures, making them suitable for microsurgery. Additionally, they demonstrated antibacterial properties, biocompatibility, and degraded at a rate of 43.09 % within 30 days. In animal trials, the sutures facilitated wound closure, reduced inflammatory responses, and minimized scar formation.

A shift from synthetic to bio-based polymer for functionalization of textile materials: A review

Textiles are used in various wearable and technical applications, requiring diverse properties. Functionalization refers to processes that impart new properties, such as flame retardancy, anti-microbial effects, UV protection, and hydrophobicity. The textile industry is shifting from synthetic polymers to eco-friendly biopolymers, which offer biodegradability and sustainability, reducing environmental impact. Biopolymer-based finishes improve performance while being safer and greener, supporting global sustainability goals. This review focuses on biopolymers used for textile functionalization and their potential in advanced medical applications like drug delivery and tissue engineering. Common biopolymer sources include renewable resources such as plants, microorganisms, and animals. Notable biopolymers, like bacterial and plant-based nanocellulose, lignin, chitosan, alginate, gelatin, collagen, keratin, and polylactic acid (PLA), are used for functions like anti-microbial, flame retardant, UV protective, and antioxidant properties. These biopolymers are also applied in tissue engineering, drug delivery, wound healing, and cosmetics as eco-friendly, biodegradable alternatives to petroleum-based materials.

Antibiotic Action, Drug Delivery, Biodegradability, and Wound Regeneration Characteristics of Surgical Sutures and Cutting-Edge Surgical Suture Manufacturing Technologies

(1) Background: With the emergence of various super bacteria, interest in antibacterial properties, drug delivery, and wound regeneration is increasing in the field of surgical materials. There are many studies on surgical sutures, but not many recent ones that have studied structurally subdivided functions. Accordingly, various studies on surgical sutures were classified based on the main functions that are considered important, and studies were conducted by categorizing the latest production technology into 3D printing and electrospinning. (2) Methods: Data from the literature (n = 1077) were collected from databases such as PubMed, Harvard.edu, MDPI, Google Scholar, Web of Science, ACS, Nature, and IOP Publishing. The selected 103 papers were divided into two main groups: cutting-edge characteristics of surgical sutures and the latest technologies for manufacturing surgical sutures. (3) Results: Cutting-edge characteristics of surgical sutures were divided into four major categories: antibacterial, drug delivery, biodegradability, and wound regeneration, and examined in depth. In addition, the final technologies for manufacturing surgical sutures were divided into electrospinning and 3D printing. (4) Conclusions: The results of this study can contribute to the development of multifunctional surgical sutures that promote wound regeneration through antibacterial properties, drug elution, and biodegradability.

Chain entanglement enhanced strong and tough wool keratin/albumin fibers for bioabsorbable and immunocompatible surgical sutures

High-performance fibers derived from non-silk proteins have garnered significant interest in biomedical applications because of their high accessibility and biocompatibility. Nonetheless, considerable challenges persist in addressing their structural defects to fabricate fibers with an optimal balance of strength and toughness. Herein, an entanglement-reinforced strategy is proposed to reconstruct high-performance non-silk protein fibers. Regenerated keratin and bovine serum albumin (BSA) are unfolded by denaturant and complementarily composited, leveraging their intrinsic cysteine re-oxidation to generate a robust mechanical cross-linking network without the requirement of an external crosslinker. The resulting drawn keratin/BSA composite fiber (DKBF) exhibits balanced mechanical performances with a breaking strength of approximately 250 MPa and a toughness of around 70 MJ m-3, outperforming that of reported regenerated keratin fibers and comparable to many natural or artificial silk fibers. Additionally, DKBFs demonstrate redox-responsive mechanical behavior and hydration-induced reversible shape memory. The DKBFs show good suturing capability for wound repair in female animal models due to their excellent bioabsorbability and immunocompatibility. This work offers valuable insights into addressing the current challenges in manufacturing mechanically robust and tough non-silk protein fibers, bringing hope for the development of more sustainable and versatile materials.

Antimicrobial Phenolic Materials: From Assembly to Function

Infectious diseases pose considerable challenges to public health, particularly with the rise of multidrug-resistant pathogens that globally cause high mortality rates. These pathogens can persist on surfaces and spread in public and healthcare settings. Advances have been made in developing antimicrobial materials to reduce the transmission of pathogens, including materials composed of naturally sourced polyphenols and their derivatives, which exhibit antimicrobial potency, broad-spectrum activity, and a lower likelihood of promoting resistance. This review provides an overview of recent advances in the fabrication of antimicrobial phenolic biomaterials, where natural phenolic compounds act as active antimicrobial agents or encapsulate other antimicrobial agents (e.g., metal ions, antimicrobial peptides, natural biopolymers). Various forms of phenolic biomaterials synthesized through these two strategies, including antimicrobial particles, capsules, hydrogels, and coatings, are summarized, with a focus on their application in wound healing, bone repair and regeneration, oral health, and antimicrobial coatings for medical devices. The potential of these advanced phenolic biomaterials provides a promising therapeutic approach for combating antimicrobial-resistant infections and reducing microbial transmission.

Application of silk fibroin-based composite films in biomedicine and biotechnology

Silk fibroin has garnered significant attention as a natural biomaterial due to its exceptional biocompatibility, tunable water solubility, optical transparency and high thermal stability. In recent years, silk fibroin films have gained prominence for their ease of fabrication and unique properties. However, their intrinsic brittleness limits broader applicability in certain fields. To overcome this challenge, researchers have developed various strategies, including physical blending, chemical modification, and genetic engineering, to improve key attributes such as mechanical strength, antimicrobial activity, and electrical conductivity. These advancements have significantly broadened the utility of silk fibroin films in diverse biomedical applications. This review provides an in-depth analysis of recent progress in silk fibroin-based composite films, emphasizing their applications in bone regeneration, wound healing, and health monitoring. Modified silk fibroin composites are highlighted for their superior material properties and enhanced functional potential in these domains. Additionally, this review discusses future research directions, offering valuable insights into pathways for further innovation and practical implementation. With continued advancements, silk fibroin composite films are poised to make transformative contributions to the fields of biomedicine and biotechnology.

Clinical Outcomes Among Patients Undergoing Open Abdominal or Orthopedic Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institutional, Retrospective Database Study

Purpose

Determining the best suture for wound closure in high-tension areas by anatomical site and procedure type remains a challenge. This study assessed the cumulative incidence of clinical outcomes among patients undergoing procedures incorporating the STRATAFIX Symmetric PDS™ Plus Knotless Tissue Control Device (STRATAFIX Symmetric) for closure of high-tension areas, such as the abdominal fascia and hip and knee joint capsule, in the course of routine clinical practice.

Patients and Methods

Patients undergoing open abdominal or orthopedic surgery between October 1, 2016, and October 31, 2023, using size 0 or 1 STRATAFIX Symmetric were identified from the Premier Healthcare Database. The cumulative incidences of 30-day internal wound dehiscence and 30-day surgical site infection (SSI) were measured. To contextualize the results, a targeted literature search of articles published between October 2016 and April 2024 describing the use of STRATAFIX Symmetric for wound closure in the abdominal fascia or joint capsule was performed.

Results

A total of 8156 patients undergoing open abdominal surgery and 25,807 patients undergoing open orthopedic surgery met the study criteria. In the abdominal surgery cohort, the cumulative incidences of 30-day internal wound dehiscence and SSI were 0.65% (95% CI: 0.49%, 0.85%) and 3.54% (95% CI: 3.15%, 3.97%), respectively. The overall cumulative incidences of 30-day internal wound dehiscence and SSI in the orthopedic surgery cohort were 0.07% (95% CI: 0.04%, 0.11%) and 0.58% (95% CI: 0.49%, 0.68%), respectively. These findings were within the range of clinical outcomes reported in 12 articles identified during the targeted literature search.

Conclusion

The cumulative incidence of 30-day internal wound dehiscence and SSI among patients undergoing abdominal and orthopedic procedures incorporating STRATAFIX Symmetric for wound closure of high-tension areas was low and comparable to prior literature.

Treating Facial Scars using Polydioxanone Threads

Traditional scar treatments, such as laser therapy, chemical peels, and surgery, are expensive and require long recovery times. Polydioxanone (PDO) threads offer a minimally invasive and cost-effective solution that enhances collagen production and skin texture. This study aimed to evaluate the effectiveness of PDO threads in the management of atrophic facial scars due to the lack of clinical research on this topic. A prospective clinical study was conducted on 20 patients with facial atrophic scars caused by accidents or previous surgical procedures. The patient and observer scar assessment scale was used to evaluate the scars from the observer's and patient's perspectives at three-time points for each patient. The observer assessment included the following variables: vascularity, pigmentation, thickness, pliability, surface area, and homogeneity. The patient assessment included the following variables: pain, color, stiffness, thickness, appearance, and itching. Statistically significant improvement was observed in atrophic facial scars treated using PDO threads in all observer variables (p<0.001). Significant improvement was recorded in the patient's color, stiffness, thickness, and appearance variables; however, itching sensation increased between T0 and T1 with no statistically significant differences in the pain variable. Within the limits of this study, we conclude that PDO threads are known for ease of use, availability, and biocompatibility. They biodegrade naturally, reducing irritation risk. By stimulating collagen, PDO threads promote natural skin regeneration and thereby improve scars without using foreign materials. The treatment method is safe and minimally invasive, with short recovery times. Clinical studies showed significant improvements in atrophic facial scars with high patient satisfaction.

Antioxidant and antibacterial coconut mesocarp polyphenol hydrogel dressing based on PVA/quaternary chitosan/sodium alginate with β-glycerophosphate

This study developed PQSp wound dressing hydrogels (S0-S6) using polyvinyl alcohol (PVA), quaternary chitosan (QCS), and sodium alginate (SA) as the matrix, with the addition of coconut mesocarp polyphenol (P-CTP, 0.1 %, 0.5 %, and 1.0 %) and β-glycerophosphate disodium (GP, 1.0 %) through a freeze-thaw method. Compared to hydrogels without P-CTP and GP (S0), the tensile strength of S1-S6 increased from 0.08 MPa to 0.45 MPa, elongation at break improved from 200 % to 320 %, and the swelling ratio decreased from 186 % to 82 % due to the effects of P-CTP and GP, while maintaining water content above 80 %, ensuring a moist environment for wound healing. Their thermal stability was also improved. SEM, FTIR, and XPS results confirmed enhanced crosslinking within the multi-network of the hydrogels, attributed to the increased hydrogen bonding from GP and P-CTP, independent of chemical crosslinking. However, antioxidant and antibacterial activities were dose-dependent only on P-CTP, with S3 and S6 showing the best effects. CAM and chicken embryo assays confirmed the hydrogels' non-toxicity and biocompatibility. These findings suggest that PQSp hydrogels, with their excellent mechanical properties, bioactivity, and safety, hold great potential for advanced wound dressing applications and provide a reference for expanding the application range of P-CTP.

A multifunctional bacterial cellulose-based dressing modified by quaternized chitosan and grafted protocatechuic acid for diabetic ulcer

Herein, we developed a multifunctional bacterial cellulose-based dressing (PHBC) modified by quaternized chitosan (HACC) along with protocatechuic acid (PA), through in situ biosynthesis combined with covalent immobilization. The obtained PHBC dressing maintained the excellent physicochemical characteristics of BC, such as high porosity (above 76 %); high water absorption ratio, >80 % of water absorption rate (approximately 30 g/g) has completed in half an hour; favorable hydrophilicity with contact angle of about 50° and excellent flexibility. The introduction of PA-grafted HACC endows exhibited outstanding antibacterial properties against, anti-inflammatory performance and antioxidant capacity. Furthermore, PHBC II, with the reaction solubility of PA was 3 mg/mL, could promote NIH3T3 and HUVECs proliferation and spread. In vivo experiments further verified that PHBC II can effectively promote new granulation tissue hyperplasia and collagen deposition and expression around diabetic ulcers, reduce the inflammatory phenomenon around the wound, and promote the internal capillaries of the wound. The repair and regeneration of the network can promote better and faster wound healing. These results illustrate that the PHBC functional dressing has an important reference value for the clinical treatment of diabetic ulcers.

Electrospun robust, biodegradable, bioactive, and nanostructured sutures to accelerate the chronic wound healing

The design and development of advanced surgical sutures with appropriate structure and abundant bio-functions are urgently required for the chronic wound closure and treatment. In this study, an integrated technique routine combining modified electrospinning with hot stretching process was proposed and implemented to fabricate poly(L-lactic acid) (PLLA) nanofiber sutures, and the Salvia miltiorrhiza Bunge-Radix Puerariae herbal compound (SRHC) was encapsulated into PLLA nanofibers during the electrospinning process to enrich the biofunction of as-generated sutures. All the PLLA sutures loading without or with SRHC were found to exhibit bead-free and highly-aligned nanofiber structure. The addition of SRHC was found to have no significant influences on the fiber morphology, diameter, and the crystallinity of as-prepared PLLA sutures. Importantly, all the SRHC-contained PLLA nanofiber sutures possessed excellent tensile and knot strength, which were of significant importance for the surgical suture applications. Besides, the antioxidant and anti-inflammatory properties of these sutures obviously enhanced with the increasing of SRHC concentration. Furthermore, thein vitrocell tests illustrated that the high fiber orientation of the sutures was able to efficiently induce the human dermal fibroblasts (HDFs) to migrate in a rapid manner, and the sutures loaded with high content of SRHC could significantly promote the attachment and proliferation of HDFs in comparison. Thein vivodiabetic mouse model experiments revealed that all the as-developed PLLA sutures could effectively close the wound, but the PLLA sutures containing high content of SRHC could dramatically promote the wound healing with high quality by shortening the healing time, improving the collagen deposition, neovascularization, and the regeneration of hair follicles, especially compared with commercial polyester (PET) suture. This study offers a simple and easily-handling strategy to develop robust, biodegradable, bioactive, and nanostructured PLLA sutures, which shows huge potential for the treatment of hard-to-heal diabetic wounds.

Silver-Treated Sutures for the Prevention of Biofilm-Associated Surgical Site Infections

BACKGROUND/OBJECTIVES

The huge concerns associated with biofilm-related infections in surgical procedures, along with the antibiotic resistance demonstrated by an increasing number of bacteria, have highlighted the need for alternative and effective prevention approaches. The aim of this research was to develop novel antimicrobial coatings on surgical sutures for the prevention of surgical site infections through nanotechnology-based methods.

RESULTS

The results demonstrated that although very low amounts of silver precursor were adopted for the treatments, the silver coating was effective against Staphylococcus aureus and antibiotic-resistant Pseudomonas aeruginosa in reducing the potential risk of infection.

METHODS

Nanostructured silver coatings were deposited onto the surface of polyglactin 910 absorbable braided sutures through a technology based on a photo-assisted chemical reaction. The materials were characterized in order to verify the efficacy of the coating in preventing biofilm formation and in reducing the bacterial colonization of the device.

CONCLUSIONS

As a broad-spectrum antimicrobial agent, silver represents an important option for the prevention and management of surgical site infections. The silver deposition technology adopted in this work provides an interesting strategy for preventing biofilm formation on medical devices such as surgical sutures.

Zinc Oxide-Loaded Recycled PET Nanofibers for Applications in Healthcare and Biomedical Devices

Polyethylene terephthalate (PET) is a widely utilized synthetic polymer, favored in various applications for its desirable physicochemical characteristics and widespread accessibility. However, its extensive utilization, coupled with improper waste disposal, has led to the alarming pollution of the environment. Thus, recycling PET products is essential for diminishing global pollution and turning waste into meaningful materials. Therefore, this study proposes the fabrication of electrospun membranes made of recycled PET nanofibers as a cost-effective valorization method for PET waste. ZnO nanoparticles were coated onto polymeric materials to enhance the antimicrobial properties of the PET fibers. Morphostructural investigations revealed the formation of fibrillar membranes made of unordered nanofibers (i.e., 40-100 nm in diameter), on the surface of which zinc oxide nanoparticles of 10-20 nm were attached. PET@ZnO membranes demonstrated effective antimicrobial and antibiofilm activity against Gram-positive and Gram-negative bacteria, yeasts, and molds, while imparting no toxicity to amniotic fluid stem cells. In vivo tests confirmed the materials' biocompatibility, as no side effects were observed in mice following membrane implantation. Altogether, these findings highlight the potential of integrating ZnO nanoparticles into recycled PET to develop multifunctional materials suitable for healthcare facilities (such as antimicrobial textiles) and biomedical devices, including applications such as textiles, meshes, and sutures.

Polycaprolactone/gelatin-QAS/bioglass nanofibres accelerate diabetic chronic wound healing by improving dysfunction of fibroblasts

Worldwide, more than 25 % of patients with diabetes develop chronic diabetic wounds in their lifetime. Infection and dysfunctional fibroblasts represent two significant etiological factors contributing to impaired wound healing in patients with diabetes. It is therefore evident that the development of wound dressings with both anti-infective and DM fibroblast modulating functions has the potential for clinical applications. In this study, a PCL/gelatine-quaternary ammonium salts (QAS)/bioglass (BG) electrospun nanofibrous membrane was developed with physico-chemical and biological properties that not only meet the clinical requirements for wound dressings but also exhibit remarkable moisturising (water adsorption rate of 382.39 ± 4.36 %) and tear-resistance properties (a tear strength of ~5.5 MPa). The incorporation of QAS and BG has enhanced the biocompatibility and bioactivity of the nanofibres, while also imparting remarkable antimicrobial properties. The antibacterial efficacy of PGQ-BG against E. coli and S. aureus was found to be 92.8 ± 0.78 % and 99.3 ± 0.55 %, respectively. Moreover, it was demonstrated that PGQ-BG nanofibers exerted a promoting effect on the extracellular matrix (ECM) in dysfunctional fibroblasts and upregulated the expression level of α-smooth muscle actin (α-SMA), a marker of their differentiation to myofibroblasts in vitro and in vivo. Furthermore, the COL-III/COL-I ratio was significantly increased, indicating that PGQ-BG may also accelerate wound healing. The nanofibrous dressing reduced scar formation by increasing the COL-III/COL-I ratio. This is the first report of BG improving fibroblast dysfunction via COL-III and COL-I promotion in fibroblasts, both in vitro and in vivo. Therefore, this novel bioactive nanofibrous dressing represents an effective and safe therapeutic strategy for improving chronic wound healing in patients with diabetes.

A guide to removing sutures

This article provides an overview of the wound healing process, outlining the four distinct phases of the healing cascade: haemostasis, inflammation, proliferation, and maturation. The different types of closure method are described and, specifically, the various types of surgical suture that can be used for wound closure, as well as the strengths and limitations of each. The article explains aspects of patient care that need to be considered such as obtaining informed consent, and the importance of nurses maintaining appropriate clinical skills. It concludes with a step-by-step outline of best practice on how to remove sutures.

Utility of preoperative prophylactic antibiotics for preventing surgical site infections in children with infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis

PURPOSE

The aim of this study was to determine the utility of prophylactic antibiotics before pyloromyotomy for the prevention of Surgical Site Infections (SSI) among children with Infantile Hypertrophic Pyloric Stenosis (IHPS).

METHODS

A systematic search of PubMed, Scopus, Embase, and Web of Science databases was performed to identify papers published till 30th July 2024. The main outcome of interest was the incidence of SSIs. The relative risk (RR) with 95% confidence interval (CI) was calculated using a random effects model. The I2 statistic was used to calculate the heterogeneity. The Newcastle-Ottawa-Scale (NOS) was used to assess the methodological quality of the included studies.

RESULTS

Five studies, published between 1999 and 2024, were included in this systematic review and meta-analysis. The risk of developing SSI among those treated was RR = 0.97, 95% CI 0.53 to 1.78, with I2 = 0%, indicating no incremental benefit of administration of prophylactic antibiotics. A sensitivity analysis was performed by excluding the database studies. Results from this analysis (RR = 0.79, 95% CI 0.29 to 2.20, I2 = 0%) demonstrated that no significant difference was observed after excluding studies with large sample sizes. All included studies were of good methodological quality as assessed with the NOS.

CONCLUSION

The findings of this review demonstrate no incremental benefit of the administration of prophylactic antibiotics before pyloromyotomy in preventing SSIs in children with IHPS. However, randomized, double-blinded, placebo-controlled trials need to be conducted in the future before any definite conclusions are drawn in this regard.

Antibacterial and wound healing stimulant nanofibrous dressing consisting of soluplus and soy protein isolate loaded with mupirocin

Severe cutaneous injuries may not heal spontaneously and may necessitate the use of supplementary therapeutic methods. Electrospun nanofibers possess high porosity and specific surface area, which provide the necessary microenvironment for wound healing. Here in, the nanofibers of Soluplus-soy protein isolate (Sol-SPI) containing mupirocin (Mp) were fabricated via electrospinning for wound treatment. The fabricated nanofibers exhibited water absorption capacities of about 300.83 ± 29.72% and water vapor permeability values of about 821.8 ± 49.12 g/m2 day. The Sol/SPI/Mp nanofibers showed an in vitro degradability of 33.73 ± 3.55% after 5 days. The ultimate tensile strength, elastic modulus, and elongation of the Sol/SPI/Mp nanofibers were measured as 3.61 ± 0.29 MPa, 39.15 ± 5.08 MPa, and 59.11 ± 1.94%, respectively. Additionally, 85.90 ± 6.02% of Mp loaded in the nanofibers was released in 5 days in vitro, and by applying the Mp-loaded nanofibers, 93.06 ± 5.40% and 90.40 ± 5.66% of S. aureus and E. coli bacteria were killed, respectively. Human keratinocyte cells (HaCat) demonstrated notable biocompatibility with the prepared nanofibers. Furthermore, compare to other groups, Sol-SPI-Mp nanofibers caused the fastest re-epithelialization and wound healing in a rat model. The findings of this study present a novel nanofiber-based wound dressing that accelerates the healing of severe skin wounds with the risk of infection.

A separable double-layer self-pumping dressing containing astragaloside for promoting wound healing

Some skin wounds often have many exudate. Ordinary single layer electrospunning nanofiber wound dressings often don't have enough capacity to absorb them. Therefore, a separable double layer electrospunning nanofiber dressing was developed in this work. The dressing had a separable feature that allowed the upper layer to be separated and removed after it had absorbed a significant amount of wound exudate. This dressing consisted of an upper layer of super hydrophilic sodium polyacrylate nanofibers and a bottom layer of 3D-structure coaxial nanofibers with encapsulated Astragaloside (AS). The results showed that nanofibers had better morphology. The water absorption rate, water vapor transmission rate and free radical scavenging rate of the double-layer dressings were 1461.71 ± 39.72 %, 1193.63 ± 134 g·m-2·day-1, and 63.35 ± 3.65 %, respectively. The double-layer nanofiber dressing achieved 65.69 ± 2.62 % and 75.10 ± 6.26 % inhibition against Staphylococcus aureus and Escherichia coli, respectively. The double-layer dressing had proliferative, migratory, and adhesive effects on L929 fibroblasts. And the double-layer dressing resulted in a 96.78 ± 1.0 % wound healing rate in rats after giving a 14 days treatment. Therefore, the 3D-structure separable double-layer wound dressing designed and prepared in this study was effective in promoting wound healing.

Antimicrobial cyclodextrin-assisted electrospun fibers loaded with carvacrol, citronellol and cinnamic acid for wound healing

This work aimed to explore an alternative to the use of antibiotics for prevention and treatment of wounds infection caused by two common bacterial pathogens Staphylococcus aureus and Pseudomonas aeruginosa. For this purpose, three different essential oil components (EOCs), namely carvacrol, citronellol and cinnamic acid, were loaded into electrospun fibers of poly-ε-caprolactone (PCL) aided by alpha-cyclodextrin (αCD) and hydroxypropyl-β-cyclodextrin (HPβCD). Electrospun-fibers prepared with each EOC and their mixtures were screened for antimicrobial capability and characterized regarding morphological, mechanical, thermal, surface polarity, antibiofilm and antioxidant properties. αCD formed poly(pseudo)rotaxanes with PCL and weakly interacted with EOCs, while HPβCD facilitated EOC encapsulation and formation of homogeneous fibers (500-1000 nm diameter) without beads. PCL/HPβCD fibers with high concentration of EOCs (mainly carvacrol and cinnamic acid) showed strong antibiofilm (>3 log CFU reduction) and antioxidant activity (10-50% DPPH scavenging effects). Different performances were recorded for the EOCs and their mixtures; cinnamic acid migrated to fiber surface and was released faster. Fibers biocompatibility was verified using hemolysis tests and in ovo tissue integration and angiogenesis assays. Overall, HPβCD facilitates complete release of EOCs from the fibers to the aqueous medium, being an environment-friendly and cost-effective strategy for the treatment of infected wounds.

Bioactive nanofibrous mats constructs: Separate efficacy of Lawsonia inermis and Scrophularia striata extracts in PVA/alginate matrices for enhanced wound healing

The study explores the use of electrospinning technology to create advanced wound dressing materials by integrating natural extracts from Lawsonia inermis (LI) and Scrophularia striata (SS) into nanofibrous matrices composed of Polyvinyl Alcohol (PVA) and Alginate (ALG). These macromolecular complexes aim to leverage the unique properties of the botanical extracts for wound healing purposes. The research assesses the physical, chemical, and mechanical attributes of the nanofibrous constructs as well as their antimicrobial activities and ability to promote wound repair. Evaluation of Cellular Viability and Cytotoxicity (MTT) tests showed high biocompatibility of the nanofibrous mats, with cell viability percentages of 92 % for LI-loaded mats and 89 % for SS-loaded mats. The antibacterial rate of extract-containing mats was 70 % higher than non-extract-containing mats. In vivo assessments on rat models with burn injuries demonstrated that mats containing LI and SS extracts substantially accelerate tissue regeneration and overall healing. Nanofibrous mats containing LI extract showed a 45 % faster wound healing process than the control, while those containing SS extract showed a 40 % improvement. Overall, the study highlights the potential of PVA/ALG nanofibrous mats augmented with LI and SS extracts as effective platforms for wound management, offering enhanced properties for superior healing outcomes.

Short-Term Hydrolytic Degradation of Mechanical Properties of Absorbable Surgical Sutures: A Comparative Study

Surgical sutures play a crucial role in wound closure, facilitating the tissue-healing process across various fields of medicine. The objective of this study was to analyse the impact of seasoning time during the initial days/weeks of seasoning in Ringer's solution on the mechanical properties of five commercial absorbable sutures: SafilQuick+®, Novosyn®, MonosynQuick®, Monosyn® and Monoplus®, each with different absorption periods. The results demonstrated that the SafilQuick+ and MonosynQuick sutures lost strength within 9-12 days, as evidenced by statistically significant changes in tensile strength. In contrast, the Novosyn and Monoplus sutures did not exhibit significant changes in strength during the study period. Statistical analysis confirmed significant differences in the behaviour of the individual sutures, highlighting the importance of selecting appropriate suture material in the context of the specific medical procedure.

Facile roll-to-roll production of nanoporous fiber coatings for advanced wound care sutures

Theranostic sutures are derived from innovative ideas to enhance wound healing results by adding wound diagnostics and therapeutics to typical sutures by functionalizing them with additional materials. Here, we present a new direct electrospinning method for the fast, continuous, inexpensive, and high-throughput production of versatile nanofibrous-coated suture threads, with precise control over various essential microstructural and physical characteristics. The thickness of the coating layer and the alignment of nanofibers with the thread's direction can be adjusted by the user by varying the spooling speed and the displacement between the spinneret needle and thread. To show the flexibility of our method for a range of different materials selected, gelatin, polycaprolactone, silk fibroin, and PEDOT:PSS (poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate)) were the resultant nanofibers characterized by scanning electron microscopy (SEM) imaging and conductivity tests. In a series of in vitro and ex vivo tests (pig skin), sutures were successfully tested for their flexibility and mechanical properties when used as weaving and knotting sutures, and their biocompatibility with a keratinocyte cell line. For temperature-based drug-releasing tests, two fluorescent molecules as drug models with high and low molecular weight, namely fluorescein isothiocyanate-dextran (20 kDa) and rhodamine B (470 Da), were used, and their steady release with incremental increase of temperature to 37 °C over 120 min was seen, which is appropriate for bacterial treatment drugs. Given the advantages of the presented technique, it seems to have promising potential to be used in future medical applications for wound closure and bacterial infection treatment via a temperature-triggered drug release strategy.

O-carboxymethyl chitosan in biomedicine: A review

O-carboxymethyl chitosan (O-CMC) is a chitosan derivative produced through the substitution of hydroxyl (-OH) functional groups in glucosamine units with carboxymethyl (-CH2COOH) substituents, effectively addressing the inherent solubility issues of chitosan in aqueous solutions. O-CMC has garnered significant interest due to its enhanced solubility, elevated viscosity, minimal toxicity, and advantageous biocompatibility properties. Furthermore, O-CMC demonstrates antibacterial, antifungal, and antioxidant characteristics, rendering it a promising candidate for various biomedical uses such as wound healing, tissue engineering, anti-tumor therapies, biosensors, and bioimaging. Additionally, O-CMC is well-suited for the fabrication of nanoparticles, hydrogels, films, microcapsules, and tablets, offering opportunities for effective drug delivery systems. This review outlines the distinctive features of O-CMC, offers analyses of advancements and future potential based on current research, examines significant obstacles for clinical implementation, and foresees its ongoing significant impacts in the realm of biomedicine.

Development and characterization of curcumin nanosuspension-embedded genipin-crosslinked chitosan/polyvinylpyrrolidone hydrogel patch for effective wound healing

This study investigated the development of a genipin-crosslinked chitosan (CS)-based polyvinylpyrrolidone (PVP) hydrogel containing curcumin nanosuspensions (Cur-NSs) to promote wound healing in an excisional wound model. Cur-NSs were prepared, and a simplex centroid mixture design was employed to optimize hydrogel properties for high water absorption, degree of crosslinking, and sufficient toughness. The in vivo wound healing effect was tested in Wistar rats. The optimized hydrogel consisted of a 70:30 ratio of CS:PVP, crosslinked with a 2 % w/w genipin solution. It exhibited high swelling capability (486 %) while maintaining solidity, robustness, and durability. Incorporating 5 % w/w Cur-NSs resulted in a more compact structure, although with a reduction in swelling properties. The release kinetics of Cur from the hydrogel followed the Korsmeyer-Peppas Fickian diffusion model. In vitro biocompatibility studies demonstrated that the hydrogel was non-toxic to skin fibroblast cells. The in vivo experiment revealed a desirable wound healing rate with over 80 % recovery by day 7. Cur-NSs likely aided wound healing by reducing the inflammatory response and stimulating fibroblast proliferation. Additionally, the CS-based hydrogel provided a moist wound environment with hydration and gas transfer, further accelerating wound closure. These findings suggest that the Cur-NS-embedded hydrogel shows promise as a wound dressing material.

Polydopamine-armored zeolitic imidazolate framework-8-incorporated zwitterionic hydrogel with multifunctional properties for infected wound healing

Diabetic skin wound healing is compromised by bacterial infections, oxidative stress, and vascular disruption, leading to delayed recovery and potential complications. This study developed an antibacterial, antioxidant, and adhesive hydrogel dressing that promotes rapid bacterial-infected diabetic wound healing using the biological macromolecule of polydopamine (PDA). This hydrogel comprised PDA-armored zeolitic imidazolate framework-8 nanoparticles (PDA@ZIF-8 NPs) combined with a second armor of zwitterionic polymer network (poly(acrylamide-co-sulfobetaine methacrylate); PAS), realizing low concentration Zn2+ release, good adhesion (14.7 kPa for porcine skin), and improved tensile strength (83.2 kPa). The hydrogel exhibited good antibacterial efficacy against both Staphylococcus aureus (S. aureus, 92.8 %), Escherichia coli (E. coli, 99.6 %) and methicillin-resistant S. aureus (MRSA, 99.2 %), which was attributed to the properties of the incorporated PDA@ZIF-8 NPs. Notably, in vitro, the PDA@ZIF-8 PAS hydrogel not only promoted fibroblast proliferation and migration but also facilitated endothelial cell angiogenesis. In vivo, the PDA@ZIF-8 PAS hydrogel retained its Zn2+-releasing function and effectively suppressed bacterial growth in infected wounds, thereby accelerating the regeneration of both normal and diabetic wounds. This multiarmored hydrogel is a promising sustained-release carrier for functional metal ions and drugs, making it applicable for not only skin healing, but potentially the regeneration of other complex tissues.

Polydopamine modified multifunctional carboxymethyl chitosan/pectin hydrogel loaded with recombinant human epidermal growth factor for diabetic wound healing

The development of a multifunctional wound dressing that can adapt to the shape of wounds and provide controlled drug release is crucial for diabetic patients. This study developed a carboxymethyl chitosan-based hydrogel dressing with enhanced mechanical properties and tissue adherence that were achieved by incorporating pectin (PE) and polydopamine (PDA) and loading the hydrogel with recombinant human epidermal growth factor (rhEGF). This EGF@PDA-CMCS-PE hydrogel demonstrated robust tissue adhesion, enhanced mechanical properties, and superior water retention and vapor permeability. It also exhibited significant antioxidant capacity. The results showed that EGF@PDA-CMCS-PE could effectively scavenge 2,2'-Azinobis-(3-ethylbenzthiazoline-6-sulphonate)， (1,1-diphenyl-2-picrylhydrazyl), and superoxide anions and increase superoxide dismutase and catalase levels in vivo. In vitro cytotoxicity and antibacterial assays showed good biocompatibility and antimicrobial properties. The sustained release of EGF by the hydrogel was confirmed, with a gradual release profile over 120 h. In vivo studies in diabetic mice showed that the hydrogel significantly accelerated wound healing, with a wound contraction rate of 97.84% by day 14. Histopathological analysis revealed that the hydrogel promoted fibroblast proliferation, neovascularization, and orderly connective tissue formation, leading to a more uniform and compact wound-healing process. Thus, EGF@PDA-CMCS-PE hydrogel presents a promising tool for managing chronic diabetic wounds, offering a valuable strategy for future clinical applications.

The polycaprolactone and silk fibroin nanofibers with Janus-structured sheaths for antibacterial and antioxidant by loading Taxifolin

Electrospinning is a widely recognized method for producing Janus or core-shell nanofibers. In this study, nanofibrous membranes were fabricated through co-axial electrospinning utilizing polycaprolactone (PCL) and silk fibroin (SF) as the Janus shell, and taxifolin (TAX) and SF as the core. The resulting nanofibers had diameters of 816 ± 161 nm and core diameters of 73 ± 5 nm. The morphology and properties of the PCL-SF@SF/TAX nanofibers were subsequently analyzed. The results demonstrated that the nanofibrous membranes achieved physical and chemical characteristics potential for tissue engineering and drug delivery. Specifically, the membranes exhibited a Young's modulus of 9.64 ± 0.29 MPa, a water contact angle of 79.1 ± 1.3°, and a weight loss of 17.3 ± 1.0 % over a period of 28 days. The incorporation of TAX endowed the membranes with antibacterial properties, effectively combating Escherichia coli and Staphylococcus aureus. Furthermore, the membranes demonstrated antioxidant capabilities, with a DPPH radical scavenging efficiency of 38.5 ± 5.6 % and a Trolox-equivalent antioxidant capacity of 0.24 ± 0.01 mM. The release of the antioxidant was sustained over 28 days, following first-order release kinetics. The nanofibrous membranes, referred to as PSST, exhibit promising potential for use as biomaterials, characterized by their antibacterial activity, antioxidant and cytocompatibility.

Electrospun radially oriented berberine-PHBV nanofiber dressing patches for accelerating diabetic wound healing

A dressing patch made of radially oriented poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanofibers was successfully manufactured with a modified electrospinning strategy. The as-electrospun PHBV radially oriented nanofiber dressing patch exhibited uniform and bead-free nanofibrous morphology and innovative radially oriented arrangement, which was demonstrated to possess obviously improved mechanical property, increased surface hydrophilicity and enhanced biological properties compared to the PHBV nanofiber dressing patch control with traditionally randomly oriented pattern. Interestingly, it was found that the radially oriented pattern could induce the cell migration from the periphery to the center along the radially oriented nanofibers in a rapid manner. To further improve the biofunction of PHBV radially oriented nanofiber dressing patch, berberine (Beri, an isoquinoline alkaloid) with two different concentrations were encapsulated into PHBV nanofibers during electrospinning, which were found to present a sustained drug release behavior for nearly one month. Importantly, the addition of Beri could impart the dressing patch with excellent anti-inflammatory property by significantly inhibiting the secretion of pro-inflammatory factors of M1 macrophages, and also showed an additive influence on promoting the proliferation of human dermal fibroblasts (HDFs), as well as inhibiting the growth of E. coli, S. aureus and C. albicans, compared with the Beri-free dressing patch. In the animal studies, the electrospun PHBV radially oriented nanofiber dressing patch loading with high Beri content was found to obviously accelerate the healing process of diabetic mouse full-thickness skin wound with shortened healing time (100% wound closure rate after 18 days' treatment) and improved healing quality (improved collagen deposition, enhanced re-epithelialization and neovascularization and increased hair follicles). In all, this study reported an innovative therapeutic strategy integrating the excellent physical cues of electrospun PHBV radially oriented nanofiber dressing patch with the multiple biological cues of Beri for the effective treatment of hard-to-heal diabetic wounds.

Citrus flavonoids-loaded chitosan derivatives-route nanofilm as drug delivery systems for cutaneous wound healing

This study focuses on creating new forms of biomimetic nanofiber composites by combining copolymerizing and electrospinning approaches in the field of nanomedicine. The process involved utilizing the melt polymerization of proline (Pr) and hydroxyl proline (Hyp) to synthesize polymers based on Pr (PPE) and Hyp (PHPE). These polymers were then used in a grafting copolymerization process with chitosan (CS) to produce PHPC (1560 ± 81.08 KDa). A novel electrospun nanofiber scaffold was then produced using PHPC and/or CS, hyaluronic acid, polyvinyl alcohol, and naringenin (NR) as a loading drug. Finally, Mouse Dermal Fibroblast (MDF) cells were introduced to the wound dressing and assessed their therapeutic potential for wound healing in rats. The scaffolds were characterized by FTIR, NMR, DSC, and SEM analysis, which confirmed the amino acid grafting, loading drug, and porous and nanofibrous structures (>225 nm). The results showed that the PHPC-based scaffolds were more effective for swelling/absorption of wound secretions, had more elasticity/elongation, faster drug release, more MDF-cytocompatibility, and antibacterial activity against multidrug-resistant S. aureus compared to CS-based scaffolds. The in vivo studies showed that NR in combination with MDF can accelerate cell migration/proliferation, and remodeling phases of wound healing in both PHPC/CS-based scaffolds. Moreover, PHPC-based scaffolds promote collagen content, and better wound contraction, epithelialization, and neovascularization than CS-based, showing potential as wound-dressing.

Turning sublimed sulfur and bFGF into a nanocomposite to accelerate wound healing via co-activate FGFR and Hippo signaling pathway

Clinical treatment of diabetic refractory ulcers is impeded by chronic inflammation and cell dysfunction associated with wound healing. The significant clinical application of bFGF in wound healing is limited by its instability in vivo. Sulfur has been applied for the treatment of skin diseases in the clinic for antibiosis. We previously found that sulfur incorporation improves the ability of selenium nanoparticles to accelerate wound healing, yet the toxicity of selenium still poses a risk for its clinical application. To obtain materials with high pro-regeneration activity and low toxicity, we explored the mechanism by which selenium-sulfur nanoparticles aid in wound healing via RNA-Seq and designed a nanoparticle called Nano-S@bFGF, which was constructed from sulfur and bFGF. As expected, Nano-S@bFGF not only regenerated zebrafish tail fins and promoted skin wound healing but also promoted skin repair in diabetic mice with a profitable safety profile. Mechanistically, Nano-S@bFGF successfully coactivated the FGFR and Hippo signalling pathways to regulate wound healing. Briefly, the Nano-S@bFGF reported here provides an efficient and feasible method for the synthesis of bioactive nanosulfur and bFGF. In the long term, our results reinvigorated efforts to discover more peculiar unique biofunctions of sulfur and bFGF in a great variety of human diseases.

Intelligent electrospinning nanofibrous membranes for monitoring and promotion of the wound healing

The incidence of chronic wound healing is promoted by the growing trend of elderly population, obesity, and type II diabetes. Although numerous wound dressings have been studied over the years, it is still challenging for many wound dressings to perfectly adapt to the healing process due to the dynamic and complicated wound microenvironment. Aiming at an optimal reproduction of the physiological environment, multifunctional electrospinning nanofibrous membranes (ENMs) have emerged as a promising platform for the wound treatment owing to their resemblance to extracellular matrix (ECM), adjustable preparation processes, porousness, and good conformability to the wound site. Moreover, profiting from the booming development of human-machine interaction and artificial intelligence, a next generation of intelligent electrospinning nanofibrous membranes (iENMs) based wound dressing substrates that could realize the real-time monitoring of wound proceeding and individual-based wound therapy has evoked a surge of interest. In this regard, general wound-related biomarkers and process are overviewed firstly and representative iENMs stimuli-responsive materials are briefly summarized. Subsequently, the emergent applications of iENMs for the wound healing are highlighted. Finally, the opportunities and challenges for the development of next-generation iENMs as well as translating iENMs into clinical practice are evaluated.

3D Printing of Polysaccharide-Based Hydrogel Scaffolds for Tissue Engineering Applications: A Review

In tissue engineering, 3D printing represents a versatile technology employing inks to construct three-dimensional living structures, mimicking natural biological systems. This technology efficiently translates digital blueprints into highly reproducible 3D objects. Recent advances have expanded 3D printing applications, allowing for the fabrication of diverse anatomical components, including engineered functional tissues and organs. The development of printable inks, which incorporate macromolecules, enzymes, cells, and growth factors, is advancing with the aim of restoring damaged tissues and organs. Polysaccharides, recognized for their intrinsic resemblance to components of the extracellular matrix have garnered significant attention in the field of tissue engineering. This review explores diverse 3D printing techniques, outlining distinctive features that should characterize scaffolds used as ideal matrices in tissue engineering. A detailed investigation into the properties and roles of polysaccharides in tissue engineering is highlighted. The review also culminates in a profound exploration of 3D polysaccharide-based hydrogel applications, focusing on recent breakthroughs in regenerating different tissues such as skin, bone, cartilage, heart, nerve, vasculature, and skeletal muscle. It further addresses challenges and prospective directions in 3D printing hydrogels based on polysaccharides, paving the way for innovative research to fabricate functional tissues, enhancing patient care, and improving quality of life.

Do Absorbable Sutures Work for Rectus Diastasis Repair in Abdominoplasty Patients?

Background

The standard treatment for rectus diastasis is rectus sheath plication during abdominoplasty. Lasting correction of diastasis is essential, but there is currently a debate as to whether absorbable or nonabsorbable rectus plication achieves a lower rate of recurrence.

Objectives

The goal of this study is to assess long-term patient outcomes and the recurrence of rectus diastasis after plication with long-lasting absorbable sutures.

Methods

A retrospective study of abdominoplasties performed by the senior author between 2018 and 2022 was performed. Only female patients with >6 months of follow-up were included. Plication of the rectus muscles was performed with a combination of interrupted, buried, figure of eight #0 polydioxanone suture and running #0 Maxon (Covidien, Mansfield, MA). Outcomes were assessed by physical examination at postoperative visits. A retrospective chart review was used to obtain demographic and perioperative information.

Results

Seventy-one patients underwent abdominoplasty with an average follow-up of 21.1 months. The average age was 43 years, and the average BMI was 27 kg/m2. Correction of rectus diastasis was performed using absorbable sutures in all patients with no recurrence of diastasis in any patient (0% diastasis recurrence rate). Complications included delayed wound healing (11%), seroma (8.5%), hematoma (2.8%), and deep vein thrombosis/pulmonary embolism (2.8%). No patients needed reoperation.

Conclusions

Abdominal wall plication using a double-layered, long-lasting absorbable suture closure is a safe, reliable, and effective method to address rectus diastasis during abdominoplasty. Our technique achieved no recurrence of diastasis in any patient and a low complication profile.

Level of Evidence 3

Natural and Synthetic Polymers for Biomedical and Environmental Applications

Natural and synthetic polymers are a versatile platform for developing biomaterials in the biomedical and environmental fields. Natural polymers are organic compounds that are found in nature. The most common natural polymers include polysaccharides, such as alginate, hyaluronic acid, and starch, proteins, e.g., collagen, silk, and fibrin, and bacterial polyesters. Natural polymers have already been applied in numerous sectors, such as carriers for drug delivery, tissue engineering, stem cell morphogenesis, wound healing, regenerative medicine, food packaging, etc. Various synthetic polymers, including poly(lactic acid), poly(acrylic acid), poly(vinyl alcohol), polyethylene glycol, etc., are biocompatible and biodegradable; therefore, they are studied and applied in controlled drug release systems, nano-carriers, tissue engineering, dispersion of bacterial biofilms, gene delivery systems, bio-ink in 3D-printing, textiles in medicine, agriculture, heavy metals removal, and food packaging. In the following review, recent advancements in polymer chemistry, which enable the imparting of specific biomedical functions of polymers, will be discussed in detail, including antiviral, anticancer, and antimicrobial activities. This work contains the authors' experimental contributions to biomedical and environmental polymer applications. This review is a vast overview of natural and synthetic polymers used in biomedical and environmental fields, polymer synthesis, and isolation methods, critically assessessing their advantages, limitations, and prospects.