Absorbable polyglycolide devices in trauma and bone surgery

Use of a Nanofiber Resorbable Scaffold During Rotator Cuff Repair: Surgical Technique and Results After Repair of Small- to Medium-Sized Tears

Background:

The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair.

Purpose/Hypothesis:

To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status.

Results:

At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores (P < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively (P < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch.

Conclusion:

Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.

PDA-PEG-Ce6-Mn Multifunctional Nanoparticles for Magnetic Resonance Images-Guided Photo-Dynamic/Photo-Thermal Therapy

One of the most common brain cancer type is gliomas. Although traditional multi-modal therapy has made some progress, overall poor prognosis and low long-run rate of patient’s survival still persist. Due to its selective, noninvasive and repetitive nature, photo-dynamic/photo-thermal therapy (PDT/PTT) is considered to enhance therapeutic effect of glioma. We report a new type of polydopamine (PDA) nanoparticle with targeting ability and excellent PDT/PTT synergistic effect. The Mn2+ chelated nanocomposite material exhibited a favorable contrast T1-weighted magnetic resonance images (MRI). In the U251 tumor-bearing mouse model, near-infrared (NIR) imaging and MRI-guided PDT/PTT achieved significant synergistic therapeutic effects compared to their single treatment methods. Conclusively, PDA-PEG-Ce6-Mn nanoparticle demonstrated high potential in the diagnosis and treatment of glioma.

Fast-Scanning Chip-Calorimetry Measurement of Crystallization Kinetics of Poly(Glycolic Acid)

We report fast-scanning chip-calorimetry measurement of isothermal crystallization kinetics of poly(glycolic acid) (PGA) in a broad temperature range. We observed that PGA crystallization could be suppressed by cooling rates beyond -100 K s^-1 and, after fast cooling, by heating rates beyond 50 K s^-1. In addition, the parabolic curve of crystallization half-time versus crystallization temperature shows that PGA crystallizes the fastest at 130 °C with the minimum crystallization half-time of 4.28 s. We compared our results to those of poly(_L-lactic acid) (PLLA) with nearby molecular weights previously reported by Androsch et al. We found that PGA crystallizes generally more quickly than PLLA. In comparison to PLLA, PGA has a much smaller hydrogen side group than the methyl side group in PLLA; therefore, crystal nucleation is favored by the higher molecular mobility of PGA in the low temperature region as well as by the denser molecular packing of PGA in the high temperature region, and the two factors together decide the higher crystallization rates of PGA in the whole temperature range.

Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children's Forearm Shaft Fractures with at Least Four Years of Follow-Up

The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.

The Effect of Diclofenac Sodium-Loaded PLGA Rods on Bone Healing and Inflammation: A Histological and Histomorphometric Study in the Femur of Rats

Implants made of poly(lactide-co-glycolide) (PLGA) are biodegradable and frequently provoke foreign body reactions (FBR) in the host tissue. In order to modulate the inflammatory response of the host tissue, PLGA implants can be loaded with anti-inflammatory drugs. The aim of this study was to analyze the impact of PLGA 80/20 rods loaded with the diclofenac sodium (DS) on local tissue reactions in the femur of rats. Special emphasis was put on bone regeneration and the presence of multinucleated giant cells (MGCs) associated with FBR. PLGA 80/20 alone and PLGA 80/20 combined with DS was extruded into rods. PLGA rods loaded with DS (PLGA+DS) were implanted into the femora of 18 rats. Eighteen control rats received unloaded PLGA rods. The follow-up period was of 3, 6 and 12 weeks. Each group comprised of six rats. Peri-implant tissue reactions were histologically and histomorphometrically evaluated. The implantation of PLGA and PLGA+DS8 rods induced the formation of a layer of newly formed bone islands parallel to the contour of the implants. PLGA+DS rods tended to reduce the presence of multi-nucleated giant cells (MGCs) at the implant surface. Although it is known that the systemic administration of DS is associated with compromised bone healing, the local release of DS via PLGA rods did not have negative effects on bone regeneration in the femora of rats throughout 12 weeks.

Hierarchical porosity in additively manufactured bioengineering scaffolds: Fabrication & characterisation

Biomedical scaffolds with a high degree of porosity are known to facilitate the growth of healthy functioning tissues. In this study, scaffolds with hierarchical porosity are manufactured and their mechanical and thermal properties are characterised. Multi-scale porosity is achieved in scaffolds fabricated by Fused Deposition Modelling (FDM) in a novel way. Random intrinsic porosity at micron length scale obtained from particulate leaching is combined with the structured extrinsic porosity at millimeter length scales afforded by controlling the spacing between the struts. Polylactic acid (PLA) is blended with Polyvinyl alcohol (PVA) and an inorganic sacrificial phase, sodium chloride (NaCl), to produce pores at length scales of up to two orders of magnitude smaller than the inter-filament voids within 3D printed lattices. The specific elastic modulus and specific strength are maximised by optimising the polymer blends. The porosity level and pore size distribution of the foamy filaments within lattices are quantified statistically. Compression tests are performed on the porous samples and the observed mechanical response is attributed to the microstructure and density. Simple cellular solid models that possess power law are used to explain the measured trends and the dependence is associated with various mechanisms of elastic deformation of the cell walls. The relationship between pore architecture, pore connectivity, the blend material composition, and mechanical response of produced foams is brought out. Foams obtained using the PLA:PVA:NaCl 42%-18%-40% material blends show relatively high specific elastic modulus, specific strength and strain at failure. A quadratic power law relating the Young's modulus with the relative density is experimentally obtained, which is consistent with theoretical models for open-cell foams. 3D printing with blends, followed by leaching, produces structures with cumulative intrinsic and extrinsic porosity as high as 80%, in addition to good mechanical integrity.

Polyester functional graphenic materials as a mechanically enhanced scaffold for tissue regeneration

Traditional metal implants such as titanium, cobalt, and chromium have found wide utility in medicine; however, these come with a risk of toxicity. To overcome metal-related toxicity and enable degradability, polyesters including polycaprolactone (PCL), polylactic acid (PLA), and polyglycolic acid (PGA) show promise for the replacement of various biomedical applications of metals due to their accepted biocompatibility and FDA approval. However, polyesters are less stiff than their metallic counterparts, limiting their application to non-load bearing injury sites, such as fixation hardware for fingers. To improve mechanical properties, graphene oxide (GO)-polyester composites are a promising class of biodegradable scaffolds. Initial reports of these composites are encouraging, but mechanical properties still fall short. Traditional composites rely on non-covalent association between GO and the polyesters, which often leads to failure at the interface and weakens the overall strength of the material. Herein, we present a strategy for attachment of these FDA-approved polyesters onto a derivative of GO using a robust covalent bond. By covalently functionalizing the graphenic backbone with polyesters and without metal catalysts, we create functional graphenic materials (FGMs) to not only simultaneously retain biodegradability and compatibility, but also mechanically strengthen PCL, PLA, and PGA; we observed an average increase in the Young's modulus of over 140% compared to the graphenic backbone. These polyester-functionalized FGMs are a promising platform technology for tissue implants.

Polyesters are a promising class of biocompatible polymer, however, their mechanical properties fall short of metals and ceramics. This paper covalently binds polyesters to graphenic moieties resulting in enhanced mechanical properties.

Optimized Bioactive Glass: the Quest for the Bony Graft

Technological advances have provided surgeons with a wide range of biomaterials. Yet improvements are still to be made, especially for large bone defect treatment. Biomaterial scaffolds represent a promising alternative to autologous bone grafts but in spite of the numerous studies carried out on this subject, no biomaterial scaffold is yet completely satisfying. Bioactive glass (BAG) presents many qualifying characteristics but they are brittle and their combination with a plastic polymer appears essential to overcome this drawback. Recent advances have allowed the synthesis of organic-inorganic hybrid scaffolds combining the osteogenic properties of BAG and the plastic characteristics of polymers. Such biomaterials can now be obtained at room temperature allowing organic doping of the glass/polymer network for a homogeneous delivery of the doping agent. Despite these new avenues, further studies are required to highlight the biological properties of these materials and particularly their behavior once implanted in vivo. This review focuses on BAG with a particular interest in their combination with polymers to form organic-inorganic hybrids for the design of innovative graft strategies.

Synergistic effect of a drug loaded electrospun patch and systemic chemotherapy in pancreatic cancer xenograft

Pancreatic cancer has a high rate of local recurrence and poor prognosis even with adjuvant chemotherapy after curative resection. The aim of this study was to investigate if local drug delivery combined with low dose systemic chemotherapy can increase the therapeutic effect of chemotherapy while reducing systemic toxicities. Poly-L-lactic acid-based 5-FU releasing patch was fabricated by electrospinning, and its tumour killing effects were first confirmed in vitro. The 5-FU patch directly adhered to the tumour in subcutaneous and orthotopic murine models, and induced a significant decrease in tumour size. Systemic gemcitabine treatment group, 5-FU drug releasing patch group, and systemic gemcitabine plus 5-FU patch group were compared by tumour size measurement, non-invasive bio-imaging, and histology in subcutaneous models. Combination of local drug patch and systemic chemotherapy led to increased tumour suppression effects that lasted longer, as well as increased survival rate. Histology revealed higher degree of apoptosis in the combined group. Systemic toxicity was recovered within 7 days after the treatment in all mice. Conclusively, local drug delivery using biocompatible polymer patch significantly inhibited tumour growth, and combination with systemic chemotherapy was more effective than single systemic chemotherapy.

Biocompatibility and safety of PLA and its copolymers

PLA and its copolymers are commonly used for a wide variety of applications. While they are considered to be biocompatible, side effects resulting from their implantation have been reported. The implantation of biomaterials always results in a foreign body reaction. Such a reaction has also been reported following PLA and its copolymers. This article reviews the process of inflammatory reaction that is to be expected following implantation of PLA, and it highlights specific cases in which the inflammatory reaction can result in safety concerns. The authors also review selected cases from different medical fields to demonstrate possible clinical side effects resulting from its use.

Comparison of Different Fixation Types Used in Unilateral Mandibular Condylar Fractures: An In Vivo Study With New Biomechanical Model

INTRODUCTION

The aim of this in vivo study is to compare the single-titanium, double-titanium mini plate, and single resorbable plate systems used in internal rigid fixation of the unilateral mandibular condylar fractures on new design biomechanical model.

METHODS

Thirty synthetic polyurethane models were used for biomechanical testing. Fracture lines were created for each model. Fragments were fixed with single-titanium plates in Group A (n = 10), double-titanium plates in Group B (n = 10), and single biodegradable plate (PPLA) in Group C (n = 10). Masticatory forces were applied to the models and the biomechanical properties of the titanium plate and screws, resorbable plate, and screws were evaluated.

RESULTS

The average failure force for Group A, Group B, and Group C is 199, 324, 177N and the average bone displacement for Group A, Group B, Group C is 1.9, 0.3, 2.1 mm, respectively.

DISCUSSION

Double titanium plates showed the most acceptable results in the fixation of unilateral subcondylar fractures where the single titanium and biodegradable plate systems failed to provide enough stability in unilateral subcondylar fracture fixation. Biodegradable plate systems are still not an alternative in fixation of unilateral condylar fractures.

The Recent Revolution in the Design and Manufacture of Cranial Implants: Modern Advancements and Future Directions

Large format (i.e., >25 cm) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant computer-aided design and 3-dimensional (3-D) printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative.

Calcium Orthophosphate-Containing Biocomposites and Hybrid Biomaterials for Biomedical Applications

The state-of-the-art on calcium orthophosphate (CaPO4)-containing biocomposites and hybrid biomaterials suitable for biomedical applications is presented. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through the successful combinations of the desired properties of matrix materials with those of fillers (in such systems, CaPO4 might play either role), innovative bone graft biomaterials can be designed. Various types of CaPO4-based biocomposites and hybrid biomaterials those are either already in use or being investigated for biomedical applications are extensively discussed. Many different formulations in terms of the material constituents, fabrication technologies, structural and bioactive properties, as well as both in vitro and in vivo characteristics have been already proposed. Among the others, the nano-structurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin, as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using CaPO4-based biocomposites and hybrid biomaterials in the selected applications are highlighted. As the way from a laboratory to a hospital is a long one and the prospective biomedical candidates have to meet many different necessities, the critical issues and scientific challenges that require further research and development are also examined.

Preparation, cell compatibility and degradability of collagen-modified poly(lactic acid)

Poly(lactic acid) (PLA) was modified using collagen through a grafting method to improve its biocompatibility and degradability. The carboxylic group at the open end of PLA was transferred into the reactive acylchlorided group by a reaction with phosphorus pentachloride. Then, collagen-modified PLA (collagen-PLA) was prepared by the reaction between the reactive acylchlorided group and amino/hydroxyl groups on collagen. Subsequently, the structure of collagen-PLA was confirmed by Fourier transform infrared spectroscopy, fluorescein isothiocyanate-labeled fluorescence spectroscopy, X-ray photoelectron spectroscopy, and DSC analyses. Finally, some properties of collagen-PLA, such as hydrophilicity, cell compatibility and degradability were characterized. Results showed that collagen had been grafted onto the PLA with 5% graft ratio. Water contact angle and water absorption behavior tests indicated that the hydrophilicity of collagen-PLA was significantly higher than that of PLA. The cell compatibility of collagen-PLA with mouse embryonic fibroblasts (3T3) was also significantly better than PLA in terms of cell morphology and cell proliferation, and the degradability of PLA was also improved after introducing collagen. Results suggested that collagen-PLA was a promising candidate for biomedical applications.

Current progress on bio-based polymers and their future trends

This article reviews the recent trends, developments, and future applications of bio-based polymers produced from renewable resources. Bio-based polymers are attracting increased attention due to environmental concerns and the realization that global petroleum resources are finite. Bio-based polymers not only replace existing polymers in a number of applications but also provide new combinations of properties for new applications. A range of bio-based polymers are presented in this review, focusing on general methods of production, properties, and commercial applications. The review examines the technological and future challenges discussed in bringing these materials to a wide range of applications, together with potential solutions, as well as discusses the major industry players who are bringing these materials to the market.

Porous biodegradable metals for hard tissue scaffolds: a review

Scaffolds have been utilized in tissue regeneration to facilitate the formation and maturation of new tissues or organs where a balance between temporary mechanical support and mass transport (degradation and cell growth) is ideally achieved. Polymers have been widely chosen as tissue scaffolding material having a good combination of biodegradability, biocompatibility, and porous structure. Metals that can degrade in physiological environment, namely, biodegradable metals, are proposed as potential materials for hard tissue scaffolding where biodegradable polymers are often considered as having poor mechanical properties. Biodegradable metal scaffolds have showed interesting mechanical property that was close to that of human bone with tailored degradation behaviour. The current promising fabrication technique for making scaffolds, such as computation-aided solid free-form method, can be easily applied to metals. With further optimization in topologically ordered porosity design exploiting material property and fabrication technique, porous biodegradable metals could be the potential materials for making hard tissue scaffolds.

Fabrication aspects of PLA-CaP/PLGA-CaP composites for orthopedic applications: a review

For several decades, composites made of polylactic acid-calcium phosphates (PLA-CaP) and polylactic acid-co-glycolic acid-calcium phosphates (PLGA-CaP) have seen widespread uses in orthopedic applications. This paper reviews the fabrication aspects of these composites, following the ubiquitous materials science approach by studying "processing-structure-property" correlations. Various fabrication processes such as microencapsulation, phase separation, electrospinning, supercritical gas foaming, etc., are reviewed, with specific examples of their applications in fabricating these composites. The effect of the incorporation of CaP materials on the mechanical and biological performance of PLA/PLGA is addressed. In addition, this paper describes the state of the art on challenges and innovations concerning CaP dispersion, incorporation of biomolecules/stem cells and long-term degradation of the composites.

Hydroxyapatite reinforced poly(3-hydroxybutyrate) and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) based degradable composite bone plate

Poly(3-hydroxybutyrate) (P3HB), its co-polymers with 3-hydroxyvalerate (HV) (PHBV8 and PHBV22), and their hydroxyapatite (HAp) containing composites (5 and 15%, w/w) were prepared by injection molding. PHBV bone plates with low valerate contents and 15% (w/w) HAp appear to have better mechanical properties than the others. Flexural strengths of 15% (w/w) HAp-loaded P3HB, PHBV8 and PHBV22 were 78.28, 63.45 and 39.38 MPa, respectively. Tensile strengths of 15% (w/w) HAp-loaded P3HB, PHBV8 and PHBV22 were 18.99, 15.44 and 11.02 MPa, respectively. For the ageing test, bone plates were incubated in phosphate-buffered saline PBS (0.1 M, pH 7.4) at 37 degrees C and at pre-determined time points they were removed and subjected to a three-point bending test. Incubation in PBS caused a sharp decrease in the mechanical properties within the first 24 h, followed either by a gradual decrease or no change for a period of about 1 month. SEM results showed that there was no significant material erosion in the 4-week incubation period. P3HB loaded with 15% HAp appeared to yield the most suitable bone plate, insofar as mechanical properties are concerned with potential for further testing in vivo.

Scaffolds for Growth Factor Delivery as Applied to Bone Tissue Engineering

There remains a substantial shortfall in the treatment of severe skeletal injuries. The current gold standard of autologous bone grafting from the same patient has many undesirable side effects associated such as donor site morbidity. Tissue engineering seeks to offer a solution to this problem. The primary requirements for tissue-engineered scaffolds have already been well established, and many materials, such as polyesters, present themselves as potential candidates for bone defects; they have comparable structural features, but they often lack the required osteoconductivity to promote adequate bone regeneration. By combining these materials with biological growth factors, which promote the infiltration of cells into the scaffold as well as the differentiation into the specific cell and tissue type, it is possible to increase the formation of new bone. However due to the cost and potential complications associated with growth factors, controlling the rate of release is an important design consideration when developing new bone tissue engineering strategies. This paper will cover recent research in the area of encapsulation and release of growth factors within a variety of different polymeric scaffolds.

Starch and its Derived Products: Biotechnological and Biomedical Applications

Starches are one of the most abundant renewable natural resources available to us, however their potential as a biomass feedstock for the production of a vast range of commercially viable chemicals/components for application in many areas of industrial, food and biomedical sciences is currently under-exploited. This review begins by presenting an overview of starch sources, composition and structure, and physicochemical characteristics. Specific topics discussed include amylose and amylopectin structure, their location in the amorphous and crystalline regions of starch granules, granule morphology, gelatinisation and pasting characteristics. The remainder of the review then focuses upon the biotechnological production of starch hydrolysis products, such as maltodextrins, glucose and fructose syrups, and cyclodextrins, and the chemical modification of starch, namely, oxidation, stabilisation (esterification and etherification), and cross-linking. Finally some specific examples of the development of starch-derived biomaterials for application in areas such as orthopaedics, bone cements, tissue engineering, and hydrogels are presented.

Biocomposites and hybrid biomaterials based on calcium orthophosphates

The state-of-the-art of biocomposites and hybrid biomaterials based on calcium orthophosphates that are suitable for biomedical applications is presented in this review. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through successful combinations of the desired properties of matrix materials with those of fillers (in such systems, calcium orthophosphates might play either role), innovative bone graft biomaterials can be designed. Various types of biocomposites and hybrid biomaterials based on calcium orthophosphates, either those already in use or being investigated for biomedical applications, are extensively discussed. Many different formulations, in terms of the material constituents, fabrication technologies, structural and bioactive properties as well as both in vitro and in vivo characteristics, have already been proposed. Among the others, the nanostructurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using biocomposites and hybrid biomaterials based on calcium orthophosphates in the selected applications are highlighted. As the way from the laboratory to the hospital is a long one, and the prospective biomedical candidates have to meet many different necessities, this review also examines the critical issues and scientific challenges that require further research and development.

Self-healing biomaterials

The goal of this review is to introduce the biomaterials community to the emerging field of self-healing materials, and also to suggest how one could utilize and modify self-healing approaches to develop new classes of biomaterials. A brief discussion of the in vivo mechanical loading and resultant failures experienced by biomedical implants is followed by presentation of the self-healing methods for combating mechanical failure. If conventional composite materials that retard failure may be considered zeroth generation self-healing materials, then taxonomically speaking, first generation self-healing materials describe approaches that "halt" and "fill" damage, whereas second generation self-healing materials strive to "fully restore" the prefailed material structure. In spite of limited commercial use to date, primarily because the technical details have not been suitably optimized, it is likely from a practical standpoint that first generation approaches will be the first to be employed commercially, whereas second generation approaches may take longer to implement. For self-healing biomaterials the optimization of technical considerations is further compounded by the additional constraints of toxicity and biocompatibility, necessitating inclusion of separate discussions of design criteria for self-healing biomaterials.

In Vitro and In Vivo Behaviors of the Three-layered Nanocarbonated Hydroxyapatite/Collagen/PLGA Composite

A three-layered nano-carbonated hydroxyapatite/collagen/poly (lactic-co-glycolic acid) (nCHAC/PLGA) composite membrane that consisted of 8 wt% nCHAC + PLGA/4 wt%nCHAC + PLGA/PLGA was developed using a layer-by-layer casting. The human periodontal ligament and osteoblastic MC3T3-E1 cells were cultured on the three-layered composite membrane; the co-culture gave a more positive response than the pure PLGA membrane. Subsequently, the composite and pure PLGA membranes were implanted into critical 6.2 mm defects in rat crania. After 4 weeks, significant healing was observed in the defects implanted with the nCHAC/PLGA composite membrane, while similar healing was only observed with pure PLGA implants after 8 weeks. This novel composite appears to be a very promising candidate for periodontal and bone defects therapy.

Scaffold Characteristics for Functional Hollow Organ Regeneration

Many medical conditions require surgical reconstruction of hollow organs. Tissue engineering of organs and tissues is a promising new technique without harvest site morbidity. An ideal biomaterial should be biocompatible, support tissue formation and provide adequate structural support. It should degrade gradually and provide an environment allowing for cell-cell interaction, adhesion, proliferation, migration, and differentiation. Although tissue formation is feasible, functionality has never been demonstrated. Mainly the lack of proper innervation and vascularisation are hindering contractility and normal function. In this chapter we critically review the current state of engineering hollow organs with a special focus on innervation and vascularisation.

Bimodal Porous Scaffolds by Sequential Electrospinning of Poly(glycolic acid) with Sucrose Particles

Electrospinning is a method to produce fine, biopolymer mesh with a three-dimensional architecture that mimics native extra-cellular matrix. Due to the small fiber diameter created in this process, conventional electrospun scaffolds have pore sizes smaller than the diameter of most cells. These scaffolds have limited application in tissue engineering due to poor cell penetration. We developed a hybrid electrospinning/particulate leaching technique to create scaffolds with increased porosity and improved cellular ingrowth. Poly(glycolic acid) (PGA) and a sucrose-ethanol suspension were electrospun in equal, alternating sequences at intervals of one, two, and ten minutes each. The scaffolds revealed fiber mesh with micropores of 10 m and uniformly distributed sucrose particles. Particulate leaching of sucrose from the one- or two-minute scaffolds revealed honeycomb structures with interconnected macropores between 50 and 250 m. Sucrose leaching from the ten-minute scaffolds resulted in laminated structures with isolated macropores between 200 and 350 m. Macropore size was directly proportional to the duration of the sucrose spinning interval. After 24 hours of cell culture, conventionally spun scaffolds demonstrated no cellular penetration. Conversely, the PGA/sucrose scaffolds demonstrated deep cellular penetration. This hybrid technique represents a novel method of generating electrospun scaffolds with interconnected pores suitable for cellular ingrowth.

Degradation behaviors of electrospun resorbable polyester nanofibers

Biodegradable materials are widely used in the biomedical field because there is no postoperative surgery after implantation. Widely used synthetic biodegradable materials are polyesters, especially those used in tissue engineering. Advances in the tissue engineering field have brought much attention in terms of scaffold fabrication, such as with biodegradable polyester nanofibers. The rationale for using nanofibers for tissue engineering is that the nonwoven polymeric meshwork is a close representation of the nanoscale protein fiber meshwork in native extracellular matrix (ECM). Electrospinning technique is a promising way to fabricate controllable continuous nanofiber scaffold mimicking the ECM structure. Electrospun nanofibers provide high surface-to-volume ratio and high porosity as a promising scaffold for tissue engineering. Because the degradation behaviors of scaffolds significantly affect new tissue regeneration, the degradation of the material becomes one of the crucial factors when considering using polyester nanofibers as scaffolds in tissue engineering. In this review paper, we focus on the degradation studies of several bioresorbable polyester nanofibrous scaffolds used in tissue engineering. The degradable properties of nanofibers were compared with the corresponding degradable materials in macroscale. The factors that might affect the degradation behaviors were analyzed.

Knowledge-based approach towards hydrolytic degradation of polymer-based biomaterials

The concept of hydrolytically degradable biomaterials was developed to enable the design of temporary implants that substitute or fulfill a certain function as long as required to support (wound) healing processes or to control the release of drugs. Examples are surgical implants, e.g., sutures, or implantable drug depots for treatment of cancer. In both cases degradability can help to avoid a second surgical procedure for explanation. Although degradable surgical sutures are established in the clinical practice for more than 30 years, still more than 40% of surgical sutures applied in clinics today are nondegradable.1 A major limitation of the established degradable suture materials is the fact that their degradation behavior cannot reliably be predicted by applying existing experimental methodologies. Similar concerns also apply to other degradable implants. Therefore, a knowledge-based approach is clearly needed to overcome the described problems and to enable the tailored design of biodegradable polymer materials. In this Progress Report we describe two methods (as examples for tools for this fundamental approach): molecular modeling combining atomistic bulk interface models with quantum chemical studies and experimental investigations of macromolecule degradation in monolayers on Langmuir-Blodgett (LB) troughs. Finally, an outlook on related future research strategies is provided.

Injectable biomaterials for minimally invasive orthopedic treatments

Biodegradable and injectable hydroxy terminated-poly propylene fumarate (HT-PPF) bone cement was developed. The injectable formulation consisting HT-PPF and comonomer, n-vinyl pyrrolidone, calcium phosphate filler, free radical catalyst, accelerator and radiopaque agent sets rapidly to hard mass with low exothermic temperature. The candidate bone cement attains mechanical strength more than the required compressive strength of 5 MPa and compressive modulus 50 MPa. The candidate bone cement resin elicits cell adhesion and cytoplasmic spreading of osteoblast cells. The cured bone cement does not induce intracutaneous irritation and skin sensitization. The candidate bone cement is tissue compatible without eliciting any adverse tissue reactions. The candidate bone cement is osteoconductive and inductive and allow osteointegration and bone remodeling. HT-PPF bone cement is candidate bone cement for minimally invasive radiological procedures for the treatment of bone diseases and spinal compression fractures.

Composite scaffolds for the engineering of hollow organs and tissues

Several types of synthetic and naturally derived biomaterials have been used for augmenting hollow organs and tissues. However, each has desirable traits which were exclusive of the other. We fabricated a composite scaffold and tested its potential for the engineering of hollow organs in a bladder tissue model. The composite scaffolds were configured to accommodate a large number of cells on one side and were designed to serve as a barrier on the opposite side. The scaffolds were fabricated by bonding a collagen matrix to PGA polymers with threaded collagen fiber stitches. Urothelial and bladder smooth muscle cells were seeded on the composite scaffolds, and implanted in mice for up to 4 weeks and analyzed. Both cell types readily attached and proliferated on the scaffolds and formed bladder tissue-like structures in vivo. These structures consisted of a luminal urothelial layer, a collagen rich compartment and a peripheral smooth muscle layer. Biomechanical studies demonstrated that the tissues were readily elastic while maintaining their pre-configured structures. This study demonstrates that a composite scaffold can be fabricated with two completely different polymer systems for the engineering of hollow organs. The composite scaffolds are biocompatible, possess adequate physical and structural characteristics for bladder tissue engineering, and are able to form tissues in vivo. This scaffold system may be useful in patients requiring hollow organ replacement.