Surgical Materials: Current Challenges and Nano-enabled Solutions

Abstract

Surgical adhesive biomaterials have emerged as substitutes to sutures and staples in many clinical applications. Nano-enabled materials containing nanoparticles or having a distinct nanotopography have been utilized for generation of a new class of surgical materials with enhanced functionality. In this review, the state of the art in the development of conventional surgical adhesive biomaterials is critically reviewed and their shortcomings are outlined. Recent advancements in generation of nano-enabled surgical materials with their potential future applications are discussed. This review will open new avenues for the innovative development of the next generation of tissue adhesives, hemostats, and sealants with enhanced functionality for various surgical applications.

Figure 1

Fabrication of hemostatic cationic hydrogel particles. (A) N-(3-aminopropyl)methacrylamide (APM) hydrogel particles as hemostatic agents (scale bar: 5mm in the SEM image and 500 μm in the inset). Images of a rat tail amputation (B) 5 min after applying gauze showing bleeding and (C) 5 min after applying hydrogel particles showing bleeding was stopped. (D) Image from a rat liver laceration incision, showing bleeding. (E) Image from hydrogel particles applied on liver, showing complete hemostasis (reprinted from Ref. [107]).

Figure 2

Engineering synthetic nanoparticles with hemostatic properties. (A) Schematic of hemostatic nanoparticles made of PLGA-PLL core with PEG arms terminated with the RGD. (B) SEM micrograph of nanoparticles (Scale bar: 1μm). (C) Femoral artery injury model used to assess the in vivo function of hemostatic nanoparticles, arrow shows the injury site. (D) SEM image of clot formed in an injured artery after the administration of nanoparticles, arrow shows the clot and fibrin mesh (Scale bar: 1 μm). (E) Cross section view of clot following artery injury and applying coumarin 6 (C6)-labeled nanoparticles (Blue: DAPI-stained cell nuclei; green: C6 from synthetic platelets within the clot) (reprinted from Ref. [108]).

Figure 3

Development of an antibacterial hydrogel-based tissue adhesive. (A) Synthesis of an antibacterial hydrogel based on a branched catechol functionalized PEG and silver ion. (B) TEM images of silver nanoparticles formed through the reaction between silver ion and catechol functionalized PEG. (C) Cumulative silver release from the fabricated antibacterial hydrogel over two weeks (reprinted from Ref. [134]).

Figure 4

Hierarchical topography of geckos sole. The topography is formed from microscale filament (setae), which branch into nanoscale tips with mushroom-like heads (reprinted from Ref. [139]).

Figure 5

SEM images of gecko-inspired surfaces. (A, B, C) Angled polyurethane posts with angled mushroom tips. The tip orientation was changed at different angles: (A) 34°; (B) 23°; (C) 90°. (D) 1 cm² polyurethane patch covered with angled posts supported 1kg weight (reprinted from Ref. [142]). (E) Two-level polyurethane posts fabricated using molding to create hierarchical topography (reprinted from Ref. [143]).

Figure 6

Gecko-inspired bioadhesives. (A) SEM images of a PGSA patch with nanopillars. (B) PGSA patch after 8 days of implantation which confirms the stability of nanopillars in vivo (reprinted from Ref. [146]). (C) SEM image of PCL patch with micropillars coated with cyanoacrylate. (D) A 3 mm diameter puncture in a rat colon. (E) Closure of the punctured region with the PCL patch. (F) Image of a 3 mm defect created in rat stomach. (G) Successful implementation of the PCL patch in closing the defect (reprinted from Ref. [147]).

Figure 7

Porcupine quill-inspired tissue adhesives. (A, B) SEM images of barbless and barbed polyurethane quills (scale bar 500μm). (C,D,E) Images showing the quills surface topography after removal from porcine skin. The topography creates mechanical interlocking, which increases the pullout force of the quills from the skin (scale bar: 500μm). (F,G) Adhesion test of a patch containing barbless and barbed quills to porcine skin. The barbed quills improve the path attachment through mechanical interlocking (reprinted from Ref. [151]).