Applications of Chitosan in Surgical and Post-Surgical Materials

Abstract

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

Keywords: bleeding control; bone regeneration; hemostasis; hydrogels; scaffolds; soft tissue; sponges; sutures; tissue regeneration; viscosupplementation.

Figure 1

Chemical structure of chitosan. Highly reactive positions are highlighted in green; poorly reactive position are highlighted in yellow. Reprinted from [21] under the terms of the Creative Commons Attribution License 4.0 (copyright 2021 Cazorla-Luna et al.; doi:10.3390/polym13142241).

Figure 2

Schematic representation of the commonly used fabrication methods for producing chitosan-based scaffolds—freeze-drying, freeze gelation, salt leaching, electrospinning, and 3D printing. Reprinted with permission from Saravanan et al. [36]. Copyright 2016, Elsevier.

Figure 3

Macroscopic and microscopic images of scaffolds fabricated by different methods in bone tissue engineering. (A–D) show the macroscopic images of scaffolds prepared by freeze-drying, electrospinning, the sol–gel method, and 3D-bioprinting, respectively, and (E–H) show the corresponding SEM images of the scaffolds. Reprinted with permission from Soundarya et al. [42]. Copyright 2018, Elsevier.

Figure 4

Schematic representation of the fabrication process of chitosan sponge and the interaction of its molecules. Reprinted with permission from Fan et al. [43]. Copyright 2020, IOP Publishing.

Figure 5

Stereomicroscopy images of bilayer membranes (1×, 2×) and SEM images of chitosan/PEO nanofiber coated porous layer surface (a–c) with 250×, 1000× and 2500× magnifications; cross-sectional view of bilayer structure (d–f) with 250×, 500× and 10,000× magnifications. Reprinted with permission from Tamburaci et al. [114]. Copyright 2021, Elsevier.

Figure 6

Schematic illustration for the formation of dendronized chitosan (DC) hydrogels and the application for corneal stromal defects. (A) Cartoon presentation of DCs featured with radial amphiphilicity and their self-assembly in water to form fibrous bundles and the instant formation of hydrogels via heating around physiological temperature. (B) Injection of DC solution into the corneal stromal defects of a rabbit model, in situ formation of a hydrogel filler, and defects repairing. Reprinted with permission from Feng et al. [152]. Copyright 2021, American Chemical Society.

Figure 7

Antimicrobial activity evaluation. (A) In vitro. (B) Adenosine triphosphate (ATP) assay of microbial proliferation in patients with surgical wounds, * p < 0.05. Reprinted from [167] under the terms of the Creative Commons Attribution License 4.0 (copyright 2019 Wang et al.; doi:10.3390/polym11111906).