Advanced Technologies and Polymer Materials for Surgical Sutures

Advanced Technologies and Polymer Materials for Surgical Sutures
Copyright
Contributors
1 . Advances in biopolymer based surgical sutures
1.1 Introduction
1.2 Polymers as suture materials
1.3 Biopolymers
1.4 Biopolymers for sutures
1.4.1 Collagen
1.4.2 Polylactic acid (PLA)
1.4.3 Silk
1.4.4 Chitin & chitosan
1.4.5 Polyhydroxyalkanoate (PHA)
1.4.6 Cellulose
1.5 Sterilization of sutures
1.6 Conclusion and future perspectives
References
2 . Functionalization of sutures
2.1 Introduction
2.2 Suture materials: from hairs to antibacterial biopolymers
2.3 Suture types
2.4 Biocompatibility studies for functionalized sutures
2.5 Functionalization
2.5.1 Coating in fibers
2.5.1.1 Dip-coating
2.5.1.2 Electrodeposition
2.5.2 Grafted sutures
2.5.2.1 Monomer
2.5.2.2 Solvent
2.5.2.3 Temperature of reaction
2.5.3 Stimuli-responsive polymers on sutures
2.6 Functionalization of nonabsorbable sutures
2.6.1 Polypropylene sutures
2.6.1.1 Functionalization with azoles
2.6.1.2 Functionalization with Ag
2.6.2 Modified silk sutures
2.7 Functionalization of absorbable sutures
2.7.1 Functionalization with silver
2.7.2 Chitin sutures
2.7.3 Caprolactam sutures gentamicin/silver loaded
2.7.4 Drug-loading on absorbable sutures
2.8 Conclusions
Acknowledgments
References
3 . Improving the therapeutic value of sutures
3.1 Content
3.2 General concepts
3.2.1 History of sutures
3.2.2 Characteristics and classification of sutures
3.2.3 Characteristics of commercial sutures
3.3 Suture modification: bioactive devices as the future of the suture technology
3.3.1 Structural modification
3.3.1.1 Fiber dimensions
3.3.1.2 Topography and microstructure of the suture
3.3.2 Chemical modification
3.3.2.1 Antimicrobial sutures
3.3.2.2 Incorporation of antimicrobial agents in sutures
3.3.2.3 Surface incorporation of antimicrobial agents in sutures
3.3.3 Drug delivery sutures
3.3.4 Stimuli responsive systems
3.3.4.1 pH-responsive polymers
3.3.4.2 Thermo-responsive polymers
3.3.4.3 Stimuli responsive sutures
3.4 Conclusion
Acknowledgments
References
4 . Evaluating the mechanical properties of sutures
4.1 Introduction
4.2 Mechanical properties
4.2.1 Tensile strength
4.2.2 Knot strength
4.2.3 Breaking strength
4.2.4 Knot-pull tensile strength
4.2.5 Wound breaking strength
4.2.6 Elasticity
4.2.7 Plasticity
4.2.8 Memory
4.2.9 Pliability
4.2.10 Capillarity
4.2.11 Abrasion
4.3 Characterization techniques
4.3.1 Universal testing machine (UTM)
4.3.2 Abrasive testing
4.4 Effect of antibacterial coating on mechanical properties
4.5 Conclusion
References
5 . Polymers for surgical sutures
5.1 Introduction
5.2 Types of polymeric surgical sutures and their applications
5.2.1 Natural polymers
5.2.1.1 Gut
5.2.1.2 Silk
5.2.2 Synthetic and absorbable polymers
5.2.2.1 PGA-PCL blend
5.2.2.2 PGA-PLA blend
5.2.2.3 P4HB
5.2.2.4 PDS
5.2.3 Synthetic and nonabsorbable polymers
5.2.3.1 Nylon
5.2.3.2 PP
5.2.3.3 PET
5.2.3.4 Polybutester
5.2.3.5 PVDF and PTFE
5.3 Tissue adhesive polymers as suture candidate
5.4 Challenges with current technologies
5.4.1 Bioactive sutures
5.4.2 Smart sutures
5.4.3 Biomimetic sutures
5.4.4 Translation of basic discoveries in clinical applications
5.5 Future perspective and remarks
5.6 Conclusion
Acknowledgments
References
6 . Smart sutures
6.1 Introduction
6.2 Base material of smart suture
6.2.1 Paper
6.2.2 Polyglycerol sebacate
6.2.3 Polycaprolactone
6.2.4 PCL/PGS blend
6.2.5 Cotton
6.2.6 Carbon nanotubes
6.2.7 Wicking
6.2.8 Polyurethane
6.3 Temperature sensors for smart sutures
6.4 pH sensor smart sutures
6.5 Strain smart sutures
6.6 Glucose smart sutures
6.7 Microfluidic analysis smart sutures
6.8 Resorbable smart sutures
6.9 Future smart sutures
6.9.1 Bacterial detection sensors
6.9.2 Neutrophil sensor
6.9.3 Colorimetric smart sutures
6.10 Conclusions
References
7 . Bioactive sutures: advances in surgical suture functionalization
7.1 Introduction
7.2 Suture structure
7.2.1 Absorbable sutures
7.2.2 Nonabsorbable sutures
7.2.3 Monofilament sutures
7.2.4 Multifilament sutures
7.3 Fabricating bioactive suture methods
7.3.1 Fiber level
7.3.2 Cell and gene activators
7.3.3 Stimuli responsive
7.3.4 Researched bioactive suture
7.4 Cell based bioactive sutures
7.4.1 Stem cells
7.4.2 Stem cells for wound healing
7.4.3 Stem cells – cardiovascular application
7.4.4 Stem cells – tendon repair
7.4.5 Stem cell suture conclusions
7.4.6 mRNA suture
7.4.7 Gene regulation
7.4.8 Growth factor bioactive suture
7.5 Incorporated bioactive material
7.5.1 Chitin bioactive sutures
7.5.2 Bioactive glass for antibacterial sutures
7.6 Future developments of bioactive sutures
7.6.1 Surface architecture sutures
7.7 Conclusion
References
8 . Engineering aspects of suture fabrication
8.1 Introduction
8.1.1 Surgical sutures
8.1.2 The association of surgical sutures with wound healing cascade
8.2 Why is the engineering of suture fabrication important?
8.2.1 Suture design parameters
8.2.1.1 Structural attributes
8.2.1.1.1 Suture size
8.2.1.1.2 Suture configuration/geometry
8.2.1.1.3 Needle type
8.2.1.1.4 Surface features
8.2.1.1.5 Surface coatings
8.2.1.2 Physical attributes
8.2.1.2.1 Absorbability of sutures
8.2.1.2.2 Engineering of mechanical performance
8.2.1.2.2.1 Tensile strength.
8.2.1.2.2.2 Knot strength.
8.2.1.2.2.3 Stiffness and flexibility.
8.2.1.2.2.4 Elasticity and plasticity.
8.2.1.2.2.5 Coefficient of friction.
8.2.1.2.2.6 Capillarity.
8.2.1.2.2.7 Memory.
8.2.1.2.2.8 Comparisons of mechanical performances of few sutures.
8.2.1.3 Biological attributes
8.2.1.3.1 Capillarity, biofilms and bacterial attacks
8.2.1.3.2 Tissue responses and adhesions
8.2.1.3.3 Influence of pH of body fluid
8.3 Broadening the functionality of sutures
8.3.1 Engineering drug-eluting sutures
8.3.1.1 Choosing the right technique of fabrication
8.3.1.2 Choosing the right polymer
8.3.1.3 Choosing the right technique of postprocessing
8.4 Conclusions
References
9 . Revisiting the properties of suture materials: an overview
9.1 Introduction
9.1.1 Characteristics of sutures
9.2 Types of suture materials and examples
9.2.1 Absorbable sutures
9.2.2 Non-absorbable sutures
9.2.2.1 Silk suture
9.2.2.2 Nylon
9.2.2.3 Polypropylene
9.2.2.4 Polybutester – novafil
9.2.2.5 Stainless steel non-absorbable sutures
9.2.3 Emerging alternatives to conventional sutures
9.2.3.1 Staples
9.2.3.2 Absorbable staples
9.2.3.3 Non-absorbable staples
9.2.3.4 Tissue adhesives
9.3 Suture materials and their properties: recent advances
9.3.1 Silk-based sutures
9.3.2 Poly(ε-caprolactone) based sutures
9.3.3 Polyamide-based sutures
9.3.4 Collagen-based sutures
9.3.5 Polyurethane-based sutures
9.3.6 Polypropylene sutures
9.3.7 Chitosan-based sutures
9.3.8 Bio-based sutures
9.4 Properties of suture materials: comparative analysis
9.4.1 Physico-mechanical properties
9.4.2 Biological properties
9.5 Micro and nanotechnology-enabled suture materials
9.6 Conclusions and future outlook
References
10 . Suture materials, emerging trends
10.1 Introduction
10.2 Taxonomy of sutures
10.3 Absorbable and nonabsorbable suture materials
10.4 Monofilament, multifilament sutures and barbed sutures brands
10.5 Categories of absorbable sutures
10.5.1 Catgut sutures
10.5.2 Chromic gut sutures
10.5.3 Polyglycolic acid sutures
10.5.4 Polydioxanone sutures
10.5.5 Poliglecaprone sutures
10.5.6 Polyglactin sutures
10.6 Slowly absorbable sutures
10.6.1 Polydioxanone (PDS II)
10.6.2 Polyglyconate (Maxon)
10.6.3 Nonabsorbable sutures
10.6.4 Silk suture
10.6.5 Polymerized caprolactum suture (Supramid)
10.6.6 Polyester suture (Mersilene, Ethibond)
10.6.7 Nylon (Dermalon or Ethilon)
10.6.8 Polybutester (Novafil)
10.6.9 Polypropylene (Prolene)
10.6.10 Structurally coated and un-coated sutures
10.6.10.1 Coated sutures include
10.6.10.2 Un-coated sutures include
10.6.11 Application-based suture categories
10.7 New trends in sutures
10.7.1 Knotless barbed sutures
10.7.2 Antibacterial sutures
10.7.3 Stem cell seeded suture
10.7.4 Smart sutures: electronic/elastic sutures
10.8 Conclusion
References
Further reading
11 . Biocompatibility and cytotoxicity of polymer sutures
11.1 Introduction
11.2 Classification of sutures
11.2.1 Origin based classification
11.2.2 Material based classification
11.2.3 Classification based on size
11.2.4 Classification based on physical configuration
11.3 Necessary characteristics of suture materials
11.3.1 Physical and mechanical properties
11.3.2 Handling properties
11.3.3 Biological properties
11.4 Biocompatibility of sutures
11.4.1 Measuring biocompatibility
11.4.1.1 In vitro tests
11.4.1.2 In vivo tests
11.4.1.3 Usage tests
11.4.1.4 Standards that regulate the measurement of biocompatibility
11.5 Cytotoxicity of sutures
11.6 Conclusion
References
12 . Shape memory polymers as sutures
12.1 Introduction
12.2 Sutures
12.2.1 SMP sutures
12.2.1.1 Main factors for SMPs sutures
12.2.1.1.1 Importance of polyurethane based sutures
12.2.1.1.2 Applications of SMPs sutures
12.3 Conclusion
References
13 . Drug release kinetics of sutures
13.1 Introduction
13.2 Surgical sutures
13.3 Drug release from antiinflammatory sutures
13.4 Drug release from growth factor embedded sutures
13.5 Drug release from antithrombotic sutures
13.6 Drug release kinetics of antibacterial sutures
13.7 Oxygen release from sutures
13.8 Conclusion
References
Index
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