Advanced Technologies and Polymer Materials for Surgical Sutures

Description

Polymeric materials offer a high level of versatility due to the range of applications possible within the biomedical and clinical fields – including wound closure - particularly in comparison to metals or ceramics. These specialised materials also allow for a diverse array of therapeutic effects. Although there have been advances in improving polymeric materials for surgical sutures, there is little information available regarding improving the therapeutic value of sutures, and advanced technologies used to implement this improvement. Advanced Technologies and Polymer Materials for Surgical Sutures provides thorough coverage on suture materials with improved mechanical and therapeutic properties that can improve quality of life; chapter topics include drug-releasing kinetics of sutures, shape memory polymer sutures and future trends.

This book is a useful resource for academics and researchers in the materials science and biomedical engineering fields, as well as professionals in biomaterials and biotextiles development and clinicians looking to learn more about suture material properties and suture/body interactions.

Depicts recent advances in both the therapeutic effects of polymer-based sutures, as well as the various manufacturing techniques employed in the production of sutures
Offers an interdisciplinary approach, covering material properties and engineering technologies, as well as an understanding of the biological properties of sutures, such as suture/body interactions
Comprehensive coverage allows both experienced researchers in the area and new entrants (such as clinicians) to learn more about this important topic

Front Cover 2
ADVANCED TECHNOLOGIES AND POLYMER MATERIALS FOR SURGICAL SUTURES 3
ADVANCED TECHNOLOGIES AND POLYMER MATERIALS FOR SURGICAL SUTURES 5
Copyright 6
Contents 7
Contributors 11
1 - Advances in biopolymer based surgical sutures 15
- 1.1 Introduction 15
- 1.2 Polymers as suture materials 16
- 1.3 Biopolymers 17
- 1.4 Biopolymers for sutures 18
  - 1.4.1 Collagen 18
  - 1.4.2 Polylactic acid (PLA) 19
  - 1.4.3 Silk 20
  - 1.4.4 Chitin & chitosan 23

Front Cover 2
ADVANCED TECHNOLOGIES AND POLYMER MATERIALS FOR SURGICAL SUTURES 3
ADVANCED TECHNOLOGIES AND POLYMER MATERIALS FOR SURGICAL SUTURES 5
Copyright 6
Contents 7
Contributors 11
1 - Advances in biopolymer based surgical sutures 15
- 1.1 Introduction 15
- 1.2 Polymers as suture materials 16
- 1.3 Biopolymers 17
- 1.4 Biopolymers for sutures 18
  - 1.4.1 Collagen 18
  - 1.4.2 Polylactic acid (PLA) 19
  - 1.4.3 Silk 20
  - 1.4.4 Chitin & chitosan 23
  - 1.4.5 Polyhydroxyalkanoate (PHA) 24
  - 1.4.6 Cellulose 25
- 1.6 Conclusion and future perspectives 26
- 1.5 Sterilization of sutures 26
- References 27
2 - Functionalization of sutures 33
- 2.1 Introduction 33
- 2.2 Suture materials: from hairs to antibacterial biopolymers 34
- 2.3 Suture types 35
- 2.4 Biocompatibility studies for functionalized sutures 36
- 2.5 Functionalization 37
  - 2.5.1 Coating in fibers 37
    - 2.5.1.1 Dip-coating 38
    - 2.5.1.2 Electrodeposition 39
  - 2.5.2 Grafted sutures 40
    - 2.5.2.1 Monomer 41
    - 2.5.2.2 Solvent 42
    - 2.5.2.3 Temperature of reaction 43
  - 2.5.3 Stimuli-responsive polymers on sutures 43
- 2.6 Functionalization of nonabsorbable sutures 44
  - 2.6.1 Polypropylene sutures 45
    - 2.6.1.1 Functionalization with azoles 46
    - 2.6.1.2 Functionalization with Ag 47
  - 2.6.2 Modified silk sutures 49
- 2.7 Functionalization of absorbable sutures 50
  - 2.7.2 Chitin sutures 51
  - 2.7.1 Functionalization with silver 51
  - 2.7.3 Caprolactam sutures gentamicin/silver loaded 52
  - 2.7.4 Drug-loading on absorbable sutures 52
- 2.8 Conclusions 53
- Acknowledgments 53
- References 53
3 - Improving the therapeutic value of sutures 59
- 3.2 General concepts 59
  - 3.2.1 History of sutures 60
  - 3.2.2 Characteristics and classification of sutures 61
  - 3.2.3 Characteristics of commercial sutures 64
- 3.1 Content 59
- 3.3 Suture modification: bioactive devices as the future of the suture technology 67
  - 3.3.1 Structural modification 68
    - 3.3.1.1 Fiber dimensions 68
    - 3.3.1.2 Topography and microstructure of the suture 69
  - 3.3.2 Chemical modification 70
    - 3.3.2.1 Antimicrobial sutures 70
    - 3.3.2.2 Incorporation of antimicrobial agents in sutures 71
    - 3.3.2.3 Surface incorporation of antimicrobial agents in sutures 72
  - 3.3.3 Drug delivery sutures 74
  - 3.3.4 Stimuli responsive systems 79
    - 3.3.4.1 pH-responsive polymers 80
    - 3.3.4.2 Thermo-responsive polymers 81
    - 3.3.4.3 Stimuli responsive sutures 82
  - 3.4 Conclusion 83
  - References 84
  - Acknowledgments 84
- 4 - Evaluating the mechanical properties of sutures 91
  - 4.1 Introduction 91
  - 4.2 Mechanical properties 93
    - 4.2.1 Tensile strength 94
    - 4.2.2 Knot strength 95
    - 4.2.3 Breaking strength 96
    - 4.2.4 Knot-pull tensile strength 96
    - 4.2.5 Wound breaking strength 97
    - 4.2.8 Memory 98
    - 4.2.6 Elasticity 98
    - 4.2.7 Plasticity 98
    - 4.2.10 Capillarity 99
    - 4.2.9 Pliability 99
    - 4.2.11 Abrasion 100
  - 4.3 Characterization techniques 101
    - 4.3.1 Universal testing machine (UTM) 101
    - 4.3.2 Abrasive testing 101
  - 4.4 Effect of antibacterial coating on mechanical properties 102
  - 4.5 Conclusion 103
  - References 104
- 5 - Polymers for surgical sutures 109
  - 5.1 Introduction 109
  - 5.2 Types of polymeric surgical sutures and their applications 117
    - 5.2.1 Natural polymers 117
      - 5.2.1.1 Gut 117
      - 5.2.1.2 Silk 118
    - 5.2.2 Synthetic and absorbable polymers 119
      - 5.2.2.1 PGA-PCL blend 119
      - 5.2.2.2 PGA-PLA blend 120
      - 5.2.2.3 P4HB 123
      - 5.2.2.4 PDS 124
    - 5.2.3 Synthetic and nonabsorbable polymers 124
      - 5.2.3.1 Nylon 124
      - 5.2.3.3 PET 126
      - 5.2.3.4 Polybutester 126
      - 5.2.3.2 PP 126
      - 5.2.3.5 PVDF and PTFE 127
    - 5.3 Tissue adhesive polymers as suture candidate 127
    - 5.4 Challenges with current technologies 129
      - 5.4.1 Bioactive sutures 129
      - 5.4.2 Smart sutures 131
      - 5.4.3 Biomimetic sutures 131
      - 5.4.4 Translation of basic discoveries in clinical applications 132
    - 5.5 Future perspective and remarks 133
    - 5.6 Conclusion 134
    - Acknowledgments 134
    - References 135
  - 6 - Smart sutures 143
    - 6.1 Introduction 143
    - 6.2 Base material of smart suture 144
      - 6.2.1 Paper 144
      - 6.2.3 Polycaprolactone 145
      - 6.2.2 Polyglycerol sebacate 145
      - 6.2.4 PCL/PGS blend 146
      - 6.2.5 Cotton 146
      - 6.2.6 Carbon nanotubes 147
      - 6.2.7 Wicking 147
      - 6.2.8 Polyurethane 147
    - 6.3 Temperature sensors for smart sutures 147
    - 6.4 pH sensor smart sutures 149
    - 6.5 Strain smart sutures 151
    - 6.6 Glucose smart sutures 153
    - 6.7 Microfluidic analysis smart sutures 154
    - 6.8 Resorbable smart sutures 155
    - 6.9 Future smart sutures 156
      - 6.9.2 Neutrophil sensor 157
      - 6.9.1 Bacterial detection sensors 157
      - 6.9.3 Colorimetric smart sutures 158
    - 6.10 Conclusions 160
    - References 160
  - 7 - Bioactive sutures: advances in surgical suture functionalization 163
    - 7.1 Introduction 163
    - 7.2 Suture structure 163
      - 7.2.2 Nonabsorbable sutures 164
      - 7.2.3 Monofilament sutures 164
      - 7.2.1 Absorbable sutures 164
      - 7.2.4 Multifilament sutures 165
    - 7.3 Fabricating bioactive suture methods 165
      - 7.3.1 Fiber level 165
      - 7.3.2 Cell and gene activators 166
      - 7.3.3 Stimuli responsive 166
      - 7.3.4 Researched bioactive suture 166
    - 7.4 Cell based bioactive sutures 167
      - 7.4.2 Stem cells for wound healing 167
      - 7.4.1 Stem cells 167
      - 7.4.3 Stem cells – cardiovascular application 169
      - 7.4.4 Stem cells – tendon repair 170
      - 7.4.5 Stem cell suture conclusions 172
      - 7.4.6 mRNA suture 173
      - 7.4.8 Growth factor bioactive suture 174
      - 7.4.7 Gene regulation 174
    - 7.5 Incorporated bioactive material 177
      - 7.5.1 Chitin bioactive sutures 177
      - 7.5.2 Bioactive glass for antibacterial sutures 178
    - 7.7 Conclusion 180
    - 7.6 Future developments of bioactive sutures 180
      - 7.6.1 Surface architecture sutures 180
    - References 181
  - 8 - Engineering aspects of suture fabrication 185
    - 8.1 Introduction 185
      - 8.1.1 Surgical sutures 185
      - 8.1.2 The association of surgical sutures with wound healing cascade 185
    - 8.2 Why is the engineering of suture fabrication important? 186
      - 8.2.1 Suture design parameters 186
        
        8.2.1.1 Structural attributes 188
        
        8.2.1.1.1 Suture size 188
        
        8.2.1.1.2 Suture configuration/geometry 190
        
        8.2.1.1.3 Needle type 191
        
        8.2.1.1.4 Surface features 193
        
        8.2.1.1.5 Surface coatings 195
        
        8.2.1.2 Physical attributes 195
        
        8.2.1.2.1 Absorbability of sutures 195
        
        8.2.1.2.2 Engineering of mechanical performance 198
        
        8.2.1.2.2.2 Knot strength. 199
        
        8.2.1.2.2.3 Stiffness and flexibility. 199
        
        8.2.1.2.2.1 Tensile strength. 199
        
        8.2.1.2.2.4 Elasticity and plasticity. 200
        
        8.2.1.2.2.7 Memory. 200
        
        8.2.1.2.2.5 Coefficient of friction. 200
        
        8.2.1.2.2.8 Comparisons of mechanical performances of few sutures. 200
        
        8.2.1.2.2.6 Capillarity. 200
        
        8.2.1.3 Biological attributes 202
        
        8.2.1.3.1 Capillarity, biofilms and bacterial attacks 202
        
        8.2.1.3.3 Influence of pH of body fluid 203
        
        8.2.1.3.2 Tissue responses and adhesions 203
        
        8.3 Broadening the functionality of sutures 204
        
        8.3.1 Engineering drug-eluting sutures 205
        
        8.3.1.1 Choosing the right technique of fabrication 205
        
        8.3.1.2 Choosing the right polymer 206
        
        8.3.1.3 Choosing the right technique of postprocessing 207
        
        8.4 Conclusions 207
        
        References 208
        
        9 - Revisiting the properties of suture materials: an overview 213
        
        9.1 Introduction 213
        
        9.1.1 Characteristics of sutures 214
        
        9.2 Types of suture materials and examples 214
        
        9.2.1 Absorbable sutures 214
        
        9.2.2 Non-absorbable sutures 216
        
        9.2.2.1 Silk suture 217
        
        9.2.2.2 Nylon 217
        
        9.2.2.3 Polypropylene 219
        
        9.2.2.4 Polybutester – novafil 220
        
        9.2.2.5 Stainless steel non-absorbable sutures 220
        
        9.2.3 Emerging alternatives to conventional sutures 221
        
        9.2.3.3 Non-absorbable staples 221
        
        9.2.3.1 Staples 221
        
        9.2.3.2 Absorbable staples 221
        
        9.2.3.4 Tissue adhesives 222
        
        9.3 Suture materials and their properties: recent advances 222
        
        9.3.1 Silk-based sutures 223
        
        9.3.2 Poly(ε-caprolactone) based sutures 225
        
        9.3.3 Polyamide-based sutures 226
        
        9.3.4 Collagen-based sutures 227
        
        9.3.5 Polyurethane-based sutures 228
        
        9.3.6 Polypropylene sutures 230
        
        9.3.7 Chitosan-based sutures 230
        
        9.3.8 Bio-based sutures 231
        
        9.4 Properties of suture materials: comparative analysis 232
        
        9.4.1 Physico-mechanical properties 232
        
        9.4.2 Biological properties 235
        
        9.5 Micro and nanotechnology-enabled suture materials 238
        
        9.6 Conclusions and future outlook 241
        
        References 243
        
        10 - Suture materials, emerging trends 251
        
        10.1 Introduction 251
        
        10.2 Taxonomy of sutures 251
        
        10.4 Monofilament, multifilament sutures and barbed sutures brands 252
        
        10.5 Categories of absorbable sutures 252
        
        10.5.1 Catgut sutures 252
        
        10.5.4 Polydioxanone sutures 253
        
        10.5.2 Chromic gut sutures 253
        
        10.5.5 Poliglecaprone sutures 253
        
        10.5.3 Polyglycolic acid sutures 253
        
        10.5.6 Polyglactin sutures 254
        
        10.3 Absorbable and nonabsorbable suture materials 252
        
        10.6 Slowly absorbable sutures 254
        
        10.6.3 Nonabsorbable sutures 254
        
        10.6.1 Polydioxanone (PDS II) 254
        
        10.6.2 Polyglyconate (Maxon) 254
        
        10.6.5 Polymerized caprolactum suture (Supramid) 255
        
        10.6.6 Polyester suture (Mersilene, Ethibond) 255
        
        10.6.4 Silk suture 255
        
        10.6.7 Nylon (Dermalon or Ethilon) 255
        
        10.6.8 Polybutester (Novafil) 256
        
        10.6.9 Polypropylene (Prolene) 256
        
        10.6.10 Structurally coated and un-coated sutures 256
        
        10.6.10.1 Coated sutures include 256
        
        10.6.10.2 Un-coated sutures include 256
        
        10.6.11 Application-based suture categories 257
        
        10.7 New trends in sutures 257
        
        10.7.2 Antibacterial sutures 257
        
        10.7.1 Knotless barbed sutures 257
        
        10.7.3 Stem cell seeded suture 258
        
        10.7.4 Smart sutures: electronic/elastic sutures 259
        
        10.8 Conclusion 260
        
        References 260
        
        Further reading 261
        
        11 - Biocompatibility and cytotoxicity of polymer sutures 263
        
        11.1 Introduction 263
        
        11.2 Classification of sutures 264
        
        11.2.1 Origin based classification 264
        
        11.2.2 Material based classification 265
        
        11.2.3 Classification based on size 266
        
        11.2.4 Classification based on physical configuration 266
        
        11.3 Necessary characteristics of suture materials 267
        
        11.3.1 Physical and mechanical properties 268
        
        11.3.3 Biological properties 269
        
        11.3.2 Handling properties 269
        
        11.4 Biocompatibility of sutures 269
        
        11.4.1 Measuring biocompatibility 271
        
        11.4.1.1 In vitro tests 271
        
        11.4.1.3 Usage tests 272
        
        11.4.1.4 Standards that regulate the measurement of biocompatibility 272
        
        11.4.1.2 In vivo tests 272
        
        11.5 Cytotoxicity of sutures 273
        
        11.6 Conclusion 275
        
        References 275
        
        12 - Shape memory polymers as sutures 279
        
        12.1 Introduction 279
        
        12.2 Sutures 283
        
        12.2.1 SMP sutures 284
        
        12.2.1.1 Main factors for SMPs sutures 285
        
        12.2.1.1.2 Applications of SMPs sutures 287
        
        12.2.1.1.1 Importance of polyurethane based sutures 287
        
        12.3 Conclusion 292
        
        References 293
        
        13 - Drug release kinetics of sutures 297
        
        13.1 Introduction 297
        
        13.2 Surgical sutures 299
        
        13.3 Drug release from antiinflammatory sutures 300
        
        13.4 Drug release from growth factor embedded sutures 303
        
        13.5 Drug release from antithrombotic sutures 305
        
        13.6 Drug release kinetics of antibacterial sutures 305
        
        13.7 Oxygen release from sutures 309
        
        13.8 Conclusion 311
        
        References 311

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