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PhD Dissertation 09Feb2021GL.pdf (5.73 MB)

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Towards Development of Affinity Polymer-Based Adhesion Barriers for Surgical Mesh Devices

Learn, Greg Daniel
http://orcid.org/0000-0002-4422-0924
http://rave.ohiolink.edu/etdc/view?acc_num=case1612871430445022

Abstract Details

2021, Doctor of Philosophy, Case Western Reserve University, Biomedical Engineering.
Post-surgical adhesions are internal scars that pathologically adhere together adjacent tissues/organs/biomaterials. They pose a tremendous but frequently underestimated burden across many surgical disciplines, being especially prevalent following abdominal surgery. Peritoneal adhesions can cause discomfort, intestinal obstructions, infertility, and increased morbidity/mortality of subsequent surgery. Once formed, treatments for adhesions tend to be risky and ineffective, so prophylactic strategies are desirable. Implantation of meshes, such as in hernia repair, often exacerbates peritoneal adhesions. Knitted polypropylene (PP) meshes are the most common hernioplasty devices, but are notoriously adhesiogenic owing to material and structural characteristics that promote incorporation, such as hydrophobicity and reticular construction. The ideal strategy to prevent mesh adhesions entails adhering a smooth, continuous, hydrophilic barrier material on the mesh visceral face to mitigate tissue attachment processes. Prior studies developed polymerized cyclodextrin (pCD) materials having unique capabilities for sustained, multi-window drug release, and suggested that these hydrophilic polymers passively resist cell attachment. In several animal species, pCD could deliver antibiotics for weeks to successfully resolve mesh infection, another hernioplasty complication for which only suboptimal solutions exist. In the present work, pCD materials were explored toward application as novel adhesion barriers for PP surgical meshes. First, nonthermal plasma activation was assessed as a strategy to improve PP-pCD bonding, as PP is generally unreceptive to coatings. Plasma introduced hydroxyls onto PP, enhancing PP-pCD adherence. Second, protein adsorption, bacterial attachment, and fibroblast viability/attachment upon pCD-coated and bare PP materials were evaluated. These events play roles in mesh adhesion, infection, and biocompatibility. pCD decreased protein adsorption and bacterial attachment to PP, without fibroblast cytotoxicity. Third, effects of PP plasma activation on protein adsorption, fibroblast/bacterial attachment, and mesh mechanical properties were investigated. Regardless of duration, plasma exposure of bare PP reduced protein adsorption and bacterial attachment, and increased fibroblast attachment, but longer treatments progressively embrittled PP mesh. Fourth, preliminary studies in vivo explored effects of pCD barriers on adhesions to PP mesh. These animal experiments suggested that pCD-covered mesh surfaces resisted adhesions, while bare PP meshes did not. Altogether, pCD materials have potential as adhesion barriers that could uniquely combat both mesh adhesions and prosthetic infection.
Horst von Recum, PhD (Advisor)
Jeffrey Capadona, PhD (Committee Chair)
Kathleen Derwin, PhD (Committee Member)
Guang Zhou, PhD (Committee Member)
Michael Rosen, MD (Committee Member)
320 p.
Biomedical Engineering
Adhesion Barrier; Adhesion Prevention; Adhesions; Biofouling; Biomaterial; Biotextile; Cyclodextrin; Hernia; Hernia Mesh; Implant; Mesh; Peritoneal Adhesions; Plasma; Polymer; Polypropylene; Post-Surgical Adhesions; Surgery; Surgical Mesh; Textile

Recommended Citations

Citations

  • Learn, G. D. (2021). Towards Development of Affinity Polymer-Based Adhesion Barriers for Surgical Mesh Devices [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1612871430445022

    APA Style (7th edition)

  • Learn, Greg. Towards Development of Affinity Polymer-Based Adhesion Barriers for Surgical Mesh Devices. 2021. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1612871430445022.

    MLA Style (8th edition)

  • Learn, Greg. "Towards Development of Affinity Polymer-Based Adhesion Barriers for Surgical Mesh Devices." Doctoral dissertation, Case Western Reserve University, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1612871430445022

    Chicago Manual of Style (17th edition)

case1612871430445022
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© 2021, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.