Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Abstract

Polypropylene (PP) large pore size nets have been most widely used implants for hernia repair. Nevertheless, the growth of bacteria within PP mesh pores after operation is a major reason of hernia recurrence. Secondly, pre-operative prophylaxis during mesh implantation has failed due to the hydrophobic nature of PP meshes. Herein, chitosan cross-linked and levofloxacin HCl incorporated, antimicrobial PP mesh devices were prepared using citric acid as a bio-based and green cross-linking agent. The inert PP mesh fibers were surface activated using O2 plasma treatment at low pressure. Then, chitosan of different molecular weights (low and medium weight) were cross-linked with O2 plasma activated surfaces using citric acid. Scanning electron microscopy (SEM), energy dispersive X-ray (EDX) spectroscopy, and Fourier transform infrared (FTIR) spectroscopy confirmed that chitosan was cross-linked with O2 plasma-treated PP mesh surfaces and formed a thin layer of chitosan and levofloxacin HCl on the PP mesh surfaces. Moreover, antimicrobial properties of chitosan and levofloxacin HCl-coated PP meshes were investigated using an agar plate release method. The coated PP meshes demonstrated excellent antimicrobial inhibition zone up to 10 mm. Thus, modified PP meshes demonstrated sustained antimicrobial properties for six continuous days against Staphylococcus aureus (SA) and Escherichia coli (EC) bacteria.

Nanodiamond‐chitosan functionalized hernia mesh for biocompatibility and antimicrobial activity

“…To ensure proper integration to the body, the implantable mesh should provide a minimum immune response and good biocompatibility to enhance cell attachment and proliferation, which leads to an acceleration of the healing process 3 . Therefore, the decoration of PP mesh surface with different biofriendly materials can provide the required biocompatibility such as enhanced cell growth 4 and microbial resistance 5 without compromising its bulk properties 6–9 . As the application of metal nanoparticles in biological areas is limited, 10 composite approach 8,11 and copolymers 12 were used to address these issues.…”

“…Applying bioactive material is another approach to improve the biocompatibility of the material used for biological application. Among them, chitosan is one of the most popular ones for mesh modification due to its excellent properties, including its biocompatibility, biodegradability, nontoxicity, inherent antimicrobial property, and potential to carry drugs 6,7 . Chitosan also shows anti‐adhesive property that can address the adhesion problem after hernia surgery 13,14 .…”

Nonthermal plasma treatment of polymers modulates biological fouling but can cause material embrittlement

“…Additionally, plasma can easily treat objects with complex geometries and high surface areas. Numerous studies have therefore explored plasma surface treatments for surgical meshes (Avetta et al, 2014;Binnebösel et al, 2012Binnebösel et al, , 2010Gorgieva et al, 2015;Hu et al, 2017;Junge et al, 2007;Kulaga et al, 2014;Kumar et al, 2013;Labay et al, 2015;Lanzalaco et al, 2019;Lu et al, 2019;Nisticò et al, 2017Nisticò et al, , 2015Nisticò et al, , 2013Nisticò et al, , 2012Paul et al, 2010;Rivolo et al, 2016;Sanbhal et al, 2019Sanbhal et al, , 2018bSannino et al, 2005;Zhang et al, 2014).…”

The Patenting and Technological Trends in Hernia Mesh Implants

“…Despite other biomedical applications, the use of chitosan has also been reported in the literature as part of a system for sustained antimicrobial drug delivery in combination with PP meshes. 79 Positive results were obtained suggesting that the use of chitosan for controlled drug delivery could prevent mesh infection.…”