Abstract
The state-of-the-art hernia meshes, used in hospitals for hernia repair, are predominantly polymeric textile-based constructs that present high mechanical strength, but lack antimicrobial properties. Consequently, preventing bacterial colonization of implanted prosthetic meshes is of major clinical relevance for patients undergoing hernia repair. In this study, the co-axial electrospinning technique was investigated for the development of a novel mechanically stable structure incorporating dual drug release antimicrobial action. Core/shell structured nanofibers were developed, consisting of Nylon-6 in the core, to provide the appropriate mechanical stability, and Chitosan/Polyethylene oxide in the shell to provide bacteriostatic action. The core/shell structure consisted of a binary antimicrobial system incorporating 5-chloro-8-quinolinol in the chitosan shell, with the sustained release of Poly(hexanide) from the Nylon-6 core of the fibers. Homogeneous nanofibers with a "beads-in-fiber" architecture were observed by TEM, and validated by FTIR and XPS. The composite nanofibrous meshes significantly advance the stress–strain responses in comparison to the counterpart single-polymer electrospun meshes. The antimicrobial effectiveness was evaluated in vitro against two of the most commonly occurring pathogenic bacteria; S. aureus and P. aeruginosa, in surgical site infections. This study illustrates how the tailoring of core/shell nanofibers can be of interest for the development of active antimicrobial surfaces.
Highlights
Hernia repair is one of the most commonly performed elective operations with approximately 100,000 hernia repair surgeries being carried out in the UK, over 700,000 in the US, and 1,100,000 inguinal and abdominal wall hernia surgeries in China every year [1, 2]
Electrospun fiber morphology and core/shell structure All electrospinning experiments were optimized towards their electrospinning parameters, as well as by tailoring the solution parameters via parametric studies
Numerous studies have shown that the repulsive forces between the ionic groups of the chitosan backbone augment during the electrospinning process affecting the CS, c PA6, d CS-5CLO8Q, e PA6-PHMB and f core/shell PA6-PHMB/CS-5CLO8Q. (g–i) TEM micrographs of the core/shell PA6-PHMB/ CS-5CLO8Q nanofibrous mats. (Core to shell feed rate: 2.5 and 5.0 μL min−1)
Summary
Hernia repair is one of the most commonly performed elective operations with approximately 100,000 hernia repair surgeries being carried out in the UK, over 700,000 in the US, and 1,100,000 inguinal and abdominal wall hernia surgeries in China every year [1, 2]. Inguinal hernia surgery is the most frequent accounting for over 75%, followed by epigastric and incisional at 15% and other forms 10% [3]. Suture closures are recognized for having high recurrence rates, while synthetic and bioprosthetic meshes carry their own downsides, such as being heavyweight, which induces foreign body sensation, leading to fibrosis and tissue adhesion, post-surgical infection, etc. The use of hernia meshes reduces recurrence by 30–50% compared to suture repair [6, 7]. Intravenous and oral administration of prophylactic antibiotics does not ensure sufficient protection against surgical site infection [8]
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