Improving the Antibacterial Property of Porcine Small Intestinal Submucosa by Nano-Silver Supplementation: A Promising Biological Material to Address the Need for Contaminated Defect Repair

Objective: We hypothesize that introduction of nano-silver particles to porcine-derived small intestinal submucosa (NS-PSIS) would lead to significant enhancement in antibacterial property in repairing contaminated abdominal defect. Background: Porcine-derived small intestinal submucosa (PSIS) is an acellular and xenogenic biological material intensively used in repairing and regenerating wounded and dysfunctional tissues. Surgical site infection (SSI) remains so far a serious problem and major challenge, particularly in contaminated tissue-deficient repairing. Methods: Self-assembly was used to fabricate NS-PSIS. The antibacterial property was evaluated in vitro and in vivo by means of repairing full-thickness contaminated abdominal defect in rats. The native PSIS and polypropylene-oxidized regenerated cellulose were served as controls. In addition, changes in biomechanical resistance, morphology and immunohistochemistry for inflammatory reaction and neovasculation in the repaired abdominal wall were analyzed. Biosafety was investigated by pyrogen test, skin irritation test and silver measurement in vivo. Results: NS-PSIS exhibited strong antibacterial activity against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa on agar diffusion, with mean diameters of inhibition zone ranging from 11.9 to 23.5 mm. There were significantly lower SSI incidence and a tendency of better abdominal wall resistance in the NS-PSIS group as compared with the PSIS or polypropylene-oxidized regenerated cellulose group after repairing contaminated abdominal defect in rats. Nano-silver modified PSIS did not change the native PSIS property in the tissue recolonization, remodeling and neovascularization. NS-PSIS was not pyrogenic or skin irritated, without silver residual in vivo after repairing contaminated abdominal defect. Conclusion: Nano-silver particles to PSIS lead to significant enhancements in antibacterial property in vitro and in vivo without decreasing its biomechanical resistance and biocompatibility. This study provides proof of concept for the use of nano-silver modified naturally derived PSIS as an ideal scaffold for SSI prevention in the contaminated tissue-deficient repair.

[1]  Darlan de Medeiros Kestering,et al.  Experimental study comparing the tensile strength of different surgical meshes following aponeurotic-muscle deformity synthesis on Wistar rats. , 2007, Acta cirurgica brasileira.

[2]  S. Greenstein,et al.  Evaluation of polylactic acid-carbon mesh for repair of ventral herniorrhaphy. , 1986, American journal of surgery.

[3]  W. Cobb,et al.  Incisional Herniorrhaphy with Intraperitoneal Composite Mesh: A Report of 95 Cases , 2003, The American surgeon.

[4]  M. Mihelsons,et al.  The Analysis of Infection after Polypropylene Mesh Repair of Abdominal Wall Hernia , 2006, World Journal of Surgery.

[5]  Uwe Klinge,et al.  The lightweight and large porous mesh concept for hernia repair , 2005, Expert review of medical devices.

[6]  B. Klosterhalfen,et al.  Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. , 2002, Journal of biomedical materials research.

[7]  M. Deysine.  Pathophysiology, prevention, and management of prosthetic infections in hernia surgery. , 1998, The Surgical clinics of North America.

[8]  A. Carbonell,et al.  Infection Risk of Open Placement of Intraperitoneal Composite Mesh , 2009, The American surgeon.

[9]  H. C. van der Mei,et al.  The phenomenon of infection with abdominal wall reconstruction. , 2007, Biomaterials.

[10]  B. Miedema,et al.  Transgastric biologic mesh delivery and abdominal wall hernia repair in a porcine model. , 2009, Endoscopy.

[11]  S. Horgan,et al.  Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. , 2005, Archives of surgery.

[12]  J. Rosenberg,et al.  Choice of mesh for laparoscopic ventral hernia repair , 2007, Hernia.

[13]  J. Jeekel,et al.  Evaluation of new prosthetic meshes for ventral hernia repair , 2006, Surgical Endoscopy And Other Interventional Techniques.

[14]  J. Michalek,et al.  Can Gastric Irrigation Prevent Infection During NOTES Mesh Placement? , 2008, Journal of Gastrointestinal Surgery.

[15]  C. Dowsett.  The use of silver-based dressings in wound care. , 2004, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[16]  B. Matthews,et al.  The susceptibility of prosthetic biomaterials to infection , 2005, Surgical Endoscopy And Other Interventional Techniques.

[17]  L. F. Martin,et al.  Sonication provides maximal recovery of staphylococcus epidermidis from slime-coated vascular prosthetics. , 1991, The American surgeon.

[18]  Sang Hun Lee,et al.  Buprederm™, a New Transdermal Delivery System of Buprenorphine: Pharmacokinetic, Efficacy and Skin Irritancy Studies , 2008, Pharmaceutical Research.

[19]  J. Deprest,et al.  Hernia repair: the search for ideal meshes , 2009, Hernia.

[20]  Klaus Thaler,et al.  Transgastric placement of biologic mesh to the anterior abdominal wall , 2009, Surgical Endoscopy.

[21]  E. Ersoy,et al.  Effect of polylactic acid film barrier on intra-abdominal adhesion formation. , 2008, The Journal of surgical research.

[22]  M. Franklin,et al.  The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up , 2008, Surgical Endoscopy.

[23]  Chad E. Johnson,et al.  Bioactivity of Small Intestinal Submucosa and Oxidized Regenerated Cellulose/Collagen , 2008, Advances in skin & wound care.

[24]  J. Jeekel,et al.  Prevention of adhesion formation to polypropylene mesh by collagen coating: A randomized controlled study in a rat model of ventral hernia repair , 2004, Surgical Endoscopy And Other Interventional Techniques.

[25]  W. Peetermans,et al.  Foreign body infection: a new rat model for prophylaxis and treatment. , 1999, The Journal of antimicrobial chemotherapy.

[26]  C James Kirkpatrick,et al.  Tissue-like self-assembly in cocultures of endothelial cells and osteoblasts and the formation of microcapillary-like structures on three-dimensional porous biomaterials. , 2007, Biomaterials.

[27]  K. Billiar,et al.  Evaluation of the porcine intestinal collagen layer as a biomaterial. , 2000, Journal of biomedical materials research.

[28]  S. Rothenburger,et al.  Infection potentiation study of synthetic and naturally derived surgical mesh in mice. , 2007, Surgical infections.

[29]  K. Dunn,et al.  The role of Acticoat with nanocrystalline silver in the management of burns. , 2004, Burns : journal of the International Society for Burn Injuries.

[30]  P. Holtom,et al.  Porcine Small Intestine Submucosa Does Not Show Antimicrobial Properties , 2004, Clinical orthopaedics and related research.