Transient Phase Behavior of an Elastomeric Biomaterial Applied to Abdominal Laparotomy Closure

Publication date: Available online 31 May 2017
Source:Acta Biomaterialia
Author(s): Omer E. Kaymakcalan, Julia L. Jin, Zhexun Sun, Nicole G. Ricapito, Mary Clare McCorry, Kerry A. Morrison, David Putnam, Jason A. Spector
Secure closure of the fascial layers after entry into the peritoneal cavity is crucial to prevent incisional hernia, yet appropriate purchase of the tissue can be challenging because of the proximity of the underlying protuberant bowel which may become punctured by the surgical needle or strangulated by the suture itself. Whereas currently employed devices, the metal malleable retractor and Glassman Visceral Retainer are unable to provide complete visceral protection during abdominal closure, a puncture resistant, biocompatible, and degradable matrix that can be left in place without need for removal would facilitate rapid and safe abdominal closure. We describe a novel elastomer (CC-DHA) that undergoes a rapid but controlled solid-to-liquid phase transition through the application of a destabilized carbonate cross-linked network. The elastomer is comprised of a polycarbonate cross-linked network of dihydroxyacetone, glycerol ethoxylate, and tri(ethylene glycol). The ketone functionality of the dihydroxyacetone facilitates hydrolytic cleavage of the carbonate linkages resulting in a rapidly degrading barrier that can be left in situ to facilitate abdominal fascial closure. Using a murine laparotomy model we demonstrated rapid dissolution and metabolism of the elastomer without evidence of toxicity or intraabdominal scarring. Furthermore, needle puncture and mechanical properties demonstrated the material to be both compliant and sufficiently puncture resistant. These unique characteristics make the biomaterial extraordinarily useful as a physical barrier to prevent inadvertent bowel injury during fascial closure, with the potential for wider application across a variety of medical and surgical applications.Statement of SignificanceCompletion of abdominal surgery requires fascial closure, which requires a delicate balance between hernia prevention and inadvertent bowel injury. We describe a novel biocompatible elastomer (CC-DHA) of a polycarbonate cross-linked network of dihydroxyacetone, glycerol ethoxylate, and tri(ethylene glycol), for use as a rapidly degrading barrier. Using a murine laparotomy model we demonstrated rapid dissolution and metabolism of the elastomer without evidence of toxicity or intraabdominal scarring. Furthermore, needle puncture and mechanical properties demonstrated the material to be both compliant and sufficiently puncture resistant. These characteristics make this new biomaterial extraordinarily useful as a physical barrier to prevent inadvertent bowel injury during fascial closure, with the potential for wider application across a variety of medical and surgical applications.

Graphical abstract

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