Proof of concept, design, and manufacture via 3‐D printing of a mesh with bactericidal capacity: Behaviour in vitro and in vivo

Abstract

Currently, hernia treatment involves implantation of a mesh prosthesis, usually made of polypropylene, and the primary complication is infection of the device, which leads to an exponential increase in morbidity. Three-dimensional printing offers a method of dealing with complications of this magnitude. Therefore, in this study, the bactericidal properties and effectiveness of three-dimensional-printed meshes with polycaprolactone (PCL) and gentamicin were evaluated in vitro in Escherichia coli cultures, and their histological behaviour was examined in vivo. Different PCL meshes were implanted into four groups of rats, with 10 rats in each group: PCL meshes, PCL meshes with alginate and calcium chloride, PCL meshes with gentamicin, and PCL meshes with alginate and gentamicin. Thirty-six microporous meshes were manufactured, and their bactericidal properties were assessed. When the meshes did not include an antibiotic, an inhibition halo was not observed; when the gentamicin was free, an asymmetric inhibition area of 5.65 ± 0.46 cm 2 was present; when the gentamicin was encapsulated, a rectangular area of 5.40 ± 0.38 cm 2 was observed. In the rats, macroporous and microporous mesh implants produced mild inflammation and substantial fibrosis with collagen and neovascular foci. A significant difference was observed in fibroblastic activity between the PCL with alginate group and the PCL with alginate and gentamicin group microporous meshes (p = .013) and in collagen deposits between the macroporous and microporous meshes in the PCL mesh group (p = .033). The feasibility of manufacturing drug-doped printed PCL meshes containing alginate and gentamicin was verified, and the meshes exhibited bactericidal effects and good histopathological behaviour.

3D Printing of Drug-Loaded Thermoplastic Polyurethane Meshes: A Potential Material for Soft Tissue Reinforcement in Vaginal Surgery

“…Some preliminary work has been done about the use of 3D printing for mesh implant manufacture. However, these works were not realistic as they propose the use of materials such as PLA or PCL that are biodegradable and do not present appropriate mechanical properties for this task [38,48,49]. Some of these works incorporated some antibiotics to the material.…”

3D-Printing of Drug-Eluting Implants: An Overview of the Current Developments Described in the Literature

“…As a postprinting procedure, finished drug-free 3D-printed implants can be loaded with drugs by a coating procedure [ 62 , 63 ]. Furthermore, drug solutions can be applied dropwise on the printed object [ 64 , 65 , 66 ] or the whole implant can be immersed in a drug solution, often under vacuum, to absorb the drug [ 67 , 68 , 69 , 70 , 71 , 72 ]. These methods are often very time-consuming and only porous structures [ 67 , 68 ] enable the possibility of suitable drug concentrations in the inner parts of the implant.…”

“…The on-demand manufacturing of optimal fitting shapes by 3D-printing may make presurgical modifications of commercial surgical meshes redundant. 3D-printed meshes have been developed using different printing techniques and loaded with antibacterial, anti-inflammatory or contrast agents [ 36 , 49 , 51 , 65 , 140 ]. Gentamicin or ciprofloxacin containing meshes inhibited bacterial growth of E. coli or S. aureus in vitro or were successfully implemented in rat or rabbit models [ 36 , 51 , 65 ].…”

New Insights into the Application of 3D-Printing Technology in Hernia Repair

“…Other antibiotics have been tested as candidates for their use in 3D-printed devices. Qamar et al tested the use of ciprofloxacin to treat complicated abdominal or urinary tract infections [100]. These authors manufactured PP and PVA meshes of varying combinations of material composition, drug loaded, thread width, pore pore shape, and number of pores per surface unit (100 cm 2 ).…”