Study of the Implantable and Non-Implantable Application in Medical Textile

Abstract

Nowadays medical textiles are one of the more continuous growing parts in technical textile market. The generally medical textile should have strength, biodegraded, nontoxic, biologically compatible, dimensional stability, resistant to allergens and cancer, more comfort human body, antifungal and antimicrobial performance. Development with inside the discipline of textiles, either natural or manmade textiles, typically aimed toward how they beautify the consolation to the users. Development of medical textiles may be taken into consideration as one such development, that’s virtually supposed for changing the painful days of sufferers into the snug days. The basically are used the implantable materials to repair the affected parts of the person body. The generally are used in wound sutures and used surgery time replacement and other segment to replacement like artificial ligaments, vascular grafts. This includes type of the sutures, soft tissue implants, orthopedic implants, cardiovascular implants etc. Non-implantable materials are used for external applications for role of bandages, wound care and wound care products, plasters etc. This paper are discusses the main role of implantable and non-implantable medical textile products.

1. Introduction

Some desirable properties of medical fibers include non-toxicity strength ability, biocompatibility, biodegradability, good absorbability, softness and freedom from additives and contaminates. The textile material and scientification technics has used generally in medical, surgical application like strength, flexibility, comfort and antimicrobial performances. The basically medical material products are made to multifilament and monofilament yarn, these are made by knitted, nonwoven, woven, braided fabrics and composite structures [1]. The term medical textile literally means textile used for medical purposes. Newsday around the world in textile industries are more growing part of the medical sectors and hygiene products. Medical textiles represent one of the maximum dynamic studies fields’ features of technical textiles and its variety of applications. They constitute systems designed and done for a scientific application (intra body/greater body, implantable and non-implantable) textiles utilized in organic structures to estimate, treat, growth or regenerate a tissue, organ or characteristic of the body (plaster, dressings, bandages, strain garments) [2].

Absorbency, high flexibility, softness, high strength, non-toxicity and biocompatibility of textile materials are the key factors which has fuelled the growth of the textiles for its use in implantable, non-implantable, extracorporeal and hygienic products¹. Although the natural way to replace a defective body part is the transplantation method, however owing to a number of incentives counting availability this is not always possible thus implantable textiles in the form of fiber and fabric are used in effective repair to the body. Sutures, soft tissue implants, orthopedic and cardiovascular grafting are the implantable textiles which has helped medical science in achieving unparalleled success in recent times [3, 4]. Non-implantable substances are utilized in outside packages, which can also additionally or might not keep in touch with the skin. The substances used must be nonallergenic, anti-cancer, anti-bacterial, permeable to air have a very good capacity to take in liquids, excessive capillarity and wettability, permit moisture shipping and feature the capacity to be sterilized. The foremost packages of those substances confer with wound care and bandages. These materials can be classified into two separated and specialization areas of application. Implantable materials: sutures or wound closure, vascular grafts, artificial ligaments, artificial joints. Non-implantable materials: wound dressing, bandages, plasters, pressure garments, orthopedic belts etc.

2. Implantable textiles

These are used for replacing diseased organ or tissue within the body. These replacements must be non-toxic and biocompatible. The implants are normally used for replacing arteries, heart valves, joints etc. Two types of fibers are used for implantable textile.

2.1 Biodegradable fibers

These are the fibers which are degraded by biological conditions within 2–3 months and mostly used inside the body. These include collagen, alginate, polyactide, polyglycolide, polyamine and some polyurethane [5, 6].

2.2 Non-biodegradable fibers

• These are the fibers which are not degraded by biological condition for a long time and mostly used for external purposes. These include polytetrafluoroethylene (PTFE), polyester, polypropylene, carbon and others.

• Factors which are important for implantable textiles are:

• Biocompatibility and biostability

• The properties of polyester will influence the success of implantation in terms of biodegradability (Tables 1 and 2).

Parameters	Fiber type	Fabric type
Cardiovascular implants, vascular grafts, heart valves	Polyester, PTFE	Knitted, woven
Artificial tendons, artificial ligaments, artificial skin, artificial lumen, eye contact lenses etc.	PTFE, polyester, polyamide, silk, carbon, etc.	Woven, braided
Sutures thread	Collagen, polylactide, polyglycolide, polyester, polyamide, PTFE, polypropylene, polyethylene	Mono-filament, braided
Orthopedic implants, artificial joints, artificial bones etc.	Silicone, polyacetal, polyethylene, polysulphone, carbon, polyester, glass, ceramic	Composite

Table 1.

The implantable ingredients application in medical sectors [1, 2, 3, 4, 15].

Application	Implant
Abdominal wall, hernia	Meshes, patches
Blood vessel	Tubular prostheses (woven, knitted, nonwoven), stents, stent graft coatings
Dura	Patches (nonwoven)
Heart	Patches, occluder, suturing ring of valves
Osteosynthesis	Fiber reinforced devices, cords for fixation
Tendon/ligament	Reinforcement
Trachea, esophagus	Prostheses

Table 2.

Major applications for implantable textile medical devices [5, 6, 7, 8, 15].

3. Sutures

Suture is a generic term for all materials used to bring the served body tissue together and to hold these tissues in their normal position until healing takes place. Sutures are threads that are used as the way of repairing damaged tissues, cut vessels and surgical incisions by uniting the basic edges of the wounds in their required sites. It provides the necessary strength and a temporary barrier to prevent the unwanted infection. The key qualities stimulating the suture design are universal applicability, easy to handle, no kinks, coiling, twisting, or levitating, biocompatibility, inertness, uniformity in tensile strength in terms of suture type and size, frictionless surface to glide through tissue high friction for secure knotting, sterilizable without composition changes, complete absorption i.e. no residue after healing. A suture is a thread that both approximated and maintains tissues until the natural healing process has provided a sufficient level of wound strength or compresses blood vessels in order to stop bleeding. Sutures for wound closure are either monofilament or multifilament threads twisted, spun together or braided. They can also be dyed, undyed, coated or uncoated [7]. Patients’ safety is major factor for application of a suture. An incision into the lung would need to be closed using a suture with a high elasticity level, slow degradation rate and high tensile strength level. So, a surgery is never successful if the wound is not sutured or closed in a proper manner as to promote healing in a timely and safe fashion also if the suture of a rough morphology (e.g. braided) the tissue will swell more and more susceptible to infection than if a smooth suture (e.g. monofilament) is used [8].

3.1 Classification and types of sutures

The classification of the sutures may be done as follows into two types depending on their nature and structure:

3.1.1 Assimilated type (absorbable sutures)

Assimilated type of sutures is intended to be absorbed by the body i.e. to be broken down in the body and a second surgery for their removal is not desired. e.g. catgut, collagen and poly glycolic acid. Catgut is one of the most commonly used materials for the manufacture of sutures and is extracted from the ox bone. Being highly absorbable it can also be implanted in the human body even in the case of an infection however its strength deteriorates to half after a week in the body, regardless of the fact that 3 weeks are required for the recovery of an incision after surgery [9].

3.1.2 Non-assimilated type (non-absorbable)

Non-assimilated types of sutures are considered to be implanted for long term and need to be removed latter. (E.g. cotton, silk, polyester, polyamide and polyethylene.) Cotton sutures necessitate meticulous aseptic technique during use. The main benefit of such sutures is that they are not irritant and the shortcoming is that it is the weakest suture material. Despite the possession of necessary physical form, compatibility and mechanical properties, the very slow biodegradation of the silk filament and the need for the surgical removal is the main draw back in many applications (Figure 1) [10].

Figure 1.

Nylon monofilament suture [9, 10].

The different types of suture include monofilament suture, a braided suture, a pseudo monofilament suture and a twisted strand suture each having its own positive and negative points. Monofilament sutures are made of a single filament of polyester, polyamide, polypropylene or polydioxanone and offer smooth suture drag and low tissue drag. Using such sutures, it is easy to make or place a knot in the depth of the body although the security and the flexibility of the knot are low. In braided type of sutures 8–16 polyester, polyamide or silk monofilaments are braided and coated with a lubricant to increase the flexibility and handle of the sutures. A pseudo monofilament sutures have a core of several twisted materials coated with an extrusion of the same material. It offers low tissue drag, good knottability, low knot security and fair flexibility.

3.1.3 Intelligent sutures

The basically are used sutures in the surgical operation and other injuries. The basically are used suture thread length to tie blood vessels or sew tissues part of body. The many types of suture threads are used as absorbable performance characteristics. All this absorbable intelligent materials technique in sutures are very good working and this is doing better performance in medical sectors. This types all material are used biodegradable and biocompatible polymer. The generally many types of absorbable suture are used made from synthetic polymers.

4. Soft tissue implants

The soft tissues are utilization in biomedical materials application like artificial tender, artificial corners and artificial prosthness etc. There are two main thrust of tissue engineering research. They are (i) the in vivo route and (ii) the in vitro approach. The objective of in vivo route is to initiate tissue engineering therapies inside the body for the repair and regeneration of damaged or diseased tissue. This approach can be successful for blood cell and nerve regeneration (both peripherial and spiral cord), skin repair, remodeling of defective bone, cornea and retina and for repairing damaged myocardium (heart muscle) following a myocardial infarction (heart attack). Not all diseases and injuries can be controlled by in vivo therapies. For example use in complex tissue cultures for the production of enzymes, drug and growth factors and for toxicological and pharmacological assays. It is depending on the medical sectors application. Ligament implants are carried out to provide autologous transplant reinforcement in construction or to cure the functional residual instabilities. These implants are either made by the braiding process or by the special flat knitting process and high tenacity polyethylene terephthalate or high tenacity polypropylene multifilament are used in making the implants for the artificial ligaments (Figure 2) [11].

Figure 2.

Woven ligament structure [11].

5. Hard tissues

Hard tissue compatible materials must have excellent mechanical properties compatible to hard tissue. Textile structural composites are used for implants. Typical characteristics of polymer related to hard tissue replacement are good processability, chemical stability and biocompatibility. Applications include artificial bone, bone cement and artificial joints. The current practice is to combine bioactive ceramics with polymers or metals to improve interfacial properties. Fiber reinforced composite material may be designed with the required high structure strength and biocompatibility properties needed for these application and are now replacing metal implants for artificial joints and bones.

5.1 Orthopedic implants

Orthopedics is a branch of medicine that deals with disorders with the bones, joints and associated muscles. Orthopedic implants generally serve two purposes, as hard tissue to replace bones and joints, and as fixation plates to stabilize fractured bones. The first orthopedic implants were mainly metal structures. Fracture fixation devices include, spinal fixation devices, fracture plates, wires, pins and screws, adhesives while joint replacement hip, knee, elbow, wrist and finger (Figure 3).

Figure 3.

Hip bone implants [11, 12, 15].

The fiber types used for orthopedic implants include polyacetal, polypropylene, and silicone. Composite structures composed of poly (d, l-lactide urethane) and reinforced with polyglycolic acid have excellent physical properties. This sensor principle is designed to allow for a relative strain resolution as small as 10-4–10-5.

5.2 Cardiovascular implants

Due to a steadily growing number of patients and considerable diagnostic and therapeutic advances, vascular diseases are becoming more and more important in general and clinical practices thus the vascular grafts are the need of the hour. Vascular grafts are used in surgery to replace damaged thick arteries or veins. The implantation of synthetic and biological grafts in the circulatory system yield several types of complications ranging from infection to wall rupture. Dilation, suture line failure, structural defects (holes, perforations, rents, and slits), bleeding and infection are some of the main problems caused due to the failure of the grafts. Textile structures are usually the materials used for arterial replacement; however, they do not always meet all the requirements. Gel weave is a true zero-porosity twill woven polyester graft. It is manufactured using an advanced technique of weaving fully texturized polyester on modern looms (Figure 4) [12].

Figure 4.

Knitted structure for a cardiovascular implant [12, 13, 14, 15].

The most important aspects of an arterial graft include porosity, compliance, and biodegradability and the design considerations for the graft are selection of the right type of polymer, the type of the yarn, fabric and the crimping. Polyester (e.g. Dacron) or PTFE (e.g. Teflon) and polyurethane are the most commonly. Commercial prostheses contain either single- or two-ply yarns. On one hand these yarns usually have a round cross-section and on the other hand trilobal yarns have been used for the reason it provides the advantage of offering a large surface area making the preclott easier and faster, but they are more prone to fatigue and mechanical damage [13, 14].

6. Non-implantable medical textiles

These are the materials which are used for external applications on the body and may or may not make contact with skin. This includes:

• Wound care

• Plasters

• Orthopedic belts

• Wadding

• Protective eye pads

7. Desired properties for non-implantable medical textiles

Absorbent, wicking performance, non-toxic, breathability, soft, elasticity, non-allergic, ability to be sterilize etc (Table 3).

Application	Fiber types	Fabric structure
Absorbent pads	Cotton, viscose, lyocell	Non-woven
Wound contact layer	Alginate fiber, chitosan, silk, lyocell, cotton, viscose	Non-woven, woven knitted
Base layer	Viscose, lyocell, plastic film	Non-woven, woven
Simple non-elastic and non-elastic bandages	Cotton, viscose, lyocell, polyamide fiber, elastomeric fiber yarns	Non-woven, woven
High–support bandages	Cotton, viscose, lyocell, elastomeric fiber yarns	Non-woven, woven knitted
Compression bandages	Cotton, viscose, lyocell, elastomeric fiber yarns	Non-woven, woven knitted
Orthopedic bandages	Cotton, viscose, lyocell, PET, PP, polyurethane form	Woven, knitted
Plaster	Cotton, viscose, lyocell, PET, PP, glass fiber	Non-woven, woven knitted
Gauges	Alginate fiber, chitosan, lyocell, cotton, viscose	Non-woven, woven knitted
Wadding	Viscose, cotton linter, wood pulp	Nonwoven
Lint	Cotton	Woven

Table 3.

Showing application areas and type of fiber used [2, 3, 4, 5, 15, 16].

8. Wound dressing

Different types of dressings are available for a variety of medical and surgical applications.

• Functions of wound dressings:

• Protection against infection

• Absorb blood and exudate

• Promote healing

• To keep the wound smooth and pliable

• Medication to the wound

The wound contact layer should prevent adherence of the dressing to the wound and be easily removed without disturbing new tissue growth. Gauge and paraffin coated gauge are the most common dressings used. Most gauges are made from cotton in the form of a loose plain weave. The burns and skin graft sites must have their dressing changed frequency. When the dressing is removed, it is not only painful, but it can also destroy the regenerating tissues. This can delay the healing process because scarring and reopen the wounds for possible bacteria entrance. The paraffin coated gauge which is usually multilayered is a little easier to remove than dry gauge. Gauge may be impregnated with plaster sterilization is required. Finishing agents such as wetting agents and optical whiteners are not added to gauge fabrics because of the possibility of irritation and possible carcinogenic effects [15, 16].

Nonwoven fabrics can be used for the following advantages:

• Better sterilization

• Smooth and lint free (allows for a lesser change for debris to be left in the wound)

• Can be made softer and more absorbent by latex or thermal calendering

• For port operative dressing, sophisticated nonwoven structure is possible. Nonwoven fabrics made of atelocollagen filaments are used as wound dressing for burns.

• Polypropylene fabric/carbonized rayon fabric would transmit liquid to the absorbent material and enable to keep the skin dry.

Wound dressings act as physical barrier for wounds and are found to have some distinguished Properties like fluid control, odor management, and microbial control and wound healing acceleration (Table 4).

Types	Properties
Passive products	Traditional dressing that provide cover over the wound
Interactive products	Polymeric film to permeable to oxygen but not bacteria
Bioactive products	Dressing that deliver substance active in healing, e.g. alginate, chitogan

Table 4.

Classification of wound dressings [15, 16, 17, 18].

8.1 Dressing material

8.1.1 Calcium alginate fiber

The basically raw material for the product of this fiber is alginic acid, an emulsion attained from the marine brown algae. It possesses a variety of parcels, including the capability to stabilize thick suspense, to form film layers, and to turn into gels. When the dressing made of this fiber is applied to crack, the rear ion exchange take place and this fiber is placed on the crack in dry state and begin to absorb the exudates.

8.1.2 Sorbalgon

It is a supple, non-woven dressing made from high quality calcium alginate fiber with excellent gel forming properties A Sorbalgon dressing absorbs approximately 10 ml exudates per gram dry weight (Figure 5).

Figure 5.

Sorbalgon wound dressing [4, 15, 16].

8.1.3 Thin film dressing

Thin film has very superior absorbent properties and outer surface thin film give better comfort behavior. This thin layer film has basically working of the easily absorb body fluid and proper safe keep it to the dressing leakage and wound maceration.

8.1.4 Acticoat dressing

Acticoat dressing is give better protection against fungal infection performance as compared to traditional antimicrobial dressing materials. This dressing is better kill rate and more effective fungal species.

9. Bandages

The bandage has generally essential properties should be like breathable, stretchable, non-slip, non-stick to more comfort help during injuries time of human body. Bandages are designed to perform a whole variety of specific functions depending upon the final medical requirement. The basically bandages are used in injuries and wound place to keep it dressing. Such bandages are in form of light-weight knitted fabrics or open-weave woven fabrics, made from either cotton or viscose. Their primary function is to hold the healing wound dressings firmly in place. They themselves do not have healing functions to play [17, 18].

Orthopedic cushion bandages are used under plaster casts and compression bandages to prove padding and prevent discomfort.

Different types of bandages can be classified.

A1: Light weight conforming stretch bandage.

A2: light support bandages.

A3: Compression bandages.

A3 (a): Light compression bandages.

A3 (b): Moderate compression bandages.

A3 (c): High compression bandages.

A3 (d): Extra high performance compression bandages.

9.1 Features of different types of bandages

9.1.1 Compression bandages

It provides necessary support to circumscribe movement and speed up the mending process Compression tapes are used for the treatment and forestallment of deep tone thrombosis, leg ulceration, and swollen modes and are designed to ply a needed quantum of contraction on the leg when applied at a constant pressure. Compression tapes are classified by the quantum of contraction they can play at the ankle and include extra-high, high, moderate, and light contraction and can be either woven and contain cotton and elastomeric yarns or underpinning and weft knitted in both tubular or completely-fashioned forms.

9.1.2 Compression hosiery

• Compression hosiery can be used as an alternative to compression bandaging for the treatment of active ulcers.

• Compression hosiery is classified according to the pressure level applied at the ankle.

• Compression hosiery is made from a number of different fibers including nylon, cotton yarn and elastane.

9.1.3 Orthopedic bandages

A cloth girth saturated with cataplasm of Paris is dipped into water and also wrapped around the broken branch thereby creating an establishment- fitting yet fluently removed flake in the shape of a tube or cylinder. This type of operation of cataplasm in the form of a broken branch is generally known as an orthopedic cast. The modern plaster fabric is made from spun bonded nonwovens of cotton, viscose, polyester or glass fiber (Figure 6) [19].

Figure 6.

Orthopedic bandages [17, 18, 19, 20].

9.1.4 Pressure garments

Pressure garments play a vital role in the proper healing of wounds and reduce the effects of scaring, but for the garments to perform their job properly, they need to be in good condition. The continuous wearing of pressure garments prevents the thickening, buckling, and nodular formations seen in hypertrophic scars [20].

10. Conclusions

Medical textiles have visible speedy improvement over the previous couple of decades. Nowadays, new biodegradable fibers have enabled the improvement of novel sorts of implants, and contemporary-day fabric machines can produce third-dimensional spacer fabric that supply advanced overall performance over conventional fabric materials.

• These and lots of different advances have made clinical textiles a crucial detail in contemporary-day ailment management, and they are turning into increasingly critical with the growing quantity of aged humans with inside the populations of evolved countries.

• The more significance of medical textiles in human life, healthful residing and development is immense.

• The improvement of latest technology and new gadgets will assist sufferers to conquer the hardships that they used to go through with inside the past.

• There are many extra unknown regions of medical textiles; we must do studies on the ones issues. We must pay extra interest to the manufacturing of healthful and nice clinical fabric materials. In addition to technology, we want to hold a watch at the rate of our products.

• Through this it is going to be viable to supply nice whole and easily to be had contemporary-day medical textiles.

• Textile substances preserve to serve a critical feature with inside the improvement of number clinical and surgical products.