ABSTRACT
OBJECTIVES/HYPOTHESIS: Novel laryngotracheal wound coverage devices are limited by complex anatomy, smooth surfaces, and dynamic pressure changes and airflow during breathing. We hypothesize that a bioinspired mucoadhesive patch mimicking how geckos climb smooth surfaces will permit sutureless wound coverage and also allow drug delivery. STUDY DESIGN: ex-vivo. METHODS: Polycaprolactone (PCL) fibers were electrospun onto a substrate and polyethylene glycol (PEG) - acrylate flocks in varying densities were deposited to create a composite patch. Sample topography was assessed with laser profilometry, material stiffness with biaxial mechanical testing, and mucoadhesive testing determined cohesive material failure on porcine tracheal tissue. Degradation rate was measured over 21 days in vitro along with dexamethasone drug release profiles. Material handleability was evaluated via suture retention and in cadaveric larynges. RESULTS: Increased flocking density was inversely related to cohesive failure in mucoadhesive testing, with a flocking density of PCL-PEG-2XFLK increasing failure strength to 6880 ± 1810 Pa compared to 3028 ± 791 in PCL-PEG-4XFLK density and 1182 ± 262 in PCL-PEG-6XFLK density. The PCL-PEG-2XFLK specimens had a higher failure strength than PCL alone (1404 ± 545 Pa) or PCL-PEG (2732 ± 840). Flocking progressively reduced composite stiffness from 1347 ± 15 to 763 ± 21 N/m. Degradation increased from 12% at 7 days to 16% after 10 days and 20% after 21 days. Cumulative dexamethasone release at 0.4 mg/cm2 concentration was maintained over 21 days. Optimized PCL-PEG-2XFLK density flocked patches were easy to maneuver endoscopically in laryngeal evaluation. CONCLUSIONS: This novel, sutureless, patch is a mucoadhesive platform suitable to laryngeal and tracheal anatomy with drug delivery capability. LEVEL OF EVIDENCE: NA Laryngoscope, 131:1958-1966, 2021.
Subject(s)
Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Wound Closure Techniques/instrumentation , Wound Healing/drug effects , Animals , Biocompatible Materials , Cadaver , Dexamethasone/therapeutic use , Drug Delivery Systems/trends , Drug Evaluation, Preclinical , Glucocorticoids/therapeutic use , Humans , Larynx/anatomy & histology , Larynx/pathology , Pharmaceutical Preparations/administration & dosage , Polyesters/chemistry , Polyethylene Glycols/chemistry , Sutureless Surgical Procedures/methods , Swine , Tissue Engineering/methods , Tissue Scaffolds/chemistry , Trachea/anatomy & histology , Trachea/pathology , Wound Healing/physiologySubject(s)
Electric Stimulation Therapy/adverse effects , Hypoglossal Nerve Diseases/etiology , Hypoglossal Nerve/physiopathology , Sleep Apnea, Obstructive/therapy , Female , Fluoroscopy , Follow-Up Studies , Humans , Hypoglossal Nerve Diseases/diagnosis , Hypoglossal Nerve Diseases/physiopathology , Middle Aged , Sleep Apnea, Obstructive/physiopathologyABSTRACT
PURPOSE OF REVIEW: To review current literature regarding the use and utility of nasal saline irrigation in nasal and sinus diseases. RECENT FINDINGS: Nasal irrigations, in various forms, are a widely used and accepted means of treatment of the symptoms of chronic rhinosinusitis and other sinonasal disease processes. Over the past two decades, significant research has been done to evaluate the role of nasal irrigations in the treatment of sinonasal disease. The use of a high-volume, low-pressure system like a squeeze bottle remains the optimal delivery device. Although additional research is required for many of the additives discussed, the use of xylitol in chronic rhinosinusitis and topical fluconazole in allergic fungal sinusitis appear promising. SUMMARY: Use of nasal saline irrigations can improve symptoms of sinonasal disease and may improve outcomes in certain settings. Ongoing research will continue to shape and optimize understanding of maximally effective nasal irrigations.