Integration of extracellular matrix with chitosan adhesive film for sutureless tissue fixation

Background and Objectives. Extracellular matrices (ECMs) are currently applied in reconstructive surgery to enhance wound healing and tissue remodelling. Sutures and staples are usually employed to stabilize ECM on tissue although they may damage the matrix structure. In this investigation, a novel biocompatible bandage was developed to fix ECM on tissue without sutures. Study Design/Materials and Methods. An adhesive film, based on chitosan, was integrated with small intestine submucosa (SIS) in a single bandage strip. This bandage was bonded to sheep small intestine upon laser irradiation of the chitosan film (P = 0.12 W, Fluence = 46±1 J/cm2) to assess tissue adhesion strength. Thermocouples were used to estimate temperatures under SIS during laser irradiation. Bandage strips were also mechanically tested to evaluate their tensile strength before and after irradiation. Results and Conclusions. The bandage successfully bonded to intestine achieving a shear stress of 9.6± 1.6 kPa (n = 15). During laser irradiation, the temperature increased modestly to 31±2°C (n = 14) beneath the ECM portion of the bandage. The bandage withstood a tensile strength of 3,122±780 and 3,384±791 kPa, before and after laser irradiation respectively (n = 10, P = 0.47, t-test). The SIS-chitosan bandage bonded effectively to tissue without sutures and preserved the ECM structure avoiding irreversible thermal denaturation of imbedded bioactive proteins.