Abstract:
Globalization of world market has
put a sufficient pressure of textiles manufacture to think about their
survival. Changing scenario demands change in approach to diversification of
product. Now textiles does not means only looking fashionable and covering
body, but also it can be more functional and use for technical applications like
agriculture , aerospace, geo textiles, medical textiles and etc,. The
medical textiles are one part of technical textiles, it is an interdisciplinary
field and it’s collaborated between medical and textile sectors.
Medical science has become very
advanced from last few decades. More and more techniques are invented to
procure better health methods. Use of medical textiles for replacing damaged
tissues or organs is the result of advanced medical invention. However
substitute for defective body parts was used to be transplantation of that part
or organ, but this is not always possible. Thus use of textiles as a substitute
to replace and aid for damaged body parts is being utilized by the surgeons and
physicians.
In this paper, discussed about the application
of textiles in various medical fields namely, health care, hygiene
products, extra corporeal devices and surgical textiles, Non implantable and
implantable materials, Phase Change Materials and Super Absorbent Fibers in these
felids.
Introduction:
The
term “medical
textiles” literally means textiles used for medical purposes. Textile
apart from being a vital part of human life are since long been used in medical
field, though the tern has been coined very recently. Textile materials have a
range of properties such as flexibility, elasticity, strength, etc. based on
these properties research work has been going on rapidly around the world
towards the application of textiles in medical field. Specialist from
physicians to textile chemists and textile engineers are ready to devote
themselves unitedly to apply these broad ranges of properties of textile
material in medical technology (1).
Categories
of Medical Textiles
Surgical Sutures (2)
Fibers
are also used as sutures in surgery. Sutures are sterile filaments which are
used to hold tissues together until they heal adequately or to join tissues
implanted prosthetic devices., Sutures are either braided or monofilament are
mostly used to close wounds and approximate tissues. The textile materials have
generated considerable interest in medical technology where materials in the
form of monofilament, multifilament, woven and nonwoven structures are being
used for bio and medical applications. The major requirement of the textile
materials is the bioreceptivity and biocompatibility at the application site in
human being. The medical textile group in the Department of Textile
Technology at IIT Delhi has been working on the development of antimicrobial
biocompatible sutures and scaffolds for tissue engineering. Because of the
lack of proper post-surgical care, the bacterial infection in stitched wounds
is prevalent in many of the cases.
The
development of an antimicrobial suture based on Nylon and Polypropylene
monofilaments is being pursued in the Medical
Textile group. The surface functionalization of the suture is carried out
in such a way that the inherent characteristics, such as
mechanical and knot strength of the suture are not affected. Both the high
energy gamma radiation and the plasma irradiation are being used to activate
the materials for the surface functionalization. An antimicrobial drug is
immobilized on the suture surface which subsequently is released slowly into
tissues surrounding the stitch and prevents the microbial invasion. The tissue
compatibility of these sutures is excellent and no adverse reaction has been
observed against these sutures. Fig:
1 Surgical Suture Process
Barbed Sutures
Recently a bi-directional barbed
suture has been developed which obviates the necessity to tie a knot. It has
ability to put tension in the tissues with less suture slippage in the wound,
as well as to more evenly distribute the holding forces there by reducing tissue
distortion. The barbed suture with a steeper cutangle and a median cut depth
have a higher tissue holding capacity than those with a moderate cutangle and a
nominal cut depth. Fig: 2
Barbed Suture Needle
GELATIN COATED SUTURES
Gelatin
coated sutures are having a superior handling characteristics. The gelatin
coating given to the suture material improves the surface smoothness and
reduces the fraying characteristics. It can be obtained by means of treating
the suture with that of aqueous solution of gelatin to coat the suture and it
is made to have a contact with that of fixative agent to crosslink gelatin.
This process includes the step of contacting the coated suture with that of buffer
solution and heats it to 500C for a particular period of time
interval. Usually heating can be carried out for about 1-20hrs. Sometimes
plasticizers can be incorporated into the gelatin solution. The plasticisers
used are triethyl citrate, glycerin or other poly hydric alcohols. The
plasticiser used is mainly to enhance the benefits of the gelatin coating. The
fixative solution used in the process is a cross linking agent. The preferred
cross linking agent is preferably a dialdehyde such as glyoxal, which may be
used alone or in conjunction with formaldehyde or other aldehyde.
Dressing
Materials (3
&4)
Calcium Alginate Fibers
The
raw material for the production of this fibre is alginic acid, a compound
obtained from the marine brown algae. It has a variety of properties, including
the ability to stabilize viscous suspension, to form film layers, and to turn
into gels. When the dressing made of this fibre is applied to wound, the
reverse ion exchange take place, and this fibre is placed on the wound in dry
state and begins to absorb the exudates. The calcium ions are then gradually
exchange against sodium ions that are present in the blood and wound exudates.
The
fiber absorbs large amounts of secretion, starts to swell and in the presence
turns into a moist gel that fills and securely covers the wound. Both the
extent and the rate of gel formation depend on the available amount of
secretions. The more exudates present the more rapid gel formation occur.
Addition of excess sodium ion causes further dissolution of the gel, so that
calcium alginate fibres remaining in the wound can be resorbed. If necessary,
but mayh also without problems be rinsed out with physiological saline
solution.
Sorbalgon
It
is a supple, non-woven dressing made from high quality calcium alginate fibre
with excellent gel forming properties. The dressing offers number of practical
therapeutic advantages for wound healing over any other commonly uses textiles.
A Sorbalgon dressing absorbs approximately 10ml
exudates per gram dry weight and thus provide with an absorption capacity. They
in addition differ from textile dressings with respect to applied mechanism of
absorption. It takes wound secretion directly into the fibres i.e., using intra
capillary forces.
Super Absorbable Polymer
Super absorbents are swell able cross linked polymer, which have
the ability to absorb and store 400-600 times there own weight of aqueous
liquid by forming a gel. The liquid is then retained and not released, even
under pressure. The absorption rate of the polymers differs according to their
mechanism used for preparation. SAP cannot dissolve because of their 3-D
polymeric network structure of the many different types of polymers, only a few
can be made into useful fibers. This is because a polymer must meet certain
requirements before it can be successfully and efficiently converted into a
fibrous product. Some of the most important of these requirements are:
· Polymer chains should be linear, long, and flexible. Side groups
should be simple, small, or polar.
· Polymers should be dissolvable or melt able for extrusion.
· Chains should be capable of being oriented and crystallized.
Common fiber-forming polymers include cellulosic (linen, cotton,
rayon, acetate), proteins (wool, silk), polyamides, polyester (PET), olefins,
vinyls, acrylics, polytetrafluoroethylene (PTFE), polyphenylene sulfide (PPS),
aramids (Kevlar, Nomex), and polyurethanes (Lycra, Pellethane, Biomer). Each of
these materials is unique in chemical structure and potential properties. For
example, among the polyurethanes is an elastomeric material with high
elongation and elastic recovery, whose properties nearly match those of elastin
tissue fibers. This material when extruded into fiber, fibrillar, or fabric
form derives its high elongation and elasticity from alternating patterns of
crystalline hard units and noncrystalline soft units. Although several of the
materials mentioned above are used in traditional textile as well as medical
applications, various polymeric materials both absorbable and nonabsorbable
have been developed specifically for use in medical products.
The reactivity of tissues in contact with fibrous structures
varies among materials and is governed by both chemical and physical
characteristics. Absorbable materials typically excite greater tissue reaction,
a result of the nature of the absorption process itself. Among the available
materials, some are absorbed faster (e.g., polyglycolic acid, polyglactin acid)
and others more slowly (e.g., polyglyconate). Semiabsorbable materials such as
cotton and silk generally cause less reaction, although the tissue response may
continue for an extended time. Nonabsorbable materials (e.g., nylon, polyester,
and polypropylene) tend to be inert and to provoke the least reaction. To
minimize tissue reaction, the use of catalysts and additives is carefully
controlled in medical-grade products (5).
Water Absorbent Polymer
Water
absorbent polymers are known as hydro-gel, water crystal, super absorbent
polymers etc., are simply a type of plastic that possesses some unique water
absorbing qualities. This is due to the presence of sodium or potassium
molecules that form bridges between the long hydro carbon chains. These bridges
are known as cross linking, which enables the polymer to form into a huge
single super molecule, including its ability to degrade in the environment and
breakdown into simpler molecules, and hold significant amount of water. When
water comes in contact with super absorbent an electrical repulsion takes with
in the particles. When this happens, water is drawn into the particles
resulting in swelling of each particle. At maximum absorption capacity each
particle will expand to over 30 times its original volume. When water
evaporates it shrinks, returning to unswollen state.
Spider Silk
Modified
goat milk will contain web protein .A goat that produces spider's web protein
is about to revolutionist the materials industry. It is Stronger and more
flexible than steel, spider silk offers a lightweight alternative to carbon
fibre. Up to now it has been impossible to produce "spider fibre"
on a commercial scale. Unlike silk worms, spiders are too anti-social to farm
successfully. Fig: 4
Spider silk (Spinners)
Now a Canadian company
claims to be on the verge of producing unlimited quantities of spider silk - in
goat's milk. Using techniques similar to those used to produce Dolly the sheep,
scientists at Nexia Biotechnologies in Quebec have bred goats with spider
genes. New kids on the block Called Webster and Pete, the worlds first "web
kids" cannot dangle from the ceiling, nor do they have a taste for
flies. In fact they look like any other goat. But when they mate, it is hoped
they will sire nanny goats that produce milk that contains the spider silk
protein. This "silk milk" will be used to produce a web-like material
called Biosteel. Naturally occurring spider silk is widely recognized as the
strongest, toughest fibre known to man.
Its tensile strength is greater than steel and it is 25 percent
lighter than synthetic, petroleum-based polymers. These qualities will allow
Biosteel to be used in applications where strength and lightness are essential,
such as aircraft, racing vehicles and bullet-proof clothing. Kind to humans
another advantage of spider silk is that it is compatible with the human body.
That means Biosteel could be used for strong, tough artificial tendons,
ligaments and limbs. The new material could also be used to help tissue repair,
wound healing and to create super-thin, biodegradable sutures for eye-or
neurosurgery (6).
Antimicrobial Fiber
Antibacterial fiber is produced by entrapping the metal ion with a
cation exchange fibre having a sulphonic or carboxyl group through an ion
exchange reaction. The antibacterial metal ion is silver or silver in
combination with either copper or zinc. The great advantage of this material is
that those are not to react with tissue. Flexible products such as sponges and
textile wites, which have protracted antimicrobial effect. The wipes are
impregnated with biocides by spra8ying, dipping or soaking for use in medical
field.
Acticoat
Dressing
It provides broader and faster protection against fungal infection
than conventional antimicrobial products. The dressings are layered with mono
crystalline silver known to have antimicrobial and antifungal properties,
creating a protective barrier as silver ions are consumed. Acticoat has the
faster kill rate and was effective against more fungal species. The product can
be applied to variety of wounds including graft and donor sites and surgical
wounds.
Antimicrobial Wound
Dressing
Kerlix AMD is pure cotton treated with anecia's polyhexamethylene
biguandine agent. These antimicrobial agents resist bacterial growth with in
the dressing as well as reducing bacterial penetration through the product.
Wound covering, is made of a hydrophobic bacteria-adsorbing material which
comprises the antimicrobial active component which is not released into wounds,
it is preferably made of mixture of hydrophobic fibres and fibre comprising
antimicrobial property (7).
Phase Change Materials (PCM):
Phase change technology in textiles means incorporating micro
capsules into textile structures. Phase change materials (pcm) are used in
health care applications for faster recovery of patients. These are the material
that possesses the ability to change their physical state from solid to liquid
or vice- versa, within a certain range of temperature. The energy required for
breaking the bonds and changing from solid to liquid is absorbed from the
surroundings. During the entire phase change the temperature of the surrounding
substrate and the pcm remains constant. These pcm’s can be used in micro
encapsulated form for surgical clothing, bedding material and intensive care
material purposes. Microfibres, non woven and their composites are used in
drapes, gowns, caps, mask, etc. due to their dispesability, barrier properties,
breathability, drapeability, strength, softness and comfortability. A British
company has developed a special bra, called “mamo test bra”, which can detect
breast cancer at a very early stage. The black bra is coated with
thermochrombic liquid crystal ink, which changes color with the amount of heat.
It is subjected to the cancerous tumours are warmer than the adjacent areas and
can be detected by different color patterns (8).
Disposable Products:
Absorbent disposable products, such as diapers, sanitary napkins,
tempons, incontinence products, panty shields, wipe, etc. are mostly single use
items and are designed to receive, absorb and retain body fluids and solid
waste. The disposable diaper for baby care was first marketed in Sweden in the
late 1930’s. and the present all-in-one diaper consists of multilayer
components with an enhanced facility to collect urine and faucal waste and
incorporates a super absorbent polymer as an absorbent component.
A modern breathable disposable feminine product consists of three
layers, of which the inner top layer is made of a blend of hydrophobic
(polyester), low density fibres (polyethylene) and is liquid and water
permeable. The core layer, packed with wood- pulp as other absorbent materials,
is highly absorbent and the third layer consists of a multi layer barrier, that
is water vapour permeable, but resistant to liquid water. It is of interested
to note that fibers obtained from gellan gum are utilized for making tempons.
The gum is obtained from the culture of pseudomonas elodeabacterium by
fermentation. A washable or disposable nursing pad has been developed to absorb
breast milk leaking from a nursing mother into her outer garments, principally
during the night.
A modern incontinence
product also consist of three layers, a cover stock, that is permeable and
diffuses the liquid laterally, a highly absorbent core, and a barrier polyethylene
or polyvinyl chloride film that helps the patient clothes or bedding to keep
dry (9).
Smart Textiles for Health Care:
Intelligent
or ‘smart’ textile is an emerging field in textile research, where the material
is designed to sense and react to different stimuli or environmental
conditions. The extent of intelligence can be divided in three sub- groups;
passive smart, active smart and very smart textiles. An important development
applicable to the medical field is the ‘wearable computer system’. For example,
a smart t- shirt with conductive fibers capable
Fig: 4 Schematic of an embedded
network of processing element in a textile fabric for health monitoring
Of feeding sensor signals into a small transmitter has been
manufactured. Such apparel capable of recording, analyzing, storing, sending
and displaying biofunctional data including internet connectivity can be used
to monitor the health status of the wearer. The first textile material that, in
retroaction, was labeled as a ‘smart textiles’ was silk thread having a shape
memory.
Smart t-shirt was originally designed for combat soldiers in the
military to detect the location and severity of wounds and subsequently to
monitor their physiological state, and to transmit the information to remote
medical sites. The concept was later extended to medical applications in which
the transmission of data from such a’ wearable computer’ enables the remote
monitoring of heart beat, blood oxygen level, respiration and body temperature
to start with. The health status can also be interpreted and transmitted to a doctor’s
office or to a hospital monitoring system as required. Such a’ smart’ system
can also be used for monitoring babies considered at risk for sudden infant
death syndrome. Keeping watch on post- surgical geriatric patients at home,
remote monitoring of stroke patients in bed , tightness of pressure garments,
heat stress suffered by fire fighters and three dimensional scanning and
medical imaging of patients.
The concept of smart textiles is also being extended to new
finishes, for example, to provide vitamins to the body through garments, termed
as ‘wearable vitamins’. Fuji spinning has developed a finish to fix
pro-vitamins to fibres in a staple manner. A finished t-shirt, containing vitamin
C and also E now, has been developed (10).
Compression Bandages
The basic function of bandages is compression, retention and
support. This is obtained by properties intrinsic to the component and further
enhanced and re-enforced supportively by the process of weaving and finishing
relevant to the required end use. The regulation of the blood flow and
prevention of swelling is closely interlinked with this property and there by
enhancing improved healing healing process. It provides necessary support to restrict
movement and speed up the healing process (11).
Conclusion:
Thus the application of textile in high performance and
specialized fields are increasing day by day. There will be an increasing role
for medical textile in future. Thus the textile will be used in all extra
corporal devices, external or implanted materials, healthcare and hygienic
products. Textile materials continue to serve an important function in the
development of a range of medical and surgical products. The introduction of
new materials, the improvement in production techniques and fiber properties,
and the use of more accurate and comprehensive testing have all had significant
influence on advancing fibers and fabrics for medical applications. As more is
understood about medical textiles, there is every reason to believe that a host
of valuable and innovative products will emerge; in future many more
developments will happen in medical textiles particularly Phase Change Materials and Super
Absorbent Fibers.
References:
- A.A.Desai, “Biomedical Textiles” Journal of
Textile Association Jan –Feb 2004
- Indian Journal
of Fiber and Textile Research, Vol. 31, Pp 215-229.
- Somasundram D
&Kothari V K (2007) “Textile
Materials in Implantable Medical Surgeries” Indian Textile Journal
July Pp 73.
- Krishnabala S.
& Thangeswaran P. (2005) “Biomaterials
in Medical Applications” Asian Textile Journal, Vol. 14/6, Pp 57-61.
- Hayavadana J
et. al, “Biomedical Textiles”
Asian Textile Journal, February (2004), Pp 93-98.
- I.V.
Walker, proceedings of Medical Textile Conference., 1999,
Bolton Institute, U.K., Publishing
Co., Cambridge, Pp 12- 19
- Rigby A.J et.
al, Medical Textiles, Textile
Horizon March 1999
- S. Anand, ‘Medical Textiles’, Wood head
publishing Ltd, Abington, 2001.
- Opportunities for
healthcare and medical textiles growth’, Technical Textiles International,
2003
- Alistan. et. al, Hand book of Technical Textiles, Wood head Publishing Limited
– England PP 412.
- M.R. Ten Breteler et. al “ Textile
Slow-Release Systems With Medical Applications” Autex Research Journal, Vol. 2, No4, December
2002