Secure closure of the fascial layers after entry into the peritoneal cavity is crucial to prevent
incisional hernia, yet appropriate purchase of the tissue can be challenging due to the proximity of the underlying protuberant bowel which may become punctured by the surgical needle or strangulated by the
suture itself. Devices currently employed to provide visceral protection during abdominal closure, such as the
metal malleable retractor and Glassman Visceral Retainer, are unable to provide complete protection as they must be removed prior to complete closure. A
puncture resistant, biocompatible, and degradable matrix that can be left in place without need for removal would facilitate rapid and safe abdominal closure. We describe a novel
elastomer (CC-DHA) that undergoes a rapid but controlled solid-to-liquid phase transition through the application of a destabilized
carbonate cross-linked network. The
elastomer is comprised of a
polycarbonate cross-linked network of
dihydroxyacetone,
glycerol ethoxylate, and tri(
ethylene glycol). The
ketone functionality of the
dihydroxyacetone facilitates hydrolytic cleavage of the
carbonate linkages resulting in a rapidly degrading barrier that can be left in situ to facilitate abdominal fascial closure. Using a murine
laparotomy model we demonstrated rapid dissolution and metabolism of the
elastomer without evidence of toxicity or intraabdominal
scarring. Furthermore, needle
puncture and mechanical properties demonstrated the material to be both compliant and sufficiently
puncture resistant. These unique characteristics make the
biomaterial extraordinarily useful as a physical barrier to prevent inadvertent bowel injury during fascial closure, with the potential for wider application across a variety of medical and surgical applications.
STATEMENT OF SIGNIFICANCE: Fascial closure after abdominal surgery requires delicate maneuvers to prevent
incisional hernia while minimizing risk for inadvertent bowel injury. We describe a novel biocompatible and biodegradable
polycarbonate elastomer (CC-DHA) comprised of
dihydroxyacetone,
glycerol ethoxylate, and tri(
ethylene glycol), for use as a rapidly degrading protective visceral barrier to aid in abdominal closure. Rapid
polymer dissolution and metabolism was demonstrated using a murine
laparotomy model without evidence of toxicity or intraabdominal
scarring. Furthermore, mechanical studies showed the material to be sufficiently
puncture resistant and compliant. Overall, this new
biomaterial is extraordinary useful as a physical barrier to prevent inadvertent bowel injury during fascial closure, with the potential for wider application across a variety of medical and surgical applications.