In vivo soft tissue reinforcement with bacterial nanocellulose

The use of surgical meshes to reinforce damaged internal soft tissues has been instrumental for successful hernia surgery; a highly prevalent condition affecting yearly more than 20 million patients worldwide. Intraperitoneal adhesions between meshes and viscera are one of the most threatening complications, often implying reoperation or side effects such as chronic pain and bowel perforation. Despite recent advances in the optimization of mesh porous structure, incorporation of anti-adherent coatings or new approaches in the mesh fixation systems, clinicians and manufacturers are still pursuing an optimal material to improve the clinical outcomes at a cost-effective ratio. Here, bacterial nanocellulose (BNC), a bio-based polymer, is evaluated as a soft tissue reinforcement material regarding mechanical properties and in vivo anti-adhesive performance. A double-layer BNC laminate proved sufficient to meet the standards of mechanical resistance for abdominal hernia reinforcement meshes. BNC-polypropylene (BNC-PP) composites incorporating a commercial mesh have also been prepared. The in vivo study of implanted BNC patches in a rabbit model demonstrated excellent anti-adherent characteristics of this natural nanofibrous polymer 21-days after implantation and the animals were asymptomatic after the surgery. BNC emerges as a novel and versatile hernioplasty biomaterial with outstanding mechanical and anti-adherent characteristics.Authors acknowledge financial support from the Spanish Ministry of Science and Innovation through the RTI2018-096273-B-I00 project, the ‘Severo Ochoa’ Programme for Centres of Excellence in R&D (CEX2019-000917-S) and the Generalitat de Catalunya 2017SGR765 grant. Authors are also grateful for the PhD scholarships of I. A-S. (BE-2017-076734) and S. R-S. (BES-2016-077533) and the 2019LLAV00046 project. The ICMAB members participate in the CSIC Interdisciplinary Platform for Sustainable Plastics towards a Circular Economy, SUSPLAST, and in the Aerogels COST ACTION (CA 18125). This work has been performed within the framework of the doctoral program in materials science of UAB (I. A-S. and S. R-S.). We acknowledge the support by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI) to cover the publication fee.Peer reviewe