Download PDF
J Reconstr Microsurg 2022; 38(01): 047-055
DOI: 10.1055/s-0041-1729881
Original Article

Hierarchical Ceramic Coating Reduces Adherence of Cells, Blood, Bacteria, and Tissue on Titanium Microsurgical Instruments

Henriette Jaurich‡   *
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Mustafa Becerikli  ‡   *
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Jörg Zerrer
2   ELB – Eloxalwerk Ludwigsburg Helmut Zerrer GmbH, Ludwigsburg, Germany
,
Christoph Wallner
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Johannes M. Wagner
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Mehran Dadras
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Birger Jettkant
3   Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Thomas A. Schildhauer
3   Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Marcus Lehnhardt
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
,
Ole Jung‡   *
4   Department of Oral and Maxillofacial Surgery, Head- and Neurocentrum, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Björn Behr   *
1   Department of Plastic and Reconstructive Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
› Author Affiliations Funding This study was funded by German Federal Ministry for Economic Affairs and Energy, grant: 4048801CK5.
› Further Information
    Permissions and Reprints

Abstract

Background Progress in the field of microsurgery allows more detailed reconstructions of the smallest tissue structures. The applied instruments are left with biological residues after coming into contact with body fluids or tissue, leading to compromised surgical precision. Designing of residue-free innovative instruments would reduce the necessity of subsidiary practices and would improve the surgical precision.

Methods We designed a ceramic coating (Lotus ceramic coating system 26—LCC-26) that exhibits self-cleaning surface properties on coated titanium specimens. A titanium surface was modified by blasting technology and electropolishing, followed by applying a high-performance ceramic and sol-gel finish layer. The physical surface characterization was performed by scanning electron microscopy and measuring the contact angle. The cell-repellent properties and cytotoxicity were investigated using live-dead staining, BrdU, and lactate dehydrogenase assay. Furthermore, bacterial and fluid-adhesion tests were performed. Finally, blood compatibility was analyzed according to DIN ISO 10993.

Results The composite system LCC-26 increased the hydrophobic character of the titanium surface (the water contact angle of 74.9 degrees was compared with 62.7 degrees of the uncoated native titanium; p < 0.01) and led to the fluid and cell-repellent properties shown by the reduction in fibroblast adherence by ∼50.7% (p < 0.05), the reduction in Staphylococcus aureus pathogen colonization by 74.1% (p < 0.001), and the decrease in erythrocyte adherence by 62.9% (p < 0.01). Furthermore, the LCC-26 coated titanium microforceps dipped in human whole blood exhibited blood-repellent character (reduction in blood adherence by 46.1%; p < 0.05). Additionally, cyto- and hemocompatibility was guaranteed in direct and indirect tests.

Conclusion Titanium surface modification on surgical instruments exhibits cell, bacteria, and blood-repellent properties with a full guarantee of cyto- and hemocompatibility. Thus, innovatively coated instruments could contribute to increased precision during microsurgical interventions and optimized medical operation routines in the future.

Keywords

surface modification - titanium - self-cleaning instrument - cyto- and hemocompatibility

* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 27 November 2020

Accepted: 28 March 2021

Article published online:
21 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Wong C-H, Wei F-C. Microsurgical free flap in head and neck reconstruction. Head Neck 2010; 32 (09) 1236-1245
    CrossrefPubMedGoogle Scholar
  • 2 Levin LS. From autotransplantation to allotransplantation: a perspective on the future of reconstructive microsurgery. J Reconstr Microsurg 2018; 34 (09) 681-682
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Jones NF, Hansen SL, Bates SJ. Toe-to-hand transfers for congenital anomalies of the hand. Hand Clin 2007; 23 (01) 129-136
    CrossrefPubMedGoogle Scholar
  • 4 Tintle SM, Levin LS. The reconstructive microsurgery ladder in orthopaedics. Injury 2013; 44 (03) 376-385
    CrossrefPubMedGoogle Scholar
  • 5 Buncke HJ, Chang DW. History of microsurgery. Semin Plast Surg 2003; 17 (01) 5-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Pierse D, Steele AD, Walter DO. The introduction of titanium alloys in ophthalmic microsurgical instruments. Br J Ophthalmol 1976; 60 (08) 597-598
    CrossrefPubMedGoogle Scholar
  • 7 Becerikli M, Jaurich H, Wallner C. et al. P2000 - A high-nitrogen austenitic steel for application in bone surgery. PLoS One 2019; 14 (03) e0214384
    CrossrefPubMedGoogle Scholar
  • 8 Nguyen HH, Wan S, Tieu KA, Zhu H, Pham ST. Rendering hydrophilic glass-ceramic enamel surfaces hydrophobic by acid etching and surface silanization for heat transfer applications. Surf Coat Tech 2019; 370: 82-96
    CrossrefPubMedGoogle Scholar
  • 9 Velayi E, Norouzbeigi R. Single-step prepared hybrid ZnO/CuO nanopowders for water repellent and corrosion resistant coatings. Ceram Int 2019; 45 (14) DOI: 10.1016/j.ceramint.2019.05.229.
    CrossrefPubMedGoogle Scholar
  • 10 Kawashita M, Tsuneyama S, Miyaji F, Kokubo T, Kozuka H, Yamamoto K. Antibacterial silver-containing silica glass prepared by sol-gel method. Biomaterials 2000; 21 (04) 393-398
    CrossrefPubMedGoogle Scholar
  • 11 Jaiswal S, McHale P, Duffy B. Preparation and rapid analysis of antibacterial silver, copper and zinc doped sol-gel surfaces. Colloids Surf B Biointerfaces 2012; 94: 170-176
    CrossrefPubMedGoogle Scholar
  • 12 Zhang JX, Guan RF, Zhang XP. Synthesis and characterization of sol–gel hydroxyapatite coatings deposited on porous NiTi alloys. J Alloys Compd 2011; 509 (13) 4643-4648
    CrossrefPubMedGoogle Scholar
  • 13 Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V. Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 2010; 38 (02) 112-120
    CrossrefPubMedGoogle Scholar
  • 14 Balamurugan A, Balossier G, Laurent-Maquin D. et al. An in vitro biological and anti-bacterial study on a sol-gel derived silver-incorporated bioglass system. Dent Mater 2008; 24 (10) 1343-1351
    CrossrefPubMedGoogle Scholar
  • 15 Ewald A, Glückermann SK, Thull R, Gbureck U. Antimicrobial titanium/silver PVD coatings on titanium. Biomed Eng Online 2006; 5 (01) 22 DOI: 10.1186/1475-925X-5-22.
    CrossrefPubMedGoogle Scholar