Closing Surgical Incisions With a Paintbrush and Nanoparticles

New submitter BiancaM (3582365) writes "A group of chemists has shown the power of nanoparticles for closing and healing surgical wounds. Using no more than a paintbrush they are able to close surgical openings as well as classical techniques such as sutures. However in fragile deep tissues such as liver even more remarkable results were found- normally fatal damage to internal organs is repaired in seconds using a nanoparticle glue. The results show that closing after surgery can be faster and simpler using nanomaterials to glue wounds shut." For something between the above linked abstract and the research paper, there's this write-up at PhysOrg, and a video of the technique in action.

Comments

Couldn't resist

[flopsquad]

First paste [to fix your busted liver]!

Re:Superglue

[Anonymous Coward]

Holy hell, if you're going to play at "Arrogant /. Commenter", you need to at least use the proper terminology; cyanoacrylate (or 2-octyl cyanoacrylate, or Dermabond), not super glue.

The answer to your ignorant question, btw, is no. Carry on.

Re:Well, that's not quite nanotechnology

[Jmc23]

Did you read what you wrote?

Yes, it would be disappointing if something said nanotechnology and nanomachines and all you got was nanoparticles. However, all it said was nanoparticles. Why would you expect anything else? More importantly, do we even need anything else? (btw, google around, there's already nanomotors that can be used inside human cells... though all they can do is bump into stuff)

Sucky Surgeon

[Anonymous Coward]

Is it just me, or does that guy really suck at suturing? I'm not a physician (never even played one), but I've watched instructional videos, and that didn't look like how the pros do it. The pros can suture and tie a knot way faster. If you suture like that then obviously glue would be better!

I felt really bad for whatever mammal that was (dog? rabbit?), especially because of the suturing job. I guess it could be worse; some scientists spend 8 hours a day putting rats under a guillotine. But then they die quickly, and don't have to get sliced up repeatedly. I suppose the product will help minimize pain for research animals in the future, as well as human patients.

Re:Sucky Surgeon

[sumdumass]

I've had a good share of sutures in my life. Many of them was given while I was awake and watching too. I was thinking the same thing about how this guy sucks at it. But it likely isn't his full time job. I can lay carpet and do electrical work but I'm slow as snot compared to the pros.

On the other hand, I like the concept of the glue way better but fear it would turn my random $500 ER visits into a $5000 visit. But then again, I wouldn't have the pleasure of the ER doctor's jokes about how my arm or finger or whatever reminds him of his wife's meatloaf while they are stitching me up.

Re:Sucky Surgeon

[Jmc23]

He really sucks. He actually picked up part of the fascia. He's a clumsy oaf.

BTW, usually you don't use a guillotine to kill animals unless you're a sadistic mother fucker. You use the guillotine to remove their head for easier access to the brain. Which you have carefully prepared by slowly killing the rat by slicing its diaphragm and injecting saline into its heart to flush all that pesky blood out.

Re:Sucky Surgeon

[sumdumass]

The good kind of fucked up country. What kind of fucked up country do you live in?

Re:Sucky Surgeon

[K. S. Kyosuke]

Is it just me, or does that guy really suck at suturing? I'm not a physician (never even played one), but I've watched instructional videos, and that didn't look like how the pros do it.

Well of course! What, did you expect to be a suturing pro after watching your first suturing video? Of course you have to learn it piece by piece, what would happen to the instructional video industry if they taught you everything instantly? Won't somebody think of the instructors?

Re:Sucky Surgeon

[wonkey_monkey]

Maybe he's not a surgeon:

A group of chemists has shown

No sense bringing in a surgeon when all that's needed is a bare minimum of skill with scalpel and suture.

Re:Sucky Surgeon

[quantumghost]

Is it just me, or does that guy really suck at suturing? I'm not a physician (never even played one), but I've watched instructional videos, and that didn't look like how the pros do it. The pros can suture and tie a knot way faster. If you suture like that then obviously glue would be better!

I felt really bad for whatever mammal that was (dog? rabbit?), especially because of the suturing job..

FWIW, the animal did appear to be adequately anesthetized as it did not flinch with the incision or suturing, and, no, he was not good, he barely knew what he was doing:
- wrong scalpel. That was a 10 blade used for long linear incision (e.g. > 10-40 mm). He should have used an 11 or 15 blade which are smaller and better suited to precision cuts, which these were not - he hacked at the skin instead if cleanly incising (so the technique was bad, the blade was dull, and he used the wrong blade).
- he did not use a pair of forceps to grasp the skin putting him self at risk of a needle-stick injury.
- needle entry was not perpendicular to the skin
- he used PDS suture (it looked purple) , which is _never_ used on skin (especially externalized). Prolene is used for an external knot, or vicryl or monocryl for a subcuticular suture
- the suture looks to be a 3-0 or 4-0....that's what I would use to close an adult human (5-0,which is smaller, for the face). Should probably be using 5-0 or 6-0 here. Then again, this guy would probably break that suture since he doesn't have the manual dexterity or technique. - he should have used a horizontal or 2 vertical mattress sutures to close the defect, not a single simple suture
- he didn't tie square knots and his tying was worse than a medical student's (who don't know how to suture either)
So I may just be nitpicking but, then again, that's what I do as an academic surgeon who trains upcoming surgeons.

But to actually address the article: It looks promising. I have questions about:
A) potential toxicity (nanoparticles can behave in less predictable way in-vivo) [large volumes of iron can be toxic to the body hemosiderin leading to iron overload], also silica is sometimes not well tolerated by the body
B) I would like to see this applied in a larger model (porcine would be good), with a large volume hemorrhage (analogous to a human GSW or stabbing wound) to see if the tensile strength of this seal scales up and to see if a large volume of blood will wash it away rendering it useless.
C) Does it withstand the detergent like properties of bile?
D) What percentage of normal tensile strength does this technique afford? Sutures physically hold tissue together to prevent separation under shear stress - how much strength does this stuff afford?
E) Does the substance affect normal wound healing (scar tissue is a normal, appropriate response, in an adult, to tissue injury; less scar may mean abnormal or poorer wound healing)
F) Will it be scalable (yes you can produce it in a lab easily enough, but can you make medical grade easily?)
G) Can it cause injury to adjoining tissue? The edge of the wound is hypoxic (low oxygen concentration), will this be toxic to these at risk tissues?

It is a long way from the lab to clinical use, but this appears promising. Look forward to seeing how the technology plays out. And no....it won't put me out of a job, but if it works out it may make my job easier and give better outcomes.

Re:Sucky Surgeon

[Anonymous Coward]

Um yes, that's all fine, but this article had the word "nano" in it which means we're living in the future now.

Re:Sucky Surgeon

[Immerman]

Really? If you want to do an honest comparison of the effectiveness of your chemical "glue" to sutures then it seems to me that you should really have someone that's at least minimally competent put in the sutures. Of course if your intent is actually just to show off how awesome your "glue" is, then by all means compare it to the results of your incompetent suturing.

Re:Sucky Surgeon

[Anonymous Coward]

H) What happens if I dip my balls in it? will it fix the wrinkles?

Re:Sucky Surgeon

[Anonymous Coward]

I think you probably should be emailing this list to the people that did this, not posting it on slashdot, mainly because it is a series of intelligent observations and questions, which are not well tolerated here.

Re:Sucky Surgeon

[excelsior_gr]

FWIW, silica nanoparticles have a GRAS certificate from the FDA and can be used in food products. Also, silica is chemically pretty stable at our body temperature and the only thing it can do is adsorb water. In fact, I'm surprised that it even had the effect of binding the tissue together (maybe provided a porous network for the blood to come in through by capillary forces and coagulate? Your guess is probably better than mine). That being said, the toxicity needs to be evaluated, but we can be optimistic.

The particles used in the experiment were super fine (only 50 nm in diameter) and synthesized using wet chemistry. Sigma Aldrich sells the LUDOX TM-50 that was used in the experiment readily in dispersion form at 28.30 EUR/L. This looks pretty scalable. If somewhat larger silica particles also exhibit the desired effects (i.e. if the glue effect is due to the high specific surface area, rather than the small particle size), then fumed silica can also be used which can be produced by the ton. The high temperatures of silica synthesis will also guarantee that the environment is pretty sterile (at least in the reactor, the engineers will "only" have to make sure that it stays that way until packaging, but it should be viable).

Re:Sucky Surgeon

[quantumghost]

FWIW, silica nanoparticles have a GRAS certificate from the FDA and can be used in food products. Also, silica is chemically pretty stable at our body temperature and the only thing it can do is adsorb water.

Enteral (oral/GI administration) ingestion of a chemical is radically different then parenteral administration (through the skin or means other than through the GI tract). There are drugs that are safe one way, and deadly the other, and vice-versa. The human body is very fickle in that regards. Silica is very dangerous if inhaled.

In fact, I'm surprised that it even had the effect of binding the tissue together (maybe provided a porous network for the blood to come in through by capillary forces and coagulate? Your guess is probably better than mine).

It may initiate a wild, but localize inflammatory reaction. A concern then would be is it really _limited_? Widespread inflammation can be deadly.

That being said, the toxicity needs to be evaluated, but we can be optimistic.

Yes.

The particles used in the experiment were super fine (only 50 nm in diameter) and synthesized using wet chemistry. Sigma Aldrich sells the LUDOX TM-50 that was used in the experiment readily in dispersion form at 28.30 EUR/L. This looks pretty scalable. If somewhat larger silica particles also exhibit the desired effects (i.e. if the glue effect is due to the high specific surface area, rather than the small particle size), then fumed silica can also be used which can be produced by the ton. The high temperatures of silica synthesis will also guarantee that the environment is pretty sterile (at least in the reactor, the engineers will "only" have to make sure that it stays that way until packaging, but it should be viable).

My problem is not with sterility. My problem is that most industrial chemical processes use heavy metals and other toxic substances as catalysts or intermediates....or that the intermediate steps that are difficult to eliminate may be toxic. This is why a pharmaceutical plant is vastly different from an industrial plant. The tolerance level is _much_ lower for pharmaceuticals. I tried looking up their analysis of LUDOX, but couldn't find it, the MSDS sheet did not list any minor components, but did list the silica as "chemically produced". I think you get my point.

Re:Sucky Surgeon

[excelsior_gr]

The Wikipedia article on silicosis mentions that amorphous silica is "less toxic" than crystalline silica. The particles used in the experiment were amorphous, which is encouraging.

I also couldn't find any analysis data. I also checked Aerosil and HDK that are from competing companies. As far as I know no catalysts are used in the production of silica (there are some way upstream in the process, but due to the several intermediate stages none should be found in the silica). However, the intermediates (e.g. silanes, tetraethyl orthosilicate, etc) are quite toxic, but they are also very reactive and also in this case no residues should be present in the final silica powder. But, as you can see, there are many "shoulds" involved, and there is no working around the clinical trials anyway...

Re:Superglue

[SuricouRaven]

Regular superglue is slightly toxic - or rather the breakdown products are. But only slightly. I've used it to patch up minor wounds a couple of times.

Re:Superglue

[queazocotal]

Regular superglue (neglecting that it's actually dermabobond) forms a healed wound with several layers.
You get the two sides of the wound somewhat reacting and generating an abnormal layer, and you have bits of plastic in the wound.

http://onlinelibrary.wiley.com... (image)

The technique mentioned essentially makes the cut surfaces into glue, with a non-toxic additive.
There will not be a scar due to reaction between the glue and the flesh - because there is no glue in that sense.
The scar tissue will be very limited - as the flesh is clamped together along the whole length of the cut, without anything in between it.

Re:Superglue

[wonkey_monkey]

dermabobond

That's fun to say. Derma-bo-bond.

Re:Superglue

[Anonymous Coward]

Regular superglue is slightly toxic - or rather the breakdown products are. But only slightly. I've used it to patch up minor wounds a couple of times.

Cyanoacrylates include methyl 2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names such as "Super Glue" and "Krazy Glue"), n-butyl cyanoacrylate and 2-octyl cyanoacrylate (used in medical, veterinary and first aid applications). Octyl cyanoacrylate was developed to address toxicity concerns and to reduce skin irritation and allergic response. Cyanoacrylate adhesives are sometimes known generically as instant glues or superglues (although "Super Glue" is a trade name).

The generic term "superglue" is used even in clinical medicine: it is not far from the truth and is something the "average joe" can understand. The only real difference is in the hydrolysis of the ester, methyl 2- will break down to methanol versus octanol. Both are toxic, but both are also tolerable in low-grade doses. In addition, dermabond is only approved for use on the surface of the skin, not internally.

Re:Superglue

[seven of five]

Careful. Sniffing Krazy Glue makes you sane.

researcher vs surgeon

[TheMeuge]

I AM a physician, and yes, whoever does the demonstration takes quite a bit away from the demonstration by being pretty horrific at suturing... like 2nd year medical student who hasn't practiced bad. If they are going to compare quality of tissue approximation between sutures and their glue, they should probably use proper technique. A plastic surgeon would have laid out 10 sutures or more into the same space, probably in half the time. I am sure there's a senior surgery resident out there who wouldn't mind getting a few hundred bucks to tie a few sutures on camera.

That being said, there are some structures in the body that are very fragile, and difficult to sew. Also, the elderly and the chronically ill have tissues that just fall apart, limiting the usefulness of many surgeries in managing their illness. If we could create seams that don't rely as much on tissue strength, we could probably operate on quite a few more people.

Re:researcher vs surgeon

[St.Creed]

Another possible use that would be VERY helpful is if this would prevent the formation of hyperkeloid scar tissue. Not very life-threatening, but disfiguring, especially in the face.

Personally, if this really works in humans as well as it looks now, I wouldn't hesitate to nominate this team for a Nobel prize for medicine.

Re:Superglue

[ArcadeMan]

What does that have to do with flying cars? Your reply makes no sense at all.

Re:Superglue

[ArcadeMan]

Maybe baby.

Re:Well, that's not quite nanotechnology

[ArcadeMan]

though all they can do is bump into stuff

Sounds like cavemen, babies and congressmen.

Re:Shocking.

[ArcadeMan]

All I know is that some black guy named Ben invented rice and that he was someone's uncle.

"The Power of Nanoparticles"?

[Karellen]

Really? As if all nano-scale particles have some kind of magical properties? (On top of those relating to branding and getting hits on your press-release?)

From TFA:

Silica nanoparticles (SiO2NP) with radius of about 50 nm (Supporting Information, Figure S3) were synthesized by the Stöber method and applied as a solution in deionized water at concentration of 30 wt% (pH 8.5) or, when indicated, as a powder. Iron oxide Fe2O3 nanoparticles (Fe2O3NP) were purchased from Alfa Aeser, stabilized by citric acid, peptized, and used in aqueous solution in milli-Q water at 42 gL-1

That's not nanotech, that's fucking chemistry.

I doubt that should even count as your basic type-IV nanomaterials or type-V biopolymer nanotech. There's nothing "nano" to see here except for the 18th-century tech known as "molecules", and it's certainly not worthy of 61 separate uses of "nano-" words in the paper.

No wonder any discussion around "real" nanotechnology (i.e. atomically precise manufacturing - the technology the word was invented to describe) is so damn confusing.

Re:"The Power of Nanoparticles"?

[Immerman]

If the existence of particles as particles is important to the outcome then it's not just chemistry, and 50nm is very firmly in the nanotech range - that's over 300 carbon-bonds across, probably including tens of thousands of atoms. Sure, it's barely (if at all) nano-engineered, but it's very definitely nano-scale technology.

Re:"The Power of Nanoparticles"?

[excelsior_gr]

Since the size of the particles is in the order of magnitude of nanometers, the term nanoparticles is quite legit. The fact that you come from a different field and you are not familiar with the terminology does not necessarily mean that the article is using the term incorrectly or that they are trying to be "hype". The field of nanoparticle manufacturing is HUGE, of high importance in may fields (medicine, batteries, catalytic chemistry etc) and decades-old.

Re:Well, that's not quite nanotechnology

[paiute]

> calling this "nano" anything is a huge letdown.

There's nothing wrong with using "nano-" for nanometer-scale processes.

"Nano" gets grant money. "Tiny" or "minute" or "itsy bitsy" does not.

Re:Superglue

[davester666]

It's pronounced Der-mab-o-bond