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Interface before bulk: Mechanism-informed strategy for preventing postoperative adhesion based on polymer implants
Shengli Gao1, Jingwen Liu1, Yong Zhang2
1State Key Laboratory of Synergistic Chem-Bio Synthesis, School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China.
Acta Biomaterialia
|September 19, 2025
Summary
Postoperative adhesions (POAs) are a major surgical complication. This study proposes an "interface-before-bulk" design for anti-adhesion implants (AAIs), focusing on surface properties to prevent tissue adhesion effectively.
Area of Science:
- Biomaterials Science
- Surgical Innovation
- Tissue Engineering
Background:
- Postoperative adhesions (POAs) are a significant clinical challenge, causing morbidity and healthcare costs.
- Current anti-adhesion implants (AAIs) often focus on bulk properties, with limited success in preventing POAs.
- Understanding the AAI-tissue interface is crucial for developing effective adhesion prevention strategies.
Purpose of the Study:
- To re-examine POA prevention mechanisms with a focus on anti-adhesion implants (AAIs).
- To propose an "interface-before-bulk" conceptual framework for AAI design.
- To highlight advancements in polymer-based AAIs and their interface properties.
Main Methods:
- Comprehensive literature review of biological, chemical, and physical studies at the tissue interface.
- Analysis of AAI-tissue interface properties (anti-fouling, anti-inflammatory, anti-fibrotic).
- Evaluation of bulk properties (mechanical strength, degradation, compliance) as supportive factors.
Main Results:
- The AAI-tissue interface is the dominant factor in adhesion initiation and progression.
- Interface properties (anti-fouling, anti-inflammatory, anti-fibrotic) are primary determinants of efficacy.
- Bulk properties support and maintain interface functionality for enhanced anti-adhesion performance.
Conclusions:
- An "interface-before-bulk" design strategy is proposed for polymer-based AAIs.
- Prioritizing interface-driven design enhances AAI efficacy in preventing POAs.
- Tailored bulk material engineering complements interface strategies for improved clinical outcomes.
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