Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes
Purpose Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of Staphylococcus aureus mesh infection. Methods A 1% carboxymethylcellulose gel containing 0....
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| Veröffentlicht in: | Hernia : the journal of hernias and abdominal wall surgery 2019-08, Vol.23 (4), p.789-800 |
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| creator | Pérez-Köhler, B. Benito-Martínez, S. Rodríguez, M. García-Moreno, F. Pascual, G. Bellón, J. M. |
| description | Purpose
Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of
Staphylococcus aureus
mesh infection.
Methods
A 1% carboxymethylcellulose gel containing 0.05% chlorhexidine was prepared and tested in vitro and in vivo. The in vitro tests were antibacterial activity (
S. aureus
; agar diffusion test) and gel cytotoxicity compared to aqueous 0.05% chlorhexidine (fibroblasts; alamarBlue). For the in vivo study, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (
n
= 15) and inoculated with 0.25 mL of
S. aureus
(10
6
CFU/mL). Defects were repaired with a lightweight polypropylene mesh (Optilene) without coating (
n
= 3) or coated with a carboxymethylcellulose gel (
n
= 6) or chlorhexidine-loaded carboxymethylcellulose gel (
n
= 6). Fourteen days after surgery, bacterial adhesion to the implant (sonication, immunohistochemistry), host tissue incorporation (light microscopy) and macrophage reaction (immunohistochemistry) were examined.
Results
Carboxymethylcellulose significantly reduced the toxicity of chlorhexidine (
p
|
| doi_str_mv | 10.1007/s10029-019-01917-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2185982340</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2185982340</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-37931297a01af85ec9da7f87c14fef7a544caa0268805cf9bdbddecdff9a7143</originalsourceid><addsrcrecordid>eNp9kM1u3CAUhVGVqvlpX6CLCClrt2BjA8sqStpKkbrJHl3DZeyIMRPA0sy-Dx6SSZtdFvxInPNd8RHylbNvnDH5Pde91Q3jL4vLRn8gZ7wVqtEtEyfP96FvhGbDKTnP-YExpsSgPpHTjik2KDWckb83-x2meYtLgUBzWd2BxoWWCemakUZPgdopxDThfnbzgk2I4NBRC2mM-8MWy3QIFkNYQ6yFDQYKmcJS5hFsqeiKtRHKvGyoj4lOmJYZaMIdzIluMU-YP5OPHkLGL6_nBbm_vbm__tXc_fn5-_rHXWM72Zemk7rjrZbAOHjVo9UOpFfScuHRS-iFsACsrT9jvfV6dKNzaJ33GiQX3QW5OmJ3KT6umIt5iGta6kTTctVr1XaC1VR7TNkUc07oza76gXQwnJln7-bo3VTn5sW70bV0-Ypexy26_5V_omugOwZyfVo2mN5mv4N9AjR_kbM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2185982340</pqid></control><display><type>article</type><title>Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Pérez-Köhler, B. ; Benito-Martínez, S. ; Rodríguez, M. ; García-Moreno, F. ; Pascual, G. ; Bellón, J. M.</creator><creatorcontrib>Pérez-Köhler, B. ; Benito-Martínez, S. ; Rodríguez, M. ; García-Moreno, F. ; Pascual, G. ; Bellón, J. M.</creatorcontrib><description>Purpose
Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of
Staphylococcus aureus
mesh infection.
Methods
A 1% carboxymethylcellulose gel containing 0.05% chlorhexidine was prepared and tested in vitro and in vivo. The in vitro tests were antibacterial activity (
S. aureus
; agar diffusion test) and gel cytotoxicity compared to aqueous 0.05% chlorhexidine (fibroblasts; alamarBlue). For the in vivo study, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (
n
= 15) and inoculated with 0.25 mL of
S. aureus
(10
6
CFU/mL). Defects were repaired with a lightweight polypropylene mesh (Optilene) without coating (
n
= 3) or coated with a carboxymethylcellulose gel (
n
= 6) or chlorhexidine-loaded carboxymethylcellulose gel (
n
= 6). Fourteen days after surgery, bacterial adhesion to the implant (sonication, immunohistochemistry), host tissue incorporation (light microscopy) and macrophage reaction (immunohistochemistry) were examined.
Results
Carboxymethylcellulose significantly reduced the toxicity of chlorhexidine (
p
< 0.001) without limiting its antibacterial activity. While control and gel-coated implants were intensely contaminated, the chlorhexidine-gel-coated meshes showed a bacteria-free surface, and only one specimen showed infection signs. The macrophage reaction in this last group was reduced compared to the control (
p
< 0.05) and gel groups.
Conclusions
When incorporated in the carboxymethylcellulose gel, chlorhexidine showed reduced toxicity yet maintained its bactericidal effect at the surgery site. Our findings suggest that this antibacterial gel-coated polypropylene meshes for hernia repair prevent bacterial adhesion to the mesh surface and have no detrimental effects on wound repair.</description><identifier>ISSN: 1265-4906</identifier><identifier>EISSN: 1248-9204</identifier><identifier>DOI: 10.1007/s10029-019-01917-9</identifier><identifier>PMID: 30806886</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Abdominal Surgery ; Abdominal wall ; Agar diffusion test ; Animals ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Anti-Infective Agents - pharmacology ; Anti-Infective Agents - therapeutic use ; Antibacterial activity ; Antimicrobial agents ; Bacterial Adhesion - drug effects ; Biocompatible Materials ; Biomaterials ; Carboxymethylcellulose ; Carboxymethylcellulose Sodium - pharmacology ; Carboxymethylcellulose Sodium - therapeutic use ; Chlorhexidine ; Chlorhexidine - pharmacology ; Chlorhexidine - therapeutic use ; Coatings ; Cytotoxicity ; Fibroblasts ; Fibroblasts - drug effects ; Gel diffusion ; Gels - therapeutic use ; Hernia ; Hernias ; Herniorrhaphy - methods ; Immunohistochemistry ; Macrophages ; Medicine ; Medicine & Public Health ; Original Article ; Polypropylene ; Rabbits ; Sonication ; Staphylococcal Infections - prevention & control ; Staphylococcus aureus - drug effects ; Staphylococcus infections ; Surgery ; Surgical mesh ; Surgical Mesh - microbiology ; Transplants & implants ; Wound healing</subject><ispartof>Hernia : the journal of hernias and abdominal wall surgery, 2019-08, Vol.23 (4), p.789-800</ispartof><rights>Springer-Verlag France SAS, part of Springer Nature 2019</rights><rights>Hernia is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-37931297a01af85ec9da7f87c14fef7a544caa0268805cf9bdbddecdff9a7143</citedby><cites>FETCH-LOGICAL-c375t-37931297a01af85ec9da7f87c14fef7a544caa0268805cf9bdbddecdff9a7143</cites><orcidid>0000-0002-5061-1526</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10029-019-01917-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10029-019-01917-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30806886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pérez-Köhler, B.</creatorcontrib><creatorcontrib>Benito-Martínez, S.</creatorcontrib><creatorcontrib>Rodríguez, M.</creatorcontrib><creatorcontrib>García-Moreno, F.</creatorcontrib><creatorcontrib>Pascual, G.</creatorcontrib><creatorcontrib>Bellón, J. M.</creatorcontrib><title>Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes</title><title>Hernia : the journal of hernias and abdominal wall surgery</title><addtitle>Hernia</addtitle><addtitle>Hernia</addtitle><description>Purpose
Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of
Staphylococcus aureus
mesh infection.
Methods
A 1% carboxymethylcellulose gel containing 0.05% chlorhexidine was prepared and tested in vitro and in vivo. The in vitro tests were antibacterial activity (
S. aureus
; agar diffusion test) and gel cytotoxicity compared to aqueous 0.05% chlorhexidine (fibroblasts; alamarBlue). For the in vivo study, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (
n
= 15) and inoculated with 0.25 mL of
S. aureus
(10
6
CFU/mL). Defects were repaired with a lightweight polypropylene mesh (Optilene) without coating (
n
= 3) or coated with a carboxymethylcellulose gel (
n
= 6) or chlorhexidine-loaded carboxymethylcellulose gel (
n
= 6). Fourteen days after surgery, bacterial adhesion to the implant (sonication, immunohistochemistry), host tissue incorporation (light microscopy) and macrophage reaction (immunohistochemistry) were examined.
Results
Carboxymethylcellulose significantly reduced the toxicity of chlorhexidine (
p
< 0.001) without limiting its antibacterial activity. While control and gel-coated implants were intensely contaminated, the chlorhexidine-gel-coated meshes showed a bacteria-free surface, and only one specimen showed infection signs. The macrophage reaction in this last group was reduced compared to the control (
p
< 0.05) and gel groups.
Conclusions
When incorporated in the carboxymethylcellulose gel, chlorhexidine showed reduced toxicity yet maintained its bactericidal effect at the surgery site. Our findings suggest that this antibacterial gel-coated polypropylene meshes for hernia repair prevent bacterial adhesion to the mesh surface and have no detrimental effects on wound repair.</description><subject>Abdominal Surgery</subject><subject>Abdominal wall</subject><subject>Agar diffusion test</subject><subject>Animals</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-Infective Agents - pharmacology</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antibacterial activity</subject><subject>Antimicrobial agents</subject><subject>Bacterial Adhesion - drug effects</subject><subject>Biocompatible Materials</subject><subject>Biomaterials</subject><subject>Carboxymethylcellulose</subject><subject>Carboxymethylcellulose Sodium - pharmacology</subject><subject>Carboxymethylcellulose Sodium - therapeutic use</subject><subject>Chlorhexidine</subject><subject>Chlorhexidine - pharmacology</subject><subject>Chlorhexidine - therapeutic use</subject><subject>Coatings</subject><subject>Cytotoxicity</subject><subject>Fibroblasts</subject><subject>Fibroblasts - drug effects</subject><subject>Gel diffusion</subject><subject>Gels - therapeutic use</subject><subject>Hernia</subject><subject>Hernias</subject><subject>Herniorrhaphy - methods</subject><subject>Immunohistochemistry</subject><subject>Macrophages</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Polypropylene</subject><subject>Rabbits</subject><subject>Sonication</subject><subject>Staphylococcal Infections - prevention & control</subject><subject>Staphylococcus aureus - drug effects</subject><subject>Staphylococcus infections</subject><subject>Surgery</subject><subject>Surgical mesh</subject><subject>Surgical Mesh - microbiology</subject><subject>Transplants & implants</subject><subject>Wound healing</subject><issn>1265-4906</issn><issn>1248-9204</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kM1u3CAUhVGVqvlpX6CLCClrt2BjA8sqStpKkbrJHl3DZeyIMRPA0sy-Dx6SSZtdFvxInPNd8RHylbNvnDH5Pde91Q3jL4vLRn8gZ7wVqtEtEyfP96FvhGbDKTnP-YExpsSgPpHTjik2KDWckb83-x2meYtLgUBzWd2BxoWWCemakUZPgdopxDThfnbzgk2I4NBRC2mM-8MWy3QIFkNYQ6yFDQYKmcJS5hFsqeiKtRHKvGyoj4lOmJYZaMIdzIluMU-YP5OPHkLGL6_nBbm_vbm__tXc_fn5-_rHXWM72Zemk7rjrZbAOHjVo9UOpFfScuHRS-iFsACsrT9jvfV6dKNzaJ33GiQX3QW5OmJ3KT6umIt5iGta6kTTctVr1XaC1VR7TNkUc07oza76gXQwnJln7-bo3VTn5sW70bV0-Ypexy26_5V_omugOwZyfVo2mN5mv4N9AjR_kbM</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Pérez-Köhler, B.</creator><creator>Benito-Martínez, S.</creator><creator>Rodríguez, M.</creator><creator>García-Moreno, F.</creator><creator>Pascual, G.</creator><creator>Bellón, J. M.</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0002-5061-1526</orcidid></search><sort><creationdate>20190801</creationdate><title>Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes</title><author>Pérez-Köhler, B. ; Benito-Martínez, S. ; Rodríguez, M. ; García-Moreno, F. ; Pascual, G. ; Bellón, J. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-37931297a01af85ec9da7f87c14fef7a544caa0268805cf9bdbddecdff9a7143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal Surgery</topic><topic>Abdominal wall</topic><topic>Agar diffusion test</topic><topic>Animals</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Anti-Infective Agents - pharmacology</topic><topic>Anti-Infective Agents - therapeutic use</topic><topic>Antibacterial activity</topic><topic>Antimicrobial agents</topic><topic>Bacterial Adhesion - drug effects</topic><topic>Biocompatible Materials</topic><topic>Biomaterials</topic><topic>Carboxymethylcellulose</topic><topic>Carboxymethylcellulose Sodium - pharmacology</topic><topic>Carboxymethylcellulose Sodium - therapeutic use</topic><topic>Chlorhexidine</topic><topic>Chlorhexidine - pharmacology</topic><topic>Chlorhexidine - therapeutic use</topic><topic>Coatings</topic><topic>Cytotoxicity</topic><topic>Fibroblasts</topic><topic>Fibroblasts - drug effects</topic><topic>Gel diffusion</topic><topic>Gels - therapeutic use</topic><topic>Hernia</topic><topic>Hernias</topic><topic>Herniorrhaphy - methods</topic><topic>Immunohistochemistry</topic><topic>Macrophages</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Polypropylene</topic><topic>Rabbits</topic><topic>Sonication</topic><topic>Staphylococcal Infections - prevention & control</topic><topic>Staphylococcus aureus - drug effects</topic><topic>Staphylococcus infections</topic><topic>Surgery</topic><topic>Surgical mesh</topic><topic>Surgical Mesh - microbiology</topic><topic>Transplants & implants</topic><topic>Wound healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pérez-Köhler, B.</creatorcontrib><creatorcontrib>Benito-Martínez, S.</creatorcontrib><creatorcontrib>Rodríguez, M.</creatorcontrib><creatorcontrib>García-Moreno, F.</creatorcontrib><creatorcontrib>Pascual, G.</creatorcontrib><creatorcontrib>Bellón, J. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pérez-Köhler, B.</au><au>Benito-Martínez, S.</au><au>Rodríguez, M.</au><au>García-Moreno, F.</au><au>Pascual, G.</au><au>Bellón, J. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes</atitle><jtitle>Hernia : the journal of hernias and abdominal wall surgery</jtitle><stitle>Hernia</stitle><addtitle>Hernia</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>23</volume><issue>4</issue><spage>789</spage><epage>800</epage><pages>789-800</pages><issn>1265-4906</issn><eissn>1248-9204</eissn><abstract>Purpose
Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of
Staphylococcus aureus
mesh infection.
Methods
A 1% carboxymethylcellulose gel containing 0.05% chlorhexidine was prepared and tested in vitro and in vivo. The in vitro tests were antibacterial activity (
S. aureus
; agar diffusion test) and gel cytotoxicity compared to aqueous 0.05% chlorhexidine (fibroblasts; alamarBlue). For the in vivo study, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (
n
= 15) and inoculated with 0.25 mL of
S. aureus
(10
6
CFU/mL). Defects were repaired with a lightweight polypropylene mesh (Optilene) without coating (
n
= 3) or coated with a carboxymethylcellulose gel (
n
= 6) or chlorhexidine-loaded carboxymethylcellulose gel (
n
= 6). Fourteen days after surgery, bacterial adhesion to the implant (sonication, immunohistochemistry), host tissue incorporation (light microscopy) and macrophage reaction (immunohistochemistry) were examined.
Results
Carboxymethylcellulose significantly reduced the toxicity of chlorhexidine (
p
< 0.001) without limiting its antibacterial activity. While control and gel-coated implants were intensely contaminated, the chlorhexidine-gel-coated meshes showed a bacteria-free surface, and only one specimen showed infection signs. The macrophage reaction in this last group was reduced compared to the control (
p
< 0.05) and gel groups.
Conclusions
When incorporated in the carboxymethylcellulose gel, chlorhexidine showed reduced toxicity yet maintained its bactericidal effect at the surgery site. Our findings suggest that this antibacterial gel-coated polypropylene meshes for hernia repair prevent bacterial adhesion to the mesh surface and have no detrimental effects on wound repair.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>30806886</pmid><doi>10.1007/s10029-019-01917-9</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-5061-1526</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1265-4906 |
| ispartof | Hernia : the journal of hernias and abdominal wall surgery, 2019-08, Vol.23 (4), p.789-800 |
| issn | 1265-4906 1248-9204 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Abdominal wall Agar diffusion test Animals Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Anti-Infective Agents - pharmacology Anti-Infective Agents - therapeutic use Antibacterial activity Antimicrobial agents Bacterial Adhesion - drug effects Biocompatible Materials Biomaterials Carboxymethylcellulose Carboxymethylcellulose Sodium - pharmacology Carboxymethylcellulose Sodium - therapeutic use Chlorhexidine Chlorhexidine - pharmacology Chlorhexidine - therapeutic use Coatings Cytotoxicity Fibroblasts Fibroblasts - drug effects Gel diffusion Gels - therapeutic use Hernia Hernias Herniorrhaphy - methods Immunohistochemistry Macrophages Medicine Medicine & Public Health Original Article Polypropylene Rabbits Sonication Staphylococcal Infections - prevention & control Staphylococcus aureus - drug effects Staphylococcus infections Surgery Surgical mesh Surgical Mesh - microbiology Transplants & implants Wound healing |
| title | Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes |
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