Author - Liangpeng Ge 1 and Shixuan Chen 2

Year of publication – 2020

Introduction-

Tissue adhesives have gained a very considerate position as non-invasive wound closure methods. There
are a number of potential tissue adhesives being developed each having many application in surgical and
clinical field. However each of these adhesives obtain their adhesive and cohesive properties through
contributions from various forces such as hydrogen bonding, capillary forces, van der Waals forces,
static electric force, and covalent bonds. Researchers seem to be more focused on incorporating van der
Waal forces especially in biomimetic adhesives. However to interpret the strength, cohesive and
adhesive properties of the material the developed tissue adhesives are subjected to various tests like
tension tests, peel tests, lap and shear tests, and pull-off /pull-out tests each having their own aim and
objective. Over the past 30 years there has been a noticeable number of adhesives that have been
studied and developed which may be categorized as natural, synthetic or biomimetic. One of the most
basic type of biologic adhesive that was developed is the fibrin glue which forms a rubber like mass that
adheres to the wound surface and achieve hemostasis, unfortunately there seems to be a drastic
reduction in the mechanical strength of the material in wet conditions. This drawback is also noticed in
dextran based adhesives. Collagen based adhesives are relatively new and show a potential in effectively
adhering to the wound but require a long time to attain its highest bonding strength. Gelatin based
adhesives form a gel matrix and can bond to various soft tissue surfaces yet may cause toxicity and
degrades slowly. Chitosan based adhesives are produced by partial deacetylation of chitin from
crustaceans, fungi, and other non-vegetable organisms. These adhesives have multiple advantages like
being biodegradable biocompatible and having a low immune response. It has also been found to
accelerate wound healing and may be formulated in powder, fibers and hydrogels. The synthetic and
semisynthetic class of adhesives have better adhesion than that of natural adhesion. However, these
adhesions present several disadvantages, including low bio-absorption and metabolism, low adherence
to wet surfaces and higher cytotoxicity. A few of these include polycyanoacrylates, polyurethanes, poly
(ethylene glycol), polyesters, as well as dendrimer polymers. Out of these the most extensively used in
the medical field are PEG (polyethylene glycol) and Polyurethanes. On the other hand Biomimetic
adhesives found mainly in mussels are likely to become the next generations of tissue adhesives for
clinic use, since the stable adhesion properties exhibited in a wet environment are identified to meet
the requirement of bio adhesives for diverse applications. The biodegradable, immunogenic and
harmless property of mussel derived adhesive are a game changer but there has been an uneconomical
extraction and limited mussel adhesive application. Another type of biomimetic adhesive which has
recently gained an extensive amount of attention is the Gecko inspired tissue adhesive which is inspired
from the gecko’s ability to stick upside down and defy gravity using the van der Waal forces. However
these adhesion property seem to disappear when submerged in water

Limitations-

Currently there hasn’t been any adhesive that complies with all the ideal requirements in the surgical
field. Quite a number of tissue adhesives have been developed over the year that are being used
although it carries along a few disadvantages. Fibrins lose their strength in a wet environment an carry a
risk of disease transmission since they are derived from animal or human plasma. Dextran based
adhesive degrade relatively very fast and which does not give enough time to meet the long-term
adhesion requirement.

The synthetic adhesives present several disadvantages that include low bio-absorption and metabolism,
low adherence to wet surfaces and higher cytotoxicity. Among the biomimetic based adhesives the
mussel based adhesives have suffered from uneconomical extractions and unsuccessful large-scale
production have limited mussel adhesive application. Therefore there were many modifications and
addition of substances made to this material to improve its properties. Currently the emerging bio
adhesive is gecko inspired adhesives that also have drawbacks like the quantity production, endurance
and disappearance of adhesion when submerged in water.

Conclusion –

This article remarks on the challenges and future directions for design, fabrication, and application of
tissue adhesives in the medical field. Each component in various tissue adhesives play a role in attaining
properties that are desirable but also introduce a few drawbacks. Therefore to develop an exceptional
tissue adhesive one must have profound knowledge on different substances and understand their
chemical nature. Altogether this article explains the various mechanism of adhesion and properties of
various tissue adhesives that may inspire and help continue progress in future in creating an ideal tissue
adhesive