1.4.

6
Medical Fibers and Biotextiles
CALVIN CHANG 1 ,2,4 , BRIAN GINN 6 , NATALIE K. LIVINGSTON 1,2,4 , ZHICHENG YAO 2, 4, 5 ,
BENJAMIN SLAVIN 2,3 , MARTIN W. KING 7 , SANGWON CHUNG 7,8 , HAI-QUAN MAO 1 ,2, 4,5

1Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States

2Translational Tissue Engineering Center, Johns Hopkins School of Medicine, Baltimore, MD,
United States

3Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore,
MD, United States

4Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, United States

5Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD,
United States

6Secant Group, Telford, PA, United States

7Department of Textile Engineering, Chemistry & Science, North Carolina State University, Raleigh,
NC, United States

8Biomedical Engineering, Joint Department of Biomedical Engineering, North Carolina State

University and University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Introduction available and offer a wide range of structural complexities

Biotextiles, or medical textiles, are fibrous fabrics with defined
structures generated from synthetic or natural materials that
are used for the prevention, treatment, or diagnosis of injury
or disease. They are used as biodurable or biodegradable com-
ponents of implantable medical devices, as part of systems for
ex vivo manipulation of media and cells, and for in vitro cell
culture and testing. Civilizations dating as early as the ancient
Egyptians used natural materials such as flax, silk, linen, and
cotton to create sutures and bandages for wound healing. Some
natural fibers are still in use today because of their intricate
and versatile structures, favorable biocompatibility, and abun-
dance. With advancements in fields such as chemistry, bioma-
terials, engineering, and manufacturing, it is now common to
make synthetic fibers with tailored physical and biochemical
properties. Specifically, improvements in spinning and fiber
assembly methods and surface modification treatments have
led to a rapid growth in new products and applications.
An important application is for surgical use, for example.
Implantable and topical biotextiles have become readily
and utilities. They can be designed to perform multiple
functions, including maintenance of comfort and hygiene,
prevention of injury and infection, treatment of injury and
disease, and even replacement of injured tissues. Exam-
ples include vascular grafts, heart valves, ligaments, hernia
meshes, and hemostatic wound dressings. Several commer-
cially available biotextiles for surgical applications are listed
in Table 1.4.6.1. These applications require careful consid-
erations of biocompatibility and biostability.
The desired properties of biotextiles vary by application.
Nonetheless, favorable attributes generally include high sur-
face area, high porosity, lightness of weight, ability to fold,
good flexibility, and tunable strength. A high surface area
allows for more effective tissue interface, drug delivery, and
cell attachment. Lightweight and foldable materials allow for
minimally invasive implantation; strong and flexible materi-
als can tolerate damage induced during implantation. On
the other hand, thin and porous materials allow for bet-
ter integration, as cells and surrounding tissue can readily
interact with and grow into the material. Biodegradable or

575
576 SEC T I O N 1 . 4     Materials Processing

TABLE
1.4.6.1    Examples of Commercial Biotextile Products and Their Clinical Applications

Devices With Examples of

Clinical Biotextile Fiber Fabric Resorption Commercial
Application Component Polymer Structure Structure Time Products
General Esophageal PET Monofilament Braided Permanent Polyflex
surgery stent
PDO Monofilament Braided 11–12 weeks SX-ELLA
Hernia repair PP Microfiber Nonwoven Permanent Surgimesh
mesh
PP Monofilament Warp knit Permanent Sepramesh
PTFE Expanded film ePTFE Permanent Dualmesh, Dulex
membrane
PGCL and PP Monofilament Warp, knit Partially Ultrapro
resorbable
PLA Monofilament Self-fixation, Partially Parietex ProGrip
pile resorbable
component
P(GA-co-LA-co- Multifilament Knit 3 years TIGR Matrix
TMC),
P(LA-co-TMC)
Permanent Nylon 6 Monofilament – Permanent Ethilon
suture
Multifilament Braided Permanent Nurolon
PET Monofilament – Permanent Surgidac
Multifilament Braided Permanent Mersilene,
Ethibond,
Ticron
PP Monofilament – Permanent Prolene,
Surgipro
PBT-TMEG Monofilament – Permanent Vascufil,
Novafil
PVDF-HFP Monofilament – Permanent Pronova
Silk Multifilament Braided Permanent Perma-hand,
Sofsilk
Resorbable Collagen (catgut) Monofilament – 70–90 days Chromic/plain
suture
PDO Monofilament – 180–250 days PDS
PGCL Monofilament – 90–120 days Monocryl
PLGA Monofilament – 40–70 days Vicryl
Multifilament Braided Polysorb
PGA-PCL-TMC- Monofilament – 20–60 days Caprosyn
PLA
PGA-PDO- Monofilament – 90–110 days Biosyn
TMC
P(GA-co- Monofilament – 60–180 days Maxon
TMC)
Barbed suture PDO Monofilament – 120–180 days Quill
P(GA-co-TMC) Monofilament – 180 days V-Loc
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 577

TABLE
1.4.6.1    Examples of Commercial Biotextile Products and Their Clinical Applications—cont’d

Devices With Examples of

Clinical Biotextile Fiber Fabric Resorption Commercial
Application Component Polymer Structure Structure Time Products
Cardiovascular Annuloplasty PET Multifilament Weft knit Permanent Carpentier-
ring Edwards,
Duran AnCore
PTFE Multifilament Weft knit Permanent Koehler MRS
Arteriovenous PTFE Expanded film ePTFE Permanent Vectra, Flixene
shunt membrane
Blood filter PET Multifilament Nonwoven Permanent MacoPharma
(ex vivo)
Cardiac support PET Multifilament Knit Permanent Acorn CorCap
device
Embolic vena PTFE-FEP Monofilament Knotted Permanent Crux biomedical
cava filter
Endovascular PET Multifilament Woven Permanent Zenith, Endurant
stent graft
PTFE Expanded film ePTFE Permanent Excluder,
membrane PowerLink,
CoveraT
Heart valve PET Multifilament Weft knit Permanent St. Jude Medical,
sewing ring sorin
PTFE Multifilament Weft knit Permanent Edwards
Lifesciences
Septal defect PET Multifilament Knit Permanent CardioSEAL
repair device
PTFE Expanded film ePTFE Permanent Helex
membrane
Vascular PET Multifilament Warp knit, Permanent DeBakey,
prosthesis woven Gelweave,
Barone
PTFE Expanded film ePTFE Permanent Gore-Tex, Flixene
membrane
Dental Dental UHMWPE Multifilament Leno weave Permanent Ribbond
reinforcing
ribbon
Neural Nerve guide PGA Multifilament Woven 60–90 days NeuraGen
prosthesis
Orthopedic Bone graft/ Carbon fiber Staple fiber/ Reinforced Permanent DePuy
cement multifilament PMMA
composite
Ligament and PET Multifilament Braided/wove/ Permanent Stryker-Meadox,
tendon knitted Leeds-Keio
prosthesis
PTFE Expanded film ePTFE Permanent Gore-Tex
membrane
UHMWPE Multifilament Braided Permanent Richards Polytex
Spinal disc UHMWPE Multifilament Woven Permanent Raymedica PDN
nucleus
prosthesis
Spinal support Carbon fiber Stable fiber/ Reinforced Permanent Ocelot
multifilament PEEK
composite
(Continued)
578 SEC T I O N 1 . 4     Materials Processing

TABLE
1.4.6.1    Examples of Commercial Biotextile Products and Their Clinical Applications—cont’d

Devices With Examples of

Clinical Biotextile Fiber Fabric Resorption Commercial
Application Component Polymer Structure Structure Time Products
Skin and Skin graft PLGA Multifilament Knitted 40–70 days Dermagraft
wound Wound
dressing dressing Nylon Multifilament Knitted Temporary Biobrane
Nylon/collagen Multifilament Knitted velour Temporary TransCyte
Cotton Staple yarn Woven Temporary Kendall Curity
UHMWPE/ Multifilament/ Knitted/ Temporary Acticoat
viscose rayon staple fiber nonwoven
and PET composite
Carboxymethyl Staple fiber Nonwoven Temporary Aquacel
cellulose
Cotton/viscose Staple yarn Leno weave Temporary Jelonet
rayon
Viscose rayon/ Multifilament Knitted Temporary Kband
nylon
PET Staple fiber Nonwoven Temporary Mepore
Viscose rayon composite
PP/cellulose Staple fiber/ Nonwoven Temporary Mesorb
pulp fiber composite
Nylon Multifilament Leno weave Temporary Tegapore
Calcium alginate Staple fiber Nonwoven Temporary Kaltostat

ePTFE, Expanded polytetrafluoroethylene; FEP, fluorinated ethylene propylene polymer; PBT-TMEG, poly(butylene terephthalate-co-tetramethylene ether glycol);
PCL, polycaprolactone; PDO, poly(p-dioxanone); PEEK, polyethyletherketone; PE, polyethylene; PET, poly(ethylene terephthalate); PGA, polyglycolide; P(GA-co-
CL), poly(glycolide-co-ε-caprolactone); P(GA-co-LA-co-TMC), poly(glycolide-co-lactide-co-trimethylene carbonate); P(GA-co-TMC), poly(glycolide-co-trimeth-
ylene carbonate); PLA, polylactide; P(LA-co-TMC), poly(lactide-co-trimethylene carbonate); PLGA, poly(lactide-co-glycolide); PMMA, polymethylmethacrylate;
PP, polypropylene; PTFE, poly(tetrafluoroethylene); PVDF-HFP, poly(vinylidene fluoride-co-hexafluoropropylene); PTMC, poly(trimethylene carbonate); UHMWPE,
ultrahigh molecular weight polyethylene.

bioresorbable textiles are important for devices that serve
temporary functions such as injury repair. These proper-
ties are influenced by the biotextile manufacturing process,
including the choice of material or polymer, as well as the
structural design of the engineered textile. In this chapter,
the techniques used for fiber and textile productions, which
include steps involving polymer selection and fiber forma-
tion, fiber arrangement into various textile structures, finish-
ing, and surface modification of the biotextile products, will
be described. The effects of various design parameters on the
final structures, properties, and performance of biotextiles
will also be discussed. Lastly, several major biotextile applica-
tions in medicine and their future R&D directions will be
examined.  ing or drawing. Fiber formation parameter requirements
Fiber-Forming Polymers
Characteristics of Fiber-Forming Polymers
The primary building blocks for biotextiles are the individ-
ual fibers produced in continuous yarns or fiber fragments.
The biochemical nature of these fibers largely dictates their
biocompatibility and biodegradation profiles. The basic
requirement for polymer selection is the ability to form
fibers, meaning the polymer chains need to share several
common structural features, which include: (1) intermedi-
ate to high molecular weight (approximately 20–250 kDa)
so the polymer melt or solution will have sufficient viscos-
ity, (2) linear and ordered structure with absence of bulky
side chains or cross-links to facilitate chain alignment and
close packing, or crystalline phase formation when solidi-
fied from the melt or when precipitated from solution; and
(3) interchain interactions that can stabilize closely packed
chain segments and crystalline domains, allowing polymer
chains to align and slide along the fiber axis during stretch-
may also depend on the chemical structure of the poly-
mers used. For example, a molecular weight ranging from
20 to 30 kDa is sufficient to generate fibers from polymers
with strong interchain interactions such as nylon and PET,
which can form hydrogen bonds and strong dipole–dipole
interactions, whereas higher molecular weight is required
for polymers with fewer interchain interactions, e.g., vinyl
polymers and aliphatic polyesters. Polymers with a high

degree of crystallinity (e.g., silk, poly(tetrafluoroethylene)
(PTFE), poly(vinylidene fluoride) (PVDF), polyethylene,
and polydioxanone) typically have greater mechanical prop-
erties, and can form fibers more easily too.
The degradation of resorbable polymers in the body is
driven by hydrolysis or enzymatic degradation. Biocom-
patible materials and implants should have nontoxic deg-
radation by-products to minimize inflammatory response
in the host. The mechanism of bioerosion and degradation
for biotextiles occurs through surface or bulk degrada-
tion mechanism until the fiber has been totally resorbed.
Examples of natural and synthetic fibers, including those
that resorb into the biological environment postimplan-
tation, and their relative resorption times, are provided
in Table 1.4.6.2. Permanent synthetic polymers were
originally developed for nonmedical applications, such as
poly(ethylene-terephthalate) (PET), which was first used
in apparel textile fibers. Any additives, stabilizers, and
antioxidants that may be cytotoxic for biomedical appli-
cations require an extensive cleaning and removal process
before being adopted for implantation (Fages et al., 1998;
King, 1991).
Common nanofibrous polymers generated via electro-
spinning are poly(ε-caprolactone) (PCL), polyglycolide
(PGA), poly(lactide-co-glycolide) (PLGA), and poly(p-
dioxanone) (PDO), and are shown in Table 1.4.6.3. A wide
range of polymers, both natural and synthetic polymers, can
be processed into fibers by electrospinning, though most of
the spinning conditions are optimized through empirical
trial-and-error testing. Typical electrospinning parameters
that influence fiber formation include molecular weight,
architecture (branched vs. linear), viscosity, and conduc-
tivity, as well as other process parameters (temperature,
humidity, electrical potential, and flow rate) (Frenot and
Chronakis, 2003; Kai et  al., 2014). More detailed discus-
sion of the spinning process can be found in the section
Electrospinning.  standard conditions. In much of the world, the decitex
Natural and Synthetic Polymers for Biotextile
Production
Natural polymers consist of protein materials such as colla-
gen, elastin, and silk, and polysaccharides such as cellulose,
chitosan, chitin, and alginate. These natural polymers, which
are isolated from plants and animal tissues (Sionkowska,
2011), feature structural complexity with functional groups
that allow for postspinning modifications. Many natural
polymers contain functional moieties and bioactivities such
as cell receptor binding, growth factor binding and enrich-
ment, and thrombogenic activity, as well as enhanced bio-
compatibility and biodegradability.
Biopolymers have evolved naturally and are particularly
well suited for medical applications. Polysaccharide-based
fibers, such as cellulose fibers, have been used as wound
dressings and hemostats due to their thrombogenicity.
Alginates from algae, chitosan from crustacean shells, and
dextran from bacterial fermentation have been used for
CHAPTER 1.4.6   Medical Fibers and Biotextiles 579
fabricating surgical sutures and meshes. Proteins, such as
collagen, elastin, fibrinogen, and silk have been spun to
form fiber structures for tissue regeneration applications,
notably for nerve repair and vascular repair.
Compared with natural polymers, synthetic polymers
have good mechanical properties and thermal stability,
and can be more easily processed into different forms with
controlled batch-to-batch consistency during production.
Depending on the application, synthetic polymers have
high tunability of properties, such as strength, flexibil-
ity, degradation rate, resistivity, and chemical inertness.
They tend to be cheaper to make into fibers and yarns.
The degree of control over synthetic polymers offers great
versatility for many different applications. On the other
hand, biopolymers typically have better biofunctions and
biodegradation property. In some applications, natural–
synthetic blends are of interest, as they can combine the
advantages of each polymer type while avoiding their
disadvantages. 
Medical Fibers and Production Methods
Introduction to Textile Fibers
The first step in creating a biotextile medical device is to
generate textile fibers. Textile fiber is “a generic term for var-
ious types of matter that form the basic elements of fabrics
and other textile structures. More specifically, a textile fiber
is a unit of matter that is characterized by having an aspect
ratio (length divided by width) of at least 100, and which
can be spun into yarn or made into a fabric” (American
Society for Testing and Mater, 1985).
Fibers can be spun in different ways to create either
monofilaments or multifilament yarns, which can vary in
length. Yarn size is usually measured in linear density, i.e.,
the mass in grams of a defined amount of material under
(dtex) is used, which is the mass in grams of 10,000 m
of fiber. In North America, linear density is measured in
denier, which is the mass in grams of 9000 m of fiber. Lin-
ear density is a result of both the cross-sectional area of
the fiber and its mass density. As such, it can be related to
other properties such as strength and rigidity. For example,
Unsealed Gelsoft, a polyester yarn for vascular prosthe-
sis, has a reported linear density of 100 dtex. However,
this yarn is a multifilament yarn made of 54 round fila-
ments. Therefore each filament is only 1.9 dtex. Since each
individual filament has a lower linear density and smaller
diameter, the multifilament fiber is much more flexible
than a single 100 dtex monofilament. Flexibility is critical
in many medical textile applications, such as tissue scaf-
folds. Fig. 1.4.6.1 shows scanning electron microscopy
(SEM) micrographs of mono- and multifilament woven
sutures (Reinbold et al., 2017).
The spinning technique chosen to form fibers and yarns
affects properties such as texture, cross-section shape, and
size. For example, natural fibers typically have a cross-section
580 SEC T I O N 1 . 4     Materials Processing

TABLE
1.4.6.2   Examples of Permanent and Resorbable Fiber-Forming Polymers

Chemical and Physical Resorption

Polymera Parameters Construction/Fiber Forms Applications Time
Nylon 6 Thermoplastic Hydrophobic Melt spun into monofilaments Sutures (Nurolon; Ethilon) Permanent
Tm = 220°C Tg = 45°C and multifilament yarns
Crystallinity 50% as spun
Nylon 66 Thermoplastic Hydrophobic Melt spun into monofilaments Sutures (MonosofT; Permanent
Tm = 265°C Tg = 50°C and multifilament yarns DermalonT; surglionT)
Crystallinity 50% as spun
PE High-density PE (HDPE) Melt spun into fibers for Orthopedic and Permanent
Hydrophobic polymer composite craniofacial implants
Tm = 125°C reinforcement
Crystallinity up to 85%
Ultrahigh molecular weight PE Converted to very high Ligament prostheses and
Hydrophobic tenacity yarn by gel loadbearing orthopedic
Tm = 140–150°C spinning composites
High crystallinity
High tensile strength and
modulus
PET Thermoplastic Hydrophobic Melt spun into monofilaments Sutures (MersileneT; Permanent
Tm = 265°C and multifilament yarns surgidacT; TicronT);
Tg = 65–105°C for weaving, knitting, and hernia repair meshes;
100% amorphous as spun, braiding anterior cruciate
needs to be drawn and ligament prostheses;
annealed to have crystallinity heart valve sewing
rings; vascular and
endovascular grafts
PP Predominantly isotactic Melt spun into monofilaments, Sutures (Prolene; Permanent
Thermoplastic Hydrophobic hollow fibers or surgipro); hernia repair
Tm = 165–175°C spunbonded and melt meshes; blood filters
Crystallinity 40%–46% blown to nonwoven fabrics (e.g., renal dialysis
Higher fracture toughness machines)
than HDPE susceptible to
degradation from heat and
radiation
PTFE Thermoplastic Hydrophobic Melt spun into monofilaments Sutures; vascular and Permanent
Tm = 325°C and multifilaments endovascular grafts;
Crystallinity 50%–75% for heart valve sewing
processed fibers rings; embolic vena
cava filter; anterior
cruciate ligaments
PVDF Thermoplastic Hydrophobic Melt spun into monofilaments Sutures (Pronova) Permanent
Tm = 165–175°C and multifilaments
Crystallinity 52%–66%
Silk Biocomponent fiber prepared Spun by Bombyx mori Sutures (Perm-Hand; Classified as
from fibroin protein with sericin silkworm with sericin sofsilk) permanent
sheath coating; sericin is removed but known
Hydrophilic before processing to degrade
Crystallinity 70% in 1–2 years
Low elastic recovery
Viscose First manufactured fiber in 1892 Wet spun from alkali sodium Wound dressing Permanent
rayon Hydrophobic cellulose xanthate
Crystallinity 33% solution into continuous
Decomposition begins at 250°C multifilaments
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 581

TABLE
1.4.6.2   Examples of Permanent and Resorbable Fiber-Forming Polymers—cont’d

Chemical and Physical Resorption

Polymera Parameters Construction/Fiber Forms Applications Time
PCL Thermoplastic Melt spun into monofilaments Used as scaffolds in >24 months
Rubbery at room temperature and multifilament yarns; tissue engineering
Tm = 58–63°C can be electrospun
Tg = −65°C into nanofibers; can be
copolymerized with other
PDO Thermoplastic resorbable polymers Sutures (PDS); 6–9 months
Tm = 110–115°C intramedullar pins;
Tg = –10–0°C ligating clips
Crystallinity 55%
PGA Thermoplastic Sutures (Dexon); meshes 6–12 months
Tm = 225°C (for defect repairs and
Tg = 40–45°C periodontal inserts);
Crystallinity 45%–55% used as scaffolds in
Simplest linear aliphatic polyester tissue engineering
rigid
PLA Thermoplastic Stents; drug delivery >24 months
Tm = 173–178°C devices; used as
Tg = 60–65°C scaffolds in tissue
engineering
Polyglactin Thermoplastic Multifilament yarns; for Sutures (Vicryl; Polysorb); 3 months
910 10/90 Tm = 205°C weaving, knitting, and meshes
Tg = 43°C braiding
Crystallinity 40%
P(GA-co-CL) Thermoplastic Monofilament Sutures (Monocryl) 3–4 months
Tg = –43–18°C depending on the
copolymer ratio and molecular
weight
P(GA-co- Tm = 206°C Monofilament Sutures (Maxon) 2–6 months
TMC) Tg = 20°C
aFor abbreviations see Table 1.4.6.1.

diameter of 10–50 μm. However, advancements in spin-
ning methods have allowed for polymers to be spun to sizes
below 1 μm, as shown in Fig. 1.4.6.2, thus allowing them
to be better suited for more applications due to their high
surface-to-volume ratio. In the following sections, various
fiber-spinning techniques are described in greater detail.  spinneret holes determines the fiber’s cross-section. A circular
Melt Extrusion
In melt spinning, or melt extrusion, the polymer is heated
above its melting point then extruded through a spinneret.
As the polymer resin is extruded, cold air is used to solid-
ify the filaments. A yarn is immediately drawn, lubricated,
twisted, and entangled before it is wound onto a bobbin.
Yarns can also be texturized by blowing air through the fila-
ments as they are drawn and twisted. A typical setup for the
melt extrusion process is depicted in Fig. 1.4.6.3. A spin fin-
ish, which is scoured from the textile prior to use, is added
as a lubricant to reduce friction and prepare the yarn for the
next processes of texturing, weaving, and knitting.
Spinneret design, which includes the number, size, shape,
and length of the spinneret’s holes, affects fiber properties such
as size, number of filaments, and cross-section shape. For exam-
ple, a multifilament yarn made of 50 filaments can be produced
by designing a spinneret with 50 holes. Alternatively, two (same
or different) yarns made of 25 filaments each could be plied
together to form the 50-filament final yarn. The shape of these
cross-section is the most common fiber shape but using other
cross-sectional shapes has become more popular as they can
change overall fiber properties without having to change the
polymer used. Unique shapes such as stars, squares, and trilobes
are frequently used to increase the filaments’ ratio of surface area
to volume. Cross-sectional shape also influences other proper-
ties such as strain, yield stress, bending rigidity, and shrinkage.
With melt spinning, the fabrication process is quick and
does not require added solvents. However, melt spinning
can only be used with thermoplastic polymers, or polymers
that are not significantly affected by the melting process. 
Wet/Gel Spinning
Wet spinning can be used to form fibers from soluble non-
thermoplastic polymers or thermoplastic polymers that have
582 SEC T I O N 1 . 4     Materials Processing

TABLE
1.4.6.3   Representative Polymers used for Electrospinning and Example Spinning Conditions

Polymer Solvent Fiber Diameter Highlight

Synthetic PCL THF/DMF (1:1, w/w); 100–1200 nm As a semicrystalline polyester, PCL has slow
Polymers DMF/DCM (1:1) biodegradation rate, high biocompatibility,
and good drug permeability
PLA Acetone; DCM; 210–1181 nm
chloroform; dioxane;
THF; DMF; DMAc
PLGA DCM; HFIP; THF; 500–1500 nm Increasing the ratio of glycolide to lactide
THF/DCM in the copolymer increased the rate of
degradation
PLA-b-PEG Acetone 610–1010 nm PLA-b-PEG displays good biocompatibility
and increases hydrophilicity compared to
pure PLA
PEG-b-PCL DMF/DCM (1:3, v/v) 350–400 nm The hydrophilic PEG block increases the water
wettability and degradation rate of PCL
PS DMF; THF; DMF/THF 600–2760 nm
(1:1, w/w)
Polyanhydride Chloroform 80–3200 nm Polyanhydride undergoes surface erosion
and gives steady degradation rate
PU HFIP 400–1400 nm PU has high elasticity and low degradation
rates
PVA Water; water/DMF 50–1500 nm PVA undergoes erosion in aqueous media.
(7:3, w/w) It has good physical and mechanical
properties in dry and crystalline form.
PVP Water 190–1500 nm
PEO Water
Natural Collagen HFIP 100–1200 nm
polymers
Gelatin Transformation- 100–340 nm
enhancing activity;
hot water
Silk fibroin Formic acid 30–120 nm
Spider silk protein Formic acid
Chitosan Formic acid
Alginate/PEO or PVA Water Fiber swelling degree and mechanical
(coelectrospinning) property depend on the concentration and
type of cross-linking agent used
Fibrin Water Fibrin fiber is formed by cross-linking
fibrinogen with thrombin in the presence
of Ca ions
Hyaluronic acid Water Hyaluronic acid fibers can be formed by
different cross-linking methods

DCM, Dichloromethane; DMAc, dimethylacetamide; DMF/THF, dimethylformamide/tetrahydrofuran; HFIP, hexafluoroisopropanol; PCL, polycaprolactone; PLA,
polylactide; PLGA, poly(lactide-co-glycolide); PLA-b-PEG, poly(lactide-b-ethylene glycol); PEG, polyethylene glycol; PS, polystyrene; PU, polyurethane; PVA,
polyvinyl alcohol; PVP, polyvinylpyrrolidone; PEO, polyethylene oxide.

excessively high melt viscosity or melting temperature, which
prevent use of melt extrusion equipment. The polymer is
solubilized in either an organic or aqueous phase, extruded
through a spinneret, like melt spinning, and then into a
solution of opposite phase or into a cross-linking solution
to precipitate fiber as shown in Fig. 1.4.6.4A (Mather and
Wardman, 2011). Alternatively, the polymer solution can be
introduced directly into the coagulation bath as shown in Fig.
1.4.6.4B. The wet/gel fiber spinning method is applicable
for many synthetic and biological polymers, including PCL,
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 583

• Figure 1.4.6.1  Scanning electron microscopy micrographs of (A) a monofilament suture (Resonlon, 75 cm
USP 3/0, Resorba (Nürnberg, Germany)) and (B) a multifilament suture (Ethibond Excel, 75 cm, USP 3-0 from
Ethicon (Johnson and Johnson Medical GmbH, Norderstedt, Germany)). (Modified from Reinbold, J., Uhde,
A.K., Müller, I., Weindl, T., Geis-Gerstorfer, J., Schlensak, C., Krajewski, S., 2017. Preventing surgical site
infections using a natural, biodegradable, antibacterial coating on surgical sutures. Molecules 22 (9), 1570.)

• Figure 1.4.6.2  Relationship between fiber dimensions and surface area compared to a biological scale.

PLGA, cellulose, chitosan, alginate, cyclodextrin, fibrin, and Electrospinning

collagen. For example, polylactide (PLA):PLGA may be sol-
ubilized in a chloroform solution and then extruded into an
isopropanol solution, which it is not soluble in, to precipi-
tate out a PLA:PLGA fiber (Razal et al., 2009). The resul-
tant PLA:PLGA yarn can then be vacuum dried to remove
residual solvent prior to use. In a similar manner, chitosan
may be solubilized in acetic acid and wet spun into an ethyl
alcohol or phosphate phthalate salt solution as a coagulation
bath (Knaul et  al., 1999). Fiber precipitation may also be
induced through changes in other factors such as tempera-
ture or solution pH. Alginate fibers may be wet spun after
the polysaccharide is solubilized in a sodium carbonate and
caustic soda solution, via extrusion into a hydrochloric acid
bath to precipitate fiber.  of nanofibers, electrospinning remains the most industrially
Electrospinning is one of the most readily accessible and
versatile techniques for producing ultrathin fibers with
diameters on the order of hundreds of nanometers to several
microns. The term “electrospinning” was coined in 1993
by Darrell H. Reneker for generating fibers from an electri-
cally charged solution (Doshi and Reneker, 1995). Medical
use of electrospun fiber mat was first developed as a wound
dressing (Tucker et  al., 2012). This technology has since
been widely adopted for producing nanofiber structures
due to its versatility, low cost, and ease of use. Although
there are other approaches, such as mechanical drawing and
melt blowing, which may be employed for the fabrication
584 SEC T I O N 1 . 4     Materials Processing

advanced as it is more suitable for producing ultrathin fibers

with narrowly distributed diameters (Li and Xia, 2004).

Electrospinning Process and Spinning Parameter

• Figure 1.4.6.3  A schematic showing a typical process of melt extru-
sion for fiber production.
Optimization
The setup for electrospinning consists of four main components:
a high-voltage power supply, a syringe pump, a spinneret, and
a grounded collector. When a high-voltage electrostatic field is
applied to a dissolved polymer solution or melted polymer fluid
with constant flow, a continuous splitting jet is ejected from the
Taylor cone to form fibers, which are collected on a grounded,
stationary target or rotating drum. The final fiber qualities, such
as diameter, surface morphology, and alignment, can be pre-
cisely controlled by the properties of the spinning fluids and the
parameters of the electrospinning process.
Exploring the formation of a Taylor cone, the most impor-
tant mechanism of the electrospinning process, can help us
understand how these parameters influence fiber quality.
The Taylor cone is the critical condition where the shape
of such a cone approaches the theoretical shape just before
jet formation (Fig. 1.4.6.5) (Li and Xia, 2004; Ghorani and
Tucker, 2015). To form a stable Taylor cone, the charged
droplets should achieve a balance of surface tension against
the electrostatic force. Therefore surface tension-related solu-
tion properties and electrostatic force-related parameters are
important to consider when controlling fiber quality.
The electrospinning process is regulated by many param-
eters, broadly classified into solution parameters, process
parameters, and ambient parameters. One example of a
solution parameter is the viscosity of the spinning solution,
which increases with increasing molecular weight of the

• Figure 1.4.6.4  Examples of wet/gel spinning processes for fiber production. (A) A schematic showing a
dry-jet-wet spinning process where a polymer solution is extruded out through an air gap into a precipitation
bath. (B) A schematic showing a coagulation wet/gel spinning process where a polymer solution is extruded
directly into a coagulation bath with a miscible but poor solvent for the polymer or with a cross-linking agent.
((A) Modified from Mather, R.R., Wardman, R.H., 2011. The Chemistry of Textile Fibers. R. Soc. Chem.)
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 585

selected polymer or solution concentration and can increase

• Figure 1.4.6.5 Schematic illustration of a basic setup for electros-
pinning. The insets show a drawing of an electrified Taylor cone and
a typical scanning electron microscopy image of the nonwoven mat
of poly(ether sulfone) nanofibers deposited on a grounded collector.
(Modified from Li, D., Xia, Y., 2004. Electrospinning of nanofibers: rein-
venting the wheel? Adv. Mater. 16 (14), 1151–1170.)
the surface tension, thus leading to larger diameter nano-
fibers, while the electrostatic force will remain unchanged
(Sill and von Recum, 2008). If the selected solvent possesses
a higher conductivity, the electrostatic field force of the
charged droplets will be greater, thus resulting in a finer jet
and a thinner final fiber.
In terms of process parameters, several scaling and
operational laws govern the electrospinning process, such
as applied voltage, flow rate of solutions, collector distance,
and shapes of spinneret and collector. Fiber diameters rang-
ing from submicron to hundreds of nanometers have been
reported (Bhardwaj and Kundu, 2010). Generally, a higher
voltage results in greater stretching of the solution due to
the larger coulombic forces in the jet as well as a stronger
electric field. This leads to rapid evaporation of solvent from
the fibers and thus reduction in the fiber diameter. Another
important process parameter is flow rate. A lower flow rate
is desired to get enough time to evaporate the solvent and
reduce the fiber diameter. The collector distance also influ-
ences the time for solvent evaporation and fiber size distri-
bution. The type of collector employed directly influences
the fiber orientation on the collector (Fig. 1.4.6.6) (Lim and
Mao, 2009; Mao et al., 2010). For example, if the collector
is a roller that is rotating at high speed, the depositing fibers
will be stretched, thus resulting in a highly oriented parallel
fiber arrangement. Likewise, randomly oriented nanofibers
can be acquired if the rotating speed is relatively slow or
stationary. Additionally, collectors may be customized to
obtain any needed fiber arrangement (Yee et al., 2008).

• Figure 1.4.6.6 Two different modes of fiber collection in electrospinning, resulting in different nanofiber
arrangements. (A) Randomly arranged fiber mat is produced from a polymer solution or melt when the electro-
spun jets are collected on a stationery grounded plate. (B) Highly aligned fibers are produced when polymer jets
are collected on a wheel or frame rotating at a sufficiently high angular velocity. (Modified from (A) Mao, H.Q.,
Lim, S.H., Zhang, S., Christopherson, G., Kam, K., Fischer, S., 2010. The nanofiber matrix as an artificial stem
cell niche. Biomater. Stem Cell Niche, Springer, Berlin, Heidelberg, pp. 89–118. (B) Lim, S.H., Mao, H.Q., 2009.
Electrospun scaffolds for stem cell engineering. Adv. Drug Delivery Rev. 61 (12), 1084–1096.)
586 SEC T I O N 1 . 4     Materials Processing

The dominant ambient parameters that can affect fiber
quality during electrospinning are temperature and relative
humidity (RH). After a stable polymer solution jet has been
initiated from a Taylor cone, solvent evaporation and fiber
deposition on the collector surface occur in ambient condi-
tions. An increase in temperature and decrease in RH helps
solvent evaporation, therefore decreasing fiber diameter. If
the RH prevents solvent evaporation, the final fiber networks
will be partially dissolved, thus compromising fiber quality
and uniformity (Fashandi and Karimi, 2012; De Vrieze et al.,
2009).  ning can be utilized to fabricate fibers with an embedded
Materials Selection for Electrospinning
To date, numerous polymer materials have been fabricated
into nanofibers through electrospinning. As the electrospin-
ning technique advances, the range of materials that can
be electrospun expands too. These materials include both
synthetic and natural polymers, multicomponent compos-
ite polymers, and inorganic/organic composite materials.
Table 1.4.6.3 summarizes the most commonly reported
biomaterials used in electrospinning (Yang et  al., 2018).
Among them, electrospun fibers made from biodegrad-
able polymers, including synthetic polyesters (PGA, PLA,
PLGA, and PCL) and natural polymers (collagen, gelatin,
silk fibroin, chitosan, and alginate), have garnered strong
interests for their potential applications in regenerative
medicine (Chong et  al., 2007; Zhang et  al., 2005). Their
tunable degradation properties also allow for potential utili-
ties in delivery of bioactive agents to control tissue regenera-
tion or therapeutics. For example, a local anesthetic-eluting
suture system, which combines the function and ubiquity of
the suture with locally controlled release properties of a bio-
degradable polymeric matrix, was prepared by using PLGA
fibers (Weldon et al., 2012). Fibrous electrospun scaffolds
with distinct alignment topography may guide cell migra-
tion, topography, differentiation, and growth of seeded or
recruited cells (Qian et al., 2018). 
Coelectrospinning
Bicomponent or multicomponent electrospun fibers can
be generated for special applications. Coaxial electros-
pinning has been developed for preparing fibers with a
core–shell or hollow structure, and emulsion electrospin-
second component with mismatch solvent compatibility.
For core–shell spinning, a spinneret fabricated from two
coaxial capillaries is required, where two spinning solu-
tions are fed into the outer and inner capillary separately.
If the viscosity of the outer solution is high enough to
form a stable Taylor cone, then a core–shell nanofibrous
structure will eventually form, regardless of the viscosity
of the inner solution, as shown in Fig. 1.4.6.7 (Hudecki
et  al., 2017; Sun et  al., 2003). If the core component
contains a bioactive agent, this core–shell nanofiber
structure is capable of delaying and extending its release
duration (Jiang et al., 2005). It is also possible to gener-
ate bicomponent nanofibers by electrospinning an emul-
sion using a typical single-nozzle spinning setup. Due to
the phase separation between the oil and water phases of
the emulsion, nanofibers with discontinuous phases can
be generated as a result of agglomeration of droplets in
the emulsion jet (Yarin, 2011). 
Centrifugal Electrospinning
Centrifugal electrospinning (CES) has been developed to
overcome several limitations of the electrospinning method,

• Figure 1.4.6.7  (A) Schematic illustration of a coaxial electrospinning setup for generating nanofibers having
a core–sheath. The spinneret was fabricated from two coaxial capillaries, through which two feed solutions
were simultaneously spun to form a continuous, coaxial jet. (B) Transmission electron microscopy image of
two as-spun hollow fibers when a heavy mineral oil was used as a core solution and then extracted with
octane after spinning. The walls of these tubes were made of a composite containing amorphous TiO2 and
polyvinylpyrrolidone. (C) Scanning electron microscopy image of a uniaxially aligned array of TiO2 (anatase)
hollow fibers. (Modified from Li, D., Xia, Y., 2004. Direct fabrication of composite and ceramic hollow nano-
fibers by electrospinning. Nano Lett. 4 (5), 933–938.)
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 587

such as low production yield and limited scalability in pro-
ducing aligned fibers. Major equipment for CES includes a
power rotation unit, high-voltage generator, spinning unit,
and collection unit. The CES technique combines the cen-
trifugal, electrostatic, gravitational, and auxiliary forces act-
ing on the initial jet. When the combination breaks through
the jet surface tension and viscous resistance, the jet is fully
stretched out, forming ultrathin fibers. During the spinning,
multiple formulations could be infused into the system and
expelled via a rotating spinneret at a speed from the order
of several hundred rpm to thousands of rpm (Mehta et al.,
2019). Highly aligned PVDF, polyethylene, and chitosan
fibers have been prepared by using a centrifugal electrospin-
ning system (Edmondson et al., 2012).  (Gilbert-Honick et  al., 2018a,b), while hydrated fibrin
Hydrogel Fiber Spinning
Hydrogels are particularly important biomaterials for cell
delivery and growth, with highly porous and hydrated
structures. A hydrogel can be chemically modified to incor-
porate cell-binding motifs and differentiation factors, while
physical properties can be tuned through cross-linking type
and density to provide a biomimetic microenvironment to
support cell proliferation and differentiation (Hsieh et al.,
2010).
Hydrogel nanofibers can be generated via electrospin-
ning through spinning of a highly hydrophilic polymer
that is cross-linked into a swellable network. For example,
gelatin methacrylate nanofibers can be electrospun and then
cross-linked into a hydrogel network when exposed to ultra-
violet light in the presence of a photoinitiator (Sun et al.,
2017). Hydrogel nanofibers produce highly extracellular
matrix (ECM)-like structures capable of supporting endo-
thelial cell and dermal fibroblast adhesion, proliferation,
and migration throughout scaffolds to facilitate improved
vascularization (Benton et al., 2009).
Alternatively, wet-spun fiber can also be formed
through a modified electrospinning technique to produce
molecularly aligned hydrogel fibers (Fig. 1.4.6.8). The use
of aqueous-based solutions enables incorporation of cells in
situ during the fiber-forming process and induces alignment
of cells on the fiber surface (Zhang et al., 2014). Biologically
derived polymers, such as fibrin, alginate, or collagen, are
used to generate fibers with this technique. Several methods
of cross-linking are possible with this hydrogel fiber-form-
ing method, including use of thrombin in the collection
solution when forming fibrin fibers to mimic physiologi-
cal blood coagulation or the use of calcium ions to rapidly
induce ionic gelation of alginate to form fibers. Fibers pro-
duced with this method have been used to improve muscle
regeneration in preclinical volumetric loss defect models
yarns have been used to study the effects of curvature on
microvasculature formation and microvascular cell organi-
zation in vitro (Barreto-Ortiz et al., 2013, 2015). 
Surface Functionalization
The surface chemistry of biomedical fibers plays a major role
in affecting how well cells or proteins may bind to a fiber
surface. Surface functionalization can be used to achieve a
desired biological response or avoid an adverse response,
such as increasing cell adhesion or decreasing complement
deposition. Generally, surface functionalization methods
can be divided into physical and chemical methods.
Physical vapor deposition (PVD) and plasma surface
treatment are common physical methods used for modify-
ing surface chemical compositions of polymer fibers. The
most common PVD processes are sputtering and evapo-
ration, which utilize a physical vapor to deposit a specific
functional film onto the surface of the target substrate
under a vacuum (Zussman et al., 2006). Plasma treatment
is another commonly used physical surface functionaliza-
tion method that employs a charged plasma to activate the
target surface. For example, electrospun PCL nanofibers
treated with O2 and N2 plasma at very low pressures will

• Figure 1.4.6.8  Electrospinning of hydrogel fibers where biological polymer is solubilized in aqueous solu-
tion and dispensed from a syringe tip into an electric field (1). The electric field induces alignment of the
polymer chains within the polymer jet (2), which is rapidly cross-linked as mechanical strain is applied upon
landing in a rotating cross-linking bath (3), capturing the aligned polymer chains into a hydrogel fiber (4).
(Modified from Zhang, S., Liu, X., Barreto-Ortiz, S.F., Yu, Y., Ginn, B.P., DeSantis, N.A., Gerecht, S., 2014.
Creating polymer hydrogel microfibres with internal alignment via electrical and mechanical stretching.
Biomaterials 35 (10), 3243–3251.)
588 SEC T I O N 1 . 4     Materials Processing

have abundant hydrophilic functional groups that form on
the surface, such as –OH, –COOH, and –NH2 depending
on the plasma selection (Formica et al., 2016).
There are many chemical methods for the surface func-
tionalization fibers. For example, various types of cross-linkers
and cross-linking techniques can be used based on the func-
tional groups on the polymer and the extent of properties to
be improved (Reddy et al., 2015). Glutaraldehyde is a widely
used chemical cross linker, because of its high chemical reac-
tivity of the aldehyde groups towards amino and hydroxyl
groups found in natural polymers (Lai, 2014). Apart from
glutaraldehyde, chemicals including carbodiimide, epichlo-
rohydrin, and sodium metaphosphate, have also been used
for surface functionalization (Hennink and van Nostrum,
2012). For polymers without reactive functional groups, sur-
face-grafting methods can be adopted to modify the surface
property of the fibers. For example, electrospun poly(ether
sulfone) fibers can be surface grafted with poly(acrylic acid),
which can then be converted to amino or hydroxyl groups
through surface reactions. These surface functionalities have
been shown to markedly influence hematopoietic stem cell
phenotype maintenance during the expansion culture (Chua
et al., 2006, 2007; Das et al., 2009).  woven textiles include planar weaves used for dressings or tubes
Textile Structures
Once fibers or yarns are produced via spinning, they are fab-
ricated into textiles using various techniques to give the final
product its desired mechanical and biological properties.
Structures typically used for medical textiles include weaves,
knits, braids, and nonwovens. Material properties dictated
by textile structure include strength, flexibility, porosity,
permeability, handleability, and stability. Generally, woven
fabrics are strong and dimensionally stable, and have low
porosity and permeability. Knit fabrics are more permeable
and have higher specific surface area for tissue integration.
Braided fabrics hold together well under longitudinal loads
but are unstable under torsional loads while also being mod-
erately porous. Choosing a final structure requires balancing
the advantages and disadvantages of each structure. The rest
of this section describes each structure in greater detail and
introduces their typical use in medical applications.
Woven Textiles
Woven structures are made by interlacing primary structural
yarns at right angles in directions called warp and weft. Warp
yarns are held in place by a loom, while the weft yarns are drawn
through warp yarns by a shuttle as warp yarns are lifted up in
particular patterns to form weave structures such as plain, twill,
satin, and leno weaves (Fig. 1.4.6.9A, B). Woven structures
have high breaking strength in both the warp and weft direc-
tions and display low elongation. Weaves are particularly adept
for vascular grafts and dental ribbon fabrications. Examples of
for a variety of grafts and tissue scaffolds (Fig. 1.4.6.9C, D).
Advanced textile production methods allow for the develop-
ment of even more complex structures, such as tapered tubular
grafts for vascular prostheses (Fig. 1.4.6.9E). 
Knitted Textiles
Knitted fabrics are made of continuous interconnected
chains of yarn loops. Rows of loops are called wales and
vertical columns are called courses. Two major variations of

• Figure 1.4.6.9  Woven textile structures. (A) Schematic diagram of woven textile structures. (B) False-
color scanning electron microscopy images of a multifilament woven poly(ethylene-terephthalate) (PET)
textile microstructure. (C) Macro view of a woven PET textile sheet. (D) Macro view of a woven PET textile
tubular graft. (E) Macro view of a tapered woven PET textile tubular vascular graft. ((B–E) Courtesy of
Secant Group, LLC.)
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 589

knit fabrics are the weft knit and warp knit constructions.
Weft knitting is simpler; one yarn forms courses in the fab-
ric. In warp knitting, a series of yarns forms wales in the
fabric. These structures are depicted in Fig. 1.4.6.10. Warp
knits are more dimensionally stable, have less stretch, and
unravel less when cut compared to weft knits. Warp knits,
such as velour or pile knits, are generally more versatile as
they can be additionally modified by adding extra yarn to
the structure to add thickness, bulk, and surface texture.
Knitted structures are generally more flexible and com-
pliant than woven structures. Knit fabrics have a much
higher porosity than woven fabrics, with typical total poros-
ity exceeding 65%. This porosity is beneficial for tissue
ingrowth but results in unacceptable water permeability.
To decrease permeability, for example when a knit struc-
ture is used as a vascular graft, knits must first be coated
or impregnated with collagen or gelatin to avoid the need
of preclotting. Knit fabrics are often subjected to heat set-
ting, which shrinks the yarn and tightens the loop structures
to improve the fabric strength, stretchiness, softness, and
stability. The addition of pile yarn to warp knits makes the
fabric softer and improves the thrombotic deposit from the
initial blood contact to improve tissue ingrowth and healing
(Fig. 1.4.6.11). 
Braided Textiles
Braiding is the interweaving of three or more yarns in an
angled overlapping pattern (Fig. 1.4.6.12). The structure
is described by the horizontal repeat distance, called a line
(l), the vertical repeat distance, called a stitch (s), the width
(w) of the yarn, and the braid angle (θ) between the yarn
and machine directions as seen in Fig. 1.4.6.8. Because of
their inherent strength and flexibility, braided structures
are the most used in surgical sutures. Advances in three-
dimensional (3D) braiding have allowed for the formation
of more complex structures, including “I” beams, hollow
channels, and solid tubes (Chen, 2015). One application of
a braided hollow tube is the vascular stent; due to the braid’s
low bending rigidity and ability to radially expand, the

• Figure 1.4.6.10  (A) Schematic diagram of knitted fabrics. (B) Closeup view of hooked loops that make
up the knit structure. (C) Macro view of knit poly(ethylene-terephthalate) textile mesh. ((B and C) Courtesy
of Secant Group, LLC.)

• Figure 1.4.6.11  Scanning electron microscopy micrographs of (A) woven poly(ethylene-terephthalate) tex-
tile composed of both texturized (center region) and untextured (flanking regions) yarn, (B) woven vascular
prosthesis (Cooley Verisoft) inner (top) and outer (bottom) views, and (C) warp-knitted vascular prosthesis
(Dialine) inner (left) and outer (right) views. ((A) Courtesy of Secant Group, LLC. (B) Modified from Tian-Jian,
R., Chin, P., Guidoin, R., Marceau, D., Roy, P.E., King, M., Xiaoping, Q., 1991. Soft filamentous woven
polyester arterial prosthesis from China. Biomaterials 12 (3), 335–344. (C) Modified from King, M.W.,
Marois, Y., Guidoin, R., Ukpabi, P., Deng, X., Martin, L., Douville, Y., 1995. Evaluating the dialine® vascular
prosthesis knitted from an alternative source of polyester yarns. J. Biomed. Mater. Res. 29 (5), 595–610.)
590 SEC T I O N 1 . 4     Materials Processing

• Figure 1.4.6.12  (A) Schematic diagrams of braided structures depicting the defining dimensions of the
textile: stitch (s), yarn width (w), line (l), and braid angle (θ); (B) Scanning electron microscopy micrograph
of a braided silk suture; (C) a braided nitinol tube with a braid structure showing that some metal fibers
can be used to generate biomedical textile; (D) a braided poly(glycolic acid) fiber tube; (E) a braided
poly(ethylene terephthalate) (PET) textile graft; (F) a braided PET knit fiber tube, showing a combination of
textile manufacture methods that can be used to generate a biomedical device. ((C–E) Courtesy of Secant
Group, LLC.)

structure is ideal for keeping arteries open and preventing
clots. Another common application of braided fabrics is in
anterior cruciate ligament (ACL) prostheses. ACL prosthe-
ses must exhibit sufficient mechanical strength, as the ACL
is subject to myriad forces, stresses, and strains. Braided
structures for this application can be designed to have pore
sizes that promote tissue infiltration while still maintaining
mechanical integrity. One challenge associated with braided
fabrics is securing the yarn at each end of the structure. This
can be addressed with finishing techniques that fuse braid
ends together, or more novel approaches such as construct-
ing the braided structure from a single wire, as has been
used for an esophageal stent (Polyflex) and for thoracic aor-
tic aneurysm repair (Murgo et al., 1998).
Textile structures may also be a combination of the three
structures we have discussed thus far, allowing for more
complex mechanical properties. For example, to make the
PET textile shown in Fig. 1.4.6.12F, yarns were knitted
together, then the knit structures were braided.  (Sato et  al., 2015). Nonwovens can also be implanted as
Nonwoven Textiles
Nonwoven fabrics are produced directly from fibers or fiber
fragments without the intermediate step of yarn production.
Nonwovens are produced by creating a porous uniform web,
often by spun-laid, wet-laid, or melt-blown processes, that is
then bonded or interlocked via mechanical, thermal, chemi-
cal, or solvent means. The fibers may be randomly oriented or
preferentially oriented in one or more directions, depending
on the production method. Total porosity, average pore size,
and pore size distribution may be controlled by changing
the density and orientation of the fibers, fiber diameter and
length, and bonding method. Multiple nonwoven layers can
be combined to further control the physical and mechanical
properties of the textile such as permeability and strength.
Nonwovens typically exhibit dimensional stability, strength,
durability, and high porosity.
The properties of nonwovens are easily modified, mak-
ing them highly versatile with wide-ranging applications.
Nonwoven textiles are often used as bandages and wound
dressings, as listed in Table 1.4.6.1, since they can be highly
absorbent and gas permeable. Nonwoven wound dressings
can also have release agents such as antimicrobial drugs
incorporated in them for localized drug release (Giram et al.,
2018). Since nonwovens can form multilayer meshes, they
also work well as filters, for example, within regenerative
tissue devices (Iwamoto et al., 2015) and for blood filtration
tissue scaffolds for applications including nerve repair (Sar-
hane et al., 2019b), intestinal prosthesis (Liu et al., 2019),
tendon grafts (Sensini and Cristofolini, 2018), and osseous
tissue regeneration (Krucińska et al., 2017). 
Finishing and Surface Coating
After polymers have been spun into fibers and yarns, and
yarns have been fashioned into textile structures, there are

• Figure 1.4.6.13  Typical vascular graft manufacturing operations.
several processing steps that must be done before the textile
is ready to be used in a medical device. Finishing operations
are based on the polymer choice, the fabrication process,
and the medical application. However, all finishing opera-
tions are concerned with the same properties: cytotoxicity,
sterility, surface modifications, and packaging. An example
of the general workflow for textile finishing for a vascular
graft is diagrammed in Fig. 1.4.6.13. Each of these pro-
cesses, including cleaning, heat setting, bleaching, shrink-
ing, inspection, packaging, and sterilization, affects the
textile’s final properties.
Additives and solvents are often employed during vari-
ous phases of the textile production process. These addi-
tions can result in cytotoxicity and other adverse events
when placed in a biological environment. Many surface
finishes, such as yarn lubricants, can be easily removed with
cleaning and scouring techniques. Other additives such as
mineral oil or silicone based require special aqueous-based
or organic-based washing procedures. After wash steps, the
product must be thoroughly tested to ensure there are no
more harmful additives or other chemicals from the prod-
uct. Finally, the product is cleaned, packaged, and sterilized.
Careful packaging is necessary to protect the textile from
light degradation, bacterial contamination, moisture, and
oxidative stress in certain cases. Sterilization can be achieved
through heat, chemical treatment, irradiation, or pressure.
There has been increasing interest in more specialized
finishing that enhances the biocompatibility or functional-
ity of the textile. For example, with any wound dressing or
CHAPTER 1.4.6   Medical Fibers and Biotextiles 591
implantation there is a chance of infection. Many research-
ers are developing antimicrobial coating agents that can
be applied to textiles during production (El-Ola, 2008).
Microencapsulation techniques can also be applied to medi-
cal textiles to deliver other drugs of interest through textile
scaffolds or wound dressing. Other biological coatings such
as collagen can be used to improve biocompatibility and
promote tissue growth (Singh et al., 2015). 
Applications of Medical Fibers and
Biotextiles
Biotextiles of General Surgery
Surgical sutures and tissue repair meshes represent two of
the most prominent applications of biotextiles in the gen-
eral surgery field. A variety of porous mesh fabrics have been
employed as a supportive material in hernia and prolapse
repair, as well as in tissue patches, as listed in Table 1.4.6.1.
Traditional constructions are warp knitted from polypropyl-
ene or polyester monofilaments or expanded polytetrafluo-
roethylene (ePTFE) membranes whose increased resistance
to infection makes them preferable to multifilament yarns.
More recently, 3D warp knits using polyester multifilament
yarns have been found to possess increased flexibility and
can be implanted endoscopically. Although the majority of
these meshes are nondegradable, recent developments have
included a resorbable component that allows for the promo-
tion of a more acute inflammatory response and, ideally,
faster healing.
Meshes and Sutures: Design and Materials
Sutures and meshes can be modified by a protein coating
(collagen and/or gelatin) or a microporous PTFE layer
applied to a single side, which reduces the risk of unwanted
adhesion in  vivo. As with other textile structures, specific
characteristics may be engineered into the mesh to meet
design goals such as added flexibility, increased strength,
reduced thickness, improved handling, and a better suture-
holding strength. Commercial sutures possess either a
monofilament or braided multifilament structure and can
be synthesized from natural materials such as silk or col-
lagen (often referred to as “catgut,” though it is actually
derived from the submucosal layer of either bovine or sheep
intestine), or synthetic materials, including nylon, polyester,
polypropylene, and stainless steel, as listed in Table 1.4.6.1. 
Barbed and Drug-Eluting Sutures
Among the more recent innovations in surgical sutures is
the development of the barbed suture (Fig. 1.4.6.14), the
structure of which allows for tissue anastomosis without
the need for the surgeon to tie a knot. The design concept
of the barbed suture mimics the quill of a porcupine,
such that angled barbs protrude from the monofilament’s
surface and mechanically interlock with the surrounding
tissue. Advantages of these self-anchoring barbed sutures
include shorter suturing time given the elimination of the
592 SEC T I O N 1 . 4     Materials Processing
• Figure 1.4.6.14  Single barbed suture samples with various cut angles and lengths. (Modified from Ingle,
N.P., King, M.W., 2010. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon
tissues. J. Biomech. 43 (2), 302–309.)
need to tie knots, as well as a more uniform distribution
of holding forces, which reduces suture slippage, tissue
distortion, and necrosis, allowing for improved cosmetic
outcomes. Given the previously mentioned favorable
characteristics, resorbable barbed sutures are a viable
clinical option for patients seeking a less invasive face-
lift procedure, known as a “threadlift.” However, recent
studies have shown this to be a more temporary solution
with results lasting between 1 and 9 years (Wu, 2019).
Additionally, Wu noted that there was an increased
complication rate associated with threadlifts performed
using barbed sutures versus traditional and more inva-
sive surgical facelifts performed using nonbarbed sutures.
Meanwhile, a 5-year retrospective analysis found barbed
sutures to be as safe as conventional sutures for the pur-
pose of closing the gastric pouch–jejunal anastomosis in
laparoscopic gastric bypass (Pennestri et al., 2018). These
findings suggest that additional work is needed to iden-
tify optimal barb dimensions, frequency, and geometry
for use with different types of tissues (Ingle et al., 2010).
Examples of barbed sutures currently approved by the
United States Food and Drug Administration (FDA) for
commercial use are included in Table 1.4.6.1.
Drug-eluting sutures represent an exciting development
in the field of surgery as they simultaneously serve both
a mechanical and a pharmaceutical function. The active
pharmaceutical ingredient can be incorporated into the
suture either during manufacturing of the suture, or after
the suture has been fabricated. Current applications of this
technology include a wet-electrospun suture comprised
of poly(l-lactide), polyethylene glycol, and levofloxacin
as a means of providing local, postoperative delivery of
antibiotics following ophthalmic procedures (Kashiwabu-
chi et  al., 2017). Further optimization will continue to
improve drug-eluting sutures, thus providing the field of
surgery with encouraging prospects for decreased rates of
postoperative infection. 
Cardiovascular Applications of Biotextiles
Examples of biotextiles developed for cardiovascular use
include heart valve sewing rings, annuloplasty rings that
provide dimensional stability to incompetent cardiac heart
valves, as well as vascular and endovascular stent grafts, as
listed in Table 1.4.6.1. One of the most significant contri-
butions of biotextiles to the field of cardiovascular surgery
has been large (10–40 mm) diameter vascular grafts. As
mentioned previously, polyester (e.g. PET) is the principal
polymer used to construct vascular grafts.
Design Criteria for Vascular Prostheses
There are multiple design combinations that are possible
for vascular grafts, including either a knitted or woven
structure that can then be produced in a straight or bifur-
cated configuration. Ideally, the properties of a vascular
prosthesis will meet all of the following criteria: available
in different shapes and sizes, sterilizable, easy to handle
and suture, cut edges that will not fray, ravel, or run,

hemostatic yet nonthrombogenic, biocompatible, low
associated infection rate, capable of promoting rapid heal-
ing, dimensionally stable, and compliant (Edwards and
Tapp, 1957). Although no single biomaterial has been
found to meet all these requirements, textile structures
designed to be flexible, porous, lightweight, and compli-
ant are able to satisfy most of these criteria. 
Woven Versus Knitted Structure
Design decisions and the goals that guide them carry sig-
nificant consequences in the field of biomaterials. Woven
structures can provide hemostasis and dimensional stabil-
ity, whereas knitted devices are more compliant, easier to
handle and suture, and promote more rapid healing. Con-
versely, warp knits are more dimensionally stable and do not
ravel in comparison with weft knits, which are more com-
pliant. Thus considering the key characteristics in relation
to the implantation site or disease state is necessary prior to
selecting the material and structure. 
Examples of Cardiovascular Biotextiles
The field has a rich history of innovations that have
addressed several physiological challenges, as was seen in the
1950s with Dr. Sterling Edwards’ use of imparting radial
folds prior to finishing, known as crimping, as a means
to avoid kinking and to facilitate handling (Edwards and
Tapp, 1957). Today, a substantial amount of effort is being
devoted toward the development of a small vessel (<6 mm
diameter) prosthesis for coronary artery bypass and tibial/
popliteal artery replacement. However, high thrombogenic-
ity, compliance mismatch of existing materials, and com-
plications due to intimal hyperplasia have prevented the
development of a successful commercial product to meet
this market need. A recent study employing a cell layer-elec-
trospun mesh composite demonstrated a construct capable
of a similar J-shaped circumferential stress–strain response
to that of native coronary artery, as well as an acceptable
level of tensile strength. However, an extended pre-culture
period and prolonged use of media additives present a signif-
icant barrier to its clinical translation (Erndt-Marino et al.,
2016). In addition to the previously discussed challenges of
meeting required compliance and mechanical properties,
a translatable small diameter vascular graft would need its
surface to be modified with an endothelial cell layer, or a
specialized surface coating, growth factors, and other bio-
active agents to prevent thrombosis and thromboembolic
events. Thus another area of interest has been the develop-
ment of biological grafts, surface-modified materials, and
tissue-engineering constructs (Chung et al., 2010).
The first clinical application of an artificial vessel based
on a synthetic scaffold was to reconstruct a low-pressure
pulmonary outflow tract in pediatric patients with a cya-
notic congenital defect (Shin’oka et  al., 2005). In this
approach, autologous bone marrow cells were seeded into
tubes made from a copolymer of lactide and caprolactone
and subsequently reinforced with a woven PGA sleeve.
While the grafts were not suitable for high-pressure arterial
CHAPTER 1.4.6   Medical Fibers and Biotextiles 593
• Figure 1.4.6.15  Three-dimensional computed tomography scan at 1
year after tissue-engineered vascular graft implantation (indicated by
red arrows). The graft is patent and there is no aneurysmal dilation.
(Modified from Hibino, N., McGillicuddy, E., Matsumura, G., Ichihara,
Y., Naito, Y., Breuer, C., Shinoka, T., 2010. Late-term results of tissue-
engineered vascular grafts in humans. J. Thor. Cardiovas. Surg. 139
(2), 431–436.)
implantation, this study demonstrated the feasibility of a
tissue-engineered approach. At the most recent follow-up
of a 25-patient cohort (range: 4.3–7.3 years, mean: 5.8
years), all grafts remained intact and patent (Fig. 1.4.6.15);
however, there were four stenotic events and one throm-
botic event that had occurred. Even though graft stenosis
appeared to be the primary mode of graft failure and the
mechanism of stenosis remains unclear, none of the grafts
actually failed over the course of this study (Hibino et al.,
2010). 
Endovascular Stent Grafts
Over the past 20 years, a sizable investment of resources has
been dedicated to the development of endovascular stent
grafts, which have utility in minimally invasive aortic aneu-
rysm repair, occlusive disease, and vascular trauma (Powell
and Kashyap, 2016; Hinchliffe and Hopkinson, 2007). The
benefits of these grafts over open surgery include decreased
patient trauma, blood loss, postoperative complications,
infection risk, and exposure time to anesthesia. Addition-
ally, the costs associated with hospitalization, patient care,
and the time for recovery and rehabilitation are significantly
lower than for open surgery. Endovascular prostheses, or
stent grafts, are tubular biotextiles with either an internal
or external stent comprised of nitinol or stainless-steel wire.
Given that the stent graft must be collapsed and folded
onto a balloon catheter and subsequently inserted through
a distal artery, the structure needs to be thin, flexible, and
hemostatic. To meet these specifications, either an ePTFE
594 SEC T I O N 1 . 4     Materials Processing

membrane or a polyester tube tightly woven from fine (45

dtex or less) untextured multifilament yarns, which allows
for minimization of overall wall thickness, may be employed
(Guidoin et al., 2004). However, the long-term durability
and fatigue resistance of such structures require further eval-
uation via in vitro testing and predictive modeling. 

Knitted Textile Structures as Sewing Rings

Given their high suture retention strength and ability to tol-
erate damage during surgery, knitted textile structures have
been used as sewing rings for aortic and mitral valves. More
recently, heart valve leaflets have also been fashioned from
textile-based structures due to their superior flexural fatigue
properties using either permanent polyester or resorbable
PCL multifilament yarns (Heim et al., 2008). 

Orthopedic Applications of Biotextiles

Ligament and Tendon Replacement With Woven
and Braided Biotextiles
In the field of orthopedics, woven and braided textile
devices have been used to construct replacement liga-
ments and tendons. However, issues such as abrasion and
wear, inadequate strength, and poor bone attachment have
been cited for premature clinical failures in ligament and
tendon applications (Guidoin et al., 2000). For example,
early failures in using a braided PTFE structure for ACL
repair was attributed to creeping of the PTFE polymer,
causing patients to experience increased knee instabil-
ity over time (Roolker et  al., 2000). More recently, 3D
braided and woven scaffolds employing resorbable fibers
spun from PGA, PLA, and their copolymers have been
reported for ligament and cartilage replacement (Fig.
1.4.6.16) (Moutos et al., 2007). Although several artifi-
cial biomaterials have been brought to market to serve as
ligament grafts for purposes such as repair of separated
shoulder joints and ACLs, an ideal prosthesis capable of
mimicking natural human tissue has yet to be found.
Another challenge for polyester implants in orthope-
dic surgery has been the host inflammatory response to
the implanted biotextile. Coating the textile implants
with antlerogenic stem cells or platelet-rich plasma
(PRP) has been shown to significantly reduce inflamma-
tion and accelerate healing in a cranial cruciate ligament • Figure 1.4.6.16 Fiber architecture of a three-dimensional (3D) orthogo-
nally woven structure. (A) Schematic showing a 3D structure that is woven
repair model in rabbits, leading to faster covering of the by interlocking multiple layers of two perpendicularly oriented sets of in-
implant by host connective tissue and increased intertwin- plane fibers (X- or warp direction, and Y- or weft direction) with a third set
ing between recipient connective tissue and polyester fiber of fibers in the Z-direction; (B) Surface view of the X–Y plane (scanning
implant, highlighting the potential benefit of combining electron microscope); (C) Cross-sectional view of the Y–Z plane; (D) Cross-
sectional view of the X–Z plane. (Modified from Moutos, F.T., Freed, L.E.,
biological components with synthetic biotextiles (Przadka
Guilak, F., 2007. A biomimetic three-dimensional woven composite scaf-
et al., 2017).  fold for functional tissue engineering of cartilage. Nat. Mater. 6 (2), 162.)

the production of fibers with superior mechanical perfor-

Fiber Reinforcement in Bone Graft Cement
Previously, loadbearing prostheses for orthopedic applica-
tions were fabricated primarily from metals and ceram-
ics due to their high strength and modulus. However,
advances in fiber spinning technologies have allowed for
mance, including fibers comprised of ultrahigh molecular
weight polyethylene, carbon, and poly(arylamide) (Kevlar).
Today, these fibers are predominantly employed as a rein-
forced composite structure for bone graft cement as well as
for spinal support devices. 

Biotextiles as Wound Dressings and Skin
Grafts
Wound Dressings and Hemostats
Another common application of biotextiles and fiber tech-
nology is in the synthesis of wound dressings and hemo-
stats. Wound dressings serve primarily as a physical barrier
to prevent infection and promote moisture absorption and
blood coagulation, while hemostats are used clinically to
stop bleeding.
Traditionally, woven cotton gauze has been used as a wound
dressing due to its superior moisture absorption and blood-
clotting ability. However, since it is composed of short staple
fibers of cellulose, woven cotton gauze tends to adhere to the
wound, consequently leading to infection and trauma upon
removal. Other materials such as polyester, polypropylene,
nylon, and viscose rayon, as well as the addition of antibiotics,
growth factors, and a barrier layer, have been combined with
absorbent cellulose as a means of fabricating a more effec-
tive wound dressing. A typical example of a layered laminate
structure includes a protective outer barrier of polyester or
polypropylene accompanied by an inner layer comprised of
absorbent cellulose. Collagen, chitosan, and cellulose deriva-
tives can all serve this purpose in layered fibril, foam, and
powdered forms, which have hemostatic properties. Other
biomaterial applications for hemostasis that have been inves-
tigated in recent years include a hydrophilic absorbent layer
of poly(acrylic acid) surrounded by a flexible outer layer of
electrospun ethylene-vinyl acetate (EVAc) copolymer, as well
as various polysaccharide polymers, including alginate, chito-
san, and dextrin (Hickman et al., 2018). Additional examples
of commercial products can be found in Table 1.4.6.1.  its high porosity, small pore size, and flexibility. Alignment
Skin Grafting for Burn Injuries
Patients suffering from severe burn injuries or chronic dia-
betic ulcers require a temporary skin graft to provide protec-
tion against infection as well as maintenance of hydration
prior to receiving an autologous dermal transplant. To meet
this need, the first commercial skin graft product that was
introduced to the market was Epicel, which is an asepti-
cally grown wound dressing prepared from autologous kera-
tinocytes grown ex vivo on a petrolatum gauze dressing in
the presence of proliferation-arrested, murine fibroblasts
(Wright et  al., 1998). Although biocompatible, this graft
consisted exclusively of biological components and conse-
quently lacked mechanical integrity, in addition to being
difficult to handle and transport. As a means of overcoming
these limitations, subsequent skin graft products have been
developed to incorporate both biological components, such
as porcine collagen and allogenic fibroblasts, with a syn-
thetic textile layer to provide improved mechanical stability
as listed in Table 1.4.6.1.  biodegradable poly(ɛ-caprolactone-co-ethyl ethylene phos-
Applications of Electrospun Fibers
Wound Dressing
Electrospun nanofiber membranes have attracted a great deal
of attention as wound dressings due to their high specific
CHAPTER 1.4.6   Medical Fibers and Biotextiles 595
surface area, high porosity, and small-sized pores, among
other characteristics. The high specific surface area enhances
fluid absorption and high porosity facilitates the exchange
of oxygen, water, and nutrients, as well as the removal of
metabolic wastes. Additionally, the small-sized pores reduce
penetration by microorganisms (Gautam et al., 2013). 
Musculoskeletal Tissue Engineering
Cellular orientation and biomechanical stress on musculo-
skeletal tissue plays an important role in ECM deposition,
neo-tissue formation, and cell phenotype maintenance. The
electrospun fiber matrix can be constructed to mimic the
orientation and architecture of native ECM collagen fibrils
and its porous nature, and therefore suitable for muscle cell
adhesion and proliferation (Abbah et al., 2015). Aligned
electrospun fibers can withstand cell adhesion stress, direct
cellular orientation, and maintain elasticity of the overall
cell-scaffold structure. For bone reconstruction, electrospun
nanofibers can be constructed to encapsulate or surface-
immobilize osteo-inductive agents such as bone morphoge-
netic protein-2 (BMP-2) (Li et al., 2015; Perikamana et al,
2015). These functionalized nanofiber scaffolds have been
shown to accelerate cranial bone regeneration by facilitating
cell adhesion and growth and locally releasing osteo-induc-
tive cues. Nanofibers also promote osteogenic differentiation
and mineralization (Li et al., 2015) and guiding collagen
deposition (Perikamana et al, 2015). 
Neural Tissue Engineering
Electrospun fibrous scaffolds in wrap and conduit forms
have been developed for neural tissue engineering due to
topography can also be incorporated inside the conduits or
wraps serving as the guidance cue for Schwann cell migra-
tion and axonal re-growth. The ability to guide cell migra-
tion and maturation by aligned fibers is illustrated in a
study by comparing human fetal tissue-derived Schwann
cells cultured on aligned and random electrospun poly(ε-
caprolactone) (PCL) fibers. Cell cytoskeleton and nuclei
elongated along the fiber axes, emulating the structure of the
bands of Büngner, which is formed during nerve repair by
activated Schwann cells to guide growing axons. The aligned
fibers can also condition Schwann cells into a myelinating
phenotype with lowered expression of neurotrophic factors
and up-regulation of an early myelination marker, myelin-
associated glycoprotein. These functions may facilitate
peripheral nerve regeneration. Additional functions such as
local release of neurotrophic factors and immune condition-
ing can also be incorporated into the scaffold to promote
tissue regeneration or modulating the tissue repair microen-
vironment. For example, nerve conduits prepared from the
phate) (PCLEEP) fibers with encapsulated glial cell-derived
neurotrophic factor (GDNF) offer a combination of bio-
chemical and topographical cues to facilitate peripheral
nerve regeneration (Chew et al., 2008). By controlling the
pore size of the electrospun fiber conduit, thus entrapping
596 SEC T I O N 1 . 4     Materials Processing
the infiltrating macrophages, a microporous PCL nanofiber
wrap creates an environment conducive to nerve repair and
improves functional recovery (Sarhane et al., 2019a).  (VEGF) to fiber surface. The functionalized nanofiber mesh
Nanofibers for Cardiovascular Repair
Electrospinning can be used to generate nanofibrous struc-
tures with various shapes and sizes to recapitulate specific
architectures and functions in repairing different cardiovas-
cular tissues, such as vascular grafts to replace blood vessels,
heart valves, myocardial patches, etc. Similar to other tis-
sue engineering applications, the multiscale topography and
anisotropy, high porosity, and mechanical property make
electrospun fibrous scaffolds a suitable choice (Capulli et
al., 2016). Aligned fiber arrangement not only can improve
the strength and elasticity of the grafts, but also can guide
the organization of the endothelial cells and cardiomyocytes
and the deposition of ECM molecules. Fibers with tunable
degradation rates, together with the use of porogenic tech-
niques and cell seeding methods, can be employed to facili-
tate cell infiltration and organization (Woods and Flanagan,
2014). Functionalization of scaffolds can be tailored for
different design features of a specific product. For example,
anti-thrombogenic agents can be conjugated to the surface
of nanofibers to extend the patency of a small diameter
vascular graft. Adhesion ligands can be conjugated to the
luminal surface of the fibrous conduit to recruit endothe-
lial cell progenitors or pre-seed autologous endothelial cells.
An electrospun small-diameter vascular graft prepared with
fibrin fiber tube encased in a thin sheath composed of PCL
nanofiber membrane provided sufficient suture retention
strength, overall mechanical property, vascular remodeling
and enabled long-term graft survival (Elliott et al., 2019).
The fibrin fiber tube allows successful endothelization,
remodeling of the tunica intima and media layers, abundant
ECM deposition particularly collagen layers and elastin
lamellae, and reduced calcification; whereas the PCL fiber
sheath improves the mechanical properties that withstands
the reperfusion burst pressure and maintains the integrity of
the graft following implantation. Such an approach has high
translational potential for generating small diameter arterial
grafts for bypass surgery (Elliott et al., 2019).
Electrospun fibers prepared from elastomeric polymers
such as polyurethanes (PUs) and cross-linkable polyesters
have excellent elasticity, which is ideal to serve as a scaffold
to generate cell populated patches to repair the myocardial
tissue damaged by a heart attack. A tri-component elasto-
meric patch was generated from electrospun poly(carbonate-
co-urethane) (PCU, Bionate®) and PLGA nanofibers using
a knitted polyester fabric as a template. This approach
imparted anisotropic structure to guide local cell alignment
and organization, improved the overall mechanical prop-
erties of the cell-grown patch construct, and sustained the
spontaneous synchronous contractility at a physiologically
relevant frequency (Şenel Ayaz et al, 2014). In a different
study, an elastomeric polyester poly(glycerol sebacate) (PGS)
prepolymer was mixed with PCL and the mixture solu-
tion was electrospun into a nanofiber mesh with improved
mechanical properties. The PGS component allowed for
direct conjugation of vascular endothelial growth factor
permits the adhesion and proliferation of myogenic and
angiogenic progenitor cells, and thus potentially improve
the integration of the patch with host tissue after implanta-
tion (Rai et al, 2015). This polymer blend approach can be
applied to generating fibers from a mixture solution contain-
ing synthetic and natural polymers (PGS, silk fibroin, and
collagen; PFC fibers). The collagen-embedded PFC fiber
mesh showed superior mechanical properties and promoted
the adhesion of endothelial cells (Wang et al., 2015).  
Nanofibers for Local Drug Delivery
The electrospun nanofiber structure can be used as a drug
loading system to achieve controlled release of drugs locally
at the site of implantation. Bioactive agents such as growth
factors and cytokines can be locally delivered to influence
tissue regeneration, angiogenesis, and inflammation. A wide
range of bioactive agents and drugs can be loaded into the
nanofibers during the electrospinning process if the agents
can be dissolved or suspended in the polymer solution, or
conjugated to the surface of the nanofibers through either
chemical linkage or physical entrapment. Since multiple
sets of fibers can be used to generate a single fibrous mesh or
membrane, codelivery of multiple agents can be achieved by
incorporating different drugs in different set of fibers. The
release rate of each agent in one set of fibers can be inde-
pendently tuned by varying the polymer-drug combination,
independent of other fibers in the same fibrous mesh. This
delivery feature can also be achieved by incorporating dif-
ferent drug-loaded nanoparticles into one set of electrospun
fibers or loading different drugs into the inner or outer layer
of a composite fibers with a core-shell structure through the
co-axial spinning technique.
Such an approach has been applied to generate an elec-
trospun fiber-based coating on an orthopedic prosthetic
device to prevent biofilm-associated chronic infections par-
ticularly in cases involving antibiotic-resistant bacteria. A
composite fiber membrane prepared from PLGA and PCL
nanofibers, each loaded with a different antibiotic during
electrospinning, was shown to effectively co-deliver a com-
bination of antibiotics locally from the implant surface. The
relative antibiotic release rate and duration can be adjusted
by tuning drug loading and weight ratio of PLGA and PCL
fibers. As tested in a mouse model for prosthetic joint infec-
tion, this conformal nanofiber coating effectively cleared
bacterial infection from the implant surface and surround-
ing tissue without affecting osseointegration (Fig. 1.4.6.17)
(Ashbaugh et al., 2016) This tunable nanofiber composite
membrane or coating can be extended to other types of
devices for a range of therapeutic applications. 
Future Directions
The future of biotextiles development is driven by the clini-
cal need for less-invasive and resorbable materials that do
 CHAPTER 1.4.6   Medical Fibers and Biotextiles 597

• Figure 1.4.6.17 Poly(lactide-co-glycolide) (PLGA)/poly(ε-caprolactone) (PCL) composite implant coating

loaded with combinatorial antibiotics. (A) Antibiotic-loaded PLGA and PCL fibers are coelectrospun onto
titanium implants to form a conformal PCL film with embedded PLGA fibers. (B) Micrographs of implants
before (left) and after electrospinning (middle) and anealing of Van/Rif composite coating(right). (C) SEM
images of coating surfaces with varying PLGA:PCL ratios. (D) Fluorescent micrograph of two PLGA fiber
coatings (red and green fibers) embedded in PCL films. (Modified from Ashbaugh, A.G., Jiang, X., Zheng,
J., Tsai, A.S., Kim, W.S., Thompson, J.M., Ordonez, A.A., 2016. Polymeric nanofiber coating with tunable
combinatorial antibiotic delivery prevents biofilm-associated infection in vivo. Proc. Nat. Acad. Sci. USA
113 (45), E6919–E6928.)

not require explantation, as well as the emphasis on pro-
regenerative features of implanted materials to promote
natural growth of viable tissue. As biotextiles are devel-
oped to become thinner, lighter, stronger, and more tun-
able in terms of flexibility, porosity, and functionalization,
they are showing their versatility over traditional materi-
als such as metals and ceramics. Current work is moving
from permanent materials to not only resorbable materi-
als, but also functional bioresorbable materials (Gajjar and
King, 2014). The development of smart devices that rely on
shape-memory, electroactivity, and self-healing properties
that can respond to environmental changes in temperature,
pH, and strain can serve as more than just scaffolding for
biomedical applications (Lendlein and Langer, 2002). These
smart devices such as biosensors, actuators, and drug deliv-
ery systems offer new ways for responsive biomaterials to
improve therapeutic potential. Bioactive fiber coatings with
slow release of antibacterial agents are being used to address
infections resulting from implantation surgeries (Ashbaugh
et al., 2016). Bioactive sutures have been developed for drug
delivery, growth factor delivery, and cell delivery through
surface modification and coating techniques (Alshomer
et al., 2017). The growth of these new biotextiles also intro-
duces new challenges in extrusion and sterilization practices
while maintaining key functionality and structural integrity.
Prevalence in 3D printing technologies has enabled the
generation of unique architectures using computer-aided
designs. While these are primarily limited to microextrusion
of polymer materials, progress in this area has expanded the
range of temperatures and fiber diameters to better mimic
the microstructure of biological tissue (Pedde et al., 2017).
New spinning techniques and improvements in electro-
spinning, bicomponent spinning, and materials improve-
ments have also expanded the range of fiber diameters
ranging from sub-50 nm to 10 μm, while also introducing
new cross-sectional geometries. These enhancements facili-
tate the development of new therapeutic strategies as the
effects of microenvironment architecture and cellular biome-
chanics are better understood. Moreover, new techniques to
manipulate biotextiles, such as flocking, tufting, and embroi-
dery, can create complex 3D structures (Pereira et al., 2007;
Rentsch et  al., 2009; Walther et  al., 2007; Wollenweber
et al., 2006). Additionally, techniques to improve foaming
in electrospun fibers can further introduce new mechanical
properties and increase porosity in these biotextile materials.
These technologies contribute to the development of thicker
tissue-engineered scaffolds to improve cell migration and tis-
sue regeneration throughout the construct. As such, biotex-
tiles and fiber-based tissue-engineering scaffolds will soon be
considered as standardized “off-the-shelf ” products that can
be scaled up to be fabricated in large quantities for com-
mercialization to meet growing clinical demand. The use of
medical fibers and biotextiles in medicine will continue to
grow as new synthetic polymers and genetically engineered
biopolymers, fiber spinning technologies, 3D constructions,
coatings, and surface modification processes are developed.
598 SEC T I O N 1 . 4     Materials Processing
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Chapter Study Questions
1. What are the general selection criteria for polymeric
materials for medical fiber production?
2. Describe the main advantages and disadvantages of syn-
thetic and natural materials as a source for producing
medical fibers.
3. Give three examples each of synthetic and natural poly-
mers and list examples of biotextile products generated
from each polymer.
4. Name one clinical challenge that biotextiles have pro-
vided a solution for, and explain what specific structural
features and properties are critical to accomplishing the
particular tasks or serving the unique functions.
5. Consider a fiber that is 2 m long and weighs 3 g.
a. If the fiber is a monofilament fiber, what is the linear
density of the fiber in denier and dtex?
b. If the fiber is a multifilament yarn made with 60 fila-
ments, what is the linear density of each fiber in denier
and dtex?
c. Contrast the advantages and disadvantages of monofila-
ments and multifilament fibers.
6. Assume that you are given a 260-denier monofilament
PET yarn to prepare a vascular graft.
a. What is the diameter of the yarn used for this graft?
b. What are the advantages and disadvantages for each of
the following structures for this vascular graft: woven,
knit, and braided textiles?
c. Pick one of the three structures and describe how you
could improve upon the disadvantages, which you have
described, by altering the textile or yarn properties.
7. Pick a natural polymer, for example, from this list: chi-
tosan, collagen, gelatin, alginate, and hyaluronic acid.
Research and briefly describe its endogenous bioactivi-
ties and its functions in a current or potential biotextile.
What properties of the biopolymer made it ideal for this
application? What are the potential disadvantages of the
biopolymer in this application?
8. The concept of combining naturally occurring biologic
elements with artificially manufactured biotextiles has
been observed with multiple products discussed in this
chapter, including hybrid textiles intended for use as
small vessel stent grafts and stem cell-coated polyester
implants for orthopedic surgery. What are some of the
advantages of products that combine textiles with bio-
logic elements? What are some potential shortcomings
of a hybrid textile compared with either the textile or
biologic element alone?
9. Consider the process of producing electrospun polymer
nanofibers.
a. Describe the basic principle of electrospinning for pre-
paring polymeric nanofiber mesh; use a sketch or sche-
matic to aid your description.
b. Explain how polymer solution properties and electrical
potential applied may influence the fiber diameter.
c. Discuss approaches to control fiber alignment. Give two
examples each for electrospun fiber products with either
ordered or random alignment.
d. Propose one method each for encapsulating a hydropho-
bic drug (e.g., vancomycin) and a water-soluble drug (e.g.,
bone morphogenetic protein-2) into electrospun fibers.
600.e1