Role of Textiles in the

Medical Field

By:
Priyanka P Sharma,
M S Parmar
and
Kirti Tewari
 Role of Textiles in the Medical Field
By: Priyanka P Sharma, M S Parmar and Kirti Tewari

From their first appearance as sutures more than 4000 years ago to their present use in products ranging
from gowns and wound dressings to arterial and skin grafts, textile materials have been explored as
potential materials for novel applications in medicine and surgery. This continuous interest has its basis in
the unique properties of fibres which in many respects resemble biological materials and in their ability to be
converted into a wide array of desired end products.

Technical textiles are one of the faster growing sectors of the textile industry. An important field of
application of technical textile in medicine has been developed, such as wound care. Bandages and wound
dressings are most commonly used because they are affordable and reusable. The medical textile should
have biocompatibility, flexibility and strength.

There is a clear difference in technical textiles and conventional textiles. Unlike conventional textiles used
traditionally for clothing or furnishing, technical textiles are used basically on account of their specific
physical and functional properties. Depending on the product characteristics, functional requirements and
end-user applications, the highly diversified range of technical textile products can be classified following
categories on the basis of their application:

• Agrotech (agriculture, horticulture and forestry)

• Geotech (geotextiles, civil engineering etc)
• Meditech (hygiene and medical)
• Protech (personal and property protection).

It is expected that technical textiles industry has immense potential in the developing countries. Out of
developing countries especially Asian countries, particularly India has great potential to make an impact in
this industry in the coming decade. The demand for technical textiles will be boosted by the changing
economic scenario in these countries. Considering its highly skilled and scientific/technical manpower and
abundant availability of raw materials, India can emerge as a key player in the technical textiles industry.

Meditech: Medical textiles is one of the areas which requires immense attention as it is directly connected to
the human beings. The medical textile products are available in woven, knitted and non-woven forms based
on the area of application. Following products may be considered under medical textile products categories:

• Baby diapers
• Incontinence diapers
• Sanitary napkin
• Surgical sutures
• Disposables
• Surgical dressing
• Contact lens
• Artificial implants.

Domestic and international scenario of medical textiles

The consumption of medical textiles worldwide was 1.5 million tons in 2000 and is growing at an annual rate
of 4.6%. The Indian market size of medical textiles was estimated to be INR 14.8 billion in 2003-04 and is
expected to grow to INR 23.3 billion by 2007-08. Market is expected to grow by 8% p.a. These figures show
the commercial potential in the field of medical textiles. The medical textile has great future in the export
market. Presently, key products exported from India are surgical sutures and surgical dressings.

Classification of medical textiles

Textile is an important part of human life and is being used in the medical field. Textile materials have wide
range properties such as flexibility, elasticity, strength etc. Textiles used for medical purposes should be
non-allergic, non-garcinogenic, non-toxic, antistatic in nature, have optimum fatigue endurance, bio-
compatibility, flame proof, and dyes must be non irritant. An important and growing part of the textile industry
is the medical and related health care and hygiene sectors.
Medical textile is classified as:

Woven medical textiles: Medical textile weaving is achieved through the process of interlacing two yarns of
similar material so that they cross each other at right angles which produces a woven fabric. The warp
yarns, or ends, run lengthwise in the fabric, and the filling threads (weft), or picks, run from side to side.
Woven medical textiles are typically used for products requiring extreme stability and high durability over a
significant number of loading cycles, or to precisely control porosity for air or fluid flow.

Braided medical textiles: Medical textile braiding is the intertwining of three or more yarns to make a fabric.
The medical fabric is formed by interfacing the yarns diagonally to the production axis of the material. An
infinite variability of process parameters creates braids with widely differing properties. Among these are
porosity, flexibility and radial strength

Knitted medical textiles: Knitting medical textiles is the method of constructing medical fabric by interlocking
a series of loops of one or more yarns. The two major classes of knitting are warp knitting and weft knitting
utilised in medical textiles:

• Medical fabric warp knitting: Warp Knitting is a type of knitting in which the yarns generally run
lengthwise in the medical fabric. The yarns are prepared as warps on beams with one or more yarns
for each needle. Examples of this type of knitting are tricot, and double needle bar knitting.
• Medical fabric weft knitting: Weft Knitting is a type of knitting in which one continuous thread runs
crosswise in the fabric making all of the loops in one course. An example is circular knitting.

Non-woven medical textiles: Nonwoven medical textiles are an assembly of textile fibres held together by
mechanical interlocking in a random web or mat. Non-woven medical textiles are carded to separate and
align the fibres and needle-punched to interlock the structure.

For practical purpose, medical textiles are generally categorised as:

• Non-implantable materials: dressings

• Implantable materials: sutures
• Extracorporeal devices: artificial leg (Fig 1). Hollow polyester fibre and hollow viscose are used in
making artificial kidney. Hollow viscose are also used in fabricating artificial liver.
• Healthcare and hygiene products: operation theatre attire (Fig 2).
Recent developments, although numerous, a few can be summarised as follows:

• Medical textiles and membranes:

Textiles have found numerous medical applications in life today, e.g., surgical hoses, hernia meshes,
vascular substitutes and filters for blood dialysis.

Dialyser membranes used to be made primarily of cellulose (derived from cotton linter). The surface of such
membranes was not very biocompatible, because exposed hydroxyl groups would activate the complement
in the blood passing by the membrane. Therefore, the basic, 'unsubstituted' cellulose membrane was
modified. One change was to cover these hydroxyl groups with acetate groups (cellulose acetate); another
was to mix in some compounds that would inhibit complement activation at the membrane surface (modified
cellulose). The original 'unsubstituted cellulose' membranes are no longer in wide use, whereas cellulose
acetate and modified cellulose dialysers are still used. Cellulosic membranes can be made in either low-flux
or high-flux configuration, depending on their pore size.

Another group of membranes is made from synthetic materials, using polymers such as
polyarylethersulfone, polyamide, polyvinylpyrrolidone, polycarbonate, and polyacrylonitrile. These synthetic
membranes activate the complement to a lesser degree than unsubstituted cellulose membranes

• Suture materials: Sutures are sterile filaments which are used to hold tissues
together until they heal adequately or to join tissues (Fig 3). The major
requirement of the textile material is the biocompatibility at the application site.
An antimicrobial suture based on nylon and polypropylene monofilaments is
being developed. Recently a bi-directional barbed suture has been developed
which obviates the necessity to tie a knot.

Coated polyglactin 910 sutures with triclosan was developed to provide the
suture material with antibacterial activity against the common putative pathogens
that cause surgical site infections (SSI) and, consequently, help to reduce the overall rate of postoperative
infection.

Steri strips are surgical strips of adhesive backed paper tape that are placed across an incision or minor cut.
They keep the edges of a wound together as it heals. Steri strips may be used instead of stitches in for
some injuries, because they lessen scarring and are easier to care for.

• Dressing materials: Many sophisticated dressings are available to the wound care practitioner, made from
a wide range of materials including polyurethane, salts of alginic acid and other gelable polysaccharides
such as starch and carboxymethylcellulose.

Hydrogel (Fig 4) is hydrophilic polymer capable of containing

large amounts of water. Water absorbed by hydrogel is not
released under ordinary pressure. Konjak-mannan, a jelly-like
food made from the starch of devil's tongue (seaweed), and
agar are examples of hydrogel. Hydrophilic groups such as
hydroxyl (OH) and carboxy (COOH) in principal and their side
chains absorb and store water. Hydrogel dressing can protect
injured skin and keep it appropriately moist to speed the
healing process. Its function is much like that of gauze and
hydrocolloid dressings, their common properties being:

• Absorb liquids exuded by the body; prevent infection from external bacilli; nonpoisonous; soft, strong, high
permeability; sterilising power, etc.

Hydrogel dressings have the following additional exceptional characteristics:

Accelerated healing, painless removal of the dressing, no residue, hence no need for physiological salt
solution washing, transparency allows observation of the healing process etc.

These materials may be used alone or in combination to form products as diverse as films, foams, fibrous
products, beads or adhesive gel-forming wafers more commonly called hydrocolloid dressings.

An improved thin film dressing with an absorbent border has been developed. The dressing has a superior
ability to rapidly take up and absorb body fluid and to prevent dressing leakage and wound maceration,
while retaining the conformability of a thin layer and a support layer. The support layer is adhered to the
occlusive layer and a layer by any suitable bonding by means such as adhesive heat or ultrasonics.

Super absorbents are swellable cross linked polymers, which have the ability to absorb and store 400-600
times their own weight of aqueous liquid by forming a gel. The liquid is then retained and not released, even
under pressure.

Antimicrobial fibre is produced by entrapping the metal ion with a cation exchange fibre having a sulphonic
or carboxyl group through an ion exchange reaction. The antibacterial metal ion is silver or silver in
combination with either copper or zinc. The great advantage of this material is that those are not to react
with tissue. Flexible products such as sponges and textile wipes, which have protracted antimicrobial effects,
are being developed. The wipes are impregnated with biocides by spraying, dipping or soaking for use in
medical field.

Kerlix AMD is pure cotton treated with Anecia's polyhexamethylene biguandine agent. These antimicrobial
agents resist bacterial growth within the dressing as well as reducing bacterial penetration through the
dressing.

The basic function of bandages is compression, retention and support. This is obtained by properties
intrinsic to the component and further enhanced and re-enforced supportively by the process of weaving and
finishing relevant to the required end use. The regulation of the blood flow and prevention of swelling is
closely interlinked with this property, thereby enhancing improved healing process. It provides necessary
support to restrict movement and to speed up the healing process.

Major challenges in the field of medical textiles are:

• Clear understanding is critically needed about the structure-property relationship of novel textile products,
so that precise simulation of mechanical parameters for specific clinical applications can be achieved.

• Tissue engineering research:

o Development of efficient manufacturing processes for preparing novel polymeric biomaterials,
fibrous scaffolds
o Detailed insight about targeted modulation of behaviour of human cells with respect to architectural
and chemical signals offered by textile and/or polymer-based materials.

• Scalable, cost-effective production under GMP (Good Manufacturing Practice) conditions.

• Multidisciplinary cooperation : There is urgent need to encourage the formation of consortia that work on
challenging topics (chronic wound management, low back pain, diabetic ulcers, joint trauma, arthritis etc), to
improve interdisciplinary networking (among textile and polymer technologists, material scientists, chemical
engineers, biotechnologist, computational biologists, genetic engineers, biochemists, clinicians, pathologists
and industry). Ideal strategy should be to bring different groups into one specific area, rather than making
one group mastering all fields.

• Translation into the clinical arena through controlled trial for applied biomedical applications.

Conclusion

The application of textile in high performance and specialised fields are increasing day by day including
medical field. As the medical textiles are directly linked to human beings, its importance cannot be
neglected. Medical textiles are already used in various fields such as implanted materials, healthcare and
hygienic products. There is a wide scope of applications of textile materials in the medical fields, which
requires lot of research activities. Indian textile industries with medical field experts have an important role to
play in this niche market as medical textiles not only have great demand in the domestic market but also
have export potential.

References

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1998 (16-28)
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Priyanka P Sharma is Ph.D student from Govt New Girls P G College Indore