title: Sealing the skin barrier around transcutaneous implants: in vitro study of keratinocyte proliferation and adhesion in response to surface modifications of titanium alloy.
abstract: Conventional amputation prostheses rely on the attachment of the socket to the stump, which may lead to soft-tissue complications. Intraosseous transcutaneous amputation prostheses (ITAPs) allow direct loading of the skeleton, but their success is limited by infection resulting from breaching of the skin at the interface with the implant. Keratinocytes provide the skin's primary barrier function, while hemidesmosomes mediate their attachment to natural ITAP analogues. Keratinocytes must attach directly to the surface of the implant. We have assessed the proliferation, morphology and attachment of keratinocytes to four titaniumalloy surfaces in order to determine the optimal topography in vitro. We used immunolocalisation of adhesion complex components, scanning electron microscopy and transmission electron microscopy to assess cell parameters. We have shown that the proliferation, morphology and attachment of keratinocytes are affected by the surface topography of the biomaterials used to support their growth. Smoother surfaces improved adhesion. We postulate that a smooth topography at the point of epithelium-ITAP contact could increase attachment in vivo, producing an effective barrier of infection.
authors.affiliation: Centre for Biomedical Engineering, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Pendegrass
authors.forename: D
authors.initials: D
authors.lastname: Gordon
authors.forename: C A
authors.initials: CA
authors.lastname: Middleton
authors.forename: S Ng Man
authors.initials: SN
authors.lastname: Sun
authors.forename: G W
authors.initials: GW
authors.lastname: Blunn
mesh_terms: D000497:Alloys / Q000737:chemistry*; D000672:Amputation Stumps; D001186:Artificial Limbs; D001672:Biocompatible Materials; D002448:Cell Adhesion; D006801:Humans; D015603:Keratinocytes / Q000378:metabolism*; D008855:Microscopy, Electron, Scanning; D046529:Microscopy, Electron, Transmission; D011474:Prosthesis Design; D013499:Surface Properties; D014025:Titanium / Q000737:chemistry*
chemical_list: D000497:Alloys; D001672:Biocompatible Materials; C031462:titanium alloy (TiAl6V4); D014025:Titanium