TEXTILES

Medical Textile Structures:

An Overview
Bhupender S. Gupta
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, fibers and fabrics have been
explored as potential materials for novel applications in medicine and surgery. This continuous
interest has its basis in the unique properties of fiberswhich in many respects resemble
biological materialsand in their ability to be converted into a wide array of desired end
products.
Textile products for medical applications include such
materials as woven and knitted polyester fabrics and
PTFE felt and mesh. Photo: IMP!
This article will provide a brief introduction to polymer
fibers, textiles, and related structures used in medicine
and will discuss the principles governing the
performance of these materials. !urrent product
concerns and developmental activities will also be
reviewed.
Manufacturin Medical !a"rics "edical textile products are based on fabrics, of which there
are four types# woven, knitted, braided, and nonwoven $see Figure %&. The first three of these are
made from yarns, whereas the fourth can be made directly from fibers, or even from polymers.
$'ore(Texbased products or electrostatically spun materials from polyurethane are examples
of products made directly from polymers.& There is, therefore, a hierarchy of structure# the
performance of the final textile product is affected by the properties of polymers whose
structures are modified at between two and four different levels of organi)ation.
Fi"ure #. $onstituent elements of medical textile
products.
*f the many different types of polymers, only a few can be made into
useful fibers. This is because a polymer must meet certain
requirements before it can be successfully and efficiently converted into a fibrous product. +ome
of the most important of these requirements are#
,olymer chains should be linear, long, and flexible.
+ide groups should be simple, small, or polar.
,olymers should be dissolvable or meltable for extrusion.
!hains should be capable of being oriented and crystalli)ed.
!ommon fiber(forming polymers include cellulosics $linen, cotton, rayon, acetate&, proteins
$wool, silk&, polyamides, polyester $,-T&, olefins, vinyls, acrylics, polytetrafluoroethylene
$,TF-&, polyphenylene sulfide $,,+&, aramids $.evlar, /omex&, and polyurethanes $0ycra,
,ellethane, 1iomer&. -ach of these materials is unique in chemical structure and potential
properties. For example, among the polyurethanes is an elastomeric material with high
elongation and elastic recovery, whose properties nearly match those of elastin tissue fibers. This
materialwhen extruded into fiber, fibrillar, or fabric formderives its high elongation and
elasticity from alternating patterns of crystalline hard units and noncrystalline soft units.
2lthough several of the materials mentioned above are used in traditional textile as well as
medical applications, various polymeric materialsboth absorbable and nonabsorbablehave
been developed specifically for use in medical products. !hemical structures of some of these
materials are illustrated in Figure 3.
Fi"ure %. Examples of fibrous
materials developed for use in
medicine.
The reactivity of tissues in contact with fibrous structures varies among materials and is
governed by both chemical and physical characteristics. 2bsorbable materials typically excite
greater tissue reaction, a result of the nature of the absorption process itself. 2mong the available
materials, some are absorbed faster $e.g., polyglycolic acid, polyglactin acid& and others more
slowly $e.g., polyglyconate&. +emiabsorbable materials such as cotton and silk generally cause
less reaction, although the tissue response may continue for an extended time. /onabsorbable
materials $e.g., nylon, polyester, polypropylene& tend to be inert and to provoke the least
reaction. To minimi)e tissue reaction, the use of catalysts and additives is carefully controlled in
medical(grade products.
!i"ers. 2s discussed, of the many types of polymers, only a few can be made into useful fibers
that can then be converted into textile products. To make fibers, polymers are extruded by wet,
dry, or melt spinning and then processed to obtain the desired texture, shape, and si)e. Through
careful control of morphology, fibers can be manufactured with a range of mechanical
properties. Tensile strength can vary from textile values $values needed for use in typical textile
products such as apparel& of 34 g5d $gram5denier& up to industrial values $values typical of
industrial products such as tire cords or belts& of 4%0 g5d. For high(performance applications,
such as body armor or structural composites, novel spinning techniques can produce fibers with
strengths approaching 60 g5d. 0ikewise, breaking extension can be varied over a broad range,
from %0407 for textile to %%87 for industrial and %008007 for elastomeric fibers.
#arns. Fibers or filaments are converted into yarns by twisting or entangling processes that
improve strength, abrasion resistance, and handling. 9arn properties $
y
& depend on those of the
fibers or filaments $
f
& as well as on the angle of twist, . "odulus $E & and strength $ & are
reduced by the cos
3
factor, while the extension at break $ & is increased by the sec
3
factor#
!a"rics. 9arns are interlaced into fabrics by various mechanical processesthat is, weaving,
knitting, and braiding.
%
The three prevalent fabric structures used for medical implants or sutures
are woven, in which two sets of yarns are interlaced at right angles: knitted, in which loops of
yarn are intermeshed: and braided, in which three or more yarns cross one another in a diagonal
pattern $see Figure 6&. .nitted fabrics can be either weft or warp knit, and braided products can
include tubular structures, with or without a core, as well as ribbon.
Figure 6. -xamples of woven $top
left&, knitted $top right, bottom left&,
and braided $bottom right& structures.
There are also numerous medical uses
for nonwoven fabrics $wipes, sponges,
dressings, gowns&, made directly from
fibers that are needle(felted,
hydroentangled, or bonded through a
thermal, chemical, or adhesive
process. /onwovens may also be
made directly from a polymer. For
example, expanded
polytetrafluoroethylene $e,TF-&
products such as sutures and arterial grafts and electrostatically spun polyurethane used as
tubular structures are examples of medical applications of polymer(to(fabric nonwovens.
3

!a"ric Structures
The properties of fabrics depend on the characteristics of the constituent yarns or fibers and on
the geometry of the formed structure. ;hether a fabric is woven, knitted, braided, or nonwoven
will affect its behavior.
$%vens. Fabrics that are woven are usually dimensionally very stable but less extensible and
porous than the other structures. *ne disadvantage of wovens is their tendency to unravel at the
edges when cut squarely or obliquely for implantation. <owever, the stitching technique known
as a 0eno weavein which two warp threads twist around a weftcan substantially alleviate
this fraying or unraveling $see Figure 4&.
6

Fi"ure &. Fabric and vascular "rafts made usin" a 'eno weave.
&nitted !a"rics. !ompared with woven fabrics, weft(knitted
structures are highly extensible, but they are also dimensionally
unstable unless additional yarns are used to interlock the loops
and reduce the extension while increasing elastic recovery. ;arp(
knitted structures are extremely versatile, and can be engineered
with a variety of mechanical properties matching those of woven
fabrics. The ma=or advantage of knitted materials is their
flexibility and inherent ability to resist unraveling when cut. 2
potential limitation of knitted fabrics is their high porosity, which
unlike that of woven fabricscannot be reduced below a
certain value determined by the construction $see Figure 8&. 2s a
result, applications requiring very low porosity usually
incorporate woven materials.
Fi"ure (. )oven *left+ and knitted
*center and ri"ht+ fabics used for
vascular "rafts, showin"
differences in porosity.
Braided Structures. Typically employed in cords and sutures, braided structures can be
designed using several different patterns, either with or without a core. 1ecause the yarns criss(
cross each other, braided materials are usually porous and may imbibe fluids within the
interstitial spaces between yarns or filaments. To reduce their capillarity, braided materials are
often treated with a biodegradable $polylactic acid& or nonbiodegradable $Teflon& coating. +uch
coatings also serve to reduce chatter or noise during body movement, improve hand or feel, and
help position suture knots that must be transported by pressure from a surgeon>s finger from
outside the body to the wound itself.
'%nw%vens. The properties of nonwoven fabrics are determined by those of the constituent
polymer or fiber and by the bonding process. For instance, expanded ,TF- products can be
formed to meet varying porosity requirements. 1ecause of the expanded nature of their
microstructure, these materials compress easily and then expanda suture, for example, can
expand to fill the needle hole made in a tissueallowing for tissue ingrowth in applications such
as arterial and patch grafts. ,olyurethane(based nonwovens produce a product that resembles
collagenous material in both structure and mechanical properties, particularly compliance
$extension per unit pressure or stress&. The porosity of both ,TF-( and polyurethane(derived
nonwovens can be effectively manipulated through control of the manufacturing processes.
Textile (erf%r)ance (rinciples
Textile materials for medical applications typically have specific performance requirements
relating to strength, stiffness, abrasion resistance, and mechanical patency.
Strenth. 2mong the many factors affecting a fabric>s strength $fiber type, molecular
orientation, crystallinity& is the variability in propertiesespecially elongationof its
constituent elements. ?sually, the greater the variability in elongation at break, the lesser the
strength. ,roducts requiring high strength $e.g., artificial ligaments& must incorporate elements
whose properties range within a narrow limit.
Stiffness. 1ending stiffnesswhich governs the handling, comfort, and conformability of a
fabricis a critical parameter in a number of medical applications. 2 low value is usually
desirable. For example, a suture with low bending stiffness requires fewer throws to tie a secure
knot and has higher knot strength. The most important factors affecting bending stiffness are the
shape of the fiber and the modulus, linear density, and specific gravity of the material. 'enerally,
the higher the denier or the modulus or the lower the specific gravity, the higher the bending
stiffness. For example, polyester has a higher modulus than that of nylon, and will result in a
stiffer material. ,olypropylene, with a lower density than nylon, should have a higher stiffness,
assuming all other factors are equal. @n addition, a trilobal or tubular structure produces a stiffer
product than does a solid circular structure of the same area or linear density.
"onofilament materials are much stiffer than multifilament. ;ith all other factors constant, the
bending stiffness of a monofilament product such as a suture of denier T will be roughly n times
greater than a multifilament structure with n filaments of denier T-n each. The use of
multifilament yarns and5or fine(denier fibers in the yarn produces a more flexible and supple end
product. .not efficiencythe ratio of the tensile strength of knotted to unknotted threadis
affected by elongation at break and bending stiffness. "ost often, the greater the elongation, or
the lower the stiffness, the greater the knot efficiency.
A"rasi%n *esistance. ;henever fibers, yarns, or fabrics rub against themselves or other
structures, abrasion resistance assumes an important role. 2 high value is usually desirable,
especially in applications such as artificial ligaments or tendons. The abrasion resistance of a
yarn is influenced by several factors#
The denier of the fiber $the lower the denier, the lower the resistance&.
The amount of twist in the yarn that binds the fibers together $the lower the twist, the
lower the resistance&.
The orientation of molecules in the fibers $the higher the orientation, usually the lower
the resistance&.
The surface coefficient of friction $the higher the coefficient, the lower the resistance&.
Therefore, one can conclude that microdenier fibers, low(twist yarns, rough surfaces, and highly
oriented materials generally exhibit low abrasion resistance. <owever, coating a bundle of fibers
with a low(friction polymer can enhance its resistance to abrasion.
Mechanical (atenc+. @mplanted products that must bear loads over the long term and maintain
their dimensional integrity require a high degree of mechanical patencythat is, the ability to
resist permanent change in physical si)e, shape, structure, and properties. The factors that
contribute to mechanical patency include#
The chemical, biological, and stress environment into which the implant is placed.
The nonreactivity of the polymer with the environment.
The si)e of the fibers.
The structure of the fabric $consolidated structures made of highly interlocked woven
material or warp knits provide an advantage&.
,erhaps most importantly, the viscoelastic properties of the material.
Thus, material selection is extremely critical for productssuch as ligament prosthesesthat
must continue to bear loads. The material specified must be able to resist the elongation or
growth that may occur as a result of stress relaxation during each cycle of operation in the body.
@f no such material is available, then biological tissues will need to be integrated into the
assemblage to provide partial support of the load and contribute to the product>s long(term
patency.
,urrent Medical Textile *esearch
The literature of the past decade, including patents, provides a broad overview of current
research activities as well as of some of the problems and concerns related to implantable
medical textiles. 2mong the more intensively studied product groups are surgical sutures,
vascular grafts, and artificial ligaments and tendons.
Surical Sutures. For surgical sutures, the predominant areas of concern are strength,
capillarity, sliding and positioning of knots, knot security, and handling characteristics. The
recent focus of suture research has been on improving the structure of the braids $two recently
proposed products are spiral( and lattice(braided materials&,
4
reducing the difference in the
elongational properties between the core and the sheath yarns, using finer(denier filaments in the
sheath yarns, and improving knot security and performance by exposing a two(throw square knot
to laser(beam energy. @n a recently conducted experiment, it was
shown that exposing a two throw square knot tied in a 6(0 "ersilene
suture to energy from a !*
3
laser beam for a brief period of time not
only made the knot fully secure but also led to an increase in knot
strength of appoximately %47 $see Figure 4&.
8

Fi"ure .. The effect on knot/breakin" stren"th of exposin" a two/throw s0uare knot tied in 1/2
Mersilene to ener"y from a $3
%
laser beam.
-ascular Grafts.Aegarding vascular grafts, the lack of healing, compliance, and suture(line
patency continue to be concerns, especially in small(caliber $B 4 mm diam& grafts.
4
Three
important efforts that highlight global developmental activities in this area are#
The use of semiabsorbable structures, with absorbable components, woven or knitted, in
the inner tube wall.
The use of spray technology in con=unction with elastomeric polymers to produce
collagen(like fiber structures with biomechanically compliant properties.
3

The incorporation of elastomeric components in the weft threads of woven prostheses.
4

?sing this technique, woven grafts of 4( to 4(mm diam could be produced, with
transverse compliance comparable to that of canine and other similarly si)ed arteries.
-xperiments with endothelial cell seeding
C
and with coated grafts containing albumin,
D
gelatin,
E

or collagen
%0
are also ongoing.
Lia)ents and Tend%ns. Finally, in the area of artificial ligaments and tendons, desirable
properties include high strength, high elasticity, low abrasion, low creep, and low stiffness.
!urrent research endeavors are examining the use of ultra(high(strength fibers $e.g., +pectra
from 2llied+ignal&, threads containing layers of both absorbable inelastic and nonabsorbable
elastic fibers, and coatings with biocompatible polymers to reduce abrasion and restrict escape of
abraded particles from within the structure.
%%

,%nclusi%n
Textile materials continue to serve an important function in the development of a range of
medical and surgical products. The introduction of new materials, the improvement in production
techniques and fiber properties, and the use of more accurate and comprehensive testing have all
had significant influence on advancing fibers and fabrics for medical applications. 2s more is
understood about medical textiles, there is every reason to believe that a host of valuable and
innovative products will emerge.
*eferences
%. <atch .0, Textile 4cience, /ew 9ork, ;est ,ublishing !o., pp 6%D6C0, %EE6.
3. +oldani ', ,anol ', +asken <F, et al., F+mall(Giameter ,olyurethane(,olydimethylsiloxane
Hascular ,rostheses "ade by a +praying, ,hase(@nversion ,rocess,F 5 Mat 4ci, Mat in Med,
6#%04%%6, %EE3.
6. .apadia @, and @brahim @", ;oven vascular grafts, ?.+. ,at. 4,D%4,03D, %EDE.
4. 1rennan .;, +kinner ", and ;eaver ', 1raided surgical sutures, ?.+. ,at. 4,E8E,04E, %EE0.
8. 'upta 1+, "ilam 10, and ,atty AA, F?se of !arbon Gioxide 0asers in @mproving .not
+ecurity in ,olyester +utures,F 5 !pp 6iomat, %#%3%%38, %EE0.
4. 'upta 1+, and .asyanov H2, F1iomechanics of the <uman !ommon !arotid 2rtery and
Gesign of /ovel <ybrid Textile !ompliant Hascular 'rafts,F 5 6iomed Mat es, 64#64%64E,
%EEC.
C. ;illiams +., !arter T, ,ark ,., et al., FFormation of a "ultilayer !ellular 0ining on a
,olyurethane Hascular 'raft Following -ndothelial !ell +eeding,F 5 6iomed Mat, 34$%&#%06
%%C, %EE3.
D. "erhi 9, Aoy A, 'uidoin A, et al., F!ellular Aeactions to ,olyester 2rterial ,rostheses
@mpregnated with !ross(0inked 2lbumin# @n Hivo +tudies in "ice,F 6iomat, %0$%&# 848D,
%EDE.
E 1ordenave 0, !aix I, 1asse(!athalinat 1, et al., F-xperimental -valuation of a 'elatin(!oated
,olyester 'raft ?sed as an 2rterial +ubstitute,F 6iomat, %0$6&# 368343, %EDE.
%0. 'uidoin A, "arceau G, !outure I, et al., F!ollagen !oatings as 1iological +ealants for
Textile 2rterial ,rostheses,F 6iomat, %0$6&# %84%48, %EDE.
%%. Frey *, Gittes ,, and .och A, ,rosthetic implant, ?.+. ,at. 8,%C4,C0D, %EE6.
Bhupender S. Gupta, PhD, received his under"raduate de"ree in textile technolo"y from the
Pun7ab 8niversity, India, and his doctorate in textile physics from the 8niversity of Manchester
Institute of 4cience and Technolo"y *Manchester, 89+. :e is currently professor of textile
materials science in the department of textile en"ineerin", chemistry, and science, $olle"e of
Textiles, at ;orth $arolina 4tate 8niversity *alei"h, ;$+. :is research interests include the
physical and mechanical properties of fibers, yarns, and fabrics< structural mechanics of
assemblies< absorbent nonwoven materials< and biomedical textiles.
Copyright 1998 Medical Plastics and Biomaterials