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The development of a polymer patch for the treatment of oesophageal leaks and perforations

Newton, Nicholas; (2021) The development of a polymer patch for the treatment of oesophageal leaks and perforations. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

Oesophageal leaks and perforations carry mortality and morbidity. Management options include surgery, stents, drains, and negative pressure therapy; all current treatment options, however, have significant associated morbidity. Here we investigate an alternative approach using a temporary polymer patch to adhere to and seal the oesophageal defect whilst supporting healing and function without damaging local tissue. This approach could offer a timely, cost effective and minimally invasive approach, especially for environments where specialised and complex surgery may not be available such as resource limited military and humanitarian healthcare settings. To quantitatively compare perforation management options (including the novel patch) a novel ex vivo model of oesophageal perforation repair was developed. The patch had a degradable poly(ε-caprolactone urea) urethane backbone with a polyhedral oligomeric silsesquioxane (POSS PCLU) component. The study successfully developed an ex vivo porcine oesophagus bench top model for testing the strength of oesophageal repair techniques. The model allowed a maximum pressure of 100kPa and was capable of quantitatively assessing perforation repair approaches. A major consideration in the patch approach to perforation repair is the adhesion of the patch to the oesophagus. The study demonstrates that the surface chemistry of the patch can be modified to improve adhesion and increase attachment strength. Here we found that both modifications of the tissue adhesion site in vivo (by removal of the outer epithelial layer of the oesophagus) and by modifying the surface chemistry of the patch (by plasma treatment) it was possible to enhance fibrin patch adhesion to the oesophagus. The optimisation of the patch surface chemistry and host tissue site for fibrin-based adhesion could have an impact in the medical use of polymer patches throughout the body.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: The development of a polymer patch for the treatment of oesophageal leaks and perforations
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10132519
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