Mitomycin C‐immobilized silver nanoparticle‐loaded polycaprolactone membrane for temporary scalp expansion after decompressive craniectomy to prevent wound infection

Malignant cerebral edema (MCE) represents a significant medical emergency characterized by unmanageable intracranial pressure (ICP), frequently arising as a consequence of traumatic brain injury (TBI) or ischemic stroke. Decompressive craniectomy (DC) is a prevalent surgical procedure employed to mitigate elevated ICP by excising a segment of the skull to enhance intracranial volume. Nevertheless, in patients suffering from MCE, the limited capacity for expansion of the scalp subsequent to DC may lead to sustained elevated ICP and complications including wound-edge necrosis, cerebrospinal fluid leakage, and infection. This investigation seeks to formulate a biocompatible, antibacterial, and anti-adhesive membrane intended for temporary scalp expansion following DC, thereby addressing these pressing concerns. The proposed membrane comprises polycaprolactone (PCL) augmented with silver nanoparticles (AgNPs) to confer antibacterial properties and is further immobilized with Mitomycin C (MMC) to minimize tissue adhesion, thereby facilitating more straightforward removal. The selection of PCL was predicated upon its remarkable mechanical strength and ductility, which make it suitable for withstanding intracranial edema and facilitating the suturing protocol. The AgNPs were synthesized through a green synthesis methodology employing epigallocatechin gallate (EGCG) to ensure environmental sustainability and the stability of the resultant nanoparticles. MMC, known for its anti-proliferative attributes, was affixed to the PCL surface via oxygen plasma treatment, thereby enhancing the anti-adhesive properties of the membrane. This study evaluates the mechanical characteristics, antibacterial effectiveness, anti-adhesive capabilities, and biocompatibility of the PCL/AgNPs/MMC membrane, thereby demonstrating its potential to improve outcomes in DC procedures by increasing intracranial volume and reducing postoperative complications.