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Osseointegrated, percutaneous intramedullary abutments provide a new opportunity to increase freedom of movement, dexterity, and power of prosthetic upper and lower extremities. Device deployment is based on the physician's experience and judgment as no biomechanical information is available or choice of implant location, shape, and materials. Furthermore, there is little opportunity for personalization to improve performance and reduce the risk of stress shielding-induced bone loss or stress concentration-induced device failure. We present a Virtual Surgical Planning (VSP) environment for assessing the expected mechanical outcome of physician choice in the placement site of a percutaneous implant. Starting from de-identified patient images, a virtual anatomical model is created to emulate the surgical implantation procedure. After digitally implanting the intramedullary component-abutment system, the mechanical performance is computationally evaluated via Finite Element Analysis (FEA) under representative in vivo static loading conditions. Our computational analysis includes two different materials for the implant: medical-grade Surgical Grade 5 Titanium alloy (Ti-6Al-4V) and super-elastic Nickel-Titanium (NiTi). The resulting analysis can inspire future design personalization and deployment in an open surgical procedure. Our VSP approach would allow interactive assessment of device location, materials, and performance to alter the normal stress-strain distribution in the bone, potentially avoiding stress shielding and device failure. Future stiffness-matching strategies (e.g., incorporation of internal porosity, new materials, or novel implant geometry), and their effect on implant strength could be evaluated in our computational model. [ABSTRACT FROM AUTHOR]

Purpose: The study evaluated if there were differences between two types of bone-anchored hearing aids (BAHA), percutaneous vs transcutaneous implants in terms of audiological and psychosocial outcomes. Methods: Eleven patients were enrolled. Inclusion criteria were: patients with conductive or mixed hearing loss in the implanted ear with a bone conduction pure-tone average (BC PTA) of the hearing threshold at 500, 1000, 2000, and 3000 Hz ≤ 55 dB HL, aged > 5 years. Patients were assigned to two groups: percutaneous implant (BAHA Connect) and transcutaneous implant (BAHA Attract). Pure-tone audiometry, speech audiometry, free-field pure-tone and speech audiometry with the hearing aid, and Matrix sentence test were performed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and the Glasgow Benefit Inventory (GBI) were used to assess the psychosocial and audiological benefits provided by the implant, and the variation in the quality of life after the surgery. Results: No differences were found comparing the data of Matrix SRT. APHAB and GBI questionnaires did not show a statistically significant difference comparing each subscale and the global score. The comparison of scores obtained from the SADL questionnaire demonstrated a difference in the "Personal Image" subscale with a better score for the transcutaneous implant. Furthermore, the Global Score of the SADL questionnaire was statistically different between groups. Other subscales did not show any significant difference. A Spearman's ρ correlation test was used to evaluate if the age could influence the SRT results; no correlation was found between age and SRT. Furthermore, the same test was used to confirm a negative correlation between SRT and the global benefit of the APHAB questionnaire. Conclusion: The current research confirms the absence of statistically significant differences comparing percutaneous and transcutaneous implants. The Matrix sentence test has shown the comparability of the two implants in the speech-in-noise intelligibility. Actually, the choice of the implant type can be done according to the patient's personal needs, the surgeon's experience, and the patient anatomy. [ABSTRACT FROM AUTHOR]

The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the “device”/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant – as a model percutaneous device – placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.

Zhongshan Wang,1,* Guangsheng Wu,2,* Zhujun Yang,3 Xuejian Li,1 Zhihong Feng,1 Yimin Zhao1 1State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi’an, People’s Republic of China; 2Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao, People’s Republic of China; 3Xi’an Central Hospital Affiliated to Xi’an Jiaotong University, Xi’an, Shaanxi, 710003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhongshan Wang; Yimin Zhao, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi’an, 710032, People’s Republic of China, Tel/Fax +86-29-84776128, Email wzs_fmmu@163.com; zhaoymdentist@163.comPurpose: Forming a compact biological seal between the gingiva and the implant interface around the percutaneous parts of an implant is one of the key issues in preventing peri-implantitis.Methods: In this study, since microRNA-21 (miR-21) has been approved to promote fibroblast proliferation and collagen formation in skin fibrosis, we prepared miR-21-loaded chitosan (CS)/tripolyphosphate (TPP)/hyaluronic acid (HA) nanoparticles (CTH NPs) and cross-linked them to smooth Ti surfaces with 0.2% gel solution for reverse transfection, after which isolated human gingival fibroblasts were cultured on the miR-21-functionalized Ti substrates.Results: An optimal CS:TPP:HA ratio (1:0.15:0.1) and N/P ratio (20:1) were chosen to produce appropriate nanoparticles. Finally, the CTH/miR-21 nanoparticle-coated smooth Ti surfaces demonstrated increased fibroblast adhesion, proliferation and expression of extracellular matrix-related genes along with similar cytotoxicity and cell spreading on the miR-21-functionalized Ti surface and the unmodified smooth Ti surface.Conclusion: The chitosan-based nanoparticles might be an efficient nonviral miRNA vector to form a stable biological seal in percutaneous areas of Ti for clinical use.Keywords: microRNA, chitosan, hyaluronic acid, nanoparticle, percutaneous implant

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Percutaneous implants are widely used in clinical practice. However, infection is the main clinical problem of percutaneous implants. Titanium dioxide nanotubes are suitable for forming coatings on complex surfaces such as implants. HHC-36, a cationic antimicrobial peptide, has been identified to have a strong broad-spectrum antibacterial effect. In the present study, we use poly D,L-lactic acid (PDLLA) and poly lactic-co-glycolic acid (PLGA) coating to build HHC-36 sustained-release system on the surface of titanium dioxide nanotubes. The titanium specimens were anodized coated with HHC-36-PDLLA/PLGA. The morphology and surface elemental distribution of the specimens were evaluated. Besides, results in the present study demonstrated that with antibacterial peptide HHC-36 sustained-release coating, titanium dioxide nanotubes maintain effective drug release for 15 days in vitro, and show significant antibacterial activity. The proliferation of Staphylococcus aureus can be effectively inhibited by PDLLA/PLGA-HHC-36 coated titanium dioxide nanotube. In addition, PDLLA-HHC-36 and PLGA-HHC-36 coating was demonstrated to be biocompatible and antibacterial in vivo. These findings demonstrated that HHC-36 coated titanium nanotube could improve antibacterial potential of percutaneous implants, and indicated a novel and efficient strategy in preventing bacterial infection of percutaneous implants.

Percutaneous devices are a key technology in clinical practice, used to connect internal organs to external medical devices. Examples include prosthesis, catheters and electrical drivelines. Percutaneous devices breach the skin’s natural barrier and create an entry point for pathogens, making device infections a widespread problem. Modification of the percutaneous implant surface to increase skin integration with the aim to reduce subsequent infection is attracting a great deal of attention. While novel surfaces have been tested in various in vitro models used to study skin integration around percutaneous devices, no skin model has been reported, for the study of bacterial infection around percutaneous devices. Here, we report the establishment of an in vitro human skin equivalent model for driveline infections caused by Staphylococcus aureus, the most common cause of driveline-related infections. Three types of mock drivelines manufactured using melt electrowriting (smooth or porous un-seeded and porous pre-seeded with human fibroblasts) were implanted in human skin constructs and challenged with S. aureus. Our results show a high and stable load of S. aureus in association with the skin surface and no signs of S. aureus-induced tissue damage. Furthermore, our results demonstrate that bacterial migration along the driveline surface occurs in micro-gaps caused by insufficient skin integration between the driveline and the surrounding skin consistent with clinical reports from explanted patient drivelines. Thus, the human skin-driveline infection model presented here provides a clinically-relevant and versatile experimental platform for testing novel device surfaces and infection therapeutics.

Percutaneous devices are a key technology in clinical practice, used to connect internal organs to external medical devices. Examples include prosthesis, catheters and electrical drivelines. Percutaneous devices breach the skin's natural barrier and create an entry point for pathogens, making device infections a widespread problem. Modification of the percutaneous implant surface to increase skin integration with the aim to reduce subsequent infection is attracting a great deal of attention. While novel surfaces have been tested in various in vitro models used to study skin integration around percutaneous devices, no skin model has been reported, for the study of bacterial infection around percutaneous devices. Here, we report the establishment of an in vitro human skin equivalent model for driveline infections caused by Staphylococcus aureus , the most common cause of driveline-related infections. Three types of mock drivelines manufactured using melt electrowriting (smooth or porous un-seeded and porous pre-seeded with human fibroblasts) were implanted in human skin constructs and challenged with S. aureus. Our results show a high and stable load of S. aureus in association with the skin surface and no signs of S. aureus -induced tissue damage. Furthermore, our results demonstrate that bacterial migration along the driveline surface occurs in micro-gaps caused by insufficient skin integration between the driveline and the surrounding skin consistent with clinical reports from explanted patient drivelines. Thus, the human skin-driveline infection model presented here provides a clinically-relevant and versatile experimental platform for testing novel device surfaces and infection therapeutics. [ABSTRACT FROM AUTHOR]

The bone-anchored hearing system (BAHS) has evolved to a common treatment option for various types of hearing revalidation. The BAHS consists of an implant in the skull that breeches the skin. Soft tissue reactions are a common complication associated with BAHS and are generally poorly understood. This study aims to investigate the influence of BAHS and associated skin reactions around the implant. A total of 45 patients were prospectively followed from implantation up to at least 1 year. Swabs were obtained at baseline, 12 weeks follow-up and during cases of inflammation (Holgers score ≥2). The microbiota was assessed using IS-proTM, a bacterial profiling method based on the interspace region between the 16S–23S rRNA genes. Detection of operational taxonomic units, the Shannon Diversity Index, sample similarity analyses and Partial Least Squares Discriminant Analysis (PLS-DA) were employed. Staphylococcus epidermidis, Streptococcus pneumoniae/mitis, Propionibacterium acnes, Staphylococcus capitis, Staphylococcus hominis, Bifidobacterium longum, Haemophilus parainfluenzae, Lactobacillus rhamnosus, Bordetella spp., Streptococcus sanguinis, Peptostreptococcus anaerobius, Staphylococcus aureus, Lactococcus lactis, Enterobacter cloacae, and Citrobacter koseri were the most commonly found bacterial species. S. pneumoniae/mitis was significantly more often observed after implantation, whereas P. acnes was significantly less observed after implantation compared with baseline. The relative abundance of S. epidermidis (17%) and S. aureus (19.4%) was the highest for the group of patients with inflammation. The Shannon Diversity Index was significantly increased after implantation compared with pre-surgical swabs for Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia (FAFV), but not for other phyla. When combining all phyla, there was no significant increase in the Shannon Diversity Index. The diversity index was similar post-surgically for patients experiencing inflammation and for patients without inflammation. With a supervised classifier (PLS-DA), patients prone to inflammation could be identified at baseline with an accuracy of 91.7%. In addition, PLS-DA could classify post-surgical abutments as non-inflamed or inflamed with an accuracy of 97.7%. This study shows the potential of using IS-proTM to describe and quantify the microbiota associated with the percutaneous BAHS. Furthermore, the results indicate the possibility of an early identification of patients susceptible to adverse skin reaction following implantation. Both S. aureus and S. epidermidis should be considered as relevant bacteria for BAHS-associated inflammation.

• Polydopamine can immobilize E-cadherin to a titanium surface with long-term stability. • Orientation of E-cadherin influences cellular response. • E-cadherin functionalization inhibits the migration of keratinocytes. • Fibroblasts do not adhere to E-cadherin functionalized substrates. Percutaneous devices suffer from imperfect sealing of the epidermis-implant interphase, the so-called three-phase junction, allowing invading pathogens access to colonize the implant at the tissue interface and potentially cause an infection. In skin, one of the key components of the epidermal barrier is the E-cadherin mediated adherens junctions. We investigated the response of a human keratinocyte cell line (HaCaT) to a titanium substrate functionalized with the extracellular domain of E-cadherin fused to an Fc domain. Polydopamine was used as a binding layer to attach the E-cadherin to the titanium surface in two ways: 1) by attaching protein A to the polydopamine followed by E-cadherin (aligned orientation) or 2) by direct attachment of the E-cadherin to the polydopamine (random orientation). The E-cadherin surface functionalization was stable for up to two months as determined by ELISA. HaCaTs did attach to the surface irrespective of E-cadherin orientation. However, decreased cell proliferation and increased cell size was observed for cells on aligned E-cadherin surfaces as compared to a positive control coated with fibronectin. The adhesion of the HaCaTs to the surface with aligned E-cadherin was more sensitive to cell media Ca2+ depletion. A confluent layer of HaCaTs was almost immobile on the aligned E-cadherin surface, as compared to a surface coated with fibronectin, whereas cell migration was also observed on randomly oriented E-cadherin. The E-cadherin coated surfaces were non-adhesive for primary human dermal fibroblasts, a cell type not expressing E-cadherin. These results show the potential of using E-cadherin as a functional surface at the three-phase junction of percutaneous implants to ensure epidermal attachment, limit epidermal downgrowth and prevent fibroblast adhesion. [ABSTRACT FROM AUTHOR]

In this study, the soft tissue around 23 percutaneous Brånemark titanium implants was studied using light microscopic morphometry. The duration of the skin penetration varied between 4 and 98 months. The results show that phagocytic and immunocompetent cells (lymphocytes, polymorphonuclear granulocytes, plasma cells, and macrophages) were present in biopsies from patients with irritated as well as nonirritated skin around the implants. The concentration of inflammatory cells was higher in the tissue close to the implant and in this region particularly just beneath the epithelium. The concentration of inflammatory cells in irritated skin did not differ statistically from nonirritated skin. This was probably related to the fact that the grade of skin irritation generally was low in the material and to the relatively small amount of material investigated. The present observations suggest that a cellular barrier of phagocytic and immunocompetent cells may be operative around percutaneous titanium implants. The mechanisms for the clinically manifest irritation and reinforced cellular barrier function are not known but may be related to both the implant per se and to invasion by exogenous agents. [ABSTRACT FROM AUTHOR]

• We combine microgroove pattern with Mg/Zn-MOF74 coating for implant modification. • This modification can enhance both biological sealing and antibacterial effect. • This method is conductive to the long-term success of implants. Enhancing soft tissue integration and preventing implant-associated infection play a crucial role in improving the long-term success of percutaneous implants. Microgroove pattern modification of titanium implants has been proven to be effective for enhancing soft tissue integration. However, single microgroove pattern modification may not improve the antibacterial activity of implants, posing a threat of bacterial infection at the percutaneous site of the implant. While hybrid magnesium/zinc-metal organic framework (Mg/Zn-MOF74) coating exhibits excellent antibacterial ability due to its degradation which generates 2,5-dihydroxyterephthalic acid (DTHA), Zn2+ and Mg2+. Therefore, we propose a surface modification method that combines microgroove pattern modification with the hybrid Mg/Zn-MOF74 coating for titanium implants. We expect to simultaneously utilize microgroove pattern modification for enhancing soft tissue integration and hybrid Mg/Zn-MOF74 coating for improve the antibacterial activity. Both in vitro and in vivo experiments have demonstrated that the combination of microgroove pattern and hybrid Mg/Zn-MOF74 coating of Ti implants can promote fibroblast migration, adhesion, and myogenic differentiation. Meanwhile, this surface modification exhibits promising antibacterial activity, and could inhibit the migration of epithelial cell. These properties not only facilitate the formation of a biological seal, but also reduce the incidence of implant-associated infection. Overall, the microgroove pattern modification combined with hybrid Mg/Zn-MOF74 coating has great potential for the surface modification of Ti implants to promote soft-tissue integration and prevent implant-associated infections. [ABSTRACT FROM AUTHOR]

Bone conduction devices (BCDs) are advocated as an amplification option for patients with congenital conductive unilateral hearing loss (UHL), while other treatment options could also be considered. The current study compared a transcutaneous BCD (Sophono) with a percutaneous BCD (bone-anchored hearing aid, BAHA) in 12 children with congenital conductive UHL. Tolerability, audiometry, and sound localization abilities with both types of BCD were studied retrospectively. The mean follow-up was 3.6 years for the Sophono users ( n = 6) and 4.7 years for the BAHA users ( n = 6). In each group, two patients had stopped using their BCD. Tolerability was favorable for the Sophono. Aided thresholds with the Sophono were unsatisfactory, as they did not reach under a mean pure tone average of 30 dB HL. Sound localization generally improved with both the Sophono and the BAHA, although localization abilities did not reach the level of normal hearing children. These findings, together with previously reported outcomes, are important to take into account when counseling patients and their caretakers. The selection of a suitable amplification option should always be made deliberately and on individual basis for each patient in this diverse group of children with congenital conductive UHL. [ABSTRACT FROM AUTHOR]

Fibroblasts, which play an important role in biological seal formation and maintenance, determine the long-term success of percutaneous implants. In this study, well-defined microporous structures with micropore diameters of 10-60 µm were fabricated by microelectromechanical systems and their influence on the fibroblast functionalities was observed. The results show that the microporous structures with micropore diameters of 10-60 µm did not influence the initial adherent fibroblast number; however, those with diameters of 40 and 50 µm improved the spread, actin stress fiber organization, proliferation and fibronectin secretion of the fibroblasts. The microporous structures with micropore diameters of 40-50 μm may be promising for application in the percutaneous part of an implant. [ABSTRACT FROM AUTHOR]

A percutaneous, osseointegrated (OI) prosthetics are alternative docking systems for upper- and lower-extremity prostheses. Persistent inflammation and micro-motion are known to cause negative soft-tissue adaptation in wound healing and may also be detrimental to implant longevity. In this study, a unique single-stage sheep amputation and implantation model was developed to assess the efficacy of a porous coated sub-dermal fixation surface in the prevention of skin regression around a percutaneous osseointegrated prosthetic implant. Porous coated and smooth sub-dermal fixation surface prosthetics were implanted in the right forelimb of skeletally mature sheep for up to 12 months. Skin regression kinetics and sub-dermal fixation surface coverage were measured from histological samples. Quantitative measurements of porous coated surfaces yielded skin migration rates of 0.90 ± 0.23, 0.56 ± 0.15, 0.44 ± 0.22 mm/month for the 6, 9, and 12 month animals, respectively. In addition, three load dependent regions of skin adaptation were identified; an interface, a transition, and a stress absorbance region. Immediate post-implantation immobilization of the skin may foster improved load-bearing percutaneous device outcomes. The skin adaptations reported here will aid in informing the design and optimization of future percutaneous, OI devices intended for the treatment of upper- and lower-extremity amputees. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013. [ABSTRACT FROM AUTHOR]

Abstract: Epidermal downgrowth, commonly associated with long-term percutaneous implants, weakens the skin-implant seal and greatly increases the vulnerability of the site to infection. To improve the skin attachment and early tissue integration with porous metal percutaneous implants, we evaluated the effect of bone marrow-derived mesenchymal stem cells (BMMSCs) to provide wound healing cues and vascularization to the dermal and epidermal tissues in establishing a barrier with the implant. Two porous metal percutaneous implants, one treated with BMMSCs and one untreated, were placed subdermally on the dorsum of Lewis rats. Implants were evaluated at 0, 3, 7, 28, and 56 days after implantation. Histological analyses evaluated cellular infiltrates, vascularization, quantity and quality of tissue ingrowth, epidermal downgrowth, and fibrous encapsulation. The amount of collagen infiltrating the porous coating was significantly greater for the BMMSC-treated implants at 3 and 28 days post implantation compared to untreated implants. There was an early influx and resolution of cellular inflammatory infiltrates in the treated implants compared to the untreated, though not statistically significant. Vascularization increased over time in both treated and untreated implants, with no statistical significance. Epidermal downgrowth was minimally observed in all implants with or without the BMMSC treatment. Our results suggest that BMMSCs can influence an early and rapid resolution of acute and chronic inflammation in wound healing, and can stimulate early collagen deposition and granulation tissue associated with later stages of wound repair. These findings provide evidence that BMMSCs can stimulate a more rapid and improved barrier between the skin and porous metal percutaneous implant. [Copyright &y& Elsevier]

Abstract: In vitro studies investigating the influence of electric DC current on bacterial detachment have demonstrated that continuous currents of only 25–125μA stimulated staphylococcal strains to detach from surgical stainless steel. However, DC currents produce more power that has to be dissipated by the skin as compared to alternating currents. Also, an excess of ions on the steel can cause negative osteogenesis and fixation results. Therefore, it is the aim of this paper to examine whether detachment of Staphylococcus epidermidis from stainless steel surfaces in a parallel plate flow chamber can also be stimulated using electric block currents. Block currents of 15, 60 and 100μA with different frequencies (0.1–2Hz) and duty cycles (5–50%) were applied to induce bacterial detachment. Block currents of 100μA cause detachment of about 76% of adhering staphylococci from stainless steel, whereas in addition the remaining bacteria are less viable, as determined by culturing the remaining bacteria on agar plates. Therewith, block current-induced detachment of adhering bacteria from stainless steel appears to be an equally promising method to prevent infection of orthopaedic fixation pins and screws than application of DC currents. [Copyright &y& Elsevier]

The development of a percutaneous artificial internal organ system requires a reliable biocompatible connection between the external environment and the inside of the human body. Such is necessary for the success of a permanent left ventricular assist device. However, the search for a satisfactory interface at the epidermal level has proven to be difficult. Carbon has been proposed for this application, but its texture does not typically promote ingrowth from surrounding tissue. We have therefore employed a new processing method to produce a fine trabecularized carbon implant. The method for preparing the implant involves infiltrating low temperature pyrolytic carbon into the surface of a carbon core which is wrapped with carbon fabric. This results in a tightly woven porous structure of carbon (carbon fiber diameter: 35–50 μm, maximal pore size > 200 μm) with gradually increasing porosity from 15–75%. We implanted test samples percutaneously in a calf for in vivo histological evaluation. Thirty days after implantation epidermal downgrowth was minimal. Microscopic analysis revealed that a thin fibrous capsule surrounded the implant, and mature connective tissue with accompanying blood vessels filled the pores of the fine trabecularized carbon layer. From these results we suggest that fine trabecularized carbon is ideally suited for a percutaneous device system in a permanent left ventricular assist device. [ABSTRACT FROM AUTHOR]

An ideal intraosseous transcutaneous implant should form a tight seal with soft tissue, besides a requirement of osseointegration at the bone-fixed position. Si substituted hydroxyapatite (Si-HA) nanorods releasing Si ion and simulating nanotopography of natural tissue were designed on Ti to enhance fibroblast response in vitro and biosealing with soft tissue in vivo . Si-HA nanorods were fabricated by alkali-heat treatment followed with hydrothermal treatment. The hydrothermal formation mechanism of Si-HA nanorods was explored. The surface characteristic of Si-HA nanorods was compared with pure HA nanorods. Fibroblast behaviors in vitro and skin response in vivo on different surfaces were also evaluated. The obtained results show that the substitution of Si did not significantly alter the phase component, morphology, roughness and wettability of HA, but additional Si and more Ca were released from Si-HA into medium. Comparing to pure HA nanrods and Ti substrate, Si-HA nanrods enhanced cell behaviors including proliferation, fibrotic phenotype and collagen secretion in vitro , and reduced epithelial down growth in vivo . The enhanced cell response and biosealing should be due to the releasing of Ca, Si and nanotopography of Si-HA nanorods. Si-HA nanorods can be a potential coating to accelerate skin integration for percutaneous implants in clinic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.)