Integrated Term Project, Semester - II, NIFT Gandhinagar

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MEDICAL TEXTILES
NAME: Shubham Singh & Srishti Kumari
COURSE: B.F.Tech
SEMESTER : II
SUBJECT: Integrated Term Project
ROLL : BFT/15/138 & BFT/15/440
MENTOR: Ms. Jalpa Vanikar

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Certificate
This is to certify that Shubham Singh (BFT/15/138) & Srishti Kumari (BFT/15/440)
who are students of Bachelor of Fashion Technology(Apparel Production) of NIFT
Gandhinagar worked on the project “Medical Textiles” under my guidance during the
period of January, 2016 to 6 May, 2016.
The matter embodied in this project is work done by the students and has
not been submitted to whether this institute or any other institute/university for the
fulfilment of the requirement of any course of study.
……………………………………………
Signature of the Mentor

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Acknowledgement
We would like to thank all the people who supported and guided us in collecting
information for our project on MEDICAL TEXTILES; without whom this report
wouldn’t have been in its present form.
We are highly grateful to our mentor Ms. Jalpa Vanikar for active direction of our project.
We would like to express our deep gratitude to her who mentored us to complete the given
project successfully; which was full of learning and enhanced our experience.
Thanks are also extended to all the faculty members of NIFT Gandhinagar for their
valuable suggestions.

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Preface
“Health is Wealth”, so goes the old adage. Health is the greatest asset a man can have. It is
the duty of everybody to keep themselves healthy.
The documentation is done according to the curriculum of our subject Integrated Term
Project. It deals with in-depth & informative study and also focuses on various kinds of
MEDICAL TEXTILES.
From cotton rolls to artificial kidneys , the scope of
MEDICAL TEXTILES is much wider and bright. The technologies in MEDICAL
TEXTILES have been a revolution and billions of money has been invested so far.
This project is a humble attempt to go through the world of MEDICAL TEXTILES. It
tries to explore every possible avenue to bring out all the major technologies. Diagrams have
been inserted wherever necessary. The facts are also compared in the tabular form which
altogether makes the project interesting, appealing and informative.

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INDEX
Serial No. Page No.
1 What are medical textiles…………………………………………………………..6
2 Areas of interest ………………………………………….…………………….….7
3 Brief history of medical textiles……………………...……………………8
4 Applications of textiles in medical field……………….…………………..8
5 Characteristics of material for medical use……………..………………….9
6 Biodegradability and bioabsorbality………………………………………10
7 Blood compatibility……………………………………..………….……11
8 Fibres used in manufacturing……………………………….....…………..12
9 Non-implantable materials…………………………....…………………..13
10 Extracorporeal devices…………………………………..………………..20
11 Healthcare/Hygiene products……………………………………………28
12 Medical Textiles market in India…………………………………………32
13 Growth drivers………………………………………………….……….34
15 Market Access……………………………………….…………………..36
16 Challenges, Opportunities and Recommendations…………………………37
17 Conclusion….….………………………………………………………..40
18 References…………………....…………………………....……………..41

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INTRODUCTION
WHAT ARE MEDICAL TEXTILES?
Combination of textile technology and medical sciences has resulted into a new
field called medical textiles. Textile materials and products that have been
engineered to meet particular needs are suitable for any medical and surgical
application where a combination of strength, flexibility and sometimes moisture
and air permeability are required. Materials used include mono-filament and multi-
filament yarns, woven, knitted, non-woven fabrics and composite structures.
The number of applications are huge and diverse, ranging from a single thread
suture to the complex composite structures for bone replacement; from simple
cleaning wipe to advanced barrier fabrics used in operating rooms.

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These materials can be categorized into four separate and specialized areas of
applications as follows: -
1. Non-Implantable materials: Wound Dressings, Bandages, Plasters etc.
2. Extracorporeal devices: Artificial Kidney/Liver/Lung
3. Implantable materials: Sutures, Vascular Grafts, Artificial Ligaments,
Artificial Joints etc.
4. Healthcare/Hygiene products: Bedding, Clothing, Surgical Gowns, Clothes,
Wipes etc.
The majority of Health-care products manufactured worldwide are disposable, and
the remaining can be re-used. Although textile materials have been widely adopted
in medical and surgical applications for many years, new uses are still being found.
Research utilizing new and existing fibers and fabric forming techniques has led to
the advancement of medical and surgical textiles. At the forefront of these
developments are the fabric manufacturers who produce a variety of fibers whose
properties govern the product and the ultimate application, whether the
requirement is absorbency, tenacity, flexibility, softness or biodegradability.
AREAS OF INTEREST
1. Textiles of bactericidal fibres.
2. Hygiene non-wovens.
3. Bandage materials.
4. Suture – thread used to sew skin
5. Operating and emergency room textiles
6. Textiles products for surgery
7. Textile reinforced prostheses – artificial replacement of a body part
8. Operating sheets
9. Hospital bed linen and blankets
10. Mattresses and their protective covers
11. Medical cushions
12. Dental floss - thread used to clean the area between teeth
13. Synthetic skin
14. General textiles for institutional and hospital use.

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15. Doctors and nurses clothing
16. Rescue service equipments
17. Textiles for medical equipments.
BRIEF HISTORY OF MEDICAL TEXTILES
The history of medical textiles began with the development of wound closures
and sutures thousands of years ago. The origin of surgery led to the development
of wound closures during 5000-3000 BC. These wound closures were particularly
made of natural materials such as flax, silk, linen strips, and cotton. In order to
reduce tissue drag and ensure a clean wound closure procedure, the natural
materials used were first lubricated in oil and wine. Mandibles(jaw/jawbones) of
soldier ants were also used to make wound closures. These were used for making
surgical clips in bowel surgery. In 30 AD, the Roman Celsus described the use of
sutures and clips, while Galen described the use of silk and catgut in 150 AD.
Suture material made from flax, hemp, and hair were described by the Indian
plastic surgeon Susruta. Surgical and suture technique finally evolved in the
1800s with the development of sterilization procedures. Synthetic sutures were
introduced with the development of synthetic polymers and fibers.
APPLICATIONS OF TEXTILES IN MEDICAL FIELD
1. Repair or replacement of injured tissue
 prostheses of bone, joint or tooth
 artificial: heart value, blood vessel or skin
 contact lens
2. Assist/ temporary substitution for psychological functions of a failed organ
 artificial heart/lung/kidney/liver or pancreas
3. Disposable article in a daily medical treatment
 tubing, syringe, suture, catheters tube inserted into a body cavity to remove
fluid etc.

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4. Navel drug delivery system
 devices for controlled release of drugs, plastic release devices
5. Clinical lab tests
 tool with quick response, high accuracy, high sensitivity for tests
6. Separation of blood components
 Plasma separation, cell separation, removal of virus and bacteria.
CHARACTERISTICS OF MATERIAL FOR MEDICAL USE
1. Non toxicity, non-allergic response
2. Ability to be sterilized
3. Mechanical properties – strength, elasticity, durability
4. Biocompatibility – Toxic materials which cause temperature rise,
inflammation, allergic reaction, deformity etc. are not preferred
5. Diffusion properties – drug delivery system, members in artificial kidneys
6. Optical properties – contact lens materials
7. Polyurethanes – widely used in hemodialysis sets, blood bags, heart assist
devices and pacemaker. Example – biomer : high tensile strength and artificial
heart pumps.
8. Silicon rubber polymer – internal applications, thermal stability, flexibility and
elasticity, plastic and reconstructive surgery, replacement of cartilage or bone.
9. PMMA(Poly Methyl Meth Acrylate) – bone cement, dentures, repair of cranial
defects, jaw correction, spinal fixations.
10. Textile materials used – fibers, yarns (mono-filament and multi-filament),
fabrics (woven, knit, non-woven), composites.

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11. Major requirements - absorbency, tenacity, flexibility, softness,
biodegradability. It may be natural/synthetic.
12. Biodegradable/Non-biodegradable.
13. Most common natural material for Medical textiles are Cotton and Silk.
14. Artificial materials are: Carbon, glass, PTFE, polyamide, polyester,
polypropylene.
15. Collagen fibers – speciality fiber, biodegradable material obtained from bovine
skin, used as suture, strong as silk.
16. Calcium alginates fiber – seaweed, wound healing, nontoxic, biodegradable.
17. Chitin – insect skin, fibers absorbed by the body, good healing, artificial skin.
BIODEGRADABILITY AND BIOABSORBALITY
Biomedical fibres can also be classified according to biodegradability. Materials
that are absorbed by the body two to three months (or longer) after implantation
are considered as biodegradable and include poly-amide and some poly-urethanes.
Although Cotton and Viscose Rayon are biodegradable, they are not used as
implants. Materials such as polyester, polypropylene, polytetrafluoroethylene
(PTFE) and carbon are not absorbed by the body and are considered non-
biodegradable.
Biodegradable materials are generally called bio-absorbable materials. They are
decomposed in the body and the Decomposition products are metabolized and
excreted from the body. They may also be temporarily used to replace the human
organs. Biomedical applications of bio-absorbable materials are surgical sutures,
synthetic skin, adhesive end joints, Drug Delivery Systems(DDS), bio-hybrid
organs etc.
Bio-absorption of polymeric materials has two stages:
1. Decomposition
2. Absorption

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Depending upon the polymer, decomposition may or may not require an enzyme.
By definition, only the enzymatically degradable polymers are called
“biodegradable”. In addition to degradability, the bio-absorbable materials must
satisfy other requirements such as biocompatibility, mechanical and chemical
properties, and must also be non-toxic.
The degradation and absorption rates should be compatible with the healing rate of
bio-tissues and organs. The healing rate is different for various human bio-tissues :
three to ten days for dermal tissues, one to two months for internal organs and two
to three months for hard tissues and at least six months for regeneration of large
organs. Bio-absorbable implant materials should maintain their mechanical
properties and functions until the bio-tissues are completely cured. After complete
healing of bio-tissues, the implanted materials should be degraded and absorbed
quickly to minimize their side effects. Factors that affect degradability include
chemical structure, crystallinity, hydrophilic/hydrophobic balance, shape and
morphology.
BLOOD COMPATIBILITY
Blood compatibility is necessary in biomedical materials, especially blood
contacting devices, such as artificial hearts and artificial vessels as well as blood
purification devices and blood catheters.
Blood compatibility implies that a material should not cause clotting of blood
formed within a blood vessel. In addition, materials used in long term should not
cause alteration of plasma proteins, destruction of enzymes, depletion of
electrolytes, adverse immune responses, damage to adjacent tissue, toxic and
allergic reactions, or destruction of cellular elements of blood such as red blood
cells, white blood cells and platelets.
Although several materials have been used successfully in conjunction with blood,
at present, there is no polymer which is truly blood compatible.
Carbon fibres have good blood compatibility and are appropriate for applications
with rigid structures, but they are not suitable for structures that are thin or that
require being flexed.

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Micro-fibres in composite form are often blood compatible. They are able to
anchor viable fibroblastic cells, thus producing a living surface. This surface is
considered blood compatible. Typical microfibers include those made of
polyesters. Other fibres include PTFE which is used as artificial artery.
Polyethylene is often used as tubing to carry blood.
FIBRES USED IN MANUFACTURING
Commodity Fibres
Fibres used in medicine and surgery may be classified depending on whether
the materials from which they are made are natural or synthetic, biodegradable or
non-biodegradable. All fibres used in medical applications must be non-toxic, non-
allergenic, non-carcinogenic, and be able to be sterilized without imparting any
change in the physical or chemical characteristics.
Commonly used natural fibres are Cotton and Silk but also included are the
regenerated cellulosic fibres (Viscose rayon); these are widely used in non-
implantable materials and healthcare/hygiene products. A wide variety of products
and specific applications utilize the unique characteristics that synthetic fibres
exhibit. Commonly used synthetic materials include polyester, polyamide,
polytetrafluoroethylene (PTFE), polypropylene, carbon, glass, and so on.
The second classification relates to the extent of fibre biodegradability.
Biodegradable fibres are those which are absorbed by the body within 2–3 months
after implantation and include Cotton, Viscose rayon, Polyamide, Polyurethane,
Collagen, and Alginate. Fibres that are slowly absorbed within the body and take
more than 6 months to degrade are considered non-biodegradable and include
Polyester (e.g. Dacron), Polypropylene, PTFE and Carbon.
Speciality Fibres
A variety of natural polymers such as Collagen, Alginate, Chitin and Chitosan
have been found to be essential materials for modern wound dressings.

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Collagen, which is obtained from bovine skin, is a protein available either in fibre
or hydrogel (gelatin) form. Collagen fibres, used as sutures, are as strong as silk
and are biodegradable. The transparent hydrogel that is formed when Collagen is
cross linked in 5–10% aqueous solution, has a high oxygen permeability and can
be processed into soft contact lenses.
Calcium alginate fibres are produced from seaweed. The fibres possess healing
properties, which have proved to be effective in the treatment of a wide variety of
wounds. Dressings comprising calcium alginate are non-toxic, biodegradable and
haemo-static.
Chitin which is obtained from crab and shrimp shells, has excellent anti
thrombogenic characteristics, and can be absorbed by the body and promote
healing. Chitin nonwoven fabrics used as artificial skin adhere to the body
stimulating new skin formation which accelerates the healing rate and reduces
pain.
Treatment of Chitin with alkali yields chitosan that can be spun into filaments of
similar strength to Viscose rayon. Chitosan is now being developed for slow drug-
release membranes.
Other fibres that have been developed include Poly-capro-lactone (PCL) and Poly-
propio-lactone (PPL), which can be mixed with cellulosic fibres to produce highly
flexible and inexpensive biodegradable nonwovens.
Melt spun fibres made from Lactic acid have similar strength and heat properties as
Nylon and are also biodegradable.
Microbiocidal compositions that inhibit the growth of microorganisms can be
applied on to natural fibres as coatings or incorporated directly into artificial fibres.
Non-Implantable Materials
These materials are used for external applications on the body and may or may not
make contact with skin. The table below illustrates the range of textile materials
employed within this category, the fibres used, and the principal method of
manufacturing.

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Table: Non-Implantable Materials
WOUND CARE
A number of wound dressing types are available for a variety of medical and
surgical applications . The functions of these materials are to provide protection
against infection, absorb blood/exudate, promote healing and, in some
instances, apply medication to the wound. Common wound dressings are
composite materials consisting of an absorbent layer held between a wound contact
layer and a flexible base material. The absorbent pad absorbs blood or liquids and
provides a cushioning effect to protect the wound. The wound contact layer should
prevent adherence of the dressing to the wound and be easily removed without
disturbing new tissue growth. The base materials are normally coated with an
adhesive to provide the means by which the dressing is applied to the wound.
Developments in coating technology have led to pressure sensitive adhesive

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coatings that contribute to wound dressing performance by becoming tacky at
room temperature but remain dry and solvent free.
The use of Collagen, Alginate, and Chitin fibres has proved successful in many
medical and surgical applications because they contribute significantly to the
healing process.
When Alginate fibres are used for wound contact layers the interaction between the
Alginate and the exuding wound creates a sodium calcium alginate gel. The gel is
hydrophilic, permeable to oxygen, impermeable to bacteria, and contributes to the
formation of new tissue.
Wound Dressings

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Wound Dressing Concept
Other textile materials used for wound dressing applications include Gauze, Lint,
and Wadding.
Gauze is an open weave, absorbent fabric that when coated with paraffin wax is
used for the treatment of burns and scalds. In surgical applications gauze serves as
an absorbent material when used in pad form (swabs). Yarns containing barium
sulphate are incorporated so that the swab is X-ray detectable.
Lint is a plain weave cotton fabric that is used as a protective dressing for first-aid
and mild burn applications.
Wadding is a highly absorbent material that is covered with a nonwoven fabric to
prevent wound adhesion or fibre loss.
BANDAGES
Bandages are designed to perform a whole variety of specific functions depending
upon the final medical requirement. They can be woven, knitted, or nonwoven and
are either elastic or non-elastic. The most common application for bandages is to
hold dressings in place over wounds. Such bandages include lightweight knitted or
simple open weave fabrics made from Cotton or Viscose that are cut into strips;
then scoured, bleached, and sterilized.
Elasticated yarns are incorporated into the fabric structure to impart support and
conforming characteristics. Knitted bandages can be produced in tubular form in
varying diameters on either warp or weft knitting machines. Woven light support
bandages are used in the management of sprains or strains and the elasticated
properties are obtained by weaving cotton crepe yarns that have a high twist
content.
Similar properties can also be achieved by weaving two warps together, one beam
under normal tension and the other under high tension. When applied under
sufficient tension, the stretch and recovery properties of the bandage provides
support for the sprained limb. Compression bandages are used for the treatment
and prevention of leg ulceration, and are designed to exert a required amount of
compression on the leg when applied at a constant tension. Compression bandages
are classified by the amount of compression they can exert at the ankle and include
extra-high, high, moderate, and light compression and can be either woven and
contain Cotton and elastomeric yarns or warp and weft knitted.

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Orthopaedic cushion bandages are used under plaster casts and compression
bandages to provide padding and prevent discomfort. Nonwoven orthopaedic
cushion bandages may be produced from either polyurethane foams, polyester, or
polypropylene fibres and contain blends of natural or other synthetic fibres.
Nonwoven bandages are lightly needle-punched to remain bulk and loft. A
development in cushion bandage materials is a fully needle punched structure
which possesses superior cushion properties compared with existing materials.
(a) Elasticated Flat Bandage (b) Tubular Finger Bandages

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(c) Tubular Elasticated Net Garment
(d) Tubular Support Bandages (e) Hip Spica

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(f) and (g) Orthopaedic Casting Bandage
(h) Pressure Gloves (i) Pressure Garment

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(j) Lumbar/Abdominal Support
(k) Anti-Embolism Stockings
EXTRACORPOREAL DEVICES
Extracorporeal devices are mechanical organs that are used for blood purification
and include the artificial kidney(dialyser), the artificial liver, and the mechanical
lung. The function and performance of these devices benefit from fibre and textile
technology.
The function of the artificial kidney is achieved by circulating the blood through a
membrane, which may be either a flat sheet or a bundle of hollow regenerated
cellulose fibres in the form of cellophane that retain the unwanted waste materials.
Multilayer filters composed of numerous layers of needle punched fabrics with

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varying densities may also be used and are designed rapidly and efficiently to
remove the waste materials.
The artificial liver utilizes hollow fibres or membranes similar to those used for the
artificial kidney to perform their function.
The microporous membranes of the mechanical lung possess high permeability to
gases but low permeability to liquids and functions in the same manner as the
natural lung allowing oxygen to come into contact with the patient’s blood.
Implantable Materials
These materials are used in effecting repair to the body whether it be wound
closure(sutures) or replacement surgery(Vascular grafts, Artificial ligaments).
Bio-compatibility is of prime importance if the textile material is to be accepted by
the body and four key factors will determine how the body reacts to the implant.
These are as follows:
1) The most important factor is porosity which determines the rate at which human
tissue will grow and encapsulate the implant.
2) Small circular fibres are better encapsulated with human tissue than larger
fibres with irregular cross-sections.
3) Toxic substances must not be released by the fibre polymer, and the fibres
should be free from surface contaminants such as lubricants and sizing agents.
4) The properties of the polymer will influence the success of the implantation in
terms of its biodegradability.

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Extracorporeal Devices
Miscellaneous surgical hosiery and other products made from non-implantable materials:
(a) Cervical Collar (b) Foam Padded Arm Sling

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(c) Adjustable Wrist Brace (d) Anti-Decubitus Boots
Implantable Materials

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Sutures
Sutures for wound closure are either monofilament or multifilament threads
that are categorised as either biodegradable or non-biodegradable. Biodegradable
sutures are used mainly for internal wound closures and non-biodegradable sutures
are used to close exposed wounds and are removed when the wound is sufficiently
healed.
Soft-Tissue Implants
The strength and flexibility characteristics of textile materials make them
particularly suitable for soft-tissue implants. A number of surgical applications
utilize these characteristics for the replacement of tendons, ligaments, and cartilage
in both reconstructive and corrective surgery.
Artificial tendons are woven or braided porous meshes or tapes surrounded by a
silicone sheath. During implantation the natural tendon can be looped through the
artificial tendon and then sutured to itself in order to connect the muscle to the
bone.
Textile materials used to replace damaged knee ligaments (anterior cruciate
ligaments) should not only possess biocompatibility properties but must also have
the physical characteristics needed for such a demanding application.
Braided polyester artificial ligaments are strong and exhibit resistance to creep
from cyclic loads. Braided composite materials containing carbon and polyester
filaments have also been found to be particularly suitable for knee ligament
replacement.
There are two types of cartilage found within the body, each performing different
tasks. Hyaline cartilage is hard and dense and found where rigidity is needed, in
contrast, elastic cartilage is more flexible and provides protective cushioning. Low
density polyethylene is used to replace facial, nose, ear, and throat cartilage; the
material is particularly suitable for this application because it resembles natural
cartilage in many ways. Carbon fibre reinforced composite structures are used to
resurface the defective areas of articular cartilage within synovial joints(knee).

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Anterior Cruciate Ligament Prostheses

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Orthopaedic Implants
Orthopaedic implants are those materials that are used for hard tissue applications
to replace bones and joints. Also included in this category are fixation plates that
are implanted to stabilize fractured bones. Fibre-reinforced composite materials
may be designed with the required high structural strength and biocompatibility
properties needed for these applications and are now replacing metal implants for
artificial joints and bones.
To promote tissue in-growth around the implant, a non-woven mat made from
graphite and PTFE(e.g. Teflon) is used, which acts as an interface between the
implant and the adjacent hard and soft tissue.
Composite structures composed of poly-urethane and reinforced with poly-glycolic
acid have excellent physical properties. The composite can be formed into shape
during surgery at a temperature of 60 °C and is used for both hard and soft tissue
applications.
Braided surgical cables composed of steel filaments ranging from 13–130mm are
used to stabilize fractured bones or to secure orthopaedic implants to the skeleton.
Cardiovascular Implants
Vascular grafts are used in surgery to replace damaged thick arteries or veins.
Commercially available vascular grafts are produced from polyester(e.g. Dacron)
or PTFE(e.g. Teflon) with either woven or knitted structures. Straight or branched
grafts are possible by using either weft or warp knitting technology. Polyester
vascular grafts can be heat set into a crimped configuration that improves the
handling characteristics. During implantation the surgeon can bend and adjust the
length of the graft, which, owing to the crimp, allows the graft to retain its circular
cross-section. Knitted vascular grafts have a porous structure which allows the
graft to become encapsulated with new tissue but the porosity can be
disadvantageous since blood leakage( haemorrhage ) can occur through the
interstices directly after implantation. This effect can be reduced by using woven
grafts but the lower porosity of these grafts hinders tissue ingrowth; in addition,
woven grafts are also generally stiffer than the knitted equivalents. In an attempt to
reduce the risk of haemorrhage, knitted grafts have been developed with internal
and external surfaces in order to fill the interstices of the graft. Another method is

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to seal the graft with the patient’s blood during implantation. This is a time-
consuming process and its effectiveness is dependent upon the patient’s blood
chemistry and the skill of the surgeon. Pre-sealed grafts have zero porosity when
implanted but become porous allowing tissue ingrowth to occur. The graft is
impregnated with either collagen or gelatin that, after a period of 14 days, degrades
to allow tissue encapsulation. Artificial blood vessels have been developed using
porous PTFE tubes. The tube consists of an inner layer of collagen to prevent
blood clot formation and an outer biocompatible layer of collagen with the tube
itself providing strength. Artificial heart valves are covered with polyester (e.g.
Dacron) fabrics in order to provide a means of suturing the valve to the
surrounding tissue.

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Vascular Prosthesis
HEALTHCARE/HYGIENE PRODUCTS
Healthcare and hygiene products are an important sector in the field of medicine
and surgery. The range of products available is vast but typically they are used
either in the operating theatre or in the hospital ward for the hygiene, care, and
safety of staff and patients. Textile materials used in the operating theatre include

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surgeon’s gowns, caps and masks, patient drapes and cover cloths of various sizes.
It is essential that the environment of the operating theatre is clean and a strict
control of infection is maintained. A possible source of infection to the patient are
the pollutant particles shed by the nursing staff which carry bacteria. Surgical
gowns should act as a barrier to prevent the release of pollutant particles into the
air. Traditionally, surgical gowns are woven cotton goods that not only allow the
release of particles from the surgeon but are also a source of contamination
generating high levels of dust(lint). Disposable non-woven surgical gowns have
been adopted to prevent these sources of contamination to the patient and are often
composite materials comprising non-woven and polyethylene films.
For example:
The need for a reusable surgical gown that meets the necessary criteria has resulted
in the application of fabric technology adopted for clean room environments.
Surgical masks consist of a very fine middle layer of extra fine glass fibres or
synthetic micro-fibres covered on both sides by either an acrylic bonded parallel-
laid or wet-laid nonwoven. The application requirements of such masks demand
that they have a high filter capacity, high level of air permeability, are lightweight
and non-allergenic. Disposable surgical caps are usually parallel-laid or spun-laid
non-woven materials based on cellulosic fibres. Operating room disposable
products and clothing are increasingly being produced from hydro-entangled non-
wovens. Surgical drapes and cover cloths are used in the operating theatre either to
cover the patient(drapes) or to cover working areas around the patient(cover
cloths).
Non-woven materials are used extensively for drapes and cover cloths and are
composed of films backed on either one or both sides with nonwoven fabrics. The
film is completely impermeable to bacteria while the non-woven backing is highly
absorbent to both body perspiration and secretions from the wound. Hydrophobic
finishes may also be applied to the material in order to achieve the required
bacteria barrier characteristics. Developments in surgical drapes has led to the use
of loop-raised warp-knitted polyester fabrics that are laminated back to back and
contain microporous PTFE films in the middle for permeability, comfort and
resistance to microbiological contaminants.

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The second category of textile materials used for healthcare and hygiene products
are those commonly used in hospital wards for the care and hygiene of the patient
and includes bedding, clothing, mattress covers, incontinence products, cloths and
wipes. Traditional woollen blankets have been replaced with cotton woven
blankets to reduce the risk of cross-infection and are made from soft-spun two-fold
yarns which possess the desirable thermal qualities, are durable and can be easily
washed and sterilised.
Clothing products, which include articles worn by both nursing staff and patients,
have no specific requirements other than comfort and durability and are therefore
made from conventional fabrics. In isolation wards and intensive care units,
disposable protective clothing is worn to minimize cross infection.
These articles are made from composite fabrics that consist of tissue reinforced
with a polyester or polypropylene spun-laid web. Incontinence products for the
patient are available in both diaper and flat sheet forms with the latter used as
bedding. The disposable diaper is a composite article consisting of an inner
covering layer(cover stock), an absorbent layer and an outer layer. The inner
covering layer is either a longitudinally orientated polyester web treated with a
hydrophilic finish, or a spun-laid polypropylene non-woven material.
A number of weft- and warp-knitted pile or fleece fabrics composed of polyester
are also used as part of a composite material which includes foam as well as PVC
sheets for use as incontinence mats. Cloths and wipes are made from tissue paper
or nonwoven bonded fabrics, which may be soaked with an antiseptic finish. The
cloth or wipe may be used to clean wounds or the skin prior to wound dressing
application, or to treat rashes or burns.
Surgical hosiery with graduated compression characteristics is used for a number
of purposes, ranging from a light support for the limb, to the treatment of venous
disorders. Knee and elbow caps, which are normally shaped during knitting on
circular machines and may also contain elastomeric threads, are worn for support
and compression during physically active sports or for protection.

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Healthcare/Hygiene Products
Surgical Garments

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MED-TEX MARKET IN INDIA
 The Med-Tex market in India was $4.4 billion in 2013 and is growing at an
annual rate of 15%.
 The Med-Tex market in India is estimated to grow to $29 billion by 2025.
 The Med-Tex market is categorized into several segments. There is no
consistent methodology for this segmentation.
The Espicom Business Intelligence reports (2011) categorized Med-Tech into:
i. Consumables
ii. Dental Products
iii. Orthopaedic & Prosthetics
Deloitte classifies the Indian Med-Tex market into segments such as :
i. Orthopaedic/ Prosthetic Goods;
ii. Bandages And Other Medical Supplies; And
iii. Others Category
Indian Med-Tex Industry (2011) - Key Segments

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Orthopaedic / Prosthetic goods as a segment grew the fastest between 2006 – 2010
at a rate of 35.5%.
While segments such as Orthopaedic/ Prosthetic goods(18.2%) are expected to
grow at a rate above the industry average.
GROWTH DRIVERS
1) Increased Public Spending:
To meet the targets by 2016, the Indian government has increased its spending
over the past Five Year Plans. The healthcare spending is geared towards multiple
focus areas, ranging from healthcare infrastructure, equipment, access to services,
and insurance among others. The Five Year Plans of the Planning Commission
have CHCs, and Sub-Centers etc. to create more facilities to provide care. Roughly
$75 billion will be spent by the government over the next 5 years for the National
Rural Health Mission. An advent in the number of healthcare facilities in the
country will lead to more requirements for medical equipment.
2)Increasing Demand
The number of hospitals in the country is increasing in both the private and public
sectors. The healthcare providers sector is expected to increase in value to over
$160 billion in 2016 at a growth rate of over 15%. Private hospitals grew at close
to 27% between 2009-2012 driven by growth in Tier II and III cities and towns.
The increase in the number of private players in the country will lead to an increase
in demand for medical equipment.
3)Government Incentives
The government has made several provisions to spur private investment in the
healthcare sector through several incentives. There is strong support from the
government, encouraging the private sector including tax deductions for creating
delivery infrastructure and duty exemptions on medical equipment.

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Hospitals(100+ beds ) are eligible for 150% deduction for capital expenditure and
are also exempted from paying Service Tax. New hospitals set up in rural areas are
entitled to 100% tax deductions on profits over 5 years. The custom duty on life-
saving equipment has been reduced to 5% from 25%. Lastly, import duty on
medical equipment has been reduced to 7.5%.
4)Demand for Quality
With an increase in incomes, there is greater affordability among the people for
quality healthcare services than before. Private healthcare accounts for a lion’s
share of the healthcare market in India. The growth in the number of specialty and
super-specialty hospitals and clinics has been a recent trend. This growth in the
niche service area facilities is expected to grow in the coming years driven by
chains such as Apollo, Fortis, and Max Healthcare. Further, the increase in
insurance penetration to reach close to 20% of the population by 2015, coupled
with growth of these specialty clinics is a driver.
5)Medical Tourism
Medical tourism is growing in India and was worth $3.9 billion of market value by
2014. This is due to the fact that several crucial and important surgeries are
comparatively cheaper in India than in developed and other developing countries.
Medical tourists expect high quality care and service at cheaper costs—something
that Indian hospitals have been able to do successfully. The growth in the medical
tourism sector will call for an increased need for high end equipment, further
spurring the Indian Med-Tex market.
6)Disease Incidents
The steep increase in the incidence of several lifestyles related Non-Communicable
diseases is driving up the demand for certain key areas of the Medical Technology
industry in India. Hospitalization cases for Oncology(study of tumours) are
expected to grow to 3.1 million cases by 2015 and 4.2 million by 2018. This
increase in the incidence would lead to an increase in the diagnosis of cancer and
related devices and equipment. Further, the need for equipment to treat the patients

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would also increase in the future. A sedentary lifestyle with a lack of physical
exercise has led to an increase in the number of cases of back and joint problems.
This has led to an increase in demand for spinal implants, various joint implants
and related products. The number of Road Traffic Accidents in India is also on the
rise. This increase in the impact of road injuries will lead to a more demand for
orthopaedics.
7) Impact Of Local Manufacturing
Local manufacturing in the country is increasing, even though the bulk of the
products produced are consumables. There is a small growth in the high tech
manufacturing segments. This growth of local manufacturing is enabling the
companies to produce cheaper medical equipment leading to more consumption
and growth in the Med-Tex market.
8)Increasing Innovation
There is a trend for increased innovation in the Medical Technology industry in
India. These innovations in products and services lead to improved accessibility
and improved services for the patients leading to growth in the Medical Textiles
market.
MARKET ACCESS
India has 29 states and 7 union territories with differing cultures & languages.
Healthcare has been mandated as a State-subject under the Constitution; therefore,
public health purchases happen independently at each of the states. Private
healthcare facilities are also distributed and there are few large corporate chains—
thereby making the selling process more difficult.
The purchasing system in India is quite bureaucratic as committee-based
purchasing is frequent and typical, which lengthens the purchasing process.
Most Med-Tex companies today follow a hands-off business model that relies on
external distributors who provide better market coverage and flexibility at a lower

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cost. However, the trade-off is that companies have less control over the customer
and market dynamics. These external third-party distributors continue to remain
valuable whenever there is a need to reach customers in remote areas. Hence, there
is a need to keep a balance between the usage of internal distribution resources and
external third-party distributors. Investment in service infrastructure will be
another key factor to penetrate the Indian market.
Today, the lack of infrastructure not only leads to challenges in reaching the
customer but also to deliver services on time. A responsive service network would
make a big difference to the continuity of patient care.
Products and solutions need to be tailored to the local market’s unmet needs.
Several multinational companies have initiated specific product development and
manufacturing programs in India. Many of the local (Indian) companies are
improving their product design with newer technologies, manufacturing
capabilities, and quality standards, while continuing to keep the costs low.
Rural Market
The Indian rural market is really unique, given the following aspects –
1) Reliability is an important factor for Indian rural market as services are not
easily accessible
2) Language is an issue—India is a multi-lingual country, so challenges in terms
of the instruction manual in local languages need to be addressed
3) Ruggedness of the system should be considered as the landscape varies from
deserts, mountains, with extreme weather conditions of both temperature and
moisture.

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CHALLENGES
Presently, the healthcare infrastructure distribution in India is skewed towards
urban areas in terms of the number of facilities(hospitals, number of beds) and
clinical staff(doctors, nurses). The rural areas which comprise approximately 70%
of the Indian population are largely undeserved. Adequately serving the healthcare
needs of the Indian rural population remains a significant challenge.
The gaps in the current healthcare sector, especially in terms of shortages of
hospital beds are evident as the density per population for each of these is
significantly lower than the world average.
Furthermore, spending per episode of illness in rural areas, especially for the poor
population is a big expense. This category of poor patients ends up spending close
to 44% of their monthly household expenditure for OPD treatment. This is even
more significant as private facilities cost close to 217% of their monthly household
expenditure. Providing affordable care to these masses is a big challenge for the
industry.
The existing manufacturing setting for medical textiles in India is not as developed
and poses a challenge for manufacturing high tech complex products.
Market access is quite difficult and complex in India. Most Medical Textile
companies follow a hands-off model and use external distributors to reach the
market. However, this results in less control over the customer and market
dynamics that poses a challenge to effectively market the product. Also, it is very
demanding to meet the specific requirements of the Indian market. There is a
requirement for low cost products with high quality that can be used in resource
constrained settings.
Further, a feasibility study found that key barriers to success in the Indian Medical
Technology industry for start-ups are access to capital, access to clinical partners
and technical resources, product engineering, development and regulatory
expertise, access to labs and equipment, lack of ideas and understanding of clinical
needs.

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OPPORTUNITIES
India is the second most populous country in the world with a huge requirement for
healthcare services. The opportunity in the Med-Tex industry is also tremendous.
The healthcare spend from the private sector comprises over 70% of the market
which is more than comparable developing countries as well as developed
countries. The hospital sector comprises about a half of the total healthcare market,
and the bulk of this market is through the in-patient segment. There are
opportunities to cater to the in-patient market.
The growth in the healthcare market is largely driven by the higher incomes of the
citizens who also have greater healthcare awareness, especially with the advent of
increased non-communicable diseases. The market currently is still
underpenetrated and this creates an opportunity to cater to the needs of such a
population.
Growing healthcare awareness is leading to increased precautionary treatments
along with an increase in the diagnostic sector. This creates an opportunity not
only in the diagnostic market but also in the hospital market as increased diagnosis
leads to increased hospitalization.
RECOMMENDATIONS
There are real opportunities in the MedTex industry in India. In order to take
realistic advantage of these opportunities, the development of products and
solutions should take into account the aspects of affordability and accessibility.
One of the most pragmatic ways of capitalising on the gaps and opportunities in
the Indian MedTex industry is to undertake a formal process of identifying and
analysing the ‘Unmet needs’ from a clinical and resource perspective. The formal
process should also consider the ‘voice of customers’ and other stakeholders in the
ecosystem. Once the unmet needs are identified and analysed, concepts to address
these problems and gaps must be generated. As mentioned earlier, these concepts
should undergo a prioritization of solutions that are affordable and accessible.

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Observations from the Google Form Survey
 The availability of Medical Textile products is quite good.
 The price of Medical Textile products is quite high and not uniform.
 There is a need to improve the quality especially in government hospitals.
 Unfortunately, many people still cannot afford it.
 Many people still don’t have a fair idea about it.
 Most of the people are still unaware about the basic hygiene skills.

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CONCLUSION
Textile materials are very important in all aspects of medicine and surgery and the
range and extent of applications to which these materials are used is a reflection of
their enormous versatility. Products utilized for medical or surgical applications
may at first sight seem to be either extremely simple items. In reality,
however, in-depth research is required to engineer a textile for even the simplest
cleaning wipe in order to meet the stringent performance specifications.
New developments continue to exploit the range of fibres and fabric-forming
techniques which are available. Advances in fibre science have resulted in a new
breed of wound dressing which contribute to the healing process. Advanced
composite materials containing combinations of fibres and fabrics have been
developed for applications where biocompatibility and strength are required. It is
predicted that composite materials will continue to have a greater impact in this
sector owing to the large number of characteristics and performance criteria
required from these materials.
Non-wovens are utilised in every area of medical and surgical textiles. Shorter
production cycles, higher flexibility and versatility, and lower production costs are
some of the reasons for the popularity of nonwovens in medical textiles.

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