WO2004030520A2 - Barbed sutures - Google Patents

Barbed sutures Download PDF

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Publication number
WO2004030520A2
WO2004030520A2 PCT/US2003/030674 US0330674W WO2004030520A2 WO 2004030520 A2 WO2004030520 A2 WO 2004030520A2 US 0330674 W US0330674 W US 0330674W WO 2004030520 A2 WO2004030520 A2 WO 2004030520A2
Authority
WO
WIPO (PCT)
Prior art keywords
suture
barb
barbs
cut
barbed
Prior art date
Application number
PCT/US2003/030674
Other languages
French (fr)
Other versions
WO2004030520A3 (en
Inventor
Jeffrey C. Lenug
Gregory Ruff
Matthew Megaro
Original Assignee
Quill Medical, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=32028519&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO2004030520(A2) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Priority to MXPA05002876A priority Critical patent/MXPA05002876A/en
Priority to BR0306508A priority patent/BR0306508B1/en
Priority to NZ538771A priority patent/NZ538771A/en
Priority to AU2003270916A priority patent/AU2003270916B2/en
Priority to EP20030752630 priority patent/EP1560683B1/en
Priority to JP2004541835A priority patent/JP4493501B2/en
Priority to DE2003615696 priority patent/DE60315696T2/en
Application filed by Quill Medical, Inc. filed Critical Quill Medical, Inc.
Priority to MX2013004515A priority patent/MX340254B/en
Priority to EP10184766.3A priority patent/EP2335889B2/en
Priority to CN038252694A priority patent/CN101027168B/en
Priority to CA 2500381 priority patent/CA2500381C/en
Publication of WO2004030520A2 publication Critical patent/WO2004030520A2/en
Publication of WO2004030520A3 publication Critical patent/WO2004030520A3/en
Priority to IL167580A priority patent/IL167580A/en
Priority to HK06101372A priority patent/HK1081484A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166Sutures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004Means for attaching suture to needle
    • A61B2017/06028Means for attaching suture to needle by means of a cylindrical longitudinal blind bore machined at the suture-receiving end of the needle, e.g. opposite to needle tip
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06057Double-armed sutures, i.e. sutures having a needle attached to each end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166Sutures
    • A61B2017/06176Sutures with protrusions, e.g. barbs
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10TTECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T83/00Cutting
    • Y10T83/849With signal, scale, or indicator
    • Y10T83/852Responsive to force

Definitions

  • This invention relates, in general, to a barbed suture useful for connecting bodily tissue in various surgical contexts, and more particularly, to the optimization of the disposition and/or configuration of the barbs on such barbed sutures.
  • Narious surgical methods employing sutures have been used in the past for closing or binding together wounds in human or animal tissue, such as skin, muscles, tendons, internal organs, nerves, blood vessels, and the like. More specifically, the surgeon may use a surgical needle with an attached conventional suture (which can be a smooth monofilament or can be a multi-filament) to pierce the tissue alternately on opposing faces of the wound and thus sew the wound closed. Whether the wound is accidental or surgical, loop stitching is the method often used, especially for surface wounds. The surgical needle is then removed and the ends of the suture are tied, typically with at least three overhand throws to form a knot.
  • conventional suture which can be a smooth monofilament or can be a multi-filament
  • conventional sutures can be of non-absorbable material such as silk, nylon, polyester, polypropylene, or cotton, or can be of bio-absorbable material such as glycolic acid polymers and copolymers or lactic acid polymers and copolymers.
  • barbed sutures which are generally of the same materials as conventional sutures, have offered numerous advantages over closing wounds with conventional sutures.
  • a barbed suture includes an elongated body that has one or more spaced barbs, which project from the body surface along the body length. The barbs are arranged to allow passage of the barbed suture in one direction through tissue but resist movement of the barbed suture in the opposite direction.
  • barbed sutures have been the provision of a non-slip attribute. Accordingly, barbed sutures do not have to be knotted, like conventional sutures. Like a conventional suture, a barbed suture may be inserted into tissue using a surgical needle.
  • U.S. Patent No. 3,123,077 to Alcamo describes an elongated cord for sewing human flesh, where the cord has a body portion and sharp-edged, resilient barbs projecting from the body at acute angles relative to the body.
  • the barbed suture can be passed through tissue in one direction, but resists movement in the opposite direction.
  • Sutures with barbs disposed in a bi-directional arrangement are shown in U.S. Patent No. 5,931,855 to Buncke and U.S. Patent No. 6,241,747 to Ruff. More particularly, the suture has barbs facing toward one end of the suture for about half the suture length and barbs facing in the opposite direction toward the other end of the suture for the other half of the suture length. This arrangement allows the barbs to move in the same direction as each respective suture end is inserted into the first and second sides of a wound.
  • Such bi-directional barbed sutures not only are especially suitable for closing wounds with edges prone to separation, but also obviate the need to secure suture ends together with knotted loops.
  • U.S. Patent No. 5,342,376 to Ruff shows an insertion device that is useful for positioning a barbed suture in order to close a wound.
  • the insertion device has a tubular body for receiving a barbed suture, and preferably also has a handle to facilitate manipulation of the device by the surgeon.
  • the insertion device is recommended for use with a barbed suture where the suture portion being inserted includes barbs facing a direction opposed to the direction of insertion. Such sutures with barbs opposing the direction of insertion are also shown in '376 to Ruff.
  • Escarpment of barbs into a monofilament reduces the straight pull tensile strength since the effective suture diameter is decreased.
  • the straight pull tensile strength of a barbed suture should be compared to the minimum knot pull strength of a conventional suture (a non-barbed suture) in accordance with the United States Pharmacopoeia since failure of conventional sutures (which have to be knotted and must meet a minimum knot pull tensile strength) occurs most frequently at the knot due to increased local stress.
  • barbed sutures can spread out the tension along the escarped suture length, often evenly along the length. Optimizing the disposition and/or the configuration of the barbs should therefore further increase the effectiveness of the new barbed suture in maximizing the holding strength and minimizing the gap formation along the wound edges. The latter is particularly beneficial for promoting wound healing.
  • new barbed sutures should approximate tissue quickly with appropriate tension, alleviate distortion of tissue, and help to minimize scarring, due to the self-retaining benefits imparted by the barbs.
  • the new barbed sutures would be especially useful in surgeries where minimization of scarring is imperative, such as cosmetic surgery, as well as in surgeries where space is limited, such as endoscopic surgery or microsurgery.
  • the present invention provides a barbed suture for connecting human or animal tissue.
  • the barbed suture comprises an elongated body having a first end and a second end.
  • the barbed suture further comprises a plurality of barbs projecting from the body. Each barb is adapted for enabling the barbed suture to resist movement, when in tissue, in the direction that is opposite from the direction in which that barb faces.
  • the barbed suture further comprises the barbs being disposed on the body in a disposition selected from a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, a random disposition, or combinations thereof.
  • the barbs may all be facing toward only one of the first and second ends.
  • the barbed suture may have at least a first portion and a second portion, where the barbs of the first portion are facing toward the first end and the barbs of the second portion are facing toward the second end.
  • the present invention provides a barbed suture for connecting human or animal tissue, where the suture comprises an elongated body having a first end and a second end.
  • the suture further comprises a plurality of barbs projecting from the body. Each barb is adapted for enabling the suture to resist movement, when the suture is in tissue, in the direction that is opposite from the direction in which that barb faces.
  • the suture further comprises the barbs having a configuration selected from a barb cut angle ⁇ ranging from about 140 degrees to about 175 degrees, a barb cut depth with a ratio of cut depth to suture diameter ranging from about 0.05 to about 0.6, a barb cut length with a ratio of cut length to suture diameter ranging from about 0.2 to about 2, a barb cut distance with a ratio of cut distance to suture diameter ranging from about 0.1 to about 6, a corrugated underside, an arcuate base, varying sizes, or combinations thereof.
  • the barbed suture preferably has a spirality ⁇ angle ranging from about 5 degrees to about 25 degrees.
  • the overlapping disposition it is meant that at least two adjacent barbs are disposed where one overlaps the other.
  • the overlapping is created by a barb (i.e., the overlapping barb) being escarped into the topside of another adjacent barb (i.e., the overlapped barb), and so on.
  • the barb cut distance between the overlapping barb and the overlapped barb may be shorter than the barb cut length of overlapped second barb, whereas, in general for barbed sutures, the barb cut distance between two barbs > the barb cut length.
  • the present invention provides a barbed suture for connecting human or animal tissue in combination with a surgical needle, where the combination comprises a barbed suture attached to a surgical needle.
  • the suture comprises a plurality of barbs projecting from an elongated body having a first end and a second end. Each barb is adapted for enabling the suture to resist movement, when the suture is in tissue, in the direction that is opposite from the direction in which that barb faces.
  • the ratio of the surgical needle diameter to the suture diameter preferably is about 3:1 or less.
  • any of the inventive barbed sutures described here may be attached to a surgical needle.
  • FIGURE 1 A is a side view of one embodiment of the present invention, showing a barbed suture with barbs disposed in a 180 degree staggered spacing;
  • FIGURE IB is a sectional view along line IB - IB of the barbed suture in Figure 1 A;
  • FIGURE 2A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a 180 degree staggered spacing;
  • FIGURE 2B is a sectional view along line 2B - 2B of the barbed suture in Figure 2A;
  • FIGURE 3A is a side view of another embodiment of the present invention, showing a barbed suture with barbs disposed in a 120 degree staggered spacing;
  • FIGURE 3B is a sectional view along line 3B - 3B of the barbed suture in Figure 3 A;
  • FIGURE 4A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a 120 degree staggered spacing;
  • FIGURE 4B is a sectional view along line 4B - 4B of the barbed suture in Figure 4A;
  • FIGURE 5A is a side view of another embodiment of the present invention, showing a barbed suture with barbs disposed in a twist cut multiple spiral disposition;
  • FIGURE 5B is a sectional view along line 5B - 5B of the barbed suture in Figure 5 A;
  • FIGURE 6A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a twist cut multiple spiral disposition;
  • FIGURE 6B is a sectional view along line 6B - 6B of the barbed suture in Figure 6A;
  • FIGURE 7A is a sectional side view of a barbed suture, which is bi-directional with barbs disposed in a twist cut multiple spiral disposition like the barbed suture in Figure 6 A, but illustrated in an enlarged section;
  • FIGURE 7B is the sectional side view as illustrated in Figure 7A, but rotated and clamped to align the barbs for measurement of the cut distance between the barbs;
  • FIGURE 8 is a side view of another embodiment of the present invention, showing a barbed suture with barbs in a random disposition;
  • FIGURE 9 is a sectional side view of another embodiment of the present invention, showing a barbed suture having a barb with a corrugated or serrated underside;
  • FIGURE 10A is a sectional perspective view another embodiment of the present invention, showing a barbed suture having a barb with an arcuate base;
  • FIGURE 10B is a sectional top plan view of the barbed suture in Figure 10A;
  • FIGURE 10C is a cross-sectional view along line 10C - 10C of Figure 10B;
  • FIGURE 10D is a cross-sectional view along line 10D - 10D of Figure 10B;
  • FIGURE 11 is a sectional side view of another embodiment of the present invention, showing a barbed suture with barbs of various sizes;
  • FIGURE 12A is a sectional perspective view of another embodiment of the present invention, showing a barbed suture with barbs in an overlapping disposition;
  • FIGURE 12B is a perspective view of a portion of the overlapping barbs of the suture of Figure 12 A;
  • FIGURE 12 C is a plan view of the portion of barbs of Figure 12B;
  • FIGURE 12D is a side view along line 12D - 12D of Figure 12C;
  • FIGURES 13A, 13B, 13C, and 13D show various surgical needles, where a barbed suture is attached to each surgical needle. DESCRIPTION
  • wound means a surgical incision, cut, laceration, severed tissue or accidental wound in human or animal skin or other human or animal bodily tissue, or other condition in a human or animal where suturing, stapling, or the use of another tissue connecting device may be required.
  • tissue includes, but is not limited to, tissues such as skin, fat, fascia, bone, muscle, organs, nerves, or blood vessels, or fibrous tissues such as tendons or ligaments.
  • polymer as used here generally includes, but is not limited to, homopolymers, copolymers (such as block, graft, random and alternating copolymers), terpolymers, et cetera, and blends and modifications thereof.
  • polymer shall include all possible structures of the material. These structures include, but are not limited to, isotactic, syndiotactic, and random symmetries.
  • the sutures are described below in a preferred embodiment with a circular cross section, the sutures could also have a non-circular cross sectional shape that could increase the surface area and facilitate the formation of the barbs.
  • Other cross sectional shapes may include, but are not hmited to, oval, triangle, square, parallelepiped, trapezoid, rhomboid, pentagon, hexagon, cruciform, and the like.
  • barbs are cut into a polymeric filament that has been formed by extrusion using a die with a circular cross section, and thus, the cross section of the filament will be circular, as that is what results during such extrusion.
  • extrusion dies can be custom made with any desired cross- sectional shape.
  • diameter as used here is intended to mean the transverse length of the cross section, regardless of whether the cross section is circular or some other shape. Suitable diameters for the inventive sutures described below may range from about
  • the diameter may be from about 0.01 mm to about 0.9 mm, or from about 0.015 mm to about 0.8 mm.
  • the typical diameter ranges from about 0.01 mm to about 0.5 mm.
  • the length of the suture can vary depending on several factors such as the length and/or depth of the wound to be closed, the type of tissue to be joined, the location of the wound, and the like. Typical suture lengths range from about 1 cm to about 30 cm, more particularly from about 2 cm to about 22 cm.
  • staggered and staggering as used here in relation to the disposition of barbs on a suture are intended to mean that the suture has at least two sets of barbs that are offset with respect to each other, where the first set is aligned longitudinally on the suture and the second set is aligned longitudinally on the suture, but a plane perpendicular to the suture and cutting transversely through the suture and intersecting the base of a barb of the first set will not intersect the base of a barb of the second set.
  • barbs project from the exterior surface of the suture body on which the barbs are disposed.
  • barbs of different sizes may be employed. In general, larger barbs are more suitable for joining certain types of tissue such as fat tissue or soft tissue. On the other hand, smaller barbs are more suitable for joining other types of tissue, such as collagen dense tissue.
  • barbed sutures may be made from the same materials used for making conventional loop sutures. Any particular chosen material for the barbed suture depends on the strength and flexibility requirements.
  • barbed sutures may be formed from a bio-absorbable material that allows the suture to degrade and thus to be absorbed over time into the tissue as the wound heals.
  • bio-absorbable materials are polymeric, and depending on the particular polymer selected, the degradation time in the wound ranges from about 1 month to over 24 months. The use of bio-absorbable materials eliminates the necessity of removing the sutures from the patient.
  • Narious bio-absorbable polymers include, but are not limited to, polydioxanone, polylactide, polyglycolide, polycaprolactone, and copolyrhers thereof.
  • Commercially available examples are polydioxanone (sold as PDS II, a trade name used by Ethicon for selling surgical sutures), copolymer of about 67% glycolide and about 33% trimethylene carbonate (sold as MAXO ⁇ ®, a trademark registered to American Cyanamid for surgical sutures), and copolymer of about 75% glycolide and about 25% caprolactone (sold as MO ⁇ OCRYL®, a trademark registered to Johnson & Johnson for sutures and suture needles). Barbed sutures made from such bio-absorbable materials are useful in a wide range of applications.
  • barbed sutures may be formed from a non-absorbable material, which may be a polymer.
  • polymers include, but are not limited to, polypropylene, polyamide (also known as nylon), polyester (such as polyethylene terephthlate, abbreviated here as PET), polytetrafluoroethylene (such as expanded polytetrafluoroethylene, abbreviated here as ePTFE and sold by Gore as GOR-TEX®), polyether-ester (such as polybutester, which is the condensation polymerization of dimethyl terephthlate, polytetramethylene ether glycol, and 1,4-butanediol, and which is marketed by Davis & Geek and by U.S.
  • the non-absorbable material may be metal (e.g., steel), metal alloys, natural fiber (e.g., silk, cotton, et cetera), and the like.
  • metal e.g., steel
  • metal alloys e.g., natural fiber
  • the ends of the barbed sutures may comprise a surgical needle.
  • the barbed suture is adapted for attachment, such as by swaging, channel wrapping, heat shrinking, or eyelet threading to the surgical needle for insertion into tissue.
  • Attachment by swaging is well described and is typically accomplished by inserting the suture end into the surgical needle hole that is longitudinally disposed at one end of the surgical needle (usually the hole has been drilled longitudinally into one end of the needle), followed by crimping the resultant about the needle hole so that the suture is secured to the surgical needle for insertion into tissue.
  • some surgical needles with a longitudinal hole in one end are heat-shrinkable tubes that are heat shrunk after insertion of the suture in order to attach the suture to the surgical needle.
  • some surgical needles have a channel or trough at one end, and the suture is laid in the trough, followed by wrapping to secure the suture to the surgical needle.
  • Surgical needles with a conventional eyelet type of hole transversely di posed in one end of the surgical needle could also be used, but are not preferred for barbed sutures.
  • part of the discussion below regards surgical needles swaged with barbed sutures, but it is contemplated that any other suitable means of attaching needles can be employed.
  • the surgical needle may be coated, the coating allowing for the needle of the inventive combination surgical needle/barbed suture to be inserted into tissue with less force than if the surgical needle were not coated.
  • the coating may be a polymer, for instance, a silicone resin coating.
  • an improved siliconized surgical needle that requires significantly less force to effect tissue penetration than a standard siliconized surgical needle is described in U.S. Patent No. 5,258,013 to Granger et al.
  • the barbs are disposed in various arrangements on the body of the suture.
  • the barbs may be formed using any suitable method, including injection molding, stamping, cutting, laser, and the like. With regard to cutting, in general, polymeric threads or filaments are purchased, and then the barbs are cut onto the filament body. The cutting may be manual, but that is labor intensive and not cost effective.
  • a very suitable cutting machine is disclosed in U.S. Patent Application Serial No. 09/943,733 to Genova et al., assignors to Quill Medical, filed August 31, 2001, the disclosure of which is incorporated by reference.
  • Such a cutting machine has a plurality of blades for escarpment of barbs onto a suture filament.
  • a typical cutting machine for manufacturing barbed sutures utilizes a cutting bed, a vise, one or more blade assemblies, and sometimes a template or guide for the blades.
  • the suture filament is placed in the bed and held by the vise, with the transverse direction of the blades generally disposed in the transverse direction of the suture filament, in order to cut a plurality of axially spaced barbs disposed on the exterior of a suture filament.
  • Suture 1 includes elongated body 2 that is generally circular in cross section and that terminates in end 4.
  • End 4 is illustrated in one embodiment as being pointed for penetrating tissue, but it is contemplated that end 4 may comprise a surgical needle (not shown) for insertion into tissue. (The other end is not shown.)
  • suture 1 includes plurality of closely spaced barbs 7, 9 arranged in a staggered uni-directional disposition. More specifically, axially spaced barbs 7 are radially arranged about 180 degrees from and staggered with respect to axially spaced barbs 9, with barbs 7, 9 facing pointed end 4.
  • First set of barbs 7 define a plane that is substantially coplanar with the plane defined by second set of barbs 9, and consequently, barbs 7, 9 define substantially the same one plane due to the radial 180 degree arrangement.
  • Figure IB which is a cross sectional view along line IB - IB of suture 1 in Figure 1A, more clearly illustrates angle X, namely the radial 180 degree arrangement of barbs 7 with respect to barbs 9.
  • angle X namely the radial 180 degree arrangement of barbs 7 with respect to barbs 9.
  • the stippling illustrates that first barb 7 of barbs 7 is closer to pointed end 4 (not shown in Figure IB), and thus, seems to be larger than farther away first barb 9 of barbs 9, due to the staggering.
  • a transverse plane that is perpendicular to suture body 2 and that intersects the base of one barb 7 of barbs 7 does not intersect the base of any barb 9 of barbs 9.
  • Suture 1 may be made with a cutting machine that produces two sets of barbs 7, 9, usually one set at a time, in a staggered position along suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
  • First set of barbs 7 is created by placing and holding a suture filament in the vise, and then, the set of blades, with a predetermined length, splices into the suture filament at an angle selected to create barbs 7 pointing in one direction toward pointed end 4.
  • Second set of barbs 9 is created similarly after offsetting the blades longitudinally (to create the staggering) approximately half of the longitudinal distance between two of barbs 7 and also rotating the suture filament about 180 degrees on the vise, which is equipped to accommodate first set of barbs 7 that are already cut.
  • suture 10 Shown in Figure 2A is suture 10, which is another embodiment of the present invention and is like suture 1, except that suture 10 is bi-directional.
  • Suture 10 includes elongated body 12 that is generally circular in cross section. Elongated body 12 terminates in first and second pointed ends 14, 16 for penetrating tissue. Also, it is contemplated that one or both ends 14, 16 may comprise a surgical needle (not shown) for insertion into tissue. Also, suture 10 includes plurality of closely spaced barbs 17, 18, 19, 20 arranged in a staggered bi-directional disposition.
  • plurality of axially spaced barbs 17 are radially arranged about 180 degrees from and staggered with respect to plurality of axially spaced barbs 19, with barbs 17, 19 facing pointed end 14 for a portion (about half of the length) of suture 10.
  • plurality of axially spaced barbs 18 are radially arranged about 180 degrees from and staggered with respect to plurality of axially spaced barbs 20, with barbs 18, 20 facing pointed end 16 for another portion (approximately the other half of the length) of suture 10.
  • First set of barbs 17, 18 define a plane that is substantially coplanar with the plane defined by second set of barbs 19, 20.
  • all of barbs 17, 18, 19, 20 define substantially the same one plane due to the radial 180 degree arrangement of first set of barbs 17, 18 with respect to second set of barbs 19, 20.
  • Figure 2B is a cross sectional view along line 2B - 2B of suture 10 in Figure 2A, more clearly illustrating angle X, namely the radial 180 degree arrangement. Due to the staggering, first barb 17 of barbs 17 is closer to pointed end 14 (not shown in Figure 2B), and thus, appears larger than farther away first barb 19 of barbs 19, as is illustrated by the stippling. A transverse plane that is perpendicular to suture body 12 and that intersects the base of one barb 17 of barbs 17 does not intersect the base of any barb 19 of barbs 19. Likewise, a transverse plane that is perpendicular to suture body 12 and that intersects the base of one barb 18 of barbs 18 does not intersect the base of any barb 20 of barbs 20.
  • Suture 10 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., except with the following change in blade direction.
  • first set of bi-directional barbs 17, 18 after the suture filament is placed and held in the vise, the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 17 facing in one direction toward pointed end 14.
  • the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length.
  • the blades are then allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 18 facing in the opposite direction toward pointed end 16.
  • the blades are offset longitudinally (to create the staggering) about half of the longitudinal distance between two of barbs 17, and also the suture filament is rotated about 180 degrees on the vice, which is equipped to accommodate first set of bi-directional barbs 17, 18 that are already cut.
  • the blades splice with a first cutting action into approximately half the length of the suture filament to create barbs 20 facing in one direction toward pointed end 16.
  • the first cutting action is followed by rotating the blades longitudinally 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length.
  • the blades are then allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 19 facing in the opposite direction toward pointed end 14.
  • the portion of suture 10 with barbs 17, 19 may have them facing toward pointed end 16 and the portion of suture 10 with barbs 18, 20 may have them facing toward pointed end 14.
  • the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff.
  • barbs may be escarped so that there may be two portions with barbs facing one end and one portion with barbs facing the other end, or two portions with barbs facing one end and two portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end to which those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
  • An advantage of a barbed suture having a radial 180 degree arrangement with staggering is that the 180 degree spacing is readily fabricated on relatively small diameter filaments and the staggering improves anchoring performance. Thus, in thin and delicate tissue, where a smaller suture is desirable, the staggered 180 degree spacing generates effective anchoring performance.
  • FIG 3A depicted is a side view of another embodiment of a suture according to the present invention, and generally designated at suture 30.
  • Suture 30 is like suture 1 shown in Figure 1A, except that the radial spacing for suture 30 is 120 degrees instead of 180 degrees as is shown for suture 1.
  • suture 30 includes elongated body 32 that is generally circular in cross section and that terminates in pointed end 34 for penetrating tissue. It is contemplated that end 34 may comprise a surgical needle (not shown) so that the suture can be inserted into tissue. (The other end is not shown.) Additionally, suture 30 includes plurality of closely spaced barbs 35, 37, 39 arranged so that all face in the same direction toward pointed end 34. Hence, the disposition of barbs 35, 37, 39 is uni-directional.
  • axial spaced barbs 35 are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 37, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 39.
  • axially spaced barbs 39 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 35.
  • first set of barbs 35 define substantially the same one plane
  • second set of barbs 37 define substantially another same one plane
  • third set of barbs 39 define substantially still another same one plane.
  • suture 30 has barbs 35, 37, 39 arranged in a staggered uni-directional 120 degree disposition.
  • Figure 3B is a cross sectional view along line 3B - 3B of suture 30 in Figure 3 A and shows with more particularity angle Y, namely the radial 120 degree arrangement of barbs 35 with respect to barbs 37, barbs 37 with respect to barbs 39, and barbs 39 with respect to barbs 35.
  • first barb 35 of barbs 35 because of the staggering, is closer to pointed end 34 (not shown in Figure 3B), and thus, seems to be larger than farther away first barb 37 of barbs 37.
  • first barb 37 of barbs 37 due to the staggering, is closer to pointed end 34 (not shown in Figure 3B), and thus, seems to be larger than even farther away first barb 39 of barbs 39.
  • a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 35 of barbs 35 does not intersect the base of any barb 37 of barbs 37.
  • a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 37 of barbs 37 does not intersect the base of any barb 39 of barbs 39.
  • a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 39 of barbs 39 does not intersect the base of any barb 35 of barbs 35.
  • Suture 30 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
  • the cutting machine is now used to produce three sets of barbs 35, 37, 39, usually one set at a time, in a staggered position along suture 30.
  • First set of barbs 35 is created by placing and holding a suture filament in the vise, followed by the blades, after having been adjusted to a predetermined length, splicing into the suture filament at an angle that is chosen to create barbs 35 so that all are facing in the same direction toward pointed end 34.
  • the blades are offset longitudinally (to create the staggering) approximately half of the longitudinal distance between two of barbs 35.
  • the filament is rotated about 120 degrees on the vise, which is equipped to accommodate first set of barbs 35 that have already been cut, and then second set of barbs 37 is created in a similar manner.
  • the blades are again offset longitudinally (to create the staggering) approximately half the longitudinal distance between two of barbs 35, and also the suture filament is rotated about 120 degrees on the vise, which is equipped to accommodate both already cut first set of barbs 35 and already cut second set of barbs 37.
  • third set of barbs 39 is created in a similar manner.
  • each successive barb is escarped at a position about 120 degrees around suture body 32 from the preceding barb and does not overlap with any other barb.
  • Suture 40 is similar to suture 30, except that suture 40 is bi-directional.
  • Suture 40 includes elongated body 42 that is generally circular in cross section and that terminates in first and second pointed ends 44, 46 for penetrating tissue. Also, it is contemplated that one or both ends 44, 46 may comprise a surgical needle (not shown) in order to be inserted into tissue.
  • Suture 40 further includes plurality of closely spaced barbs 47, 48, 49, 50, 51, 52 arranged in a staggered bi-directional disposition.
  • axially spaced barbs 47 are circumferentially arranged about 120 degrees from and staggered with respect to axially spaced barbs 49, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 51. Consequently, axially spaced barbs 51 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 47.
  • a portion of suture 40 has all of barbs 47, 49, 51 facing in the same direction toward pointed end 44.
  • axially spaced barbs 48 are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 50, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 52. Consequently, axially spaced barbs 52 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 48.
  • another portion of suture 40 has all of barbs 48, 50, 52 facing in the same direction toward pointed end 46.
  • first set of barbs 47, 48 define substantially the same one plane; second set of barbs 49, 50 define substantially another same one plane; and third set of barbs 51, 52 define substantially still another same one plane.
  • Figure 4B which is a cross sectional view along line 4B - 4B of suture 40 in Figure
  • first barb 47 of barbs 47 on account of the staggering, is closer to pointed end 44 (not shown in Figure 4B), and thus, appears larger than farther away first barb 49 of barbs 49. Also because of the staggering, first barb 49 of barbs 49 is closer to pointed end 44 (not shown in Figure 4B), and thus, appears larger than even farther away first barb 51 of barbs 51.
  • a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 47 of barbs 47 does not intersect the base of any barb 49 of barbs 49.
  • a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 49 of barbs 49 does not intersect the base of any barb 51 of barbs 51.
  • a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 51 of barbs 51 does not intersect the base of any barb 47 of barbs 47.
  • a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 48 of barbs 48 does not intersect the base of any barb 50 of barbs 50.
  • a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 50 of barbs 50 does not intersect the base of any barb 52 of barbs 52.
  • a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 52 of barbs 52 does not intersect the base of any barb 48 of barbs 48.
  • Suture 40 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., except with the following change in blade direction.
  • first set of bi-directional barbs 47, 48 after the suture filament is placed and held in the vise, the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 47 facing in one direction toward pointed end 44. Then, the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length. The blades then are allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 48 facing in the opposite direction toward pointed end 46.
  • the blades are offset longitudinally (to create the staggering) for about half the longitudinal distance between two of barbs 47, and also the suture filament is rotated about 120 degrees on the vise, which is equipped to accommodate first set of bi-directional barbs 47, 48 that are already cut.
  • the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 50 facing in one direction toward pointed end 46.
  • the first cutting action is followed by rotating the blades 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the suture filament.
  • the blades are again offset longitudinally (to create the staggering) for about half the longitudinal distance between two of barbs 47.
  • the suture filament again is rotated about 120 degrees on the vise, which is equipped to accommodate already cut first set of bi-directional barbs 47, 48 and already cut second set of bi-directional barbs 49, 50.
  • the third set of bi-directional barbs 51, 52 are made by having the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 51 facing in one direction toward pointed end 44.
  • the first cutting action is followed by rotating the blades 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the suture filament. They next splice into the other half of the length of the suture filament with a second cutting action to create barbs 52 facing in the opposite direction toward pointed end 46.
  • each successive barb is escarped at a position about 120 degrees around suture body 42 from the preceding barb and does not overlap with any other barb.
  • the portion of suture 40 having barbs 47, 49, 51 may have them facing toward pointed end 46 and the portion of suture 40 having barbs 48, 50, 52 may have them facing toward pointed end 44.
  • the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff.
  • barbs may be escarped so that there may be two portions with barbs facing one end and one portion with barbs facing the other end, or two portions with barbs facing one end and two portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end that those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
  • An advantage of a barbed suture with a radial 120 degree arrangement is that the barbs exert force in three distinct planes that compliment each other, resulting in maximization of the retention force of the suture overall. As noted above, the staggering enhances anchoring performance.
  • FIG. 5 A shown is another embodiment of the present invention, which is generally designated at suture 60, with radial spacing that is in a twist cut multiple spiral.
  • Suture 60 includes elongated body 62 of generally circular cross section. Elongated body 62 terminates in pointed end 64 for penetrating tissue. Also, it is contemplated that end 64 may comprise a surgical needle (not shown) for insertion into tissue.
  • suture 60 includes plurality of closely spaced barbs 67 arranged in a twist cut multiple spiral pattern around body 62 and facing in the same direction toward pointed end 64.
  • Figure 5B is a cross sectional view along line 5B - 5B of suture 60 in Figure 5A. Due to the twist cut multiple spiral disposition, each respective barb 67 seems to be smaller and smaller as each is farther and farther away from pointed end 64 (not shown in Figure 5B), the illusion of size difference being illustrated by the stippling.
  • Suture 60 may be constructed with a similar cutting machine as that used for making suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to
  • barbs 67 may be produced in multiple spirals that preferably are created at the same time as the suture filament is held stationary, instead of being rotated, when the cutting takes place.
  • a suture filament that is about 7 inches (about 178 mm) in length, is longitudinally twisted for a portion of the suture length, such as 39 times for a portion that is about 4.5 inches (about 114 mm) of the suture length.
  • an end is secured, and the other end is grasped and rotated 360 degrees, 39 times, so the portion of the suture filament is twisted when the suture is then placed and held in the vise.
  • Twisting preferably is performed 28 to 50 times, and may be performed more or less, such as 19 to 70 times.
  • twisting may be from about 2 to about 17 twists per inch, or about 3 to about 15 twists per inch, or about 5 to about 13 twists per inch (per inch being per 25.4 mm).
  • the blades after having been adjusted to a predetermined length, simultaneously splice into the suture filament.
  • the cutting action makes cuts to create barbs 67 so that all are facing in the same direction toward pointed end 64.
  • barbs 67 are disposed in multiple spirals on suture 60.
  • Suture 70 is of a twist cut multiple spiral disposition and thus is similar to suture 60, except that suture 70 is bi-directional.
  • Suture 70 includes elongated body 72 that is generally circular in cross section and that terminates in first and second pointed ends 74, 76 for penetrating tissue. It is contemplated that one or both of ends 74, 76 may comprise a surgical needle (not shown) for insertion into tissue.
  • Suture 70 further includes plurality of closely spaced barbs 77, 78 arranged in two respective spiral patterns, each being a multiple spiral around body 72.
  • Barbs 77, 78 are disposed on middle portion MP that is approximately 3 inches (approximately 76 mm) of suture 70, with each end portion EP of suture 70 being barb-free. More particularly, plurality of barbs 77 are arranged in a multiple spiral pattern with all barbs 77 facing toward pointed end 74 for a part (about half) of middle portion MP along the length of suture 70. Similarly, plurality of barbs 78 are arranged in a multiple spiral pattern with all barbs 78 facing toward pointed end 76 for another part (the other approximate half) of middle potion MP along the length of suture 70.
  • Figure 6B is a cross sectional view along line 6B - 6B of suture 60 in Figure 6A. Due to the multiple spiral configuration, each respective barb 77 seems to be smaller and smaller as each is farther and farther away from pointed end 74 (not shown in Figure 6B), as illustrated by the stippling.
  • Suture 70 may be made with the same cutting machine as suture 60, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., but with the following change in blade direction.
  • barbs 77 may be produced in multiple spirals that preferably are created at the same time, and then after the direction change for the blades, barbs 78 may be produced in multiple spirals that preferably are created at the same time.
  • the suture filament is held stationary instead of being rotated. More specifically, a section of about 4.5 inches (about 114 mm) in length of a suture filament is twisted, such as 39 times for a suture about 7 inches (about 178 mm) in length.
  • twisting may be from about 2 to about 17 twists per inch, or about 3 to about 15 twists per inch, or about 5 to about 13 twists per inch (per inch being per 25.4 mm).
  • the blades after having been adjusted to a predetermined length, splice into approximately half of the approximately 3 inch (approximately 76 mm) length of middle portion MP of the approximately 4.5 inch (approximately 114 mm) twisted section of the suture filament in a first cutting action with the blades making cuts to create barbs 77 so that all are facing in one direction toward pointed end 74.
  • the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the other half of the approximately 3 inch (approximately 76 mm) length of middle portion MP of the approximately 4.5 inch (approximately 114 mm) twisted section of the suture filament.
  • the blades are then allowed to splice into the other half in a second cutting action with the blades making cuts to create barbs 78 so that all are facing in the opposite direction toward pointed end 76.
  • the first cuts and the second cuts result in barbs 77, 78 being in two respective multiple spiral patterns on two respective portions of suture 70, the two respective portions defining middle portion MP of about 3 inches (about 76 mm) in length.
  • Each suture contained a total of 78 barbs introduced in two respective multiple spiral patterns around the circumference of the suture. Since the barbed suture was bi-directional, the barbs were divided into a left group with 39 barbs disposed on a first portion of the suture and a right group with 39 barbs on a second portion of the suture, each group opposing the direction of the other group from the approximate middle of the suture.
  • Each suture was about 7 inches (about 178 mm) long.
  • the middle portion MP was about 3 inches (about 76 mm) long and contained the 78 barbs that were escarped into the suture filament. Extending beyond the 3 inch (76 mm) barbed middle portion MP were two unbarbed end portions EP of the suture that were each about 2 inches (about 51 mm) long.
  • one or both ends of the barbed suture may be sufficiently pointed and rigid for insertion into tissue, or may comprise a straight or curved surgical needle.
  • the strength of the twist cut, 7 inch (178 mm) barbed sutures was tested by two methods. One method was a straight pull tensile strength test with a Universal Tester and the other method was an in vivo performance test with dogs.
  • Comparison unbarbed sutures were polydioxanone monofilaments (a synthetic absorbable suture material) of various suture diameters of about 0.018 inch (about 0.457 mm), about 0.015 inch (about 0.381 mm), and about 0.0115 inch (about 0.292 mm), which are respectively slightly larger than the United States Pharmacopoeia sizes 0, 2-0, and 3-0 for synthetic absorbable sutures.
  • size 0 has a diameter range of about 0.35 mm to about 0.399 mm; size 2-0 has a diameter range of about 0.30 mm to about 0.339 mm; and size 3-0 has a diameter range of about 0.20 mm to about 0.249 mm.
  • Each barbed suture was gripped at each end by being held with cork gasket padding in two respective serrated jaws, whereas each unbarbed suture was gripped at each end by being wrapped around two respective capstan roller grips. Capstan rollers were used for holding the unbarbed sutures to avoid stress and distension.
  • each suture specimen between the two gripped places was about 5 inches (about 126 mm) in length, which, in the case of barbed sutures, contained the entire 3 inches (76 mm) of the barbed middle portion.
  • Each specimen was pulled longitudinally at a rate of about 10 inches (about 254 mm) per minute until breakage occurred. The peak load was recorded as the straight pull tensile strength.
  • the straight pull tensile strength of 7.03 pounds at breakage for the size 0 polydioxanone barbed suture (which, due to the escarpment of the barbs, has an effective diameter that is smaller than the diameter of the conventional unbarbed size 0 polydioxanone suture) compared favorably with the minimum USP knot pull requirement of 8.60 pounds for the size 0 polydioxanone conventional unbarbed suture.
  • the dogs were monitored daily, and then subjected to euthanasia at 14 days. At the time of death, the incisions were evaluated macroscopically. With regard to various tissues, incision sizes, and locations on the dogs, all sites apposed with the size 0 polydioxanone barbed sutures stayed closed and appeared to be healing normally throughout the 14 day observation period. No dehiscence occurred.
  • the in vivo performance of the size 0 polydioxanone barbed sutures was efficacious when compared to the size 2-0 silk braided filament unbarbed sutures, the size 2-0 nylon monofilament unbarbed sutures, and the size 3-0 polydioxanone monofilament unbarbed sutures.
  • multiple spiral suture 70 the portion of suture 70 on which is disposed barbs 77 may have barbs 77 facing toward pointed end 76 and the portion of suture 70 on which is disposed barbs 78 may have barbs 78 facing toward pointed end 74.
  • the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S.
  • Patent No. 5,342,376 to Ruff may be escarped so that there may be 2 portions with barbs facing an end and 1 portion with barbs facing the other end, or 2 portions with barbs facing an end and 2 portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end to which those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
  • a barbed suture having a twist cut, multiple spiral disposition affords better wound holding capability as compared to the 120 degree spaced barbed suture.
  • the reason is that the twist cut, multiple spiral pattern results in groups of barbs that complement successive and preceding groups of barbs, which tends to provide improved anchoring when the suture is in tissue.
  • This feature is especially useful for tissue such as fat tissue, which has fewer connective fibers compared with other types of tissues, so that greater suture retention force is desirable.
  • Figure 7A shown is a sectional side view of barbed suture 80.
  • Barbed suture 80 has plurality of closely spaced barbs 81 on elongated suture body 82 of generally circular cross section. Each barb 81 has barb tip 85. Shown are suture longitudinal axis A, suture diameter SD, barb length L, barb cut depth D, barb cut angle ⁇ , cut distance P, spirality angle ⁇ , cut-out depression CD, and tip T of cut-out depression CD.
  • Figure 7B is the sectional side view as illustrated in Figure 7A, but rotated and clamped to align the barbs for measurement of the cut distance P between barbs 81.
  • Barbed suture 80 is a twist cut, multiple spiral, bi-directional barbed suture, like suture 70 in Figure 6 A, but illustrated as an enlarged section in order to show more detail with respect to the configuration of barbs 81 vis-a-vis suture longitudinal axis A, suture diameter SD, barb length L, barb cut depth D, barb cut angle ⁇ , cut distance P, spirality angle ⁇ , cut-out depression CD, and terminus T of cut-out depression CD.
  • the middle portion was about 3 inches (about 76 mm) of the suture and contained the 78 barbs that were escarped into the suture filament. Extending beyond the 3 inch (76 mm) barbed middle portion toward each suture end were two unbarbed end portions of the suture filament that were each about 2 inches (about 51 mm) long.
  • one or both ends of the barbed suture may be sufficiently pointed and rigid for insertion into tissue, or may comprise a straight or curved needle.
  • angle of spirality was measured microscopically on various barbed sutures 80 as follows.
  • line M will be parallel to the longitudinal axis of the vise while the twisted suture filament is being held in the vise. If the vise does not leave a light mark on the suture filament, then line M can be determined in that it is parallel to a line connecting the two respective terminus T of the two successive cut-out depressions CD left in suture body 82 from the escarpment of two successive barbs 81.
  • line M spirals on suture body 82 around barbed suture 80, forming angle of spirality.
  • the Optem Zoom 100 custom microscope was set with ring lighting at 60 and back lighting at coarse 12 and fine 10. Also, imaging analysis system software was used. Spirality angle was then measured between the outer surface of the barbed suture and line M. The average was calculated for 10 repeated measurements (5 from the left group of barbs and 5 from the right group of barbs on the same suture).
  • barbed suture 80 was mounted in a twisting device with one end of suture 80 clamped in a fixed position. The other end of suture 80 was rotated to insert twist until barbs 81 were aligned.
  • longitudinal cut distance P between two adjacent barbs 81 was measured microscopically between the two respective terminus T of the two successive cut-out depressions CD left in suture body 82 from the escarpment of two successive barbs 81. The average was calculated for 10 repeated measurements (5 from the left group of barbs and 5 from the right group of barbs on the same suture).
  • angle ⁇ was performed on a few additional bi-directional twist cut, multiple spiral barbed sutures with a diameter of about 0.018 inch (about 0.457 mm, slightly more than the USP requirement for a size 0 synthetic absorbable suture).
  • the mean average was 16.87 and the standard deviation was ⁇ 0.85.
  • a suitable ratio of cut length L to barbed suture diameter SD ranges from about 0.2 to about 2, more preferably from about 0.4 to about 1.7, even more preferably from about 0.8 to about 1.5.
  • very suitable barbed sutures may have a ratio of cut length L to barbed suture diameter SD from about 1 down to about 0.2, whereby the ratio of the highest possible barb elevation (the elevation of barb tip 85 above suture body 82) to the suture diameter SD correspondingly ranges from about 1 down to about 0.2. (The highest possible barb elevation is the same as the barb length L.) Also, a suitable ratio of cut depth D to barbed suture diameter SD ranges from about 0.05 to about 0.6, more preferably from about 0.1 to about 0.55, even more preferably from about 0.2 to about 0.5.
  • length L may be desirably varied depending on the intended end use, since larger barbs are more suitable for joining certain types of tissue such as fat tissue or soft tissue, whereas smaller barbs are more suitable for joining other types of tissues such as fibrous tissue.
  • a barb configuration that is a combination of large, medium, and/or small barbs disposed on the same suture will be desirable, for instance, when the barbed suture is employed in tissue that has differing layer structures.
  • Cut angle ⁇ formed between the barb and the elongated suture body desirably would range from about 140 degrees to about 175 degrees, more preferably would range from about 145 degrees to about 173 degrees.
  • the most preferred cut angle ⁇ for all barbs ranges from about 150° to about 170°. For instance, for a polydioxanone barbed suture with a diameter of about 0.018 inch
  • the preferred barb length L would be 0.45 mm; the preferred barb depth D would be 0.2 mm; and the preferred barb cut angle would be 153 degrees.
  • a suitable ratio of cut distance P to barbed suture diameter SD ranges from about 0.1 to about 6, more preferably from about 0.5 to about 4.5, even more preferably from about 1.0 to about 3.5.
  • Very suitable barbed sutures may have a ratio of cut distance P to barbed suture diameter SD from about 1.5 down to about 0.2, whereby cut distance P may be as low as about 0.1, particularly for the overlapping barb embodiment, which is discussed in more detail below vis-a-vis Figures 12A, 12B, 12C, and 12D.
  • spirality angle formed between line M and the longitudinal direction of the elongated suture body for a twist cut, multiple spiral barbed suture typically would range from about 5 degrees to about 25 degrees, more preferably from about 7 degrees to about 21 degrees.
  • the most preferred angle for all barbs on a twist cut, multiple spiral barbed suture is about 10° to about 18°.
  • Suture 90 is another embodiment of the present invention.
  • Suture 90 includes elongated body 92 that is generally circular in cross section. Elongated body 92 terminates in first and second pointed ends 94, 96 for penetrating tissue. It is contemplated that one or both ends 94, 96 may comprise a surgical needle (not shown) for insertion into tissue. Additionally, suture 90 includes plurality of closely spaced barbs 97 arranged in a random disposition. Suture 90 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
  • barbed suture 90 with a very random barb disposition is obtained.
  • the advantage of the random disposition is that the many barb angles provide superior anchoring in tissues and thus afford superior wound holding properties.
  • the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff.
  • Suture 100 includes elongated suture body 102 of generally circular cross section. Also, suture body 102 has disposed on it a plurality of closely spaced barbs 107. Each barb 107 has a barb configuration such that barb underside 108 is serrated or corrugated.
  • One or both suture ends are pointed for penetrating tissue and it is contemplated that one or both may comprise a surgical needle (not shown) for insertion into tissue.
  • Suture 100 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
  • Barb 107 having serrated underside 108 is achieved by vibrating or oscillating the cutting blades of the cutting device when barbs are being escarped into the body of a monofilament. It is intended that any of the barbed sutures of the present invention as described here may have barbs with a configuration that includes a serrated or corrugated underside.
  • Figures 10A and 10B depicted in Figure 10 A is a perspective view and depicted in Figure 10B is a top view of barbed suture 110, which is another embodiment of the present invention.
  • Suture 110 includes elongated suture body 112 of generally circular cross section. Also, suture body 112 has disposed on it a plurality of closely spaced barbs 115 having barb tips 117 (one barb 115 is shown for purposes of brevity). Barb 115 has a configuration with an arcuate base 119 where barb 115 is attached to suture body 112. One or both suture ends (not shown) are pointed for penetrating tissue and it is contemplated that one or both may comprise a surgical needle (not shown) for insertion into tissue.
  • Figures 10C and 10D are cross-sectional views respectively along line 10C - 10C and line 10D - 10D of Figure 10B.
  • Figure 10C and 10D further clarify that barb 115 becomes narrower going from base 119 toward tip 117.
  • Suture 110 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
  • the cutting device is provided with cutting blades with ends that are correspondingly arcuate with respect to arcuate base 119.
  • any of the barbed sutures of the present invention as described here may have barbs with a configuration that includes an arcuate base.
  • the arcuate base should enhance tissue anchoring as compared to a flat, linear base. Regardless, it is not desired for the base to be circular or oval, which would result from conical shaped barbs, as that could decrease tissue anchoring.
  • Shown in Figure 11 is a sectional side view of a barbed suture that is another embodiment of the present invention, and that is generally designated at 120.
  • Suture 120 includes elongated body 122 that is generally circular in cross section. Elongated body 122 terminates in end 124. End 124 is pointed for penetrating tissue and it is contemplated that end 124 may comprise a surgical needle (not shown) for insertion into tissue. (The other end is not shown, and also may be pointed for penetrating tissue and may comprise a surgical needle for penetrating tissue.) Also, suture 120 includes plurality of closely spaced barbs 125, plurality of closely spaced barbs 127, and plurality of closely spaced barbs 129.
  • Barbs 125 are relatively small in size with a relatively short barb length as compared to barbs 127, which are relatively medium in size with a relatively medium barb length, as compared to barbs 129, which are relatively large in size with a relatively long barb length.
  • Suture 120 may be made with the same cutting machine as the above-described sutures were made, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. By altering the amount of blade movement during cutting into a suture filament, then the barb cut length is made longer or shorter, as desired, to result in each of the three sets of barbs 125, 127, and 129 being of a size different from the others, where the varying sizes are designed for various surgical applications.
  • the barb size may also vary in the transverse direction, whereby the barb base may be short, medium, or long, and regardless, the barb base typically is less than about l A of the suture diameter.
  • relatively larger barbs are desirable for joining fat and soft tissues, whereas relatively smaller barbs are desirable for joining fibrous tissues.
  • Use of a combination of large, medium, and/or small barbs on the same suture helps to ensure maximum anchoring properties when barb sizes are customized for each tissue layer. Only two different sized sets of barbs (not shown) may be escarped into suture body 122, or additional sets of barbs (not shown) with four, five, six, or more different sized sets than three sizes as illustrated for sets of barbs 125, 127, and 129 may be escarped into suture body 122 as desired, in accordance with the intended end use.
  • FIG. 12A is a perspective view of another embodiment of the present invention, showing barbed suture 130 having elongated body 132 of generally circular cross section.
  • One or both suture ends are pointed for penetrating tissue and it is contemplated that one or both ends may comprise a surgical needle (not shown) for insertion into tissue.
  • Suture 130 further includes plurality of barbs 135 projecting from body 132 such that at least two longitudinally adjacent first and second barbs 135 are disposed on body 132 where first barb 135 overlaps second barb 135 if first and second barbs 135, which is readily apparent if barbs 135 are laid flat on body 132.
  • Figure 12B is a perspective view of a portion of overlapping barbs 135 of the overlapping disposition barbed suture 130 of Figure 12A
  • Figure 12C is a top plan view of Figure 12B.
  • Figure 12D is a cross-sectional view along ling 12D - 12D of Figure 12C.
  • overlapping first barb 135 is escarped into part of topside TS of overlapped second barb 135, and so on.
  • Part of topside TS of overlapped second barb 135 becomes part of underside US of overlapping first barb 135.
  • the barb cut distance between first barb 135 and second barb 135 may be shorter than the barb cut length of overlapped second barb 135, whereas, in general for barbed sutures, the barb cut distance between two barbs > the barb cut length.
  • very suitable barbed sutures may have a ratio of the barb cut distance to the barbed suture diameter from about 1.5 down to about 0.2, since the barb cut distance P may be as low as about 0.1. (See discussion of Figure 7 for comments vis-a-vis the barb cut length and the barb cut distance.)
  • This overlapping disposition allows for closely packing many barbs 135 on body 132, and typically, barbs 135 are thin, as compared to when the barb cut distance between two barbs > the barb cut length.
  • suture 130 is illustrated with barbs 135 being unidirectional, it is intended to include that suture 130 in accordance with the invention also may be a bidirectional barbed suture as described here.
  • Figures 13A, 13B, 13C, and 13D show various surgical needles, where a barbed suture is attached to each surgical needle.
  • the surgical needles may be coated with a polymer, for instance, as described above vis-a-vis U.S. Patent No. 5,258,013 to Granger et al.
  • Figure 13 A shows surgical needle Nl that is a straight elongated needle in the longitudinal direction and that is generally circular in cross section.
  • Surgical needle Nl has pointed tip TI for insertion into tissue and also has hole HI.
  • Surgical needle Nl is illustrated as attached, such as by swaging, to barbed suture SI.
  • Barbed suture SI is a barbed suture including, but not limited to, any of the above-described barbed sutures.
  • surgical needle Nl has diameter DI in the transverse direction, which is illustrated as a relatively thin diameter, such as about 0.02 inch (about 0.51 mm).
  • surgical needle Nl after having suture SI inserted into hole HI, may be crimped by standard procedures about hole HI to hold suture SI in place for suturing tissue.
  • Figure 13B shows surgical needle N2 that is a straight elongated needle in the longitudinal direction and that is generally circular in cross section.
  • Surgical needle N2 has pointed tip T2 for insertion into tissue and also has hole H2.
  • Surgical needle N2 is illustrated as attached, such as by swaging, to barbed suture S2.
  • Barbed suture S2 is a barbed suture including, but not limited to, any of the above-described barbed sutures.
  • surgical needle N2 has diameter D2 in the transverse direction, which is illustrated as a suitably thin diameter, such as about 0.032 inch (about 0.81 mm), but not as thin as diameter DI of surgical needle Nl.
  • surgical needle N2 after having suture S2 inserted into hole H2, may be crimped by standard procedures about hole H2 to hold suture S2 in place for use in suturing tissue.
  • Figure 13C shows surgical needle N3 that is a curved elongated needle in the longitudinal direction and that is generally circular in cross section.
  • Surgical needle N3 has pointed tip T3 for insertion into tissue and also has hole H3.
  • Surgical needle N3 is illustrated as attached, such as by swaging, to barbed suture S3.
  • Barbed suture S3 is a barbed suture including, but not limited to, any of the above-described barbed sutures.
  • surgical needle N3 has diameter D3 in the transverse direction, which is illustrated as a relatively thin diameter, such as about 0.02 inch (about 0.51 mm).
  • surgical needle N3, after having suture S3 inserted into hole H3 may be crimped by standard procedures about hole H3 to hold suture S3 in place for use in suturing tissue.
  • Figure 13D shows surgical needle N4 that is a curved elongated needle in the longitudinal direction and that is generally circular in cross section.
  • Surgical needle N4 has pointed tip T4 for insertion into tissue and also has hole H4.
  • Surgical needle N4 is illustrated as attached, such as by swaging, to barbed suture S4.
  • Barbed suture S4 is a barbed suture including, but not limited to, any of the above-described barbed sutures.
  • surgical needle N4 has diameter D4 in the transverse direction, which is illustrated as a suitably thin diameter, such as about 0.032 inch (about 0.81 mm), but not as thin as diameter D3 of surgical needle N3.
  • surgical needle N4 after having suture S4 inserted into hole H4, may be crimped by standard procedures about hole H4 to hold suture S4 in place for use in suturing tissue.
  • Needle tips TI, T2, T3, and T4 are schematically illustrated as pointed, but, as is well known, surgical needles come with various kinds of pointed tips, such as taper point, taper cutting, ball point, cutting edge, diamond point, thin line, and lancet point, and it is intended to include, but not be limited to, all such needle tips. Taper point, taper cutting, and diamond point are preferred needle tips for surgical needles used with barbed sutures.
  • needle diameter for surgical needles used with conventional (i.e., unbarbed) sutures is considered unimportant, and often very thick surgical needles are used with thin conventional sutures such that the ratio of surgical needle diameter to conventional suture diameter is 4:1 or even higher, such as 4.43:1.
  • a relatively thin surgical needle attached to a barbed suture is more preferable for approximating tissue when stitching a wound closed than a relatively thick surgical needle threaded with a barbed suture.
  • the reason is that the relatively thin surgical needle attached to a barbed suture allows for greater engagement of barbs in tissue, and therefore provides better closure strength to the approximated tissue that has been sutured to prevent the opposing sides of the closed wound from pulling apart, as compared to the closure strength provided to approximated tissue that has been sutured with the relatively thick surgical needle.
  • the surgical needle diameter should be of sufficient width in order to make a hole or a channel in the end, such by drilling, to allow for insertion of the barbed suture into the hole or the channel. Nevertheless, as the surgical needle diameter increases, the surgical needle is still suitable as long as the ratio of the surgical needle diameter to the barbed suture diameter is about 3:1 or less.
  • a desirable ratio of surgical needle diameter to barbed suture diameter for either a straight needle or a curved needle, is about 3:1 or less, more preferably about 2:1 or less, most preferably about 1.8:1 or less.
  • the ratio of surgical needle diameter to barbed suture diameter may be as low as about 1:1 or less, or even lower, for instance, about 0.9:1 or less, or about 08:1 or less, or as low as about 0.5: 1. It will be appreciated by the person of ordinary skill in the art that care should be taken with extremely thin needles so as to ameliorate the possibility of localized weakness, which may compromise tissue insertion. Closure strength of thin surgical needles, both having a ratio of surgical needle diameter to barbed suture diameter suitable for the present invention, was tested as follows.
  • Narious pieces of chamois leather manufactured by U.S. Chamois of Florida
  • a thickness of about 0.6 in about 15.2 mm
  • a wound having a length of about 1.25 inch (about 32 mm).
  • a first specimen was made from a piece of chamois leather by stitching together the respective edges of the wound with a drilled end surgical needle (item no. 382077 A purchased from Sulzle Company) which was swaged with a barbed suture.
  • a drilled end surgical needle (item no. 382077 A purchased from Sulzle Company) which was swaged with a barbed suture.
  • the needle was crimped about the hole to secure the barbed suture during stitching.
  • the piece of chamois leather was cut to a rectangular shape of about 3 inches (about 76 mm) in length by about 1.25 inches (about 32 mm) in width, where the stitched wound was in the middle of the length and transverse the width.
  • the needle was a taper point, curved surgical needle (3/8 of a circle), with a length of about 22 mm and a relatively thin diameter of about 0.020 inch (about 0.51 mm).
  • a second specimen was made from another piece of chamois leather by stitching together the respective edges of the wound, using a drilled end surgical needle (item no. 383271 A purchased from Sulzle Company) swaged with the same kind of barbed suture, i.e., the surgical needle was crimped about the needle hole, after insertion of the barbed suture into the hole, to secure the barbed suture during stitching.
  • the needle was a taper point curved surgical needle (3/8 of a circle) with a length of about 22 mm and a suitable thin diameter of about 0.032 inch (about 0.81 mm), although not as thin as the diameter of the needle used for first specimen.
  • Each barbed suture for each specimen was a bi-directional, twist cut multiple spiral, polydioxanone barbed suture like suture 70 in Figure 6A, except that each barbed suture had a diameter of about 0.0115 inch (about 0.291 mm, which is slightly larger than the USP requirement for a size 3-0 synthetic absorbable suture), instead of a suture diameter of about 0.018 inch (about 0.457 mm).
  • Both the first and the second specimens of stitched chamois cloth were tested for closure strength using a Test Resources Universal Tester, Model 200Q. Each specimen was gripped by two respective serrated jaws. Then, each specimen was pulled longitudinally at a rate of about 10 inches per minute (about 254 mm per minute) until complete rupture. The peak load in pounds reached before complete wound disruption was recorded as the closure strength.
  • Sprague-Dawley rats each about 600 to 700 g, were used. Two full-thickness skin incisions were made on the back of each rat to create wounds. Each wound was about 4 cm in length and parallel to the spine.
  • one of the two wounds was closed with a drilled end, curved surgical needle that was a Sulzle item no. 382273A, which was 3/8 circle.
  • the needle had a length of 18mm and a diameter of about 0.022 inch (about 0.56 mm).
  • the needle had a taper point needle tip where the needle tip had been ground to a 3-facet cut to approximate a taper cutting needle tip to facilitate penetration of rat tissue.
  • the needle was swaged to a barbed suture.
  • the other of the two wounds was closed using the same suturing technique, but with a drilled end, curved surgical needle that was a Sulzle item no. 832679 A, which was 3/8 circle.
  • the needle had a length of about 18 mm and a diameter of about 0.026 inch (about 0.66 mm). Also, the needle had a diamond point needle tip. The needle was swaged to a barbed suture.
  • Each barbed suture for each specimen was a bi-directional, twist cut multiple spiral, polydioxanone barbed suture like suture 70 in Figure 6A, except that each barbed suture had a diameter of about 0.015 inch (about 0.381 mm, which is slightly larger than the USP requirement for a size 2-0 synthetic absorbable suture), instead of a suture diameter of about 0.018 inch (about 0.457 mm).
  • a tissue specimen that was approximately a square measuring about 4 cm x about 4 cm, with the stitched wound in the middle paralleling two opposing tissue edges, was retrieved for closure strength testing.
  • the force to open each wound was determined using a Test Resources Universal Tester, Model 200Q.
  • Model 200Q The force to open each wound was determined using a Test Resources Universal Tester, Model 200Q.
  • the two edges paralleling each stitched wound were mounted in the two respective serrated jaws of the tester.
  • each specimen was pulled longitudinally at a rate of about 2 inches per minute (about 51 mm per minute) until complete rupture occurred.
  • the maximum force encountered before complete wound disruption was recorded as the closure strength.
  • the results were averaged from the first set of three wounds closed with a needle having a diameter of about 0.022 inch (about 0.56 mm) and swaged to a barbed suture. Also, the results were averaged from the second set of three wounds closed with a needle having a diameter of about 0.026 inch (about 0.66 mm) and swaged to a barbed suture.
  • the ratio of surgical needle diameter to barbed suture diameter should be about 3:1 or less, more preferably about 2:1 or less.

Abstract

A barbed suture for connecting tissue, and a combination surgical needle with a barbed suture. The suture includes an elongated body and a plurality of barbs projecting from the body. Each barb causes the suture to resist movement in an opposite direction from which the barb faces. The disposition of the barbs on the body may be staggered, twist cut multiple spiral, overlapping, or random. Also, the configuration of the barbs may be a certain spirality angle a, barb cut angle q, barb cut depth, barb cut length, barb cut distance, corrugated barb underside, arcuate barb base, or varying barb size.

Description

BARBED SUTURES
TECHNICALFIELD
This invention relates, in general, to a barbed suture useful for connecting bodily tissue in various surgical contexts, and more particularly, to the optimization of the disposition and/or configuration of the barbs on such barbed sutures.
BACKGROUND OF THE INVENTION
Narious surgical methods employing sutures have been used in the past for closing or binding together wounds in human or animal tissue, such as skin, muscles, tendons, internal organs, nerves, blood vessels, and the like. More specifically, the surgeon may use a surgical needle with an attached conventional suture (which can be a smooth monofilament or can be a multi-filament) to pierce the tissue alternately on opposing faces of the wound and thus sew the wound closed. Whether the wound is accidental or surgical, loop stitching is the method often used, especially for surface wounds. The surgical needle is then removed and the ends of the suture are tied, typically with at least three overhand throws to form a knot.
As is well known, conventional sutures can be of non-absorbable material such as silk, nylon, polyester, polypropylene, or cotton, or can be of bio-absorbable material such as glycolic acid polymers and copolymers or lactic acid polymers and copolymers. Since the time of their conception, barbed sutures, which are generally of the same materials as conventional sutures, have offered numerous advantages over closing wounds with conventional sutures. A barbed suture includes an elongated body that has one or more spaced barbs, which project from the body surface along the body length. The barbs are arranged to allow passage of the barbed suture in one direction through tissue but resist movement of the barbed suture in the opposite direction. Thus, the main advantage of barbed sutures has been the provision of a non-slip attribute. Accordingly, barbed sutures do not have to be knotted, like conventional sutures. Like a conventional suture, a barbed suture may be inserted into tissue using a surgical needle.
For instance, U.S. Patent No. 3,123,077 to Alcamo describes an elongated cord for sewing human flesh, where the cord has a body portion and sharp-edged, resilient barbs projecting from the body at acute angles relative to the body. The barbed suture can be passed through tissue in one direction, but resists movement in the opposite direction.
Sutures with barbs disposed in a bi-directional arrangement, also called double-armed sutures, are shown in U.S. Patent No. 5,931,855 to Buncke and U.S. Patent No. 6,241,747 to Ruff. More particularly, the suture has barbs facing toward one end of the suture for about half the suture length and barbs facing in the opposite direction toward the other end of the suture for the other half of the suture length. This arrangement allows the barbs to move in the same direction as each respective suture end is inserted into the first and second sides of a wound. Such bi-directional barbed sutures not only are especially suitable for closing wounds with edges prone to separation, but also obviate the need to secure suture ends together with knotted loops.
Of interest is European Published Patent Application No. 1,075,843 Al to Sulamanidze and Mikhailov, published February 2, 2001, derived from PCT/RU99/00263 (published as WO 00/51658 on September 8, 2000), priority to RU 99103732 (March 3, 1999), which shows conical barbs arranged sequentially along the length of a thread and oriented in a direction opposite to that of the thread tension, with the distance between barbs being not less than 1.5 times the thread diameter.
Also of interest is U.S. Patent No. 5,342,376 to Ruff. This patent shows an insertion device that is useful for positioning a barbed suture in order to close a wound. The insertion device has a tubular body for receiving a barbed suture, and preferably also has a handle to facilitate manipulation of the device by the surgeon. The insertion device is recommended for use with a barbed suture where the suture portion being inserted includes barbs facing a direction opposed to the direction of insertion. Such sutures with barbs opposing the direction of insertion are also shown in '376 to Ruff.
The disclosures of all patents and patent applications mentioned here are incorporated by reference.
Escarpment of barbs into a monofilament, depending on the barb cut depth, reduces the straight pull tensile strength since the effective suture diameter is decreased. However, the straight pull tensile strength of a barbed suture should be compared to the minimum knot pull strength of a conventional suture (a non-barbed suture) in accordance with the United States Pharmacopoeia since failure of conventional sutures (which have to be knotted and must meet a minimum knot pull tensile strength) occurs most frequently at the knot due to increased local stress. To optimize the performance of a barbed suture, it is advantageous to consider varying the barb geometry (barb cut angle, barb cut depth, barb cut length, barb cut distance, etc.) and/or the spatial arrangement of the barbs. This should not only enhance the tensile strength of a barbed suture, but also should enhance the ability of a barbed suture in holding and maintaining wound edges together. Unlike conventional sutures, which place tensions directly at the knots, barbed sutures can spread out the tension along the escarped suture length, often evenly along the length. Optimizing the disposition and/or the configuration of the barbs should therefore further increase the effectiveness of the new barbed suture in maximizing the holding strength and minimizing the gap formation along the wound edges. The latter is particularly beneficial for promoting wound healing.
Also, such new barbed sutures should approximate tissue quickly with appropriate tension, alleviate distortion of tissue, and help to minimize scarring, due to the self-retaining benefits imparted by the barbs. The new barbed sutures would be especially useful in surgeries where minimization of scarring is imperative, such as cosmetic surgery, as well as in surgeries where space is limited, such as endoscopic surgery or microsurgery.
SUMMARY OF THE INVENTION
Accordingly, the present invention provides a barbed suture for connecting human or animal tissue. The barbed suture comprises an elongated body having a first end and a second end. The barbed suture further comprises a plurality of barbs projecting from the body. Each barb is adapted for enabling the barbed suture to resist movement, when in tissue, in the direction that is opposite from the direction in which that barb faces. The barbed suture further comprises the barbs being disposed on the body in a disposition selected from a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, a random disposition, or combinations thereof.
For the staggered disposition, the twist cut multiple spiral disposition, and/or the overlapping disposition, the barbs may all be facing toward only one of the first and second ends. Alternatively, the barbed suture may have at least a first portion and a second portion, where the barbs of the first portion are facing toward the first end and the barbs of the second portion are facing toward the second end.
Also, in an alternative embodiment, the present invention provides a barbed suture for connecting human or animal tissue, where the suture comprises an elongated body having a first end and a second end. The suture further comprises a plurality of barbs projecting from the body. Each barb is adapted for enabling the suture to resist movement, when the suture is in tissue, in the direction that is opposite from the direction in which that barb faces. The suture further comprises the barbs having a configuration selected from a barb cut angle θ ranging from about 140 degrees to about 175 degrees, a barb cut depth with a ratio of cut depth to suture diameter ranging from about 0.05 to about 0.6, a barb cut length with a ratio of cut length to suture diameter ranging from about 0.2 to about 2, a barb cut distance with a ratio of cut distance to suture diameter ranging from about 0.1 to about 6, a corrugated underside, an arcuate base, varying sizes, or combinations thereof.
For the twist cut multiple spiral disposition, the barbed suture preferably has a spirality α angle ranging from about 5 degrees to about 25 degrees.
For the overlapping disposition, it is meant that at least two adjacent barbs are disposed where one overlaps the other. During escarpment of the barbs, the overlapping is created by a barb (i.e., the overlapping barb) being escarped into the topside of another adjacent barb (i.e., the overlapped barb), and so on. Hence, part of the topside of the overlapped barb becomes part of the underside of the overlapping barb, and so on. Thus, with the overlapping disposition, the barb cut distance between the overlapping barb and the overlapped barb may be shorter than the barb cut length of overlapped second barb, whereas, in general for barbed sutures, the barb cut distance between two barbs > the barb cut length.
In still another embodiment, the present invention provides a barbed suture for connecting human or animal tissue in combination with a surgical needle, where the combination comprises a barbed suture attached to a surgical needle. The suture comprises a plurality of barbs projecting from an elongated body having a first end and a second end. Each barb is adapted for enabling the suture to resist movement, when the suture is in tissue, in the direction that is opposite from the direction in which that barb faces. The ratio of the surgical needle diameter to the suture diameter preferably is about 3:1 or less. Suitably, any of the inventive barbed sutures described here may be attached to a surgical needle.
BRIEF DESCRIPTION OF THE DRAWINGS
FIGURE 1 A is a side view of one embodiment of the present invention, showing a barbed suture with barbs disposed in a 180 degree staggered spacing;
FIGURE IB is a sectional view along line IB - IB of the barbed suture in Figure 1 A; FIGURE 2A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a 180 degree staggered spacing; FIGURE 2B is a sectional view along line 2B - 2B of the barbed suture in Figure 2A; FIGURE 3A is a side view of another embodiment of the present invention, showing a barbed suture with barbs disposed in a 120 degree staggered spacing;
FIGURE 3B is a sectional view along line 3B - 3B of the barbed suture in Figure 3 A; FIGURE 4A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a 120 degree staggered spacing;
FIGURE 4B is a sectional view along line 4B - 4B of the barbed suture in Figure 4A;
FIGURE 5A is a side view of another embodiment of the present invention, showing a barbed suture with barbs disposed in a twist cut multiple spiral disposition;
FIGURE 5B is a sectional view along line 5B - 5B of the barbed suture in Figure 5 A;
FIGURE 6A is a side view of another embodiment of the present invention, showing a barbed suture that is bi-directional with barbs disposed in a twist cut multiple spiral disposition; FIGURE 6B is a sectional view along line 6B - 6B of the barbed suture in Figure 6A;
FIGURE 7A is a sectional side view of a barbed suture, which is bi-directional with barbs disposed in a twist cut multiple spiral disposition like the barbed suture in Figure 6 A, but illustrated in an enlarged section;
FIGURE 7B is the sectional side view as illustrated in Figure 7A, but rotated and clamped to align the barbs for measurement of the cut distance between the barbs;
FIGURE 8 is a side view of another embodiment of the present invention, showing a barbed suture with barbs in a random disposition;
FIGURE 9 is a sectional side view of another embodiment of the present invention, showing a barbed suture having a barb with a corrugated or serrated underside; FIGURE 10A is a sectional perspective view another embodiment of the present invention, showing a barbed suture having a barb with an arcuate base;
FIGURE 10B is a sectional top plan view of the barbed suture in Figure 10A;
FIGURE 10C is a cross-sectional view along line 10C - 10C of Figure 10B;
FIGURE 10D is a cross-sectional view along line 10D - 10D of Figure 10B; FIGURE 11 is a sectional side view of another embodiment of the present invention, showing a barbed suture with barbs of various sizes;
FIGURE 12A is a sectional perspective view of another embodiment of the present invention, showing a barbed suture with barbs in an overlapping disposition;
FIGURE 12B is a perspective view of a portion of the overlapping barbs of the suture of Figure 12 A;
FIGURE 12 C is a plan view of the portion of barbs of Figure 12B;
FIGURE 12D is a side view along line 12D - 12D of Figure 12C; and
FIGURES 13A, 13B, 13C, and 13D show various surgical needles, where a barbed suture is attached to each surgical needle. DESCRIPTION
As used here, the term "wound" means a surgical incision, cut, laceration, severed tissue or accidental wound in human or animal skin or other human or animal bodily tissue, or other condition in a human or animal where suturing, stapling, or the use of another tissue connecting device may be required.
Also as used here, the term "tissue" includes, but is not limited to, tissues such as skin, fat, fascia, bone, muscle, organs, nerves, or blood vessels, or fibrous tissues such as tendons or ligaments.
Moreover, the term "polymer" as used here generally includes, but is not limited to, homopolymers, copolymers (such as block, graft, random and alternating copolymers), terpolymers, et cetera, and blends and modifications thereof. Furthermore, the term "polymer" shall include all possible structures of the material. These structures include, but are not limited to, isotactic, syndiotactic, and random symmetries.
Although the sutures are described below in a preferred embodiment with a circular cross section, the sutures could also have a non-circular cross sectional shape that could increase the surface area and facilitate the formation of the barbs. Other cross sectional shapes may include, but are not hmited to, oval, triangle, square, parallelepiped, trapezoid, rhomboid, pentagon, hexagon, cruciform, and the like. Typically, barbs are cut into a polymeric filament that has been formed by extrusion using a die with a circular cross section, and thus, the cross section of the filament will be circular, as that is what results during such extrusion. However, extrusion dies can be custom made with any desired cross- sectional shape.
Hence, the term "diameter" as used here is intended to mean the transverse length of the cross section, regardless of whether the cross section is circular or some other shape. Suitable diameters for the inventive sutures described below may range from about
0.001 mm to about 1 mm, and of course, the diameter may be from about 0.01 mm to about 0.9 mm, or from about 0.015 mm to about 0.8 mm. The typical diameter ranges from about 0.01 mm to about 0.5 mm. The length of the suture can vary depending on several factors such as the length and/or depth of the wound to be closed, the type of tissue to be joined, the location of the wound, and the like. Typical suture lengths range from about 1 cm to about 30 cm, more particularly from about 2 cm to about 22 cm.
The terms "staggered" and "staggering" as used here in relation to the disposition of barbs on a suture are intended to mean that the suture has at least two sets of barbs that are offset with respect to each other, where the first set is aligned longitudinally on the suture and the second set is aligned longitudinally on the suture, but a plane perpendicular to the suture and cutting transversely through the suture and intersecting the base of a barb of the first set will not intersect the base of a barb of the second set.
The barbs project from the exterior surface of the suture body on which the barbs are disposed. Depending on the intended end use of the barbed suture, barbs of different sizes may be employed. In general, larger barbs are more suitable for joining certain types of tissue such as fat tissue or soft tissue. On the other hand, smaller barbs are more suitable for joining other types of tissue, such as collagen dense tissue.
As noted above, barbed sutures may be made from the same materials used for making conventional loop sutures. Any particular chosen material for the barbed suture depends on the strength and flexibility requirements.
More specifically, barbed sutures may be formed from a bio-absorbable material that allows the suture to degrade and thus to be absorbed over time into the tissue as the wound heals. Generally, bio-absorbable materials are polymeric, and depending on the particular polymer selected, the degradation time in the wound ranges from about 1 month to over 24 months. The use of bio-absorbable materials eliminates the necessity of removing the sutures from the patient.
Narious bio-absorbable polymers include, but are not limited to, polydioxanone, polylactide, polyglycolide, polycaprolactone, and copolyrhers thereof. Commercially available examples are polydioxanone (sold as PDS II, a trade name used by Ethicon for selling surgical sutures), copolymer of about 67% glycolide and about 33% trimethylene carbonate (sold as MAXOΝ®, a trademark registered to American Cyanamid for surgical sutures), and copolymer of about 75% glycolide and about 25% caprolactone (sold as MOΝOCRYL®, a trademark registered to Johnson & Johnson for sutures and suture needles). Barbed sutures made from such bio-absorbable materials are useful in a wide range of applications.
Additionally, barbed sutures may be formed from a non-absorbable material, which may be a polymer. Such polymers include, but are not limited to, polypropylene, polyamide (also known as nylon), polyester (such as polyethylene terephthlate, abbreviated here as PET), polytetrafluoroethylene (such as expanded polytetrafluoroethylene, abbreviated here as ePTFE and sold by Gore as GOR-TEX®), polyether-ester (such as polybutester, which is the condensation polymerization of dimethyl terephthlate, polytetramethylene ether glycol, and 1,4-butanediol, and which is marketed by Davis & Geek and by U.S. Surgical, companies owned by Tyco, under the name NONAFIL®, which is a trademark registered to American Cyanamid for surgical sutures), or polyurethane. Alternatively, the non-absorbable material may be metal (e.g., steel), metal alloys, natural fiber (e.g., silk, cotton, et cetera), and the like. Most of the barbed sutures discussed below are described as having their ends being pointed and formed of a material sufficiently stiff to allow for piercing tissue. It is contemplated that the ends of the barbed sutures may comprise a surgical needle. In this embodiment, the barbed suture is adapted for attachment, such as by swaging, channel wrapping, heat shrinking, or eyelet threading to the surgical needle for insertion into tissue. Attachment by swaging is well described and is typically accomplished by inserting the suture end into the surgical needle hole that is longitudinally disposed at one end of the surgical needle (usually the hole has been drilled longitudinally into one end of the needle), followed by crimping the resultant about the needle hole so that the suture is secured to the surgical needle for insertion into tissue. Also, some surgical needles with a longitudinal hole in one end are heat-shrinkable tubes that are heat shrunk after insertion of the suture in order to attach the suture to the surgical needle. Additionally, some surgical needles have a channel or trough at one end, and the suture is laid in the trough, followed by wrapping to secure the suture to the surgical needle. Surgical needles with a conventional eyelet type of hole transversely di posed in one end of the surgical needle could also be used, but are not preferred for barbed sutures. For the present invention, part of the discussion below regards surgical needles swaged with barbed sutures, but it is contemplated that any other suitable means of attaching needles can be employed.
Attachment of sutures and surgical needles is described in U.S. Patent No. 3,981,307 Borysko, U.S. Patent No. 5,084,063 to Korthoff, U.S. Patent No. 5,102,418 to Granger et al., U.S. Patent No. 5,123,911 to Granger et al., U.S. Patent No. 5,500,991 to Demarest et al., US. Patent No. 5,722,991 to Colligan, U.S. Patent No. 6,012,216 to Esteves et al., and U.S. Patent No. 6,163,948 to Esteves et al. A method for the manufacture of surgical needles is described in U.S. Patent No. 5,533,982 to Rizk et al. Further, it is noted that the surgical needle may be coated, the coating allowing for the needle of the inventive combination surgical needle/barbed suture to be inserted into tissue with less force than if the surgical needle were not coated. The coating may be a polymer, for instance, a silicone resin coating. For example, an improved siliconized surgical needle that requires significantly less force to effect tissue penetration than a standard siliconized surgical needle is described in U.S. Patent No. 5,258,013 to Granger et al. The barbs are disposed in various arrangements on the body of the suture. The barbs may be formed using any suitable method, including injection molding, stamping, cutting, laser, and the like. With regard to cutting, in general, polymeric threads or filaments are purchased, and then the barbs are cut onto the filament body. The cutting may be manual, but that is labor intensive and not cost effective.
A very suitable cutting machine is disclosed in U.S. Patent Application Serial No. 09/943,733 to Genova et al., assignors to Quill Medical, filed August 31, 2001, the disclosure of which is incorporated by reference. Such a cutting machine has a plurality of blades for escarpment of barbs onto a suture filament. A typical cutting machine for manufacturing barbed sutures utilizes a cutting bed, a vise, one or more blade assemblies, and sometimes a template or guide for the blades. The suture filament is placed in the bed and held by the vise, with the transverse direction of the blades generally disposed in the transverse direction of the suture filament, in order to cut a plurality of axially spaced barbs disposed on the exterior of a suture filament. With reference now to the drawings, where like reference numerals designate corresponding or similar elements throughout the several views, shown in Figure 1 A is a side view of a barbed suture according to the present invention and generally designated at 1.
Suture 1 includes elongated body 2 that is generally circular in cross section and that terminates in end 4. End 4 is illustrated in one embodiment as being pointed for penetrating tissue, but it is contemplated that end 4 may comprise a surgical needle (not shown) for insertion into tissue. (The other end is not shown.) Also, suture 1 includes plurality of closely spaced barbs 7, 9 arranged in a staggered uni-directional disposition. More specifically, axially spaced barbs 7 are radially arranged about 180 degrees from and staggered with respect to axially spaced barbs 9, with barbs 7, 9 facing pointed end 4. First set of barbs 7 define a plane that is substantially coplanar with the plane defined by second set of barbs 9, and consequently, barbs 7, 9 define substantially the same one plane due to the radial 180 degree arrangement.
Figure IB, which is a cross sectional view along line IB - IB of suture 1 in Figure 1A, more clearly illustrates angle X, namely the radial 180 degree arrangement of barbs 7 with respect to barbs 9. As also can be seen from Figure IB, the stippling illustrates that first barb 7 of barbs 7 is closer to pointed end 4 (not shown in Figure IB), and thus, seems to be larger than farther away first barb 9 of barbs 9, due to the staggering. A transverse plane that is perpendicular to suture body 2 and that intersects the base of one barb 7 of barbs 7 does not intersect the base of any barb 9 of barbs 9. Suture 1 may be made with a cutting machine that produces two sets of barbs 7, 9, usually one set at a time, in a staggered position along suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al.
First set of barbs 7 is created by placing and holding a suture filament in the vise, and then, the set of blades, with a predetermined length, splices into the suture filament at an angle selected to create barbs 7 pointing in one direction toward pointed end 4. Second set of barbs 9 is created similarly after offsetting the blades longitudinally (to create the staggering) approximately half of the longitudinal distance between two of barbs 7 and also rotating the suture filament about 180 degrees on the vise, which is equipped to accommodate first set of barbs 7 that are already cut.
Shown in Figure 2A is suture 10, which is another embodiment of the present invention and is like suture 1, except that suture 10 is bi-directional. Suture 10 includes elongated body 12 that is generally circular in cross section. Elongated body 12 terminates in first and second pointed ends 14, 16 for penetrating tissue. Also, it is contemplated that one or both ends 14, 16 may comprise a surgical needle (not shown) for insertion into tissue. Also, suture 10 includes plurality of closely spaced barbs 17, 18, 19, 20 arranged in a staggered bi-directional disposition.
More specifically, plurality of axially spaced barbs 17 are radially arranged about 180 degrees from and staggered with respect to plurality of axially spaced barbs 19, with barbs 17, 19 facing pointed end 14 for a portion (about half of the length) of suture 10. Similarly, plurality of axially spaced barbs 18 are radially arranged about 180 degrees from and staggered with respect to plurality of axially spaced barbs 20, with barbs 18, 20 facing pointed end 16 for another portion (approximately the other half of the length) of suture 10. First set of barbs 17, 18 define a plane that is substantially coplanar with the plane defined by second set of barbs 19, 20. As a result, all of barbs 17, 18, 19, 20 define substantially the same one plane due to the radial 180 degree arrangement of first set of barbs 17, 18 with respect to second set of barbs 19, 20.
Figure 2B is a cross sectional view along line 2B - 2B of suture 10 in Figure 2A, more clearly illustrating angle X, namely the radial 180 degree arrangement. Due to the staggering, first barb 17 of barbs 17 is closer to pointed end 14 (not shown in Figure 2B), and thus, appears larger than farther away first barb 19 of barbs 19, as is illustrated by the stippling. A transverse plane that is perpendicular to suture body 12 and that intersects the base of one barb 17 of barbs 17 does not intersect the base of any barb 19 of barbs 19. Likewise, a transverse plane that is perpendicular to suture body 12 and that intersects the base of one barb 18 of barbs 18 does not intersect the base of any barb 20 of barbs 20.
Suture 10 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., except with the following change in blade direction.
For first set of bi-directional barbs 17, 18, after the suture filament is placed and held in the vise, the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 17 facing in one direction toward pointed end 14. Next, the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length. The blades are then allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 18 facing in the opposite direction toward pointed end 16.
Next, the blades are offset longitudinally (to create the staggering) about half of the longitudinal distance between two of barbs 17, and also the suture filament is rotated about 180 degrees on the vice, which is equipped to accommodate first set of bi-directional barbs 17, 18 that are already cut. Then, for second set of bi-directional barbs 19, 20, the blades splice with a first cutting action into approximately half the length of the suture filament to create barbs 20 facing in one direction toward pointed end 16. The first cutting action is followed by rotating the blades longitudinally 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length. The blades are then allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 19 facing in the opposite direction toward pointed end 14.
In an alternative embodiment (not shown) for bi-directional suture 10, the portion of suture 10 with barbs 17, 19 may have them facing toward pointed end 16 and the portion of suture 10 with barbs 18, 20 may have them facing toward pointed end 14. With this variation, the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff. Additionally, it is noted that, if desired, barbs may be escarped so that there may be two portions with barbs facing one end and one portion with barbs facing the other end, or two portions with barbs facing one end and two portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end to which those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
An advantage of a barbed suture having a radial 180 degree arrangement with staggering is that the 180 degree spacing is readily fabricated on relatively small diameter filaments and the staggering improves anchoring performance. Thus, in thin and delicate tissue, where a smaller suture is desirable, the staggered 180 degree spacing generates effective anchoring performance.
Turning now to Figure 3A, depicted is a side view of another embodiment of a suture according to the present invention, and generally designated at suture 30. Suture 30 is like suture 1 shown in Figure 1A, except that the radial spacing for suture 30 is 120 degrees instead of 180 degrees as is shown for suture 1.
More particularly, suture 30 includes elongated body 32 that is generally circular in cross section and that terminates in pointed end 34 for penetrating tissue. It is contemplated that end 34 may comprise a surgical needle (not shown) so that the suture can be inserted into tissue. (The other end is not shown.) Additionally, suture 30 includes plurality of closely spaced barbs 35, 37, 39 arranged so that all face in the same direction toward pointed end 34. Hence, the disposition of barbs 35, 37, 39 is uni-directional.
Also, axial spaced barbs 35 are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 37, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 39. Hence, axially spaced barbs 39 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 35. As a result of the radial 120 degree arrangement, first set of barbs 35 define substantially the same one plane; second set of barbs 37 define substantially another same one plane; and third set of barbs 39 define substantially still another same one plane. Thus, suture 30 has barbs 35, 37, 39 arranged in a staggered uni-directional 120 degree disposition. Figure 3B is a cross sectional view along line 3B - 3B of suture 30 in Figure 3 A and shows with more particularity angle Y, namely the radial 120 degree arrangement of barbs 35 with respect to barbs 37, barbs 37 with respect to barbs 39, and barbs 39 with respect to barbs 35.
As illustrated by the stippling, first barb 35 of barbs 35, because of the staggering, is closer to pointed end 34 (not shown in Figure 3B), and thus, seems to be larger than farther away first barb 37 of barbs 37. Also, first barb 37 of barbs 37, due to the staggering, is closer to pointed end 34 (not shown in Figure 3B), and thus, seems to be larger than even farther away first barb 39 of barbs 39. A transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 35 of barbs 35 does not intersect the base of any barb 37 of barbs 37. Likewise, a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 37 of barbs 37 does not intersect the base of any barb 39 of barbs 39. Similarly, a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 39 of barbs 39 does not intersect the base of any barb 35 of barbs 35.
Suture 30 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. The cutting machine is now used to produce three sets of barbs 35, 37, 39, usually one set at a time, in a staggered position along suture 30.
First set of barbs 35 is created by placing and holding a suture filament in the vise, followed by the blades, after having been adjusted to a predetermined length, splicing into the suture filament at an angle that is chosen to create barbs 35 so that all are facing in the same direction toward pointed end 34.
Next, the blades are offset longitudinally (to create the staggering) approximately half of the longitudinal distance between two of barbs 35. Also, the filament is rotated about 120 degrees on the vise, which is equipped to accommodate first set of barbs 35 that have already been cut, and then second set of barbs 37 is created in a similar manner. Likewise, the blades are again offset longitudinally (to create the staggering) approximately half the longitudinal distance between two of barbs 35, and also the suture filament is rotated about 120 degrees on the vise, which is equipped to accommodate both already cut first set of barbs 35 and already cut second set of barbs 37. Following the longitudinal movement and rotation, third set of barbs 39 is created in a similar manner. Preferably, each successive barb is escarped at a position about 120 degrees around suture body 32 from the preceding barb and does not overlap with any other barb.
With reference now to Figure 4 A, illustrated is suture 40, another embodiment of the present invention. Suture 40 is similar to suture 30, except that suture 40 is bi-directional. Suture 40 includes elongated body 42 that is generally circular in cross section and that terminates in first and second pointed ends 44, 46 for penetrating tissue. Also, it is contemplated that one or both ends 44, 46 may comprise a surgical needle (not shown) in order to be inserted into tissue. Suture 40 further includes plurality of closely spaced barbs 47, 48, 49, 50, 51, 52 arranged in a staggered bi-directional disposition.
For about half of the length of suture 40, axially spaced barbs 47 are circumferentially arranged about 120 degrees from and staggered with respect to axially spaced barbs 49, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 51. Consequently, axially spaced barbs 51 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 47. Thus, a portion of suture 40 has all of barbs 47, 49, 51 facing in the same direction toward pointed end 44. For the other half of the length of suture 40, axially spaced barbs 48 are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 50, which are radially arranged about 120 degrees from and staggered with respect to axially spaced barbs 52. Consequently, axially spaced barbs 52 are also arranged about 120 degrees from and staggered with respect to axially spaced barbs 48. Thus, another portion of suture 40 has all of barbs 48, 50, 52 facing in the same direction toward pointed end 46.
As a result of the radial 120 degree arrangement, first set of barbs 47, 48 define substantially the same one plane; second set of barbs 49, 50 define substantially another same one plane; and third set of barbs 51, 52 define substantially still another same one plane. Figure 4B, which is a cross sectional view along line 4B - 4B of suture 40 in Figure
4A, shows more clearly angle Y, namely the radial 120 arrangement with greater specificity. As illustrated by the stippling, first barb 47 of barbs 47, on account of the staggering, is closer to pointed end 44 (not shown in Figure 4B), and thus, appears larger than farther away first barb 49 of barbs 49. Also because of the staggering, first barb 49 of barbs 49 is closer to pointed end 44 (not shown in Figure 4B), and thus, appears larger than even farther away first barb 51 of barbs 51.
A transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 47 of barbs 47 does not intersect the base of any barb 49 of barbs 49. Likewise, a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 49 of barbs 49 does not intersect the base of any barb 51 of barbs 51. Similarly, a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 51 of barbs 51 does not intersect the base of any barb 47 of barbs 47. Also, a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 48 of barbs 48 does not intersect the base of any barb 50 of barbs 50. Likewise, a transverse plane that is perpendicular to suture body 32 and that intersects the base of one barb 50 of barbs 50 does not intersect the base of any barb 52 of barbs 52. Similarly, a transverse plane that is perpendicular to suture body 42 and that intersects the base of one barb 52 of barbs 52 does not intersect the base of any barb 48 of barbs 48.
Suture 40 may be made with the same cutting machine as suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., except with the following change in blade direction.
For first set of bi-directional barbs 47, 48, after the suture filament is placed and held in the vise, the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 47 facing in one direction toward pointed end 44. Then, the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the length. The blades then are allowed to splice into the other half of the length of the suture filament with a second cutting action to create barbs 48 facing in the opposite direction toward pointed end 46. Next, the blades are offset longitudinally (to create the staggering) for about half the longitudinal distance between two of barbs 47, and also the suture filament is rotated about 120 degrees on the vise, which is equipped to accommodate first set of bi-directional barbs 47, 48 that are already cut. Then, for second set of bi-directional barbs 49, 50, the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 50 facing in one direction toward pointed end 46. The first cutting action is followed by rotating the blades 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the suture filament. They then splice into the other half of the length of the suture filament with a second cutting action to create barbs 49 facing in the opposite direction toward pointed end 44. Then, the blades are again offset longitudinally (to create the staggering) for about half the longitudinal distance between two of barbs 47. Additionally, the suture filament again is rotated about 120 degrees on the vise, which is equipped to accommodate already cut first set of bi-directional barbs 47, 48 and already cut second set of bi-directional barbs 49, 50. Following the longitudinal movement and rotation, the third set of bi-directional barbs 51, 52 are made by having the blades splice with a first cutting action into approximately half of the length of the suture filament to create barbs 51 facing in one direction toward pointed end 44. The first cutting action is followed by rotating the blades 180 degrees so that they are now disposed in the opposite direction and over the uncut half of the suture filament. They next splice into the other half of the length of the suture filament with a second cutting action to create barbs 52 facing in the opposite direction toward pointed end 46.
Preferably, each successive barb is escarped at a position about 120 degrees around suture body 42 from the preceding barb and does not overlap with any other barb.
In an alternative embodiment (not shown) for bi-directional suture 40, the portion of suture 40 having barbs 47, 49, 51 may have them facing toward pointed end 46 and the portion of suture 40 having barbs 48, 50, 52 may have them facing toward pointed end 44. With this variation, the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff. Additionally, it is noted that, if desired, barbs may be escarped so that there may be two portions with barbs facing one end and one portion with barbs facing the other end, or two portions with barbs facing one end and two portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end that those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
An advantage of a barbed suture with a radial 120 degree arrangement is that the barbs exert force in three distinct planes that compliment each other, resulting in maximization of the retention force of the suture overall. As noted above, the staggering enhances anchoring performance.
Turning now to Figure 5 A, shown is another embodiment of the present invention, which is generally designated at suture 60, with radial spacing that is in a twist cut multiple spiral. Suture 60 includes elongated body 62 of generally circular cross section. Elongated body 62 terminates in pointed end 64 for penetrating tissue. Also, it is contemplated that end 64 may comprise a surgical needle (not shown) for insertion into tissue. Furthermore, suture 60 includes plurality of closely spaced barbs 67 arranged in a twist cut multiple spiral pattern around body 62 and facing in the same direction toward pointed end 64. Figure 5B is a cross sectional view along line 5B - 5B of suture 60 in Figure 5A. Due to the twist cut multiple spiral disposition, each respective barb 67 seems to be smaller and smaller as each is farther and farther away from pointed end 64 (not shown in Figure 5B), the illusion of size difference being illustrated by the stippling.
Suture 60 may be constructed with a similar cutting machine as that used for making suture 1, such as the cutting device described in the above-noted Serial No. 09/943,733 to
Genova et al. With a twist cutting method, barbs 67 may be produced in multiple spirals that preferably are created at the same time as the suture filament is held stationary, instead of being rotated, when the cutting takes place.
More particularly, a suture filament that is about 7 inches (about 178 mm) in length, is longitudinally twisted for a portion of the suture length, such as 39 times for a portion that is about 4.5 inches (about 114 mm) of the suture length. Thus, an end is secured, and the other end is grasped and rotated 360 degrees, 39 times, so the portion of the suture filament is twisted when the suture is then placed and held in the vise.
Twisting preferably is performed 28 to 50 times, and may be performed more or less, such as 19 to 70 times. Suitably, twisting may be from about 2 to about 17 twists per inch, or about 3 to about 15 twists per inch, or about 5 to about 13 twists per inch (per inch being per 25.4 mm).
Next, the blades, after having been adjusted to a predetermined length, simultaneously splice into the suture filament. The cutting action makes cuts to create barbs 67 so that all are facing in the same direction toward pointed end 64. After twist cut multiple spiral barbed suture 60 is released from the vice and untwisted, barbs 67 are disposed in multiple spirals on suture 60.
Turning now to Figure 6A, shown is another embodiment of the present invention, which is generally designated at suture 70. Suture 70 is of a twist cut multiple spiral disposition and thus is similar to suture 60, except that suture 70 is bi-directional. Suture 70 includes elongated body 72 that is generally circular in cross section and that terminates in first and second pointed ends 74, 76 for penetrating tissue. It is contemplated that one or both of ends 74, 76 may comprise a surgical needle (not shown) for insertion into tissue. Suture 70 further includes plurality of closely spaced barbs 77, 78 arranged in two respective spiral patterns, each being a multiple spiral around body 72. Barbs 77, 78 are disposed on middle portion MP that is approximately 3 inches (approximately 76 mm) of suture 70, with each end portion EP of suture 70 being barb-free. More particularly, plurality of barbs 77 are arranged in a multiple spiral pattern with all barbs 77 facing toward pointed end 74 for a part (about half) of middle portion MP along the length of suture 70. Similarly, plurality of barbs 78 are arranged in a multiple spiral pattern with all barbs 78 facing toward pointed end 76 for another part (the other approximate half) of middle potion MP along the length of suture 70.
Figure 6B is a cross sectional view along line 6B - 6B of suture 60 in Figure 6A. Due to the multiple spiral configuration, each respective barb 77 seems to be smaller and smaller as each is farther and farther away from pointed end 74 (not shown in Figure 6B), as illustrated by the stippling.
Suture 70 may be made with the same cutting machine as suture 60, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al., but with the following change in blade direction. Using the twist cutting method, barbs 77 may be produced in multiple spirals that preferably are created at the same time, and then after the direction change for the blades, barbs 78 may be produced in multiple spirals that preferably are created at the same time. Thus during the cutting, the suture filament is held stationary instead of being rotated. More specifically, a section of about 4.5 inches (about 114 mm) in length of a suture filament is twisted, such as 39 times for a suture about 7 inches (about 178 mm) in length. Thus, an end is secured, and the other end is grasped and rotated 360 degrees, 39 times, so the twisted section of the suture filament has about 8 2/3 twists per inch (per 25.4 mm) when the suture filament is then is placed and held in the vise. Twisting preferably is performed 28 to 50 times, and may be performed more or less, such as 19 to 70 times. Suitably, twisting may be from about 2 to about 17 twists per inch, or about 3 to about 15 twists per inch, or about 5 to about 13 twists per inch (per inch being per 25.4 mm). Next, the blades, after having been adjusted to a predetermined length, splice into approximately half of the approximately 3 inch (approximately 76 mm) length of middle portion MP of the approximately 4.5 inch (approximately 114 mm) twisted section of the suture filament in a first cutting action with the blades making cuts to create barbs 77 so that all are facing in one direction toward pointed end 74. Depending on how many blades there are on the cutting machine and how many barbs 77 are desired, there may be one cutting motion to cut all barbs 77 simultaneously, or there may be repeated cutting motions until the desired number of barbs 77 are escarped into a portion of the suture filament.
Then, the blades are rotated 180 degrees so that they are now disposed in the opposite direction and over the other half of the approximately 3 inch (approximately 76 mm) length of middle portion MP of the approximately 4.5 inch (approximately 114 mm) twisted section of the suture filament. The blades are then allowed to splice into the other half in a second cutting action with the blades making cuts to create barbs 78 so that all are facing in the opposite direction toward pointed end 76. Depending on how many blades there are on the cutting machine and how many barbs 78 are desired, there may be one cutting motion to cut all barbs 78 simultaneously, or there may be repeated cutting motions until the desired number of barbs 78 are escarped into a portion of the suture filament.
When twist cut multiple spiral barbed suture 70 is released from the vise and untwisted, the first cuts and the second cuts result in barbs 77, 78 being in two respective multiple spiral patterns on two respective portions of suture 70, the two respective portions defining middle portion MP of about 3 inches (about 76 mm) in length.
More particularly, several twist cut multiple spiral, barbed sutures were manufactured from a monofilament having a diameter of about 0.018 inch (about 0.457 mm) and spun from polydioxanone (which is a synthetic absorbable suture material). A diameter of about 0.018 inch (about 0.457 mm) is slightly larger than the size 0 synthetic absorbable suture, which has a diameter range from about 0.35 mm to about 0.399 mm in accordance with the specifications of the United States Pharmacopoeia (USP).
Each suture contained a total of 78 barbs introduced in two respective multiple spiral patterns around the circumference of the suture. Since the barbed suture was bi-directional, the barbs were divided into a left group with 39 barbs disposed on a first portion of the suture and a right group with 39 barbs on a second portion of the suture, each group opposing the direction of the other group from the approximate middle of the suture. The specific cutting machine employed had 13 blades. Thus, for each group of 39 barbs, there were 3 cutting motions (3 x 13 = 39), with the blades being offset with a guide for each of the 3 cutting motions.
Each suture was about 7 inches (about 178 mm) long. The middle portion MP was about 3 inches (about 76 mm) long and contained the 78 barbs that were escarped into the suture filament. Extending beyond the 3 inch (76 mm) barbed middle portion MP were two unbarbed end portions EP of the suture that were each about 2 inches (about 51 mm) long. Depending on the suturing technique, one or both ends of the barbed suture may be sufficiently pointed and rigid for insertion into tissue, or may comprise a straight or curved surgical needle.
The strength of the twist cut, 7 inch (178 mm) barbed sutures was tested by two methods. One method was a straight pull tensile strength test with a Universal Tester and the other method was an in vivo performance test with dogs.
For the straight pull tensile strength measurement, testing was performed using a Test Resources Universal Tester, Model 200Q. The average reading of 10 repeated measurements made for each kind of suture was recorded for the barbed sutures and for the comparison unbarbed sutures. Comparison unbarbed sutures were polydioxanone monofilaments (a synthetic absorbable suture material) of various suture diameters of about 0.018 inch (about 0.457 mm), about 0.015 inch (about 0.381 mm), and about 0.0115 inch (about 0.292 mm), which are respectively slightly larger than the United States Pharmacopoeia sizes 0, 2-0, and 3-0 for synthetic absorbable sutures. In accordance with United States Pharmacopoeia specifications for synthetic absorbable sutures, size 0 has a diameter range of about 0.35 mm to about 0.399 mm; size 2-0 has a diameter range of about 0.30 mm to about 0.339 mm; and size 3-0 has a diameter range of about 0.20 mm to about 0.249 mm.
Each barbed suture was gripped at each end by being held with cork gasket padding in two respective serrated jaws, whereas each unbarbed suture was gripped at each end by being wrapped around two respective capstan roller grips. Capstan rollers were used for holding the unbarbed sutures to avoid stress and distension.
The portion of each suture specimen between the two gripped places was about 5 inches (about 126 mm) in length, which, in the case of barbed sutures, contained the entire 3 inches (76 mm) of the barbed middle portion. Each specimen was pulled longitudinally at a rate of about 10 inches (about 254 mm) per minute until breakage occurred. The peak load was recorded as the straight pull tensile strength.
The results are summarized in Table 6A below, and the far right column denotes the
USP knot pull test minimum requirements for conventional (unbarbed) sutures made from a synthetic absorbable material.
Table 6A (Tensile Strength)
USP Minimum Requirements
Barbed or Unbarbed Suture Size Straight Pull (pounds) for Knot Pull (pounds) Unbarbed 0 17.72 8.60
Unbarbed 2-0 11.86 5.91
Unbarbed 3-0 8.82 3.90
Barbed 0 7.03 not applicable
As can be seen, escarpment of barbs into the size 0 polydioxanone monofilament reduced the straight pull tensile strength by approximately 60% as compared to the conventional unbarbed size 0 polydioxanone monofilament (7.03 pounds = 40% of 17.72 pounds).
However, the straight pull tensile strength of 7.03 pounds at breakage for the size 0 polydioxanone barbed suture (which, due to the escarpment of the barbs, has an effective diameter that is smaller than the diameter of the conventional unbarbed size 0 polydioxanone suture) compared favorably with the minimum USP knot pull requirement of 8.60 pounds for the size 0 polydioxanone conventional unbarbed suture.
Additional straight pull tensile strength tests were performed on additional size 0 polydioxanone barbed sutures, as discussed below in Tables 7K-7Z, in connection with Figures 7 A and 7B. For the in vivo performance, 3 mongrel dogs, each about 14 kg, were used. On each dog, 7 incisions were made at the thorax (twice), thigh (twice), flank, ventral midline, and paramedian, each of the 7 incisions having 1, 2, or 3 closure sites. The length of each incision ranged from about 0.5 inch (about 12.5 mm) to about 4 inches (about 101 mm) and the depth of each incision was from the superficial dermis to the peritoneum.
Using the barbed sutures (all made from size 0 polydioxanone monofilament), 24 of the sites were closed. For comparison, the remaining sites were closed with various diameter sizes of conventional unbarbed sutures (1 site with size 2-0 silk braided filament, 6 sites with size 2-0 nylon monofilament, and 7 sites with size 3-0 polydioxanone monofilament), which were knotted. All closing of sites was performed according to a randomized scheme.
The dogs were monitored daily, and then subjected to euthanasia at 14 days. At the time of death, the incisions were evaluated macroscopically. With regard to various tissues, incision sizes, and locations on the dogs, all sites apposed with the size 0 polydioxanone barbed sutures stayed closed and appeared to be healing normally throughout the 14 day observation period. No dehiscence occurred.
The site apposed with the conventional unbarbed silk sutures and the sites apposed with the conventional unbarbed polydioxanone sutures also healed will without complications. No dehiscence occurred.
For the 6 topical skin sites closed with the size 2-0 nylon monofilament conventional unbarbed sutures, 3 sites exhibited partial or complete suture loss, apparently due to self- mutilation by the dogs. Knots in the conventional sutures possibly caused discomfort by creating localized pressure, and animals cannot understand that they should not manipulate the sutures. Thus, barbed sutures should help obviate the problem of an animal manipulating and pulling out the sutures.
In summary, the in vivo performance of the size 0 polydioxanone barbed sutures was efficacious when compared to the size 2-0 silk braided filament unbarbed sutures, the size 2-0 nylon monofilament unbarbed sutures, and the size 3-0 polydioxanone monofilament unbarbed sutures.
In an alternative embodiment (not shown) for bi-directional twist cut, multiple spiral suture 70, the portion of suture 70 on which is disposed barbs 77 may have barbs 77 facing toward pointed end 76 and the portion of suture 70 on which is disposed barbs 78 may have barbs 78 facing toward pointed end 74. With this variation, the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S.
Patent No. 5,342,376 to Ruff. Also if desired, it is noted that barbs may be escarped so that there may be 2 portions with barbs facing an end and 1 portion with barbs facing the other end, or 2 portions with barbs facing an end and 2 portions with barbs facing the other end, and so on (not shown), and thus, if a portion of barbs is not facing the suture end to which those barbs are adjacent, then, the barbed suture would be inserted into tissue with an insertion device.
An advantage of a barbed suture having a twist cut, multiple spiral disposition is that such a barbed suture affords better wound holding capability as compared to the 120 degree spaced barbed suture. The reason is that the twist cut, multiple spiral pattern results in groups of barbs that complement successive and preceding groups of barbs, which tends to provide improved anchoring when the suture is in tissue. This feature is especially useful for tissue such as fat tissue, which has fewer connective fibers compared with other types of tissues, so that greater suture retention force is desirable. With reference now to Figure 7A, shown is a sectional side view of barbed suture 80.
Barbed suture 80 has plurality of closely spaced barbs 81 on elongated suture body 82 of generally circular cross section. Each barb 81 has barb tip 85. Shown are suture longitudinal axis A, suture diameter SD, barb length L, barb cut depth D, barb cut angle θ, cut distance P, spirality angle α, cut-out depression CD, and tip T of cut-out depression CD. Figure 7B is the sectional side view as illustrated in Figure 7A, but rotated and clamped to align the barbs for measurement of the cut distance P between barbs 81.
Barbed suture 80 is a twist cut, multiple spiral, bi-directional barbed suture, like suture 70 in Figure 6 A, but illustrated as an enlarged section in order to show more detail with respect to the configuration of barbs 81 vis-a-vis suture longitudinal axis A, suture diameter SD, barb length L, barb cut depth D, barb cut angle θ, cut distance P, spirality angle α, cut-out depression CD, and terminus T of cut-out depression CD.
More specifically, several twist cut, multiple spiral, barbed sutures were manufactured from monofilament spun from polydioxanone and having a diameter of about 0.018 inch (about 0.457 mm, which is slightly more than the USP requirement for a size 0 synthetic absorbable suture). Each suture contained 78 barbs introduced in 2 separate multiple spiral patterns around the circumference of the suture. Since the barbs were bi-directional, they were divided into a left group with 39 barbs and a right group with 39 barbs, each group opposing the direction of the other group from the approximate middle of the suture. Each suture was about 7 inches (about 178 mm) long. The middle portion was about 3 inches (about 76 mm) of the suture and contained the 78 barbs that were escarped into the suture filament. Extending beyond the 3 inch (76 mm) barbed middle portion toward each suture end were two unbarbed end portions of the suture filament that were each about 2 inches (about 51 mm) long. Depending on the stitching technique, one or both ends of the barbed suture may be sufficiently pointed and rigid for insertion into tissue, or may comprise a straight or curved needle.
In order to characterize the configuration of barbs 81, an Optem Zoom 100 custom microscope with both ring and back lighting was used together with a CCD brand video camera in order to measure selected barbs 81 at x21.5 magnification from each of the left and right groups.
The average was calculated for 10 repeated measurements (5 from the left group of barbs and 5 from the right group of barbs on the same suture) that were made for each of cut angle θ and cut depth D. Barb cut angle θ was measured from the surface of the cut to the outer surface of barbed suture 80. Barb cut depth D was measured along a perpendicular from the outer surface of barbed suture 80 toward longitudinal axis A of barbed suture 80. The measurements enabled cut length L to be calculated using the following formula.
L = D/{Sin (180 - θ)}
Also, angle of spirality was measured microscopically on various barbed sutures 80 as follows. When the twisted suture filament is gripped by the vise during cutting of barbs 81, the vise leaves a very light mark designated as line M impressed on the suture filament. Thus, line M will be parallel to the longitudinal axis of the vise while the twisted suture filament is being held in the vise. If the vise does not leave a light mark on the suture filament, then line M can be determined in that it is parallel to a line connecting the two respective terminus T of the two successive cut-out depressions CD left in suture body 82 from the escarpment of two successive barbs 81. After cutting of barbs 81, when barbed suture 80 is released from the vise and untwisted so that suture 80 lies free, then line M spirals on suture body 82 around barbed suture 80, forming angle of spirality.
Specifically for measuring spirality angle , the Optem Zoom 100 custom microscope was set with ring lighting at 60 and back lighting at coarse 12 and fine 10. Also, imaging analysis system software was used. Spirality angle was then measured between the outer surface of the barbed suture and line M. The average was calculated for 10 repeated measurements (5 from the left group of barbs and 5 from the right group of barbs on the same suture).
Then, barbed suture 80 was mounted in a twisting device with one end of suture 80 clamped in a fixed position. The other end of suture 80 was rotated to insert twist until barbs 81 were aligned. Next on barbed suture 80, longitudinal cut distance P between two adjacent barbs 81 was measured microscopically between the two respective terminus T of the two successive cut-out depressions CD left in suture body 82 from the escarpment of two successive barbs 81. The average was calculated for 10 repeated measurements (5 from the left group of barbs and 5 from the right group of barbs on the same suture).
The results are summarized in the following Tables 7 A, 7B, 7C, and 7D.
Table 7A (size 0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Left Right Diameter (0.457 mm) cut angle θ degrees 156 ± 2 157 ± 1 not applicable cut depth D mm 0.15 ± 0.02 0.16 ± 0.04 0.35 cut length L mm 0.36 ± 0.03 0.40 ± 0.10 0.87 cut distance P mm 0.90 + 0.17 0.88 + 0.15 1.92
Table 7B (size 0 barbed suture)
Ratio of D, L, or P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle 0 degrees 151 1.642 not applicable cut depth D mm 0.215 0.027 0.47 cut length L mm 0.446 0.042 0.97 cut distance P mm 0.962 0.073 2.1 spirality angle oc degrees 20.833 1.602 not applicable
Table 7C (size 0 barbed suture)
Ratio of D, L, or P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 154 2.870 not applicable cut depth D mm 0.205 0.033 0.45 cut length L mm 0.469 0.044 1.03 cut distance P mm 0.975 0.103 2.13 spirality angle α degrees 19.333 1.506 not applicable
Table 7D (size 0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 155 2.390 not applicable cut depth D mm 0.186 0.026 0.41 cut length L mm 0.437 0.039 0.96 cut distance P mm 0.966 0.071 2.11 spirality angle degrees 18.833 2.137 not applicable
Also, some additional measurements of angle α were performed on a few additional bi-directional twist cut, multiple spiral barbed sutures with a diameter of about 0.018 inch (about 0.457 mm, slightly more than the USP requirement for a size 0 synthetic absorbable suture). The mean average was 16.87 and the standard deviation was ± 0.85.
Additionally, measurements of barb cut angle θ, barb length L, barb cut depth D, and cut distance P were performed on 3 additional bi-directional twist cut, multiple spiral barbed sutures like sutures 80, but having a diameter of about 0.0115 inch (about 0.292 mm, which is slightly more than the USP requirement for a size 3-0 synthetic absorbable suture), and measurements of spirality angle a were performed on 2 of these 3 additional barbed sutures. Also, measurements of barb cut angle θ, barb length L, barb cut depth D, cut distance P, and spirality angle α were performed on 3 additional bi-directional twist cut, multiple spiral barbed sutures like sutures 80, but with a diameter of about 0.015 inch (about 0.381 mm, , which is slightly more than the USP requirement for a size 2-0 synthetic absorbable suture). The results are summarized in the following Tables 7E, 7F, 7G, 7H, 71, and 7J.
Table 7E (size 3-0 barbed suture)
Ratio of D, L, or P over Suture
Measurement Units Average Standard Deviation Diameter (0.292 mm) cut angle 0 degrees 166 1.651 not applicable cut depth D mm 0.107 0.007 0.37 cut length L mm 0.443 0.042 1.52 cut distance P mm 0.956 0.079 3.27 spirality angle α degrees not tested not applicable not applicable
Table 7F (size 3-0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Average Standard Deviation Diameter (0.292 mm) cut angle 0 degrees 164 2.055 not applicable cut depth D mm 0.106 0.006 0.36 cut length L mm 0.395 0.042 1.35 cut distance P mm 0.959 0.074 3.28 spirality angle α degrees 7.329 0.547 not applicable
Table 7G (size 3-0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Average Standard Deviation Diameter (0.292 mm) cut angle θ degrees 165 1.031 not applicable cut depth D mm 0.104 0.009 0.36 cut length L mm 0.390 0.035 1.34 cut distance P mm 0.975 0.103 3.34 spirality angle α degrees 7.258 0.636 not applicable
Table 7H (size 2-0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Average Standard Deviation Diameter (0.381 mm) cut angle θ degrees 160.2 1.320 not applicable cut depth D mm 0.152 0.019 0.40 cut length L mm 0.449 0.057 1.18 cut distance P mm 0.944 0.098 2.48 spirality angle α degrees 9.40 1.606 not applicable
Table 71 (size 2-0 barbed suture)
Ratio of D, L, or
P over Suture
Measurement Units Average Standard Deviation Diameter (0.381 mm) cut angle θ degrees 161.0 1.707 not applicable cut depth D mm 0.158 0.014 0.41 cut length L mm 0.489 0.054 1.28 cut distance P mm 0.962 0.054 2.52 spirality angle α degrees 7.96 1.075 not applicable
Table 7J ( size 2-0 barbed suture)
Ratio of D, L, or P over Suture
Measurement Units Average Standard Deviation Diameter (0.381 mm) cut angle θ degrees 161.0 1.506 not applicable cut depth D mm 0.154 0.017 0.40 cut length L mm 0.474 0.058 1.24 cut distance P mm 0.973 0.068 2.55 spirality angle degrees 6.53 1.755 not applicable
Additional measurements were performed on several other twist cut, multiple spiral, barbed sutures manufactured from monofilament spun from polydioxanone and having a diameter of about 0.018 inch (about 0.457 mm, which is slightly more than the USP requirement for a size 0 synthetic absorbable suture) and thus similar to the above-described tested barbed sutures, except that these other barbed sutures were cut with a different cutting machine, namely a machine with one blade that moved longitudinally along the twisted filament between cutting strokes and that was controlled with a computer to make the various cuts for the escarpment of the barbs. These other barbed sutures were also tested for straight pull tensile strength and for chamois cloth closure strength. (A discussion of how chamois cloth closure strength is performed can be seen below in connection with Figures 13A and 13B.) The results for these other barbed sutures are summarized in the following Tables 7K - 7Z.
Table 7K (size 0 barbed suture)
Ratio of D. L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.6 0.718 not applicable cut depth D mm 0.221 0.011 0.48 cut length L mm 0.479 0.022 1.05 cut distance P mm 0.784 0.015 1.71 spirality angle α degrees 12.9 0.453 not applicable
Table 7L (size 0 barbed suture)
Ratio of D. L. P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.4 0.947 not applicable cut depth D mm 0.216 0.014 0.47 cut length L mm 0.465 0.024 1.02 cut distance P mm 0.774 0.015 1.69 spirality angle α degrees 13.2 0.349 not applicable
Table 7M (size 0 barbed suture)
Ratio of D. L. P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.3 0.576 not applicable cut depth D mm 0.227 0.015 0.50 cut length L mm 0.489 0.034 1.07 cut distance P mm 0.796 0.018 1.74 spirality angle α degrees 13.1 0.193 not applicable
Table 7N (size 0 barbed suture)
Ratio of D. L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.8 0.612 not applicable cut depth D mm 0.207 0.007 0.45 cut length L mm 0.453 0.016 0.99 cut distance P mm 0.798 0.017 1.75 spirality angle α degrees 13.6 0.560 not applicable
Table 7O (size 0 barbed suture)
Ratio of D. L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.9 0.549 not applicable cut depth D mm 0.188 0.016 0.41 cut length L mm 0.413 0.030 [ 0.90 cut distance P mm 0.787 0.024 1.72 spirality angle degrees 13.8 0.270 not applicable
Table 7P (size 0 barbed suture)
Ratio of D, L, P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mrn) cut angle θ degrees 153.1 0.655 not applicable cut depth D mm 0.204 0.007 0.45 cut length L mm 0.451 0.019 0.99 cut distance P mm 0.792 0.018 1.73 spirality angle degrees 13.6 0.410 not applicable
Table 70 (size 0 barbed suture)
Ratio of D, L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 163.1 0.505 not applicable cut depth D mm 0.245 0.013 0.54 cut length L mm 0.842 0.045 1.84 cut distance P mm 0.774 0.009 1.69 spirality angle degrees 10.8 0.449 not applicable
Table 7R (size 0 barbed suture)
Ratio of D. L.
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 161.1 1.126 not applicable cut depth D mm 0.233 0.017 0.51 cut length L mm 0.721 0.035 1.58 cut distance P mm 0.773 0.010 1.69 spirality angle degrees 12.6 0.189 not applicable
Table 7S (size 0 barbed suture) Ratio of D. L.
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 160.9 0.708 not applicable cut depth D mm 0.240 0.014 0.52 cut length L mm 0.734 0.037 1.61 cut distance P mm 0.774 0.009 1.69 spirality angle degrees 13.6 0.312 not applicable
Table 7T (size 0 barbed suture)
Ratio of D. L.
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 154.6 1.434 not applicable cut depth D mm 0.210 0.009 0.46 cut length L mm 0.492 0.026 1.08 cut distance P mm 0.538 0.011 1.18 spirality angle α degrees 12.3 0.223 not applicable
Table 7U (size 0 barbed suture)
Ratio of D. L.
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 152.9 0.809 not applicable cut depth D mm 0.212 0.014 0.46 cut length L mm 0.464 0.026 1.01 cut distance P mm 0.530 0.015 1.16 spirality angle α degrees 13.7 0.411 not applicable Table 7N (size 0 barbed suture)
Ratio of D. L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 153.4 0.903 not applicable cut depth D mm 0.221 0.010 0.48 cut length L mm 0.495 0.023 1.08 cut distance P mm 0.537 0.012 1.17 spirality angle α degrees 13.9 0.605 not applicable
Table 7W (size 0 barbed suture)
Ratio of D, L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 155.2 0.829 not applicable cut depth D mm 0.202 0.008 0.44 cut length L mm 0.483 0.017 1.06 cut distance P mm 0.789 0.031 1.73 spirality angle α degrees 12.6 0.328 not applicable
Table 7X (size 0 barbed suture)
Ratio of D. L,
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 155.5 0.799 not applicable cut depth D mm 0.200 0.010 0.44 cut length L mm 0.484 0.027 1.06 cut distance P mm 0.798 0.017 1.75 spirality angle degrees 11.8 0.362 not applicable
Table 7Y (size 0 barbed suture)
Ratio of D. L.
P over Suture
Measurement Units Average Standard Deviation Diameter (0.457 mm) cut angle θ degrees 155.4 0.560 not applicable cut depth D mm 0.196 0.008 0.43 cut length L mm 0.471 0.017 1.03 cut distance P mm 0.799 0.019 1.75 spirality angle α degrees 11.8 0.496 not applicable
Table 7Z
Barbed Suture Straight Pull Strength Chamois Cloth Closure Strength (pounds) (pounds to rupture)
Sample 1 7.29 11.23
(Tables 7K - 7M)
Sample 2 8.73 12.14 (Tables 7N - 7P)
Sample 3 8.5 9.22
(Tables 7Q - 7S)
Sample 4 5.92 9.27
(Tables 7T - 7V) Sample 5 7.69 9.97
(Tables 7W - 7Y) Although all the above-noted measurements were performed on bi-directional, twist cut, multiple spiral barbed sutures, the below-noted desirable ranges for measurements for barb length L, barb cut depth D, barb cut angle θ, and/or cut distance P should be the same for the various other inventive barbed sutures described here. A suitable ratio of cut length L to barbed suture diameter SD ranges from about 0.2 to about 2, more preferably from about 0.4 to about 1.7, even more preferably from about 0.8 to about 1.5. However, very suitable barbed sutures may have a ratio of cut length L to barbed suture diameter SD from about 1 down to about 0.2, whereby the ratio of the highest possible barb elevation (the elevation of barb tip 85 above suture body 82) to the suture diameter SD correspondingly ranges from about 1 down to about 0.2. (The highest possible barb elevation is the same as the barb length L.) Also, a suitable ratio of cut depth D to barbed suture diameter SD ranges from about 0.05 to about 0.6, more preferably from about 0.1 to about 0.55, even more preferably from about 0.2 to about 0.5.
Regardless, length L may be desirably varied depending on the intended end use, since larger barbs are more suitable for joining certain types of tissue such as fat tissue or soft tissue, whereas smaller barbs are more suitable for joining other types of tissues such as fibrous tissue. As discussed in more detail below vis-a-vis Figure 11, there will also be instances where a barb configuration that is a combination of large, medium, and/or small barbs disposed on the same suture will be desirable, for instance, when the barbed suture is employed in tissue that has differing layer structures.
Cut angle θ formed between the barb and the elongated suture body desirably would range from about 140 degrees to about 175 degrees, more preferably would range from about 145 degrees to about 173 degrees. The most preferred cut angle θ for all barbs ranges from about 150° to about 170°. For instance, for a polydioxanone barbed suture with a diameter of about 0.018 inch
(about 0.457 mm), which is slightly larger that the USP requirement for a synthetic absorbable suture of size 0, the preferred barb length L would be 0.45 mm; the preferred barb depth D would be 0.2 mm; and the preferred barb cut angle would be 153 degrees.
Longitudinal spacing between any two barbs is generally effected with the goal of creating as many barbs as possible along the suture, and is a factor in the ability of the barbed suture to anchor tissues while maintaining firmness. As barbs are spaced farther apart, tissue- anchoring capacity decreases. Nevertheless, if barbs are spaced too close, the integrity of the filament may be jeopardized, which could lead to a tendency of the barbs to peel back and also to a decrease in suture tensile strength.
Generally, a suitable ratio of cut distance P to barbed suture diameter SD ranges from about 0.1 to about 6, more preferably from about 0.5 to about 4.5, even more preferably from about 1.0 to about 3.5. Very suitable barbed sutures may have a ratio of cut distance P to barbed suture diameter SD from about 1.5 down to about 0.2, whereby cut distance P may be as low as about 0.1, particularly for the overlapping barb embodiment, which is discussed in more detail below vis-a-vis Figures 12A, 12B, 12C, and 12D.
Additionally, spirality angle formed between line M and the longitudinal direction of the elongated suture body for a twist cut, multiple spiral barbed suture typically would range from about 5 degrees to about 25 degrees, more preferably from about 7 degrees to about 21 degrees. The most preferred angle for all barbs on a twist cut, multiple spiral barbed suture is about 10° to about 18°.
Turning now to Figure 8, shown is suture 90, which is another embodiment of the present invention. Suture 90 includes elongated body 92 that is generally circular in cross section. Elongated body 92 terminates in first and second pointed ends 94, 96 for penetrating tissue. It is contemplated that one or both ends 94, 96 may comprise a surgical needle (not shown) for insertion into tissue. Additionally, suture 90 includes plurality of closely spaced barbs 97 arranged in a random disposition. Suture 90 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. With combinations of the above-described methods for making the 180 degree disposition (sutures 1, 10), the 120 degree disposition (sutures 30, 40), and/or the twist cut multiple spiral disposition (sutures 60, 70, 80), barbed suture 90 with a very random barb disposition is obtained. The advantage of the random disposition is that the many barb angles provide superior anchoring in tissues and thus afford superior wound holding properties. With the random disposition, the barbed suture would be inserted into tissue with an insertion device, such as that shown in the above-noted U.S. Patent No. 5,342,376 to Ruff.
With regard to Figure 9, shown is a sectional side view of barbed suture 100, which is another embodiment of the present invention. Suture 100 includes elongated suture body 102 of generally circular cross section. Also, suture body 102 has disposed on it a plurality of closely spaced barbs 107. Each barb 107 has a barb configuration such that barb underside 108 is serrated or corrugated. One or both suture ends (not shown) are pointed for penetrating tissue and it is contemplated that one or both may comprise a surgical needle (not shown) for insertion into tissue.
Suture 100 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. Barb 107 having serrated underside 108 is achieved by vibrating or oscillating the cutting blades of the cutting device when barbs are being escarped into the body of a monofilament. It is intended that any of the barbed sutures of the present invention as described here may have barbs with a configuration that includes a serrated or corrugated underside. With reference now to Figures 10A and 10B, depicted in Figure 10 A is a perspective view and depicted in Figure 10B is a top view of barbed suture 110, which is another embodiment of the present invention. Suture 110 includes elongated suture body 112 of generally circular cross section. Also, suture body 112 has disposed on it a plurality of closely spaced barbs 115 having barb tips 117 (one barb 115 is shown for purposes of brevity). Barb 115 has a configuration with an arcuate base 119 where barb 115 is attached to suture body 112. One or both suture ends (not shown) are pointed for penetrating tissue and it is contemplated that one or both may comprise a surgical needle (not shown) for insertion into tissue.
Figures 10C and 10D are cross-sectional views respectively along line 10C - 10C and line 10D - 10D of Figure 10B. Figure 10C and 10D further clarify that barb 115 becomes narrower going from base 119 toward tip 117.
Suture 110 may be made with the same cutting machine as the above-discussed sutures, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. To achieve barb 115 having arcuate base 119, the cutting device is provided with cutting blades with ends that are correspondingly arcuate with respect to arcuate base 119.
It is intended that any of the barbed sutures of the present invention as described here may have barbs with a configuration that includes an arcuate base. The arcuate base should enhance tissue anchoring as compared to a flat, linear base. Regardless, it is not desired for the base to be circular or oval, which would result from conical shaped barbs, as that could decrease tissue anchoring.
Shown in Figure 11 is a sectional side view of a barbed suture that is another embodiment of the present invention, and that is generally designated at 120. Suture 120 includes elongated body 122 that is generally circular in cross section. Elongated body 122 terminates in end 124. End 124 is pointed for penetrating tissue and it is contemplated that end 124 may comprise a surgical needle (not shown) for insertion into tissue. (The other end is not shown, and also may be pointed for penetrating tissue and may comprise a surgical needle for penetrating tissue.) Also, suture 120 includes plurality of closely spaced barbs 125, plurality of closely spaced barbs 127, and plurality of closely spaced barbs 129. Barbs 125 are relatively small in size with a relatively short barb length as compared to barbs 127, which are relatively medium in size with a relatively medium barb length, as compared to barbs 129, which are relatively large in size with a relatively long barb length. Suture 120 may be made with the same cutting machine as the above-described sutures were made, such as the cutting device described in the above-noted Serial No. 09/943,733 to Genova et al. By altering the amount of blade movement during cutting into a suture filament, then the barb cut length is made longer or shorter, as desired, to result in each of the three sets of barbs 125, 127, and 129 being of a size different from the others, where the varying sizes are designed for various surgical applications. The barb size may also vary in the transverse direction, whereby the barb base may be short, medium, or long, and regardless, the barb base typically is less than about lA of the suture diameter.
For instance, relatively larger barbs are desirable for joining fat and soft tissues, whereas relatively smaller barbs are desirable for joining fibrous tissues. Use of a combination of large, medium, and/or small barbs on the same suture helps to ensure maximum anchoring properties when barb sizes are customized for each tissue layer. Only two different sized sets of barbs (not shown) may be escarped into suture body 122, or additional sets of barbs (not shown) with four, five, six, or more different sized sets than three sizes as illustrated for sets of barbs 125, 127, and 129 may be escarped into suture body 122 as desired, in accordance with the intended end use. Also, although suture 120 is illustrated with the barbs being unidirectional, it is intended that barbed sutures with barbs having a configuration of varying sizes in accordance with the invention also may be bi-directional barbed sutures or random barbed sutures or any of the other inventive barbed sutures described here. Figure 12A is a perspective view of another embodiment of the present invention, showing barbed suture 130 having elongated body 132 of generally circular cross section. One or both suture ends (not shown) are pointed for penetrating tissue and it is contemplated that one or both ends may comprise a surgical needle (not shown) for insertion into tissue. Suture 130 further includes plurality of barbs 135 projecting from body 132 such that at least two longitudinally adjacent first and second barbs 135 are disposed on body 132 where first barb 135 overlaps second barb 135 if first and second barbs 135, which is readily apparent if barbs 135 are laid flat on body 132. Figure 12B is a perspective view of a portion of overlapping barbs 135 of the overlapping disposition barbed suture 130 of Figure 12A, and Figure 12C is a top plan view of Figure 12B. Figure 12D is a cross-sectional view along ling 12D - 12D of Figure 12C. As can be more clearly seen from Figures 12B, 12C, and 12D, during escarpment of barbs 135, overlapping first barb 135 is escarped into part of topside TS of overlapped second barb 135, and so on. Part of topside TS of overlapped second barb 135 becomes part of underside US of overlapping first barb 135.
Thus, with the overlapping disposition, the barb cut distance between first barb 135 and second barb 135 may be shorter than the barb cut length of overlapped second barb 135, whereas, in general for barbed sutures, the barb cut distance between two barbs > the barb cut length. Particularly for the overlapping barb disposition, very suitable barbed sutures may have a ratio of the barb cut distance to the barbed suture diameter from about 1.5 down to about 0.2, since the barb cut distance P may be as low as about 0.1. (See discussion of Figure 7 for comments vis-a-vis the barb cut length and the barb cut distance.) This overlapping disposition allows for closely packing many barbs 135 on body 132, and typically, barbs 135 are thin, as compared to when the barb cut distance between two barbs > the barb cut length. Also, although suture 130 is illustrated with barbs 135 being unidirectional, it is intended to include that suture 130 in accordance with the invention also may be a bidirectional barbed suture as described here.
Figures 13A, 13B, 13C, and 13D show various surgical needles, where a barbed suture is attached to each surgical needle. In order to facilitate insertion into tissue, the surgical needles may be coated with a polymer, for instance, as described above vis-a-vis U.S. Patent No. 5,258,013 to Granger et al.
Figure 13 A shows surgical needle Nl that is a straight elongated needle in the longitudinal direction and that is generally circular in cross section. Surgical needle Nl has pointed tip TI for insertion into tissue and also has hole HI. Surgical needle Nl is illustrated as attached, such as by swaging, to barbed suture SI. Barbed suture SI is a barbed suture including, but not limited to, any of the above-described barbed sutures. Additionally, surgical needle Nl has diameter DI in the transverse direction, which is illustrated as a relatively thin diameter, such as about 0.02 inch (about 0.51 mm). As discussed above vis-a- vis swaging, surgical needle Nl, after having suture SI inserted into hole HI, may be crimped by standard procedures about hole HI to hold suture SI in place for suturing tissue.
Figure 13B shows surgical needle N2 that is a straight elongated needle in the longitudinal direction and that is generally circular in cross section. Surgical needle N2 has pointed tip T2 for insertion into tissue and also has hole H2. Surgical needle N2 is illustrated as attached, such as by swaging, to barbed suture S2. Barbed suture S2 is a barbed suture including, but not limited to, any of the above-described barbed sutures. Additionally, surgical needle N2 has diameter D2 in the transverse direction, which is illustrated as a suitably thin diameter, such as about 0.032 inch (about 0.81 mm), but not as thin as diameter DI of surgical needle Nl. As discussed above vis-a-vis swaging, surgical needle N2, after having suture S2 inserted into hole H2, may be crimped by standard procedures about hole H2 to hold suture S2 in place for use in suturing tissue.
Figure 13C shows surgical needle N3 that is a curved elongated needle in the longitudinal direction and that is generally circular in cross section. Surgical needle N3 has pointed tip T3 for insertion into tissue and also has hole H3. Surgical needle N3 is illustrated as attached, such as by swaging, to barbed suture S3. Barbed suture S3 is a barbed suture including, but not limited to, any of the above-described barbed sutures. Additionally, surgical needle N3 has diameter D3 in the transverse direction, which is illustrated as a relatively thin diameter, such as about 0.02 inch (about 0.51 mm). As discussed above vis-a- vis swaging, surgical needle N3, after having suture S3 inserted into hole H3, may be crimped by standard procedures about hole H3 to hold suture S3 in place for use in suturing tissue.
Figure 13D shows surgical needle N4 that is a curved elongated needle in the longitudinal direction and that is generally circular in cross section. Surgical needle N4 has pointed tip T4 for insertion into tissue and also has hole H4. Surgical needle N4 is illustrated as attached, such as by swaging, to barbed suture S4. Barbed suture S4 is a barbed suture including, but not limited to, any of the above-described barbed sutures. Additionally, surgical needle N4 has diameter D4 in the transverse direction, which is illustrated as a suitably thin diameter, such as about 0.032 inch (about 0.81 mm), but not as thin as diameter D3 of surgical needle N3. As discussed above vis-a-vis swaging, surgical needle N4, after having suture S4 inserted into hole H4, may be crimped by standard procedures about hole H4 to hold suture S4 in place for use in suturing tissue.
Needle tips TI, T2, T3, and T4 are schematically illustrated as pointed, but, as is well known, surgical needles come with various kinds of pointed tips, such as taper point, taper cutting, ball point, cutting edge, diamond point, thin line, and lancet point, and it is intended to include, but not be limited to, all such needle tips. Taper point, taper cutting, and diamond point are preferred needle tips for surgical needles used with barbed sutures.
As is well known in the art, needle diameter for surgical needles used with conventional (i.e., unbarbed) sutures is considered unimportant, and often very thick surgical needles are used with thin conventional sutures such that the ratio of surgical needle diameter to conventional suture diameter is 4:1 or even higher, such as 4.43:1.
However, with the surgical needle/barbed suture combination of the present invention (for either a straight needle or a curved needle), the thinner that the surgical needle is, then the more preferable that the surgical needle/barbed suture is, with the desired needle diameter being thinner and thinner as it approaches the barbed suture diameter, and it is possible that the needle diameter may be even thinner than the barbed suture diameter.
In general for the present invention, a relatively thin surgical needle attached to a barbed suture is more preferable for approximating tissue when stitching a wound closed than a relatively thick surgical needle threaded with a barbed suture. The reason is that the relatively thin surgical needle attached to a barbed suture allows for greater engagement of barbs in tissue, and therefore provides better closure strength to the approximated tissue that has been sutured to prevent the opposing sides of the closed wound from pulling apart, as compared to the closure strength provided to approximated tissue that has been sutured with the relatively thick surgical needle.
The most important feature for the combination of the surgical needle attached to the barbed suture is that the surgical needle diameter should be of sufficient width in order to make a hole or a channel in the end, such by drilling, to allow for insertion of the barbed suture into the hole or the channel. Nevertheless, as the surgical needle diameter increases, the surgical needle is still suitable as long as the ratio of the surgical needle diameter to the barbed suture diameter is about 3:1 or less.
Accordingly, a desirable ratio of surgical needle diameter to barbed suture diameter, for either a straight needle or a curved needle, is about 3:1 or less, more preferably about 2:1 or less, most preferably about 1.8:1 or less. Furthermore, particularly if channel needles are employed, the ratio of surgical needle diameter to barbed suture diameter may be as low as about 1:1 or less, or even lower, for instance, about 0.9:1 or less, or about 08:1 or less, or as low as about 0.5: 1. It will be appreciated by the person of ordinary skill in the art that care should be taken with extremely thin needles so as to ameliorate the possibility of localized weakness, which may compromise tissue insertion. Closure strength of thin surgical needles, both having a ratio of surgical needle diameter to barbed suture diameter suitable for the present invention, was tested as follows.
Narious pieces of chamois leather (manufactured by U.S. Chamois of Florida) having a thickness of about 0.6 in (about 15.2 mm) were cut with a wound having a length of about 1.25 inch (about 32 mm).
A first specimen was made from a piece of chamois leather by stitching together the respective edges of the wound with a drilled end surgical needle (item no. 382077 A purchased from Sulzle Company) which was swaged with a barbed suture. In other words, after insertion of the barbed suture into the needle hole, the needle was crimped about the hole to secure the barbed suture during stitching. After stitching closed the wound, the piece of chamois leather was cut to a rectangular shape of about 3 inches (about 76 mm) in length by about 1.25 inches (about 32 mm) in width, where the stitched wound was in the middle of the length and transverse the width. The needle was a taper point, curved surgical needle (3/8 of a circle), with a length of about 22 mm and a relatively thin diameter of about 0.020 inch (about 0.51 mm).
Then, using the same stitching method, a second specimen was made from another piece of chamois leather by stitching together the respective edges of the wound, using a drilled end surgical needle (item no. 383271 A purchased from Sulzle Company) swaged with the same kind of barbed suture, i.e., the surgical needle was crimped about the needle hole, after insertion of the barbed suture into the hole, to secure the barbed suture during stitching. For the second specimen, the needle was a taper point curved surgical needle (3/8 of a circle) with a length of about 22 mm and a suitable thin diameter of about 0.032 inch (about 0.81 mm), although not as thin as the diameter of the needle used for first specimen.
Each barbed suture for each specimen was a bi-directional, twist cut multiple spiral, polydioxanone barbed suture like suture 70 in Figure 6A, except that each barbed suture had a diameter of about 0.0115 inch (about 0.291 mm, which is slightly larger than the USP requirement for a size 3-0 synthetic absorbable suture), instead of a suture diameter of about 0.018 inch (about 0.457 mm).
Both the first and the second specimens of stitched chamois cloth were tested for closure strength using a Test Resources Universal Tester, Model 200Q. Each specimen was gripped by two respective serrated jaws. Then, each specimen was pulled longitudinally at a rate of about 10 inches per minute (about 254 mm per minute) until complete rupture. The peak load in pounds reached before complete wound disruption was recorded as the closure strength. The results were that the first specimen (which was sutured with the needle that had a relatively thin diameter of about 0.020 inch, about 0.51 mm) took 5.88 pounds until wound disruption occurred and the specimen pulled apart back into 2 pieces, whereas the second specimen (which was stitched with the needle that had a suitably thin diameter of about 0.032 inch, about 0.81 mm, but not as thin as the needle for the first specimen) took only 2.88 pounds until the wound disruption and the specimen pulled apart back into 2 pieces. The results are summarized in Table 13A below.
Table 13 A (Chamois Cloth Closure Strength)
Specimen Needle Diameter Barbed Suture Diameter Ratio* Pounds to Rupture First 0.020 inch 0.0115 inch 1.74 5.88
Second 0.032 inch 0.0115 inch 2.78 2.88
*Ratio of surgical needle diameter to barbed suture diameter.
Also, various pieces of rat skin were cut and stitched for testing of more surgical needles swaged with barbed sutures as follows.
Three freshly killed Sprague-Dawley rats, each about 600 to 700 g, were used. Two full-thickness skin incisions were made on the back of each rat to create wounds. Each wound was about 4 cm in length and parallel to the spine. For each rat, one of the two wounds was closed with a drilled end, curved surgical needle that was a Sulzle item no. 382273A, which was 3/8 circle. The needle had a length of 18mm and a diameter of about 0.022 inch (about 0.56 mm). Also, the needle had a taper point needle tip where the needle tip had been ground to a 3-facet cut to approximate a taper cutting needle tip to facilitate penetration of rat tissue. The needle was swaged to a barbed suture.
The other of the two wounds was closed using the same suturing technique, but with a drilled end, curved surgical needle that was a Sulzle item no. 832679 A, which was 3/8 circle. The needle had a length of about 18 mm and a diameter of about 0.026 inch (about 0.66 mm). Also, the needle had a diamond point needle tip. The needle was swaged to a barbed suture. Each barbed suture for each specimen was a bi-directional, twist cut multiple spiral, polydioxanone barbed suture like suture 70 in Figure 6A, except that each barbed suture had a diameter of about 0.015 inch (about 0.381 mm, which is slightly larger than the USP requirement for a size 2-0 synthetic absorbable suture), instead of a suture diameter of about 0.018 inch (about 0.457 mm). For each stitched wound, a tissue specimen that was approximately a square measuring about 4 cm x about 4 cm, with the stitched wound in the middle paralleling two opposing tissue edges, was retrieved for closure strength testing.
The force to open each wound was determined using a Test Resources Universal Tester, Model 200Q. For each tissue specimen, the two edges paralleling each stitched wound were mounted in the two respective serrated jaws of the tester.
Then, each specimen was pulled longitudinally at a rate of about 2 inches per minute (about 51 mm per minute) until complete rupture occurred. The maximum force encountered before complete wound disruption was recorded as the closure strength. The results were averaged from the first set of three wounds closed with a needle having a diameter of about 0.022 inch (about 0.56 mm) and swaged to a barbed suture. Also, the results were averaged from the second set of three wounds closed with a needle having a diameter of about 0.026 inch (about 0.66 mm) and swaged to a barbed suture.
The results are summarized in Table 13B below.
Table 13B (Rat Skin Closure Strength)
Average of 3 Wounds
Specimens Needle Diameter Barbed Suture Diameter Ratio* Pounds to Rupture First set of 3 0.022 inch 0.015 inch 1.47 11.9
Second set of 3 0.026 inch 0.015 inch 1.73 8.1
*Ratio of surgical needle diameter to barbed suture diameter.
Thus, the lower the ratio of surgical needle diameter to barbed suture diameter, then the better the closure strength when suturing a wound closed with a surgical needle attached to a barbed suture. In general, the thinner the surgical needle, the better the closure strength, particularly for delicate tissues; however, for tough tissues, such as muscle and bowel, thicker needles are preferred. Thus, what is important, regardless of whether the needle is thick or thin or somewhere in the middle, is that the ratio of surgical needle diameter to barbed suture diameter should be about 3:1 or less, more preferably about 2:1 or less.
Although the present invention has been shown and described in detail with regard to only a few exemplary embodiments of the invention, it should be understood by those skilled in the art that it is not intended to limit the invention to the specific embodiments disclosed. Narious modifications, omissions, and additions may be made to the disclosed embodiments without materially departing from the novel teachings and advantages of the invention, particularly in light of the foregoing teachings. For instance, the barbed suture of the present invention can be used alone or with other closure methods, such as staples and/or skin adhesives, to aid in holding the position of the tissue. Accordingly, it is intended to cover all such modifications, omissions, additions, and equivalents as may be included within the spirit and scope of the invention as defined by the following claims.

Claims

CLAIMSWhat is claimed is:
1. A barbed suture for connecting human or animal tissue, said suture comprising (a) an elongated body having a first end and a second end and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, the barbs having a disposition on the body selected from the group consisting of a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, a random disposition, and combinations thereof.
2. The barbed suture according to claim 1, wherein the barbs are in a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, or a combination thereof, and the barbs are all facing in a direction toward only one of the first end and the second end.
3. The barbed suture according to claim 1, wherein the barbs are in a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, or a combination thereof, and the barbed suture has at least a first barbed portion and a second barbed portion, wherein the barbs of the first portion are facing in a direction toward only the first end and the barbs of the second portion are facing in a direction toward only the second end.
4. The barbed suture according to claim 1, wherein the staggered disposition includes a first set of the barbs being radially spaced about 180 degrees from a second set of the barbs.
5. The barbed suture according to claim 1, wherein the staggered disposition includes a first set of the barbs being radially spaced about 120 degrees from a second set of the barbs and the second set of the barbs being radially spaced about 120 degrees from a third set of the barbs.
6. The barbed suture according to claim 1, wherein the barbs are in a twist cut multiple spiral disposition and the barbed suture is made from a suture filament having a portion that is twisted from about 2 to about 17 times per inch when the barbs are escarped into the suture filament to make the barbed suture.
7. The barbed suture according to claim 1, wherein the barbs are in a twist cut multiple spiral disposition and the suture has a spirality angle ranging from about 5 degrees to about 25 degrees.
8. The barbed suture according to claim 7, wherein the suture has a spirality angle α ranging from about 7 degrees to about 22 degrees.
9. The barbed suture according to claim 8, the suture has a spirality angle α ranging from about 12 degrees to about 18 degrees.
10. The barbed suture according to claim 1, wherein the barbs are in an overlapping disposition such that for at least two adjacent barbs, one being an overlapping barb and one being an overlapped barb, the overlapping barb has an underside and the overlapped barb has a topside where part of the underside of the overlapping barb is derived from part of the topside of the overlapped barb.
11. The barbed suture according to claim 10, wherein the barbs are in an overlapping disposition such that for at least two adjacent barbs, one being an overlapping barb and one being an overlapped barb, each of the overlapping barb and the overlapped barb having a barb cut length, and the overlapping barb and the overlapped barb having a barb cut distance between them that is less than the barb cut length of the overlapped barb.
12. The barbed suture according to claim 1, wherein the suture is made from a material selected from the group consisting of a bio-absorbable material, a non-absorbable material, and combinations thereof.
13. The barbed suture according to claim 12, wherein the bio-absorbable material is selected from the group consisting of polydioxanone, polylactide, polyglycolide, polycaprolactone, and combinations thereof.
14. The barbed suture according to claim 12, wherein the non-absorbable material is selected from the group consisting of a polymer, a metal, a metal alloy, a natural fiber, and combinations thereof.
15. The barbed suture according to claim 14, wherein the polymer is selected from the group consisting of polyamide, polyester, polypropylene, polyurethane, polytetrafluoroethylene, polyether-ester, and combinations thereof.
16. A barbed suture for connecting human or animal tissue, said suture comprising (a) an elongated body having a first end and a second end and a diameter and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, wherein:
(I) the barbs have a disposition on the body selected from the group consisting of a staggered disposition, a twist cut multiple spiral disposition, an overlapping disposition, a random disposition, and combinations thereof, and
(II) the barbs have a configuration selected from the group consisting of a barb cut angle θ ranging from about 140 degrees to about 175 degrees, a barb cut depth with a ratio of the barb cut depth to the suture diameter ranging from about 0.05 to about 0.6, a barb cut length with a ratio of the barb cut length to the suture diameter ranging from about 0.2 to about 2, a barb cut distance with a ratio of the barb cut distance to the suture diameter ranging from about 0.1 to about 6, a corrugated barb underside, an arcuate barb base, at least two sets of barbs with each set having a barb size different from the barb size of the other set, and combinations thereof.
17. The barbed suture according to claim 16, wherein the suture is made from a material selected from the group consisting of a bio-absorbable material, a non-absorbable material, and combinations thereof.
18. The barbed suture according to claim 17, wherein the bio-absorbable material is selected from the group consisting of polydioxanone, polylactide, polyglycolide, polycaprolactone, and combinations thereof.
19. The barbed suture according to claim 17, wherein the non-absorbable material is selected from the group consisting of a polymer, a metal, a metal alloy, a natural fiber, and combinations thereof.
20. The barbed suture according to claim 19, wherein the polymer is selected from the group consisting of polyamide, polyester, polypropylene, polyurethane, polytetrafluoroethylene, polyether-ester, and combinations thereof.
21. A barbed suture for connecting human or animal tissue, said suture comprising
(a) an elongated body having a first end, a second end and a diameter and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, wherein: (I) the barbs have a disposition on the body comprising a staggered disposition, and
(JJ) the barbs have a configuration comprising (i) a barb cut θ angle ranging from about 140° to about 175°, (ii) a barb cut depth with a ratio of the barb cut depth to the suture diameter ranging from about 0.05 to about 0.6, (iii) a barb cut length with a ratio of the barb cut length to the suture diameter ranging from about 0.2 to about 2, and (iv) a barb cut distance with a ratio of the barb cut distance to the suture diameter ranges from about 0.1 to about 6.
22. A barbed suture for connecting human or animal tissue, said suture comprising
(a) an elongated body having a first end, a second end and a diameter and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, wherein: (I) the barbs have a disposition on the body comprising a twist cut multiple spiral disposition with a spirality angle α ranging from about 5° to about 25°, and (II) the barbs have a configuration comprising (i) a barb cut θ angle ranging from about 140° to about 175°, (ii) a barb cut depth with a ratio of the barb cut depth to the suture diameter ranging from about 0.05 to about 0.6, (iii) a barb cut length with a ratio of the barb cut length to the suture diameter ranging from about 0.2 to about 2, and (iv) a barb cut distance with a ratio of the barb cut distance to the suture diameter ranges from about 0.1 to about 6.
23. A barbed suture for connecting human or animal tissue, said suture comprising (a) an elongated body having a first end, a second end and a diameter and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, wherein:
(I) the barbs have a disposition on the body comprising an overlapping disposition, and (II) the barbs have a configuration comprising (i) a barb cut θ angle ranging from about 140° to about 175°, (ii) a barb cut depth with a ratio of the barb cut depth to the suture diameter ranging from about 0.05 to about 0.6, (iii) a barb cut length with a ratio of the barb cut length to the suture diameter ranging from about 0.2 to about 2, and (iv) a barb cut distance with a ratio of the barb cut distance to the suture diameter ranges from about 0.1 to about 6.
24. A barbed suture for connecting human or animal tissue, said suture comprising (a) an elongated body having a first end, a second end and a diameter and (b) a plurality of barbs projecting from the body, each barb facing in a direction and being adapted for resisting movement of the suture, when in tissue, in an opposite direction from the direction in which the barb faces, wherein:
(I) the barbs have a disposition on the body comprising a random disposition, and (LI) the barbs have a configuration comprising (i) a barb cut θ angle ranging from about 140° to about 175°, (ii) a barb cut depth with a ratio of the barb cut depth to the suture diameter ranging from about 0.05 to about 0.6, (iii) a barb cut length with a ratio of the barb cut length to the suture diameter ranging from about 0.2 to about 2, and (iv) a barb cut distance with a ratio of the barb cut distance to the suture diameter ranges from about 0.1 to about 6.
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EP20030752630 EP1560683B1 (en) 2002-09-30 2003-09-29 Barbed sutures
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IL167580A IL167580A (en) 2002-09-30 2005-03-21 Barbed sutures
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Cited By (27)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008157142A2 (en) 2007-06-13 2008-12-24 Ethicon, Inc. Bi-directional barbed suture
DE102007058256A1 (en) 2007-11-26 2009-05-28 Aesculap Ag Surgical thread mesh
US7850894B2 (en) 2006-05-04 2010-12-14 Ethicon, Inc. Tissue holding devices and methods for making the same
US8273105B2 (en) 2008-02-20 2012-09-25 Tyco Healthcare Group Lp Compound barb medical device and method
US8303881B2 (en) 2010-10-28 2012-11-06 Covidien Lp Suture containing barbs
US8348973B2 (en) 2006-09-06 2013-01-08 Covidien Lp Bioactive substance in a barbed suture
US8353931B2 (en) 2006-11-02 2013-01-15 Covidien Lp Long term bioabsorbable barbed sutures
US8414612B2 (en) 2010-11-08 2013-04-09 Covidien Lp Multifilament barbed suture
US8454653B2 (en) 2008-02-20 2013-06-04 Covidien Lp Compound barb medical device and method
US8562644B2 (en) 2007-08-06 2013-10-22 Ethicon, Inc. Barbed suture with non-symmetric barbs
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US8888810B2 (en) 2008-02-20 2014-11-18 Covidien Lp Compound barb medical device and method
US8932327B2 (en) 2008-04-01 2015-01-13 Covidien Lp Anchoring device
US9034011B2 (en) 2008-04-01 2015-05-19 Covidien Lp Anchoring device
US9044224B2 (en) 2010-04-12 2015-06-02 Covidien Lp Barbed medical device and method
US9107660B2 (en) 2012-02-01 2015-08-18 Covidien Lp Wound closure device
US9220492B2 (en) 2012-02-01 2015-12-29 Covidien Lp Wound closure device
US9307983B2 (en) 2006-09-06 2016-04-12 Covidien Lp Bioactive substance in a barbed suture
US9358002B2 (en) 2008-04-01 2016-06-07 Covidien Lp Anchoring device
US9675341B2 (en) 2010-11-09 2017-06-13 Ethicon Inc. Emergency self-retaining sutures and packaging
US9955962B2 (en) 2010-06-11 2018-05-01 Ethicon, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US10376261B2 (en) 2008-04-01 2019-08-13 Covidien Lp Anchoring suture
US10420546B2 (en) 2010-05-04 2019-09-24 Ethicon, Inc. Self-retaining systems having laser-cut retainers
US10441270B2 (en) 2008-11-03 2019-10-15 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US10492780B2 (en) 2011-03-23 2019-12-03 Ethicon, Inc. Self-retaining variable loop sutures
US10548592B2 (en) 2004-05-14 2020-02-04 Ethicon, Inc. Suture methods and devices
US11007296B2 (en) 2010-11-03 2021-05-18 Ethicon, Inc. Drug-eluting self-retaining sutures and methods relating thereto

Families Citing this family (131)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6241747B1 (en) 1993-05-03 2001-06-05 Quill Medical, Inc. Barbed Bodily tissue connector
US5931855A (en) 1997-05-21 1999-08-03 Frank Hoffman Surgical methods using one-way suture
US7056331B2 (en) 2001-06-29 2006-06-06 Quill Medical, Inc. Suture method
US6848152B2 (en) 2001-08-31 2005-02-01 Quill Medical, Inc. Method of forming barbs on a suture and apparatus for performing same
US6773450B2 (en) 2002-08-09 2004-08-10 Quill Medical, Inc. Suture anchor and method
US20040088003A1 (en) * 2002-09-30 2004-05-06 Leung Jeffrey C. Barbed suture in combination with surgical needle
US8100940B2 (en) * 2002-09-30 2012-01-24 Quill Medical, Inc. Barb configurations for barbed sutures
US7624487B2 (en) 2003-05-13 2009-12-01 Quill Medical, Inc. Apparatus and method for forming barbs on a suture
WO2004112853A1 (en) * 2003-06-20 2004-12-29 Trevino Schwarz Jose Surgical threads with anchoring teeth
US8236027B2 (en) * 2004-04-07 2012-08-07 Tze Liang Woffles Wu Surgical thread
WO2005096955A1 (en) * 2004-04-07 2005-10-20 Tze Liang Woffles Wu Surgical thread
US20060047311A1 (en) * 2004-08-26 2006-03-02 Lutz David I Expanded PTFE articles and method of making same
DE102005004318A1 (en) * 2005-01-31 2006-08-10 Ethicon Gmbh Surgical seam system
US8267961B2 (en) * 2005-06-29 2012-09-18 Ethicon, Inc. Barbed suture
US8663277B2 (en) * 2005-06-29 2014-03-04 Ethicon, Inc. Braided barbed suture
EP1978930A2 (en) * 2006-01-31 2008-10-15 Angiotech Pharmaceuticals, Inc. Sutures and anti-scarring agents
US8480557B2 (en) 2006-07-27 2013-07-09 Refine, Llc Nonaugmentive mastopexy
AU2007303137B2 (en) 2006-10-03 2014-04-10 Sinclair Pharmaceuticals Limited Minimally invasive tissue support
US20090248071A1 (en) * 2008-03-07 2009-10-01 Alure Medical , Inc. Minimally invasive tissue support
ITRM20060527A1 (en) * 2006-10-04 2008-04-05 Promoitalia Internat Srl PERFECTED SURGICAL WIRE
EP2097020B1 (en) 2006-10-05 2016-03-23 Covidien LP Flexible endoscopic stitching devices
US20070118174A1 (en) * 2006-11-16 2007-05-24 Chu David Z J Laparoscopic surgical clamp and suturing methods
US20080132943A1 (en) * 2006-12-05 2008-06-05 Nicholas Maiorino Knotless wound closure device
US20100323961A1 (en) 2007-02-09 2010-12-23 Tyco Healthcare Group Lp Surface eroding sutures
US20080195147A1 (en) * 2007-02-09 2008-08-14 Tyco Healthcare Group Lp Surface eroding barbed sutures
US20080255612A1 (en) * 2007-04-13 2008-10-16 Angiotech Pharmaceuticals, Inc. Self-retaining systems for surgical procedures
JP5178821B2 (en) * 2007-05-08 2013-04-10 ヒョンジン ヤン, Anti-compression / fiber-reinforced adhesion suture tool
US20080281357A1 (en) * 2007-05-09 2008-11-13 An-Min Jason Sung Looped tissue-grasping device
US8161618B2 (en) * 2007-09-17 2012-04-24 Tyco Healthcare Group Lp Method of forming barbs on a suture
ES2488406T3 (en) 2007-09-27 2014-08-27 Ethicon Llc Self-retaining sutures that include tissue retention elements with enhanced strength
US20090112236A1 (en) * 2007-10-29 2009-04-30 Tyco Healthcare Group Lp Filament-Reinforced Composite Fiber
US20090112259A1 (en) * 2007-10-31 2009-04-30 Angiotech Pharmaceuticals, Inc. Recombinant expressed bioadsorbable polyhydroxyalkonate monofilament and multi-filaments self-retaining sutures
US20090143819A1 (en) * 2007-10-31 2009-06-04 D Agostino William L Coatings for modifying monofilament and multi-filaments self-retaining sutures
CN101902974B (en) * 2007-12-19 2013-10-30 伊西康有限责任公司 Self-retaining sutures with heat-contact mediated retainers
US8916077B1 (en) 2007-12-19 2014-12-23 Ethicon, Inc. Self-retaining sutures with retainers formed from molten material
US8118834B1 (en) 2007-12-20 2012-02-21 Angiotech Pharmaceuticals, Inc. Composite self-retaining sutures and method
US8615856B1 (en) 2008-01-30 2013-12-31 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
WO2009097556A2 (en) 2008-01-30 2009-08-06 Angiotech Pharmaceuticals, Inc. Appartaus and method for forming self-retaining sutures
AU2015200379B2 (en) * 2008-02-20 2017-02-02 Covidien Lp Compound barb medical device and method
BRPI0907787B8 (en) 2008-02-21 2021-06-22 Angiotech Pharm Inc method for forming a self-retaining suture and apparatus for raising the retainers in a suture to a desired angle
US8216273B1 (en) 2008-02-25 2012-07-10 Ethicon, Inc. Self-retainers with supporting structures on a suture
US8641732B1 (en) 2008-02-26 2014-02-04 Ethicon, Inc. Self-retaining suture with variable dimension filament and method
US20090228021A1 (en) * 2008-03-06 2009-09-10 Leung Jeffrey C Matrix material
US20090248066A1 (en) * 2008-03-28 2009-10-01 David Hjalmar Wilkie Elastic barbed suture and tissue support system
US20100228270A1 (en) * 2008-04-11 2010-09-09 Michael Bogart Deployment System for Surgical Suture
US8864776B2 (en) * 2008-04-11 2014-10-21 Covidien Lp Deployment system for surgical suture
ES2709687T3 (en) * 2008-04-15 2019-04-17 Ethicon Llc Self-retaining sutures with bi-directional retainers or unidirectional retainers
US7967841B2 (en) * 2008-06-02 2011-06-28 Ethicon, Inc. Methods for using looped tissue-grasping devices
US20110040308A1 (en) 2008-06-13 2011-02-17 Ramiro Cabrera Endoscopic Stitching Devices
US8628545B2 (en) * 2008-06-13 2014-01-14 Covidien Lp Endoscopic stitching devices
US8784305B2 (en) * 2008-10-09 2014-07-22 Covidien Lp Tissue retractor and method of use
EP2352435B1 (en) 2008-10-31 2019-11-27 Sinclair Pharmaceuticals Limited Minimally invasive tissue support system with a superior tissue support and an inferior anchor
DE102008057216A1 (en) 2008-11-06 2010-05-12 Aesculap Ag Surgical thread with core-shell construction
DE102008057213A1 (en) 2008-11-06 2010-05-12 Aesculap Ag Medical device product, a surgical kit and a manufacturing process for the medical device product
DE102008057218A1 (en) 2008-11-06 2010-05-12 Aesculap Ag Surgical sutures with barbs incised in the unstretched state
WO2010107698A2 (en) 2009-03-14 2010-09-23 Vasostitch, Inc. Vessel access and closure device
US20120035654A1 (en) * 2009-03-14 2012-02-09 Vasostitch, Inc. Methods and systems for advancing and anchoring suture in tissue
US8402621B2 (en) 2009-04-29 2013-03-26 Covidien Lp System and method for forming barbs on a suture
DE102009020894A1 (en) 2009-05-08 2010-11-11 Aesculap Ag Elastomeric thread with anchoring structures for anchoring in biological tissues
DE102009020901A1 (en) 2009-05-08 2010-11-11 Aesculap Ag Coated thread with anchoring structures for anchoring in biological tissues
DE102009020897A1 (en) 2009-05-08 2010-11-11 Aesculap Ag Thread with coated anchoring structures for anchoring in biological tissues and a method for its production
USD708746S1 (en) 2009-06-10 2014-07-08 Covidien Lp Handle for surgical device
US8490713B2 (en) * 2009-10-06 2013-07-23 Covidien Lp Handle assembly for endoscopic suturing device
WO2011090628A2 (en) 2009-12-29 2011-07-28 Angiotech Pharmaceuticals, Inc. Bidirectional self-retaining sutures with laser-marked and/or non-laser marked indicia and methods
US9775702B2 (en) 2010-03-10 2017-10-03 Smith & Nephew, Inc. Composite interference screws and drivers
EP2386252B1 (en) 2010-05-11 2021-04-07 Aesculap AG Use of a continuous-filament thread having a plurality of barbs for the production of sutures
US8945156B2 (en) 2010-05-19 2015-02-03 University Of Utah Research Foundation Tissue fixation
US8858577B2 (en) 2010-05-19 2014-10-14 University Of Utah Research Foundation Tissue stabilization system
JP5869565B2 (en) 2010-06-26 2016-02-24 バソスティッチ, インコーポレイテッド Method and apparatus for transapical access and closure
US20120116448A1 (en) * 2010-10-30 2012-05-10 Reiffel Robert S Length-control suture technique
US20120143249A1 (en) * 2010-12-03 2012-06-07 Boston Scientific Scimed, Inc. Closure device
CN103619384A (en) * 2011-01-18 2014-03-05 麻省理工学院 Devices and uses thereof
US8852214B2 (en) 2011-02-04 2014-10-07 University Of Utah Research Foundation System for tissue fixation to bone
US8968340B2 (en) 2011-02-23 2015-03-03 Covidien Lp Single actuating jaw flexible endolumenal stitching device
KR101057377B1 (en) * 2011-03-24 2011-08-17 한스바이오메드 주식회사 Medical suture with micro cogs on the surface and producing method for the same
US9687227B2 (en) 2011-04-29 2017-06-27 Covidien Lp Apparatus and method of forming barbs on a suture
US9241709B2 (en) 2011-05-31 2016-01-26 Covidien Lp Barbed sutures
US8640331B2 (en) 2011-05-31 2014-02-04 Covidien Lp Barbed sutures
US20130172931A1 (en) 2011-06-06 2013-07-04 Jeffrey M. Gross Methods and devices for soft palate tissue elevation procedures
US8715334B2 (en) 2011-07-14 2014-05-06 Boston Scientific Scimed, Inc. Anti-migration stent with quill filaments
GB201113303D0 (en) 2011-08-02 2011-09-14 Xiros Ltd Connective tissue repair pad
EP2739241B1 (en) * 2011-08-02 2017-09-06 Xiros Limited Connective tissue repair
EP2567714A1 (en) 2011-09-07 2013-03-13 Aesculap AG Flocked surgical suture and methods for the production thereof
US10973513B2 (en) 2011-09-29 2021-04-13 Ethicon, Llc Barbed suture having increased holding strength
KR101362446B1 (en) * 2012-05-10 2014-02-11 이훈범 Filler for wrinkle removing
US10835241B2 (en) 2012-07-30 2020-11-17 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US11253252B2 (en) 2012-07-30 2022-02-22 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10390935B2 (en) 2012-07-30 2019-08-27 Conextions, Inc. Soft tissue to bone repair devices, systems, and methods
US10219804B2 (en) 2012-07-30 2019-03-05 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US9427309B2 (en) 2012-07-30 2016-08-30 Conextions, Inc. Soft tissue repair devices, systems, and methods
US11672529B2 (en) 2012-09-17 2023-06-13 Cilag Gmbh International Barbed sutures having contoured barbs that facilitate passage through tissue and increase holding strength
CN104994807A (en) * 2012-10-16 2015-10-21 朴民宰 Apparatus and method for processing surface of in vivo insertion member, said in vivo insertion member, and injection apparatus for injecting said in vivo insertion member
GB201301784D0 (en) 2013-02-01 2013-03-20 Xiros Ltd Connective tissue repair technology
US9872679B2 (en) 2013-02-05 2018-01-23 Ethicon, Inc. Locally reversible barbed sutures
US9155531B2 (en) * 2013-03-15 2015-10-13 Smith & Nephew, Inc. Miniaturized dual drive open architecture suture anchor
CA2922694C (en) 2013-08-29 2017-12-05 Teleflex Medical Incorporated High-strength multi-component suture
CN103541073B (en) * 2013-09-26 2016-03-02 辽东学院 One is entried and is restricted and using method
US11583384B2 (en) 2014-03-12 2023-02-21 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
WO2015138760A1 (en) 2014-03-12 2015-09-17 Conextions, Inc. Soft tissue repair devices, systems, and methods
US9468434B2 (en) 2014-06-03 2016-10-18 Covidien Lp Stitching end effector
KR20150145392A (en) 2014-06-19 2015-12-30 신미향 Medical puncture needle device
US9855155B2 (en) * 2014-06-26 2018-01-02 Cardinal Health Switzeerland 515 Gmbh Endoprosthesis anchoring and sealing
KR101621759B1 (en) * 2014-08-13 2016-05-17 유원석 Bending-type barbed suture
US10500303B2 (en) * 2014-08-15 2019-12-10 Tepha, Inc. Self-retaining sutures of poly-4-hydroxybutyrate and copolymers thereof
KR101637518B1 (en) 2014-10-01 2016-07-15 주식회사 오브이월드 Medical suture material equipped with Medical suture material insertion tool
US9795378B2 (en) 2014-10-31 2017-10-24 Ethicon, Inc. Method for approximating wounds
US10092286B2 (en) 2015-05-27 2018-10-09 Covidien Lp Suturing loading unit
KR101695339B1 (en) * 2015-11-02 2017-01-11 텐텍 주식회사 A Thread for Cosmetic Surgery with Different Diameter
US10258326B2 (en) 2016-02-08 2019-04-16 Ethicon, Inc. Elastic tissue reinforcing fastener
US10542970B2 (en) 2016-05-31 2020-01-28 Covidien Lp Endoscopic stitching device
US11696822B2 (en) 2016-09-28 2023-07-11 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10709439B2 (en) 2017-02-06 2020-07-14 Covidien Lp Endoscopic stitching device
CN106923930B (en) * 2017-03-13 2018-07-10 上海瀚达医疗器械有限公司 Patch based on novel weaving technology and shape and weaving method thereof
US11389192B2 (en) * 2017-06-29 2022-07-19 Cilag Gmbh International Method of suturing a trocar path incision
CN109419548A (en) * 2017-08-21 2019-03-05 上海普实医疗器械科技有限公司 Occluder for left auricle and its manufacturing method
US10905411B2 (en) 2017-11-03 2021-02-02 Covidien Lp Surgical suturing and grasping device
CN107736905A (en) * 2017-11-29 2018-02-27 爱美客技术发展股份有限公司 A kind of suture and a kind of medicine equipment
US10973509B2 (en) 2017-12-20 2021-04-13 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US11547397B2 (en) 2017-12-20 2023-01-10 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US11272924B2 (en) 2018-07-18 2022-03-15 Arthrex, Inc. Knotless closure sutures and methods of tissue fixation
US11197665B2 (en) 2018-08-06 2021-12-14 Covidien Lp Needle reload device for use with endostitch device
US11219457B2 (en) 2018-10-11 2022-01-11 Covidien Lp Laparoscopic purse string suture device
DE102019104052A1 (en) 2019-01-30 2020-07-30 Timo Bartels Self-fixing surgical thread
US11439383B2 (en) 2019-08-20 2022-09-13 Abbott Cardiovascular Systems, Inc. Self locking suture and self locking suture mediated closure device
US11129968B2 (en) * 2019-09-13 2021-09-28 Ethicon, Inc. Methods of making and implanting barbed microcatheters having fluid egress openings for infusing therapeutic fluids
KR200491577Y1 (en) * 2019-10-01 2020-05-28 손정완 Bi-directional barbed suture having needle
JP2023514194A (en) 2020-02-11 2023-04-05 エンボディ,インコーポレイテッド Surgical anchoring element and deployment device
CA3105911A1 (en) 2020-05-15 2021-11-15 Clayton L. Moliver Knotless sutures including integrated closures
CN113440190B (en) * 2021-06-28 2022-03-11 梁一凡 Novel method for manufacturing knotting-free fishbone suture line
WO2023287990A2 (en) * 2021-07-14 2023-01-19 Eurothreads LLC Twelve-dimensional barbed surgical thread
EP4285946A1 (en) 2022-06-03 2023-12-06 B. Braun Surgical, S. A. Surgical thread, surgical suture and surgical kit

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5053047A (en) * 1989-05-16 1991-10-01 Inbae Yoon Suture devices particularly useful in endoscopic surgery and methods of suturing
US5084063A (en) * 1989-09-27 1992-01-28 United States Surgical Corporation Surgical needle-suture attachment
US5102418A (en) * 1989-09-27 1992-04-07 United States Surgical Corporation Method for attaching a surgical needle to a suture
US5931855A (en) * 1997-05-21 1999-08-03 Frank Hoffman Surgical methods using one-way suture
US6241747B1 (en) * 1993-05-03 2001-06-05 Quill Medical, Inc. Barbed Bodily tissue connector

Family Cites Families (768)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1321011A (en) 1919-11-04 Surgical
US3123077A (en) * 1964-03-03 Surgical suture
US709392A (en) 1902-05-06 1902-09-16 Haydn Brown Suture-clamp.
US733723A (en) 1903-02-16 1903-07-14 Clarence D Lukens Serrefin.
US789401A (en) 1904-07-15 1905-05-09 Ernest V Acheson Umbilical forceps and metal sealing-band.
US816026A (en) 1905-03-09 1906-03-27 Albert J Meier Surgical clip.
US879858A (en) * 1907-05-16 1908-02-25 Dobson And Barlow Ltd Means for locking carding-engine-cylinder doors.
US879758A (en) 1907-06-14 1908-02-18 Frank Brooks Foster Needle.
US1142510A (en) 1914-11-04 1915-06-08 Lillian K Engle Fastening device.
US1248825A (en) 1915-04-08 1917-12-04 Carleton Dederer Surgical needle.
US1558037A (en) 1925-06-17 1925-10-20 Harry D Morton Surgical needle and suture assembly and method of making the same
US1728316A (en) 1927-07-02 1929-09-17 Kirurgiska Instr Fabriks Aktie Wound clasp
US1886721A (en) 1928-08-10 1932-11-08 Rubber Products Corp Road marker
US2094578A (en) 1932-09-13 1937-10-05 Blumenthal Bernhard Material for surgical ligatures and sutures
US2201610A (en) 1938-05-20 1940-05-21 Jr James C Dawson Wound clip
US2254620A (en) 1939-11-14 1941-09-02 George I Miller Clip
US2232142A (en) 1940-09-27 1941-02-18 Schumann Seymour Wound clip
US2347956A (en) 1943-02-06 1944-05-02 Earl P Lansing Cable sheath cutting and stripping tool
US2421193A (en) 1943-08-02 1947-05-27 Cleveland Clinic Foundation Surgical dressing
US2355907A (en) 1943-11-12 1944-08-15 Johnson & Johnson Method and apparatus for grinding and polishing ligatures
US2480271A (en) 1945-02-27 1949-08-30 Sumner Thomas Soap dispenser with reciprocating cutter blade
US2472009A (en) 1945-08-01 1949-05-31 Cleveland Clinic Foundation Surgical dressing
US2452734A (en) 1945-10-26 1948-11-02 John F Costelow Insulation cutter
US2572936A (en) 1947-02-27 1951-10-30 American Viscose Corp Process for making crimped artificial filaments
US2910067A (en) 1952-10-13 1959-10-27 Technical Oil Tool Corp Wound clip and extractor therefor
US2684070A (en) 1953-03-23 1954-07-20 Walter L Kelsey Surgical clip
US2817339A (en) 1953-08-10 1957-12-24 Norman M Sullivan Rigid fascial suture
US2814296A (en) 1954-04-15 1957-11-26 S & R J Everett & Co Ltd Surgical needles
US2779083A (en) 1955-02-09 1957-01-29 Edward N Eaton Lip and mouth adjuster
US2830366A (en) 1955-08-11 1958-04-15 Ernest F Chisena Cutting implements for electric cables
US2866256A (en) 1956-04-05 1958-12-30 Rohm & Haas Wool-like artificial fibers
US3003155A (en) 1956-07-06 1961-10-10 Felix C Mielzynski Hair darts for implanting in live or artificial media
US2988028A (en) 1956-08-13 1961-06-13 John H Alcamo Surgeon's suturing device
US2928395A (en) 1957-06-20 1960-03-15 Ethicon Inc Sutures
US3066673A (en) 1959-04-23 1962-12-04 American Cyanamid Co Surgical sutures
US3066452A (en) 1959-04-23 1962-12-04 American Cyanamid Co Precision grinding of surgical sutures
US3068869A (en) 1959-10-01 1962-12-18 Sheiden Charles Hunter Tissue suture clamp
US3273562A (en) 1960-02-24 1966-09-20 Rene G Le Vaux Skin and surgical clips
DE1810800U (en) 1960-03-09 1960-05-05 Guenter Dipl Ing Schmoele EQUIPMENT FOR FILTERING COFFEE.
US3068870A (en) 1960-03-18 1962-12-18 Levin Abraham Wound clip
US3209652A (en) 1961-03-30 1965-10-05 Burgsmueller Karl Thread whirling method
US3209754A (en) 1961-08-10 1965-10-05 Ernest C Wood Surgical clip
US3082523A (en) * 1961-09-26 1963-03-26 Imp Eastman Corp Stripping tool
US3234636A (en) 1962-03-19 1966-02-15 Ernest C Wood Clip applicator
US3187752A (en) 1962-04-27 1965-06-08 American Cyanamid Co Non-absorbable silicone coated sutures and method of making
US3166072A (en) 1962-10-22 1965-01-19 Jr John T Sullivan Barbed clips
US3221746A (en) 1963-01-25 1965-12-07 Noble John William Surgical connecting device
US3212187A (en) 1963-03-27 1965-10-19 Bard Parker Company Inc Suture cutting and removing instrument
US3214810A (en) 1963-05-23 1965-11-02 Robert V Mathison Fastener devices
GB1091282A (en) 1963-07-09 1967-11-15 Nat Res Dev Sutures
US3206018A (en) 1963-07-10 1965-09-14 Ethicon Inc Wire suturing device
US3352191A (en) 1965-04-23 1967-11-14 Allan H Crawford Dowel
US3378010A (en) 1965-07-28 1968-04-16 Coldling Surgical clip with means for releasing the clamping pressure
US3394704A (en) 1965-10-20 1968-07-30 Torrington Co Surgical needle with bonded suture
US3385299A (en) 1965-10-23 1968-05-28 New Res And Dev Lab Inc Wound clip
US3527223A (en) 1967-09-01 1970-09-08 Melvin Shein Ear stud and hollow piercer for insertion thereof
US3525340A (en) 1967-10-31 1970-08-25 Joseph G Gilbert Surgical dressing with skin clips thereon
US3586002A (en) 1968-01-08 1971-06-22 Ernest C Wood Surgical skin clip
US3494006A (en) 1968-01-12 1970-02-10 George C Brumlik Self-gripping fastening device
US3522637A (en) 1968-03-06 1970-08-04 George C Brumlik Self-gripping fastening filament
US3557795A (en) 1968-06-19 1971-01-26 Weck & Co Inc Edward Suture provided with wound healing coating
US3545608A (en) 1968-06-28 1970-12-08 Ethicon Inc Suture package
AT326803B (en) 1968-08-26 1975-12-29 Binder Fa G MESHWARE AND METHOD OF MANUFACTURING THE SAME
US3608539A (en) 1968-11-06 1971-09-28 Daniel G Miller Method for the biopsy of subcutaneous masses
DE1810800A1 (en) 1968-11-25 1970-06-04 Dr Med Gerhard Metz Special wires and needles for the tendon sutures
US3570497A (en) 1969-01-16 1971-03-16 Gerald M Lemole Suture apparatus and methods
US3833972A (en) 1969-09-11 1974-09-10 G Brumlik Self-adhering fastening filament
US3618447A (en) 1969-09-15 1971-11-09 Phillips Petroleum Co Deterioration fasteners
US3646615A (en) 1970-01-26 1972-03-07 Richard A Ness Reinforcing element for muscles
US3608095A (en) 1970-03-05 1971-09-28 Federal Tool Eng Co Method of fixing hair pieces to scalps
FR2084475A5 (en) 1970-03-16 1971-12-17 Brumlik George
CH521459A (en) 1970-03-20 1972-04-15 Sobico Inc Textile yarn and process for its manufacture
CH515699A (en) 1970-04-29 1971-11-30 Velcro Sa Soulie Multi-hook, tablecloth-shaped article
US3683926A (en) 1970-07-09 1972-08-15 Dainippon Pharmaceutical Co Tube for connecting blood vessels
US3716058A (en) 1970-07-17 1973-02-13 Atlanta Res Inst Barbed suture
US3700433A (en) 1971-07-12 1972-10-24 United Aircraft Corp Enhancement of transverse properties of directionally solidified superalloys
US4008303A (en) 1971-08-30 1977-02-15 American Cyanamid Company Process for extruding green polyglycolic acid sutures and surgical elements
US3889322A (en) 1971-10-22 1975-06-17 Ingrip Fasteners Multi-element self-gripping device
US4198734A (en) 1972-04-04 1980-04-22 Brumlik George C Self-gripping devices with flexible self-gripping means and method
US4182340A (en) 1972-05-12 1980-01-08 Spencer Dudley W C Hoof repair
US3762418A (en) 1972-05-17 1973-10-02 W Wasson Surgical suture
US3922455A (en) 1972-05-23 1975-11-25 Ingrip Fasteners Linear element with grafted nibs and method therefor
US3847156A (en) 1972-07-17 1974-11-12 Sherwood Medical Ind Inc Suture
AU476672B2 (en) 1972-07-24 1976-09-30 Ethicon Inc. Braided suture dimension control
US3985138A (en) 1972-08-25 1976-10-12 Jarvik Robert K Preformed ligatures for bleeders and methods of applying such ligatures
US3825010A (en) 1973-04-23 1974-07-23 Donald B Mc Surgical apparatus for closing wounds
US3977937A (en) 1973-10-10 1976-08-31 Candor James T System for making a non-woven sheet by creating an electrostatic field action
US3980177A (en) 1973-10-26 1976-09-14 Johnson & Johnson Controlled release suture
US3918455A (en) 1974-04-29 1975-11-11 Albany Int Corp Combined surgical suture and needle
US3981307A (en) 1974-07-01 1976-09-21 Ethicon, Inc. Thermal attachment of surgical sutures to needles
US3951261A (en) 1974-08-28 1976-04-20 Ethicon, Inc. Needled suture mounting and dispensing device and package
US3963031A (en) 1974-12-11 1976-06-15 Ethicon, Inc. Juncture-lubricated needle-suture combination
US3941164A (en) 1975-02-13 1976-03-02 Musgrave Daniel D Process for making barbed material
US4006747A (en) 1975-04-23 1977-02-08 Ethicon, Inc. Surgical method
US3990144A (en) 1975-06-30 1976-11-09 Boris Schwartz Suture cutter and removal means
US3985227A (en) 1975-11-05 1976-10-12 Ethicon, Inc. Package for armed sutures
JPS5315191Y2 (en) 1975-11-17 1978-04-21
GB1508627A (en) 1975-11-26 1978-04-26 Ethicon Inc Rapid closure suture
US4052988A (en) 1976-01-12 1977-10-11 Ethicon, Inc. Synthetic absorbable surgical devices of poly-dioxanone
US4069825A (en) 1976-01-28 1978-01-24 Taichiro Akiyama Surgical thread and cutting apparatus for the same
US4027608A (en) 1976-02-20 1977-06-07 Raymond Kelder Suturing device
USD246911S (en) 1976-02-27 1978-01-10 Bess Jr Kenneth B Automatic blind suturing machine
US4073298A (en) 1976-08-03 1978-02-14 New Research & Development Lab., Inc. Wound clip
GB1545731A (en) 1976-09-07 1979-05-16 Vnii Ispytatel Med Tech Surgical apparatus
US4043344A (en) 1976-09-20 1977-08-23 American Cyanamid Company Non-absorbable surgical sutures coated with polyoxyethylene-polyoxypropylene copolymer lubricant
US4186239A (en) 1976-12-06 1980-01-29 Berkley & Company, Inc. Monofilament weed cutters
SU715082A1 (en) 1977-01-24 1980-02-15 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Surgical suturing apparatus
US4300424A (en) 1977-03-14 1981-11-17 American Greetings Corporation Candle manufacturing system including wick cutting means
US4137921A (en) 1977-06-24 1979-02-06 Ethicon, Inc. Addition copolymers of lactide and glycolide and method of preparation
US4204542A (en) 1977-08-03 1980-05-27 Carbomedics, Inc. Multistrand carbon coated sutures
US4311002A (en) 1977-09-22 1982-01-19 Kabel Metallwerke Ghh Forming stranded stock
JPS6042301B2 (en) 1978-02-27 1985-09-21 ユニチカ株式会社 Method for drawing thick synthetic fiber filament
CA1107989A (en) 1978-05-16 1981-09-01 Alexandre Wolosianski Apparatus for screw-threading
US5147382A (en) 1978-12-08 1992-09-15 Ethicon, Inc. Elastomeric surgical sutures comprising segmented copolyether/esters
US4259959A (en) 1978-12-20 1981-04-07 Walker Wesley W Suturing element
FR2457583A1 (en) * 1979-05-21 1980-12-19 Matra IMPROVEMENTS IN METHODS AND APPARATUS FOR STRIPPING ELECTRIC WIRES
US4313448A (en) 1980-01-28 1982-02-02 Medtronic, Inc. Myocardial sutureless lead
US4317451A (en) 1980-02-19 1982-03-02 Ethicon, Inc. Plastic surgical staple
US4428376A (en) 1980-05-02 1984-01-31 Ethicon Inc. Plastic surgical staple
US4505274A (en) 1980-10-17 1985-03-19 Propper Manufacturing Co., Inc. Suture clip
US4372293A (en) 1980-12-24 1983-02-08 Vijil Rosales Cesar A Apparatus and method for surgical correction of ptotic breasts
SU982676A1 (en) 1981-04-07 1982-12-23 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Surgical cramp
DE3214479C2 (en) 1981-07-22 1986-05-15 Siemens AG, 1000 Berlin und 8000 München Hand tool for peeling off the outer sheath of electrical lines and cables
US4490326A (en) 1981-07-30 1984-12-25 Ethicon, Inc. Molding process for polydioxanone polymers
FR2520390B1 (en) 1982-01-26 1984-05-25 Asa Sa
US4454875A (en) 1982-04-15 1984-06-19 Techmedica, Inc. Osteal medical staple
US6656182B1 (en) 1982-05-20 2003-12-02 John O. Hayhurst Tissue manipulation
US4741330A (en) 1983-05-19 1988-05-03 Hayhurst John O Method and apparatus for anchoring and manipulating cartilage
US5601557A (en) 1982-05-20 1997-02-11 Hayhurst; John O. Anchoring and manipulating tissue
US5417691A (en) 1982-05-20 1995-05-23 Hayhurst; John O. Apparatus and method for manipulating and anchoring tissue
US4430998A (en) 1982-06-01 1984-02-14 Thoratec Laboratories Corporation Wound closing device
US4467805A (en) 1982-08-25 1984-08-28 Mamoru Fukuda Skin closure stapling device for surgical procedures
US4553544A (en) 1982-09-20 1985-11-19 Janome Sewing Machine Co. Ltd. Suturing instrument for surgical operation
US4493323A (en) 1982-12-13 1985-01-15 University Of Iowa Research Foundation Suturing device and method for using same
US4676245A (en) 1983-02-09 1987-06-30 Mamoru Fukuda Interlocking surgical staple assembly
US4535772A (en) 1983-03-10 1985-08-20 Kells Medical, Incorporated Skin closure device
US4595007A (en) 1983-03-14 1986-06-17 Ethicon, Inc. Split ring type tissue fastener
US4510934A (en) 1983-05-13 1985-04-16 Batra Subhash K Suture
US4548202A (en) 1983-06-20 1985-10-22 Ethicon, Inc. Mesh tissue fasteners
US4531522A (en) 1983-06-20 1985-07-30 Ethicon, Inc. Two-piece tissue fastener with locking top and method for applying same
US4532926A (en) 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with ratchet leg staple and sealable latching receiver
IL74460A (en) 1983-09-02 1990-01-18 Istec Ind & Technologies Ltd Surgical implement particularly useful for suturing prosthetic valves
US7166125B1 (en) 1988-03-09 2007-01-23 Endovascular Technologies, Inc. Intraluminal grafting system
US5104399A (en) 1986-12-10 1992-04-14 Endovascular Technologies, Inc. Artificial graft and implantation method
US4873976A (en) 1984-02-28 1989-10-17 Schreiber Saul N Surgical fasteners and method
US4635637A (en) 1984-03-29 1987-01-13 Schreiber Saul N Surgical suture
US4653486A (en) 1984-04-12 1987-03-31 Coker Tom P Fastener, particularly suited for orthopedic use
WO1986000020A1 (en) 1984-06-14 1986-01-03 Bioresearch Inc. Composite surgical sutures
US4689882A (en) 1984-10-22 1987-09-01 United Technologies Automotive, Inc. Hand tool and method for removing insulation from wire-wound ignition cable
US4610251A (en) 1985-04-19 1986-09-09 Kumar Sarbjeet S Surgical staple
US4712553A (en) 1985-05-30 1987-12-15 Cordis Corporation Sutures having a porous surface
US4637380A (en) 1985-06-24 1987-01-20 Orejola Wilmo C Surgical wound closures
US4669473A (en) 1985-09-06 1987-06-02 Acufex Microsurgical, Inc. Surgical fastener
US4610250A (en) 1985-10-08 1986-09-09 United States Surgical Corporation Two-part surgical fastener for fascia wound approximation
US4733665C2 (en) 1985-11-07 2002-01-29 Expandable Grafts Partnership Expandable intraluminal graft and method and apparatus for implanting an expandable intraluminal graft
US4750910A (en) 1986-01-22 1988-06-14 Mitsui Toatsu Chemicals, Incorporated Indigo blue-colored bioabsorbable surgical fibers and production process thereof
US4895148A (en) 1986-05-20 1990-01-23 Concept, Inc. Method of joining torn parts of bodily tissue in vivo with a biodegradable tack member
US4884572A (en) 1986-05-20 1989-12-05 Concept, Inc. Tack and applicator for treating torn bodily material in vivo
US4751621A (en) 1986-08-28 1988-06-14 Jenkins Edward L Light knife
US4841960A (en) 1987-02-10 1989-06-27 Garner Eric T Method and apparatus for interosseous bone fixation
US4719917A (en) 1987-02-17 1988-01-19 Minnesota Mining And Manufacturing Company Surgical staple
US4865026A (en) 1987-04-23 1989-09-12 Barrett David M Sealing wound closure device
US5478353A (en) 1987-05-14 1995-12-26 Yoon; Inbae Suture tie device system and method for suturing anatomical tissue proximate an opening
US5437680A (en) 1987-05-14 1995-08-01 Yoon; Inbae Suturing method, apparatus and system for use in endoscopic procedures
US4898156A (en) 1987-05-18 1990-02-06 Mitek Surgical Products, Inc. Suture anchor
JPS63288146A (en) 1987-05-20 1988-11-25 Nippon Medical Supply Corp Base paper for packing suture
US4832025A (en) 1987-07-30 1989-05-23 American Cyanamid Company Thermoplastic surgical suture with a melt fused length
FR2619129B1 (en) 1987-08-07 1990-02-09 Mas Richard SEWING THREAD NEEDLE
WO1989001841A1 (en) 1987-08-28 1989-03-09 Tsentralnoe Konstruktorskoe Bjuro Unikalnogo Pribo Method and device for laser processing of an object
FR2620633B1 (en) 1987-09-23 1991-09-20 Lyonnaise Eaux PROCESS AND DEVICE FOR MAKING A BEAM OF FILAMENTS, IN PARTICULAR SEMI-PERMEABLE HOLLOW FIBERS
ES2043842T3 (en) 1987-10-30 1994-01-01 Howmedica DEVICE FOR REPAIR OF TENDONS AND LIGAMENTS.
US4887601A (en) 1987-11-06 1989-12-19 Ophthalmic Ventures Limited Partnership Adjustable surgical staple and method of using the same
US4899743A (en) 1987-12-15 1990-02-13 Mitek Surgical Products, Inc. Suture anchor installation tool
US4968315A (en) 1987-12-15 1990-11-06 Mitek Surgical Products, Inc. Suture anchor and suture anchor installation tool
JP2561853B2 (en) 1988-01-28 1996-12-11 株式会社ジェイ・エム・エス Shaped memory molded article and method of using the same
US4930945A (en) 1988-05-20 1990-06-05 Mitsubishi Metal Corporation Insert rotary cutter
JPH0746322B2 (en) * 1988-05-23 1995-05-17 日本電気株式会社 Faulty device identification system
US5002562A (en) 1988-06-03 1991-03-26 Oberlander Michael A Surgical clip
US4900605A (en) 1988-09-16 1990-02-13 Harold Thorgersen Bristle pile textile for garment applications
EP0437481B1 (en) 1988-10-04 1995-03-15 PETROS Peter Emmanuel Surgical instrument prosthesis
US5047047A (en) 1988-10-26 1991-09-10 Inbae Yoon Wound closing device
US4905367A (en) 1988-11-08 1990-03-06 Corvita Corporation Manufacture of stretchable porous sutures
US5217494A (en) 1989-01-12 1993-06-08 Coggins Peter R Tissue supporting prosthesis
US4997439A (en) 1989-01-26 1991-03-05 Chen Fusen H Surgical closure or anastomotic device
US4994073A (en) 1989-02-22 1991-02-19 United States Surgical Corp. Skin fastener
CN2050742U (en) * 1989-04-25 1990-01-10 王勇 Suturing appliance
US4981149A (en) 1989-05-16 1991-01-01 Inbae Yoon Method for suturing with a bioabsorbable needle
US4932962A (en) 1989-05-16 1990-06-12 Inbae Yoon Suture devices particularly useful in endoscopic surgery and methods of suturing
US5222976A (en) 1989-05-16 1993-06-29 Inbae Yoon Suture devices particularly useful in endoscopic surgery
US4946468A (en) 1989-06-06 1990-08-07 Mitek Surgical Products, Inc. Suture anchor and suture anchor installation tool
US5002550A (en) 1989-06-06 1991-03-26 Mitek Surgical Products, Inc. Suture anchor installation tool
US4994084A (en) 1989-06-23 1991-02-19 Brennan H George Reconstructive surgery method and implant
US5451461A (en) 1989-09-01 1995-09-19 Ethicon, Inc. Thermal treatment of thermoplastic filaments for the preparation of surgical sutures
US5129906A (en) 1989-09-08 1992-07-14 Linvatec Corporation Bioabsorbable tack for joining bodily tissue and in vivo method and apparatus for deploying same
US5089010A (en) 1989-09-27 1992-02-18 United States Surgical Corporation Surgical needle-suture attachment possessing weakened suture segment for controlled suture release
US5133738A (en) 1989-09-27 1992-07-28 United States Surgical Corporation Combined surgical needle-spiroid braided suture device
CA2026200A1 (en) 1989-09-27 1991-03-28 Herbert W. Korthoff Combined surgical needle-suture device and method for its manufacture
US5156615A (en) 1989-09-27 1992-10-20 United States Surgical Corporation Surgical needle-suture attachment for controlled suture release
US5123911A (en) 1989-09-27 1992-06-23 United States Surgical Corporation Method for attaching a surgical needle to a suture
US5007921A (en) 1989-10-26 1991-04-16 Brown Alan W Surgical staple
US5026390A (en) 1989-10-26 1991-06-25 Brown Alan W Surgical staple
US5007922A (en) 1989-11-13 1991-04-16 Ethicon, Inc. Method of making a surgical suture
US5156788A (en) 1989-11-14 1992-10-20 United States Surgical Corporation Method and apparatus for heat tipping sutures
US5123913A (en) 1989-11-27 1992-06-23 Wilk Peter J Suture device
US4950285A (en) 1989-11-27 1990-08-21 Wilk Peter J Suture device
CA2122041A1 (en) 1989-12-04 1993-04-29 Kenneth Kensey Plug device for sealing openings and method of use
US5037433A (en) 1990-05-17 1991-08-06 Wilk Peter J Endoscopic suturing device and related method and suture
US5197597A (en) 1990-06-05 1993-03-30 United States Surgical Corporation Suture retainer
US5102421A (en) 1990-06-14 1992-04-07 Wm. E. Anpach, III Suture anchor and method of forming
US6203565B1 (en) 1990-06-28 2001-03-20 Peter M. Bonutti Surgical devices assembled using heat bondable materials
SU1752358A1 (en) 1990-06-29 1992-08-07 Крымский Медицинский Институт Surgical sutural material
US5269809A (en) 1990-07-02 1993-12-14 American Cyanamid Company Locking mechanism for use with a slotted suture anchor
US5224946A (en) 1990-07-02 1993-07-06 American Cyanamid Company Bone anchor and method of anchoring a suture to a bone
US5041129A (en) 1990-07-02 1991-08-20 Acufex Microsurgical, Inc. Slotted suture anchor and method of anchoring a suture
US5037422A (en) 1990-07-02 1991-08-06 Acufex Microsurgical, Inc. Bone anchor and method of anchoring a suture to a bone
SU1745214A1 (en) 1990-07-04 1992-07-07 Межотраслевой научно-технический комплекс "Микрохирургия глаза" Head of an automatic appliance for application of a surgical thread suture
US5342395A (en) 1990-07-06 1994-08-30 American Cyanamid Co. Absorbable surgical repair devices
US5127413A (en) 1990-08-09 1992-07-07 Ebert Edward A Sinous suture
JP2890063B2 (en) 1990-08-09 1999-05-10 グンゼ株式会社 Manufacturing method of surgical suture
CA2048464A1 (en) 1990-08-17 1992-02-18 Michael P. Chesterfield Apparatus and method for producing braided suture products
US5306288A (en) 1990-09-05 1994-04-26 United States Surgical Corporation Combined surgical needle-suture device
CA2049123C (en) 1990-09-13 2002-01-15 David T. Green Apparatus and method for subcuticular stapling of body tissue
US5372146A (en) * 1990-11-06 1994-12-13 Branch; Thomas P. Method and apparatus for re-approximating tissue
US5123910A (en) 1990-11-07 1992-06-23 Mcintosh Charles L Blunt tip surgical needle
CA2704193C (en) 1990-12-13 2011-06-07 United States Surgical Corporation Method and apparatus for tipping sutures
US5258013A (en) 1991-01-07 1993-11-02 United States Surgical Corporation Siliconized surgical needle and method for its manufacture
US5259846A (en) 1991-01-07 1993-11-09 United States Surgical Corporation Loop threaded combined surgical needle-suture device
US5320629B1 (en) 1991-01-07 2000-05-02 Advanced Surgical Inc Device and method for applying suture
US5234006A (en) 1991-01-18 1993-08-10 Eaton Alexander M Adjustable sutures and method of using the same
US5312456A (en) 1991-01-31 1994-05-17 Carnegie Mellon University Micromechanical barb and method for making the same
JP3124564B2 (en) 1991-02-21 2001-01-15 マニー株式会社 Medical suture needle and manufacturing method thereof
US5354298A (en) 1991-03-22 1994-10-11 United States Surgical Corporation Suture anchor installation system
US5480403A (en) 1991-03-22 1996-01-02 United States Surgical Corporation Suture anchoring device and method
US5101968A (en) 1991-05-07 1992-04-07 Lukens Medical Corporation Retainers for needled surgical sutures
US5192274A (en) 1991-05-08 1993-03-09 Bierman Steven F Anchor pad for catheterization system
US5269783A (en) 1991-05-13 1993-12-14 United States Surgical Corporation Device and method for repairing torn tissue
SE9101752D0 (en) 1991-06-10 1991-06-10 Procordia Ortech Ab METHOD OF PRODUCING A MICROSTRUCTURE IN A BIORESORBABLE ELEMENT
RU1823791C (en) 1991-06-17 1993-06-23 Юрий Андреевич Селезнев Spine locator and device for superposition
US5263973A (en) 1991-08-30 1993-11-23 Cook Melvin S Surgical stapling method
US5179964A (en) 1991-08-30 1993-01-19 Cook Melvin S Surgical stapling method
US5207679A (en) 1991-09-26 1993-05-04 Mitek Surgical Products, Inc. Suture anchor and installation tool
US5141520A (en) 1991-10-29 1992-08-25 Marlowe Goble E Harpoon suture anchor
DE4136266A1 (en) 1991-11-04 1993-05-06 Kabelmetal Electro Gmbh DEVICE FOR STRINGING STRAND-SHAPED GOODS, IN PARTICULAR LARGER CROSS-SECTIONS WITH ALTERNATING PUNCHING DIRECTION
US5123919A (en) 1991-11-21 1992-06-23 Carbomedics, Inc. Combined prosthetic aortic heart valve and vascular graft
US5176692A (en) 1991-12-09 1993-01-05 Wilk Peter J Method and surgical instrument for repairing hernia
US5765560A (en) 1991-12-16 1998-06-16 Adeva Medical, Gesellschaft Fur Entwicklung Und Vertrieb Von Medizinischen, Implantat-Artikeln Mbh Trachostoma valve and tissue connector and housing for use as a part thereof
US5249673A (en) 1992-02-07 1993-10-05 United States Surgical Corporation Package and method of loading for resilient surgical sutures
US5217486A (en) 1992-02-18 1993-06-08 Mitek Surgical Products, Inc. Suture anchor and installation tool
US5352515A (en) 1992-03-02 1994-10-04 American Cyanamid Company Coating for tissue drag reduction
US5225485A (en) 1992-03-03 1993-07-06 United States Surgical Corporation Polyetherimide ester suture and its method of manufacture and method of use
CA2090371A1 (en) 1992-03-27 1993-09-28 William Frank Banholzer Water jet mixing tubes used in water jet cutting devices and method of preparation thereof
FR2690840B1 (en) 1992-05-07 1994-08-19 Patrick Frechet Living tissue extension device.
US5484451A (en) 1992-05-08 1996-01-16 Ethicon, Inc. Endoscopic surgical instrument and staples for applying purse string sutures
US5242457A (en) 1992-05-08 1993-09-07 Ethicon, Inc. Surgical instrument and staples for applying purse string sutures
US5766246A (en) 1992-05-20 1998-06-16 C. R. Bard, Inc. Implantable prosthesis and method and apparatus for loading and delivering an implantable prothesis
FR2693108B3 (en) 1992-06-10 1994-08-12 Hexabio Absorbable surgical material, in particular absorbable suture thread.
US5366756A (en) 1992-06-15 1994-11-22 United States Surgical Corporation Method for treating bioabsorbable implant material
CA2094111C (en) 1992-06-15 1999-02-16 Daniel R. Lee Suture anchoring device and method
US5207694A (en) 1992-06-18 1993-05-04 Surgical Invent Ab Method for performing a surgical occlusion, and kit and applicator for carrying out the method
FR2692774B1 (en) 1992-06-25 1999-05-21 Bfl Medical Sarl MATERIAL THAT CAN BE USED FOR THE REPAIR OF THE BROKEN TENDON.
US5312422A (en) 1992-07-16 1994-05-17 Linvatec Corporation Endoscopic suturing needle
US5540704A (en) 1992-09-04 1996-07-30 Laurus Medical Corporation Endoscopic suture system
US5387227A (en) 1992-09-10 1995-02-07 Grice; O. Drew Method for use of a laparo-suture needle
CA2437773C (en) 1992-09-21 2005-02-22 United States Surgical Corporation Device for applying a meniscal staple
CN1091315A (en) 1992-10-08 1994-08-31 E·R·斯奎布父子公司 Fibrin sealant compositions and using method thereof
US5222508A (en) 1992-10-09 1993-06-29 Osvaldo Contarini Method for suturing punctures of the human body
US5282832A (en) 1992-10-09 1994-02-01 United States Surgical Corporation Suture clip
DE4304353A1 (en) 1992-10-24 1994-04-28 Helmut Dipl Ing Wurster Suturing device used in endoscopic surgical operations - has helical needle with fixed non-traumatic thread held and rotated by rollers attached to instrument head extended into patients body.
JP3165751B2 (en) 1992-10-30 2001-05-14 株式会社東芝 Semiconductor integrated circuit device
IL103737A (en) 1992-11-13 1997-02-18 Technion Res & Dev Foundation Stapler device particularly useful in medical suturing
US5649939A (en) 1992-12-08 1997-07-22 Reddick; Eddie J. Laparoscopic suture introducer
US20020095164A1 (en) 1997-06-26 2002-07-18 Andreas Bernard H. Device and method for suturing tissue
US5417699A (en) 1992-12-10 1995-05-23 Perclose Incorporated Device and method for the percutaneous suturing of a vascular puncture site
US5632753A (en) 1992-12-31 1997-05-27 Loeser; Edward A. Surgical procedures
US6387363B1 (en) 1992-12-31 2002-05-14 United States Surgical Corporation Biocompatible medical devices
US5403346A (en) 1992-12-31 1995-04-04 Loeser; Edward A. Self-affixing suture assembly
US5336239A (en) 1993-01-15 1994-08-09 Gimpelson Richard J Surgical needle
DE4302895C2 (en) 1993-02-02 1996-03-28 Wiessner Serag Gmbh & Co Kg Surgical thread
US5306290A (en) 1993-02-12 1994-04-26 Mitek Surgical Products, Inc. Suture button
US5380334A (en) 1993-02-17 1995-01-10 Smith & Nephew Dyonics, Inc. Soft tissue anchors and systems for implantation
US5341922A (en) 1993-02-24 1994-08-30 Ethicon, Inc. Peelable foil suture packaging
US5330488A (en) 1993-03-23 1994-07-19 Goldrath Milton H Verres needle suturing kit
US5395126A (en) 1993-04-05 1995-03-07 The Bentley-Harris Manufacturing Company Braided tubular gasket with integral attachment means
US5350385A (en) 1993-04-28 1994-09-27 Christy William J Surgical stab wound closure device and method
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US5342376A (en) * 1993-05-03 1994-08-30 Dermagraphics, Inc. Inserting device for a barbed tissue connector
ES2152957T3 (en) 1993-05-13 2001-02-16 American Cyanamid Co SILICONE WATERPROOF COMPOSITIONS FOR COATING, METHOD FOR COATING SUBSTRATES WITH THE SAME AND SURGICAL NEEDLES COVERED IN THIS MODE.
US5464426A (en) 1993-05-14 1995-11-07 Bonutti; Peter M. Method of closing discontinuity in tissue
WO1995001129A1 (en) 1993-07-01 1995-01-12 W.L. Gore & Associates, Inc. A suture needle
US5500000A (en) 1993-07-01 1996-03-19 United States Surgical Corporation Soft tissue repair system and method
US5921982A (en) 1993-07-30 1999-07-13 Lesh; Michael D. Systems and methods for ablating body tissue
US5354271A (en) 1993-08-05 1994-10-11 Voda Jan K Vascular sheath
US5462561A (en) 1993-08-05 1995-10-31 Voda; Jan K. Suture device
US5899911A (en) 1993-08-25 1999-05-04 Inlet Medical, Inc. Method of using needle-point suture passer to retract and reinforce ligaments
US5450860A (en) 1993-08-31 1995-09-19 W. L. Gore & Associates, Inc. Device for tissue repair and method for employing same
DE9414727U1 (en) 1993-09-09 1994-12-08 Heske Norbert Biopsy system
US5540718A (en) 1993-09-20 1996-07-30 Bartlett; Edwin C. Apparatus and method for anchoring sutures
US5411613A (en) 1993-10-05 1995-05-02 United States Surgical Corporation Method of making heat treated stainless steel needles
US5425747A (en) 1993-10-12 1995-06-20 Brotz; Gregory R. Suture
US5584859A (en) 1993-10-12 1996-12-17 Brotz; Gregory R. Suture assembly
CA2117967A1 (en) 1993-10-27 1995-04-28 Thomas W. Sander Tissue repair device and apparatus and method for fabricating same
US5566822A (en) 1993-12-09 1996-10-22 United States Surgical Corporation Suture retainer
US5545180A (en) 1993-12-13 1996-08-13 Ethicon, Inc. Umbrella-shaped suture anchor device with actuating ring member
US5527342A (en) 1993-12-14 1996-06-18 Pietrzak; William S. Method and apparatus for securing soft tissues, tendons and ligaments to bone
US5487216A (en) 1994-01-13 1996-01-30 Ethicon, Inc. Control system for an automatic needle-suture assembly and packaging machine
US5728122A (en) 1994-01-18 1998-03-17 Datascope Investment Corp. Guide wire with releaseable barb anchor
US5571216A (en) 1994-01-19 1996-11-05 The General Hospital Corporation Methods and apparatus for joining collagen-containing materials
US5662714A (en) 1994-01-21 1997-09-02 M.X.M. Device for extending living tissues
US5626611A (en) 1994-02-10 1997-05-06 United States Surgical Corporation Composite bioabsorbable materials and surgical articles made therefrom
US5391173A (en) 1994-02-10 1995-02-21 Wilk; Peter J. Laparoscopic suturing technique and associated device
US6315788B1 (en) 1994-02-10 2001-11-13 United States Surgical Corporation Composite materials and surgical articles made therefrom
GB9404268D0 (en) 1994-03-05 1994-04-20 Univ Nottingham Surface treatment of shape memory alloys
US5486197A (en) 1994-03-24 1996-01-23 Ethicon, Inc. Two-piece suture anchor with barbs
US5411523A (en) 1994-04-11 1995-05-02 Mitek Surgical Products, Inc. Suture anchor and driver combination
US5950505A (en) 1994-05-24 1999-09-14 Locher; Beat Process for stripping an insulated wire or cable having a cross-section which may be non-circular and stripping device for carrying out the process
DK0952792T3 (en) 1994-06-06 2003-12-08 Osiris Therapeutics Inc Biomatrix for tissue regeneration
US5494154A (en) 1994-07-12 1996-02-27 Look Incorporated Surgical suture package
US5593424A (en) * 1994-08-10 1997-01-14 Segmed, Inc. Apparatus and method for reducing and stabilizing the circumference of a vascular structure
US5549633A (en) 1994-08-24 1996-08-27 Kensey Nash Corporation Apparatus and methods of use for preventing blood seepage at a percutaneous puncture site
US5472452A (en) 1994-08-30 1995-12-05 Linvatec Corporation Rectilinear anchor for soft tissue fixation
US5562685A (en) 1994-09-16 1996-10-08 General Surgical Innovations, Inc. Surgical instrument for placing suture or fasteners
US6206908B1 (en) 1994-09-16 2001-03-27 United States Surgical Corporation Absorbable polymer and surgical articles fabricated therefrom
US5522845A (en) 1994-09-27 1996-06-04 Mitek Surgical Products, Inc. Bone anchor and bone anchor installation
US5464427A (en) 1994-10-04 1995-11-07 Synthes (U.S.A.) Expanding suture anchor
AU706592B2 (en) 1994-10-06 1999-06-17 Theratechnologies Inc. Sutureless wound closing with harness and plaster elements
US5807406A (en) 1994-10-07 1998-09-15 Baxter International Inc. Porous microfabricated polymer membrane structures
US5938668A (en) 1994-10-07 1999-08-17 United States Surgical Surgical suturing apparatus
DE4440095A1 (en) 1994-11-10 1996-05-15 Braun B Surgical Gmbh Surgical sutures, their use in surgery, and methods of making them
US5716358A (en) 1994-12-02 1998-02-10 Johnson & Johnson Professional, Inc. Directional bone fixation device
US5665109A (en) 1994-12-29 1997-09-09 Yoon; Inbae Methods and apparatus for suturing tissue
US5643295A (en) 1994-12-29 1997-07-01 Yoon; Inbae Methods and apparatus for suturing tissue
US5653716A (en) 1994-12-29 1997-08-05 Acufex Microsurgical, Inc. Suture manipulating instrument with grasping members
US5968076A (en) 1995-03-03 1999-10-19 United States Surgical Corporation Channel-bodied surgical needle and method of manufacture
US5531760A (en) 1995-04-14 1996-07-02 Alwafaie; Mohammed G. Skin closure clip
US5540705A (en) 1995-05-19 1996-07-30 Suturtek, Inc. Suturing instrument with thread management
US5571139A (en) 1995-05-19 1996-11-05 Jenkins, Jr.; Joseph R. Bidirectional suture anchor
WO1996039082A1 (en) 1995-06-06 1996-12-12 Raymond Thal Knotless suture anchor assembly
US5722991A (en) 1995-06-07 1998-03-03 United States Surgical Corporation Apparatus and method for attaching surgical needle suture components
US6814748B1 (en) 1995-06-07 2004-11-09 Endovascular Technologies, Inc. Intraluminal grafting system
US5571175A (en) 1995-06-07 1996-11-05 St. Jude Medical, Inc. Suture guard for prosthetic heart valve
US6129741A (en) 1995-06-10 2000-10-10 Forschungszentrum Karlsruhe Gmbh Surgical suturing needle
AU6388096A (en) 1995-06-14 1997-01-15 Medworks Corporation Surgical kit and method for performing laparoscopic urethropexy, and apparatus employed in same
US5997554A (en) 1995-06-14 1999-12-07 Medworks Corporation Surgical template and surgical method employing same
US5662654A (en) 1995-06-14 1997-09-02 Incont, Inc. Bone anchor, insertion tool and surgical kit employing same
US6042583A (en) 1995-06-14 2000-03-28 Medworks Corporation Bone anchor-insertion tool and surgical method employing same
US5643288A (en) 1995-06-14 1997-07-01 Incont, Inc. Apparatus and method for laparoscopic urethropexy
US6102947A (en) 1995-07-20 2000-08-15 Gordon; Leonard Splint with flexible body for repair of tendons or ligaments and method
US5723008A (en) 1995-07-20 1998-03-03 Gordon; Leonard Splint for repair of tendons or ligaments and method
US5669935A (en) 1995-07-28 1997-09-23 Ethicon, Inc. One-way suture retaining device for braided sutures
JPH09103477A (en) 1995-10-12 1997-04-22 Unitika Ltd Suture
US6509098B1 (en) 1995-11-17 2003-01-21 Massachusetts Institute Of Technology Poly(ethylene oxide) coated surfaces
US5645568A (en) 1995-11-20 1997-07-08 Medicinelodge, Inc. Expandable body suture
USD386583S (en) 1996-01-02 1997-11-18 Acufex Microsurgical, Inc. Proximal end of a surgical suture slotted knot pusher
USD387161S (en) 1996-01-02 1997-12-02 Acufex Microsurgical, Inc. Surgical suture knot pusher with hooks
US5810853A (en) 1996-01-16 1998-09-22 Yoon; Inbae Knotting element for use in suturing anatomical tissue and methods therefor
US5702462A (en) 1996-01-24 1997-12-30 Oberlander; Michael Method of meniscal repair
JP3327765B2 (en) 1996-02-16 2002-09-24 株式会社アズウェル Equipment for manufacturing sutures with needles
JP3659525B2 (en) 1996-02-16 2005-06-15 アルフレッサファーマ株式会社 Manufacturing device for suture with needle
US5702397A (en) 1996-02-20 1997-12-30 Medicinelodge, Inc. Ligament bone anchor and method for its use
FI107124B (en) 1996-03-01 2001-06-15 Rolf E A Nordstroem Surgical suture
RU2139690C1 (en) 1996-03-25 1999-10-20 Плетиков Сергей Михайлович Method of application of tendon suture
US6149660A (en) 1996-04-22 2000-11-21 Vnus Medical Technologies, Inc. Method and apparatus for delivery of an appliance in a vessel
US6491714B1 (en) 1996-05-03 2002-12-10 William F. Bennett Surgical tissue repair and attachment apparatus and method
DE19618891C1 (en) 1996-05-10 1997-04-03 Barbara Bloch Grass cutting monofilament
US5893856A (en) 1996-06-12 1999-04-13 Mitek Surgical Products, Inc. Apparatus and method for binding a first layer of material to a second layer of material
US6063105A (en) 1996-06-18 2000-05-16 United States Surgical Medical devices fabricated from elastomeric alpha-olefins
US5843178A (en) 1996-06-20 1998-12-01 St. Jude Medical, Inc. Suture guard for annuloplasty ring
US5716376A (en) 1996-06-28 1998-02-10 United States Surgical Corporation Absorbable mixture and coatings for surgical articles fabricated therefrom
US6117162A (en) 1996-08-05 2000-09-12 Arthrex, Inc. Corkscrew suture anchor
US5683417A (en) 1996-08-14 1997-11-04 Cooper; William I. Suture and method for endoscopic surgery
US5919234A (en) 1996-08-19 1999-07-06 Macropore, Inc. Resorbable, macro-porous, non-collapsing and flexible membrane barrier for skeletal repair and regeneration
US6984241B2 (en) 1996-09-13 2006-01-10 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
US7611521B2 (en) 1996-09-13 2009-11-03 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
US6083244A (en) 1996-09-13 2000-07-04 Tendon Technology, Ltd. Apparatus and method for tendon or ligament repair
CA2217406C (en) 1996-10-04 2006-05-30 United States Surgical Corporation Suture anchor installation system with disposable loading unit
US5897572A (en) 1996-10-11 1999-04-27 Cornell Research Foundation, Inc. Microsurgical suture needle
US5891166A (en) 1996-10-30 1999-04-06 Ethicon, Inc. Surgical suture having an ultrasonically formed tip, and apparatus and method for making same
US5817129A (en) 1996-10-31 1998-10-06 Ethicon, Inc. Process and apparatus for coating surgical sutures
US6331181B1 (en) 1998-12-08 2001-12-18 Intuitive Surgical, Inc. Surgical robotic tools, data architecture, and use
FR2757371B1 (en) 1996-12-20 1999-03-26 Mxm ELASTIC DEVICE WITH LARGE ELONGATION CAPACITY FOR LIVE TISSUE EXTENSION
US5972024A (en) 1996-12-24 1999-10-26 Metacardia, Inc. Suture-staple apparatus and method
US6074419A (en) 1996-12-31 2000-06-13 St. Jude Medical, Inc. Indicia for prosthetic device
US5843087A (en) 1997-01-30 1998-12-01 Ethicon, Inc. Suture anchor installation tool
US5884859A (en) 1997-02-07 1999-03-23 Ma; Mark Joen-Shen Coil winder for use in large umbrellas
US6012216A (en) 1997-04-30 2000-01-11 Ethicon, Inc. Stand alone swage apparatus
US5782864A (en) 1997-04-03 1998-07-21 Mitek Surgical Products, Inc. Knotless suture system and method
US5864783A (en) * 1997-04-04 1999-01-26 Sno-Way International Apparatus for testing snow removal equipment
US6867248B1 (en) 1997-05-12 2005-03-15 Metabolix, Inc. Polyhydroxyalkanoate compositions having controlled degradation rates
US5814051A (en) 1997-06-06 1998-09-29 Mitex Surgical Products, Inc. Suture anchor insertion system
JPH1113091A (en) 1997-06-23 1999-01-19 Hitachi Constr Mach Co Ltd Hydraulic drive unit for construction machine
US6071292A (en) 1997-06-28 2000-06-06 Transvascular, Inc. Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures
US5916224A (en) 1997-07-09 1999-06-29 The United States Of America As Represented By The Secretary Of The Army Tendon repair clip implant
US5895395A (en) 1997-07-17 1999-04-20 Yeung; Teresa T. Partial to full thickness suture device & method for endoscopic surgeries
US6159234A (en) 1997-08-01 2000-12-12 Peter M. Bonutti Method and apparatus for securing a suture
US20050216059A1 (en) 2002-09-05 2005-09-29 Bonutti Peter M Method and apparatus for securing a suture
US6241771B1 (en) 1997-08-13 2001-06-05 Cambridge Scientific, Inc. Resorbable interbody spinal fusion devices
US5906617A (en) 1997-08-15 1999-05-25 Meislin; Robert J. Surgical repair with hook-and-loop fastener
IL121752A0 (en) 1997-09-11 1998-02-22 Gaber Benny Stitching tool
US5887594A (en) 1997-09-22 1999-03-30 Beth Israel Deaconess Medical Center Inc. Methods and devices for gastroesophageal reflux reduction
US5935138A (en) 1997-09-24 1999-08-10 Ethicon, Inc. Spiral needle for endoscopic surgery
US5950633A (en) 1997-10-02 1999-09-14 Ethicon, Inc. Microsurgical technique for cosmetic surgery
US6027523A (en) 1997-10-06 2000-02-22 Arthrex, Inc. Suture anchor with attached disk
AU1075699A (en) 1997-10-10 1999-05-03 Allegheny Health, Education And Research Foundation Hybrid nanofibril matrices for use as tissue engineering devices
EP0908142B1 (en) 1997-10-10 2006-05-03 Ethicon, Inc. Braided suture with improved knot strength and process to produce same
US6409674B1 (en) 1998-09-24 2002-06-25 Data Sciences International, Inc. Implantable sensor with wireless communication
US6056778A (en) 1997-10-29 2000-05-02 Arthrex, Inc. Meniscal repair device
WO1999021488A1 (en) 1997-10-29 1999-05-06 Oh Nahm Gun Suture needle
US5964783A (en) 1997-11-07 1999-10-12 Arthrex, Inc. Suture anchor with insert-molded suture
US5954747A (en) 1997-11-20 1999-09-21 Clark; Ron Meniscus repair anchor system
US6015410A (en) 1997-12-23 2000-01-18 Bionx Implants Oy Bioabsorbable surgical implants for endoscopic soft tissue suspension procedure
US6001111A (en) 1998-01-16 1999-12-14 Cardiothoracic Systems, Inc. Low profile vessel occluder with and without detachable applicator
IL122994A (en) 1998-01-19 2001-12-23 Wisebands Ltd Suture tightening device for closing wounds and a method for its use
US6146406A (en) 1998-02-12 2000-11-14 Smith & Nephew, Inc. Bone anchor
RU2215542C2 (en) 1998-02-23 2003-11-10 Массачусетс Инститьют Оф Текнолоджи Biodecomposing polymers able recovery of form
DK1062278T3 (en) 1998-02-23 2006-09-25 Mnemoscience Gmbh Polymers with shape memory
US7297142B2 (en) 1998-02-24 2007-11-20 Hansen Medical, Inc. Interchangeable surgical instrument
US20020095175A1 (en) 1998-02-24 2002-07-18 Brock David L. Flexible instrument
US6494898B1 (en) 1998-02-25 2002-12-17 United States Surgical Corporation Absorbable copolymers and surgical articles fabricated therefrom
AU3812099A (en) 1998-04-01 1999-10-18 Bionx Implants Oy Bioabsorbable surgical fastener for tissue treatment
US6024757A (en) 1998-04-14 2000-02-15 Ethicon, Inc. Method for cutting a surgical suture tip
US6106545A (en) 1998-04-16 2000-08-22 Axya Medical, Inc. Suture tensioning and fixation device
US5964765A (en) 1998-04-16 1999-10-12 Axya Medical, Inc. Soft tissue fixation device
US6056751A (en) 1998-04-16 2000-05-02 Axya Medical, Inc. Sutureless soft tissue fixation assembly
NL1009028C2 (en) 1998-04-28 1999-10-29 Adri Marinus Blomme Adhesives for connecting a tubular vascular prosthesis to a blood vessel in the body as well as branching means, a vascular prosthesis, a device for inserting and adhering a vascular prosthesis and a vascular prosthesis system.
JP3983888B2 (en) 1998-05-07 2007-09-26 オリンパス株式会社 Suture tool and suture assembly for transendoscope
AU737877B2 (en) 1998-05-21 2001-09-06 Christopher J. Walshe A tissue anchor system
FI981203A (en) 1998-05-29 1999-11-30 Rolf E A Nordstroem Binding between a surgical sewing thread of silicone elastomer and a needle
JP4399585B2 (en) 1998-06-02 2010-01-20 クック インコーポレイティド Multi-sided medical device
US7452371B2 (en) 1999-06-02 2008-11-18 Cook Incorporated Implantable vascular device
US6607541B1 (en) 1998-06-03 2003-08-19 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6613059B2 (en) 1999-03-01 2003-09-02 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6514265B2 (en) 1999-03-01 2003-02-04 Coalescent Surgical, Inc. Tissue connector apparatus with cable release
US6641593B1 (en) 1998-06-03 2003-11-04 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6945980B2 (en) 1998-06-03 2005-09-20 Medtronic, Inc. Multiple loop tissue connector apparatus and methods
WO2000015144A1 (en) 1998-06-10 2000-03-23 Advanced Bypass Technologies, Inc. Aortic aneurysm treatment systems
US6045561A (en) 1998-06-23 2000-04-04 Orthopaedic Biosystems Ltd., Inc. Surgical knot manipulator
US6174324B1 (en) 1998-07-13 2001-01-16 Axya Medical, Inc. Suture guide and fastener
DE19833703A1 (en) 1998-07-27 2000-02-03 Cetex Chemnitzer Textilmaschin Tension control during precision winding of yarn packages involves periodic variation of winding speed to compensate for yarn displacement due to action of traverse
US6334865B1 (en) 1998-08-04 2002-01-01 Fusion Medical Technologies, Inc. Percutaneous tissue track closure assembly and method
US6214030B1 (en) 1998-08-10 2001-04-10 Mani, Inc. Suture needle
US6168633B1 (en) 1998-08-10 2001-01-02 Itzhak Shoher Composite surface composition for an implant structure
US6355066B1 (en) 1998-08-19 2002-03-12 Andrew C. Kim Anterior cruciate ligament reconstruction hamstring tendon fixation system
US6165203A (en) 1998-09-11 2000-12-26 Bio Innovation, Ltd. Suture anchor installation devices and methods
US6146407A (en) 1998-09-11 2000-11-14 Bio Innovation, Ltd. Suture anchor installation devices and methods
US6183499B1 (en) 1998-09-11 2001-02-06 Ethicon, Inc. Surgical filament construction
US6249370B1 (en) 1998-09-18 2001-06-19 Ngk Insulators, Ltd. Display device
US6921811B2 (en) 1998-09-22 2005-07-26 Biosurface Engineering Technologies, Inc. Bioactive coating composition and methods
US6235869B1 (en) 1998-10-20 2001-05-22 United States Surgical Corporation Absorbable polymers and surgical articles fabricated therefrom
US7044134B2 (en) 1999-11-08 2006-05-16 Ev3 Sunnyvale, Inc Method of implanting a device in the left atrial appendage
US7387634B2 (en) 1998-11-23 2008-06-17 Benderev Theodore V System for securing sutures, grafts and soft tissue to bone and periosteum
US6110484A (en) 1998-11-24 2000-08-29 Cohesion Technologies, Inc. Collagen-polymer matrices with differential biodegradability
US6522906B1 (en) 1998-12-08 2003-02-18 Intuitive Surgical, Inc. Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure
US7125403B2 (en) 1998-12-08 2006-10-24 Intuitive Surgical In vivo accessories for minimally invasive robotic surgery
US6645228B2 (en) 2001-11-13 2003-11-11 Playtex Products, Inc. Nipple
US6395029B1 (en) 1999-01-19 2002-05-28 The Children's Hospital Of Philadelphia Sustained delivery of polyionic bioactive agents
US20070225764A1 (en) * 1999-02-02 2007-09-27 Benavitz William C Insert molded suture anchor
US7211088B2 (en) 1999-02-02 2007-05-01 Arthrex, Inc. Bioabsorbable tissue tack with oval-shaped head and method of tissue fixation using the same
FR2789314B1 (en) 1999-02-09 2001-04-27 Virsol WOUND SUTURE MATERIAL BASED ON METHYLIDENE MALONATE
US6656489B1 (en) 1999-02-10 2003-12-02 Isotis N.V. Scaffold for tissue engineering cartilage having outer surface layers of copolymer and ceramic material
US6319231B1 (en) 1999-02-12 2001-11-20 Abiomed, Inc. Medical connector
US8118822B2 (en) 1999-03-01 2012-02-21 Medtronic, Inc. Bridge clip tissue connector apparatus and methods
JP2002538176A (en) 1999-03-01 2002-11-12 オーソ−マクニール・フアーマシユーチカル・インコーポレーテツド Compositions comprising tramadol substances and selective COX-2 inhibitors
RU2139734C1 (en) * 1999-03-03 1999-10-20 Суламанидзе Марлен Андреевич Surgical thread for cosmetic operations
ES2295021T3 (en) 1999-03-25 2008-04-16 Metabolix, Inc. USE AND MEDICAL APPLICATIONS OF POLYMER POLYMERS (HYDROXIALCANOATS).
US6981983B1 (en) 1999-03-31 2006-01-03 Rosenblatt Peter L System and methods for soft tissue reconstruction
US6554802B1 (en) 1999-03-31 2003-04-29 Medtronic, Inc. Medical catheter anchor
US6045571A (en) 1999-04-14 2000-04-04 Ethicon, Inc. Multifilament surgical cord
US6689153B1 (en) 1999-04-16 2004-02-10 Orthopaedic Biosystems Ltd, Inc. Methods and apparatus for a coated anchoring device and/or suture
GB9909301D0 (en) 1999-04-22 1999-06-16 Kci Medical Ltd Wound treatment apparatus employing reduced pressure
US6383201B1 (en) 1999-05-14 2002-05-07 Tennison S. Dong Surgical prosthesis for repairing a hernia
ES2373939T3 (en) 1999-05-28 2012-02-10 Tyco Healthcare Group Lp BIOABSORBIBLE BLENDS AND SURGICAL ITEMS MADE WITH THE SAME.
US6251143B1 (en) 1999-06-04 2001-06-26 Depuy Orthopaedics, Inc. Cartilage repair unit
EP1581162B1 (en) 1999-06-09 2011-04-20 Ethicon, Inc. Apparatus for adjusting flexible areal polymer implants
US7160312B2 (en) 1999-06-25 2007-01-09 Usgi Medical, Inc. Implantable artificial partition and methods of use
US6991643B2 (en) 2000-12-20 2006-01-31 Usgi Medical Inc. Multi-barbed device for retaining tissue in apposition and methods of use
US6626899B2 (en) 1999-06-25 2003-09-30 Nidus Medical, Llc Apparatus and methods for treating tissue
ES2209929T3 (en) 1999-07-16 2004-07-01 Med Institute, Inc. STENT INTENDED TO BE DISPLACED WITHOUT BINDING.
US6776340B2 (en) 1999-07-23 2004-08-17 Tri Star Technologies, A General Partnership Duplicate laser marking discrete consumable articles
US6610071B1 (en) 1999-07-26 2003-08-26 Beth Israel Deaconess Medical Center Suture system
US6596296B1 (en) 1999-08-06 2003-07-22 Board Of Regents, The University Of Texas System Drug releasing biodegradable fiber implant
US7033603B2 (en) 1999-08-06 2006-04-25 Board Of Regents The University Of Texas Drug releasing biodegradable fiber for delivery of therapeutics
US6592609B1 (en) 1999-08-09 2003-07-15 Bonutti 2003 Trust-A Method and apparatus for securing tissue
US6554852B1 (en) 1999-08-25 2003-04-29 Michael A. Oberlander Multi-anchor suture
EP1078602A3 (en) 1999-08-26 2001-04-04 Mani, Inc. Suturing needle for medical use
DK2093245T3 (en) 1999-08-27 2012-06-04 Angiodevice Internat Gmbh Biocompatible polymer device
AU5812299A (en) 1999-09-07 2001-04-10 Microvena Corporation Retrievable septal defect closure device
USD433753S (en) 1999-09-24 2000-11-14 Wisebands Ltd. Suture band tightening device for closing wounds
US6613254B1 (en) 1999-10-19 2003-09-02 Ethicon, Inc. Method for making extruded, oriented fiber
US7615076B2 (en) 1999-10-20 2009-11-10 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US7004970B2 (en) 1999-10-20 2006-02-28 Anulex Technologies, Inc. Methods and devices for spinal disc annulus reconstruction and repair
US6592625B2 (en) 1999-10-20 2003-07-15 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and spinal disc annulus stent
US6626930B1 (en) 1999-10-21 2003-09-30 Edwards Lifesciences Corporation Minimally invasive mitral valve repair method and apparatus
US6231911B1 (en) 1999-10-29 2001-05-15 Clarence Steinback Ultra high speed hot dog incisor
US6641592B1 (en) 1999-11-19 2003-11-04 Lsi Solutions, Inc. System for wound closure
US6511265B1 (en) * 1999-12-14 2003-01-28 Ati Properties, Inc. Composite rotary tool and tool fabrication method
EP1244390B1 (en) 1999-12-30 2006-08-16 Pearl Technology Holdings, LLC Face-lifting device
US6623492B1 (en) 2000-01-25 2003-09-23 Smith & Nephew, Inc. Tissue fastener
WO2001056626A1 (en) 2000-02-03 2001-08-09 Nexia Biotechnologies, Inc. Surgical sutures containing spider silk
US6270517B1 (en) 2000-02-04 2001-08-07 Gregory R. Brotz Suture assembly and method
US6264675B1 (en) 2000-02-04 2001-07-24 Gregory R. Brotz Single suture structure
US6478809B1 (en) 2000-02-04 2002-11-12 Gregory R. Brotz Suture and method of use
US6296659B1 (en) 2000-02-29 2001-10-02 Opus Medical, Inc. Single-tailed suturing method and apparatus
US9138222B2 (en) 2000-03-13 2015-09-22 P Tech, Llc Method and device for securing body tissue
US6712830B2 (en) 2000-03-15 2004-03-30 Esplin Medical Inventions, L.L.C. Soft tissue anchor
DE10019604C2 (en) 2000-04-20 2002-06-27 Ethicon Gmbh implant
DE10021122C1 (en) 2000-04-29 2001-11-08 Aesculap Ag & Co Kg Thread anchor system for connecting tissue parts and instrument for inserting an anchor implant
US7172615B2 (en) 2000-05-19 2007-02-06 Coapt Systems, Inc. Remotely anchored tissue fixation device
US7510566B2 (en) 2000-05-19 2009-03-31 Coapt Systems, Inc. Multi-point tissue tension distribution device and method, a chin lift variation
US6645226B1 (en) 2000-05-19 2003-11-11 Coapt Systems, Inc. Multi-point tension distribution system device and method of tissue approximation using that device to improve wound healing
US20040260340A1 (en) 2000-05-19 2004-12-23 Jacobs Daniel Irwin Remotely anchored tissue fixation device and method
US20050119694A1 (en) 2000-05-19 2005-06-02 Jacobs Daniel I. Remotely anchored tissue fixation device and method
US20040010275A1 (en) 2000-05-19 2004-01-15 Daniel Jacobs Multi-point tissue tension distribution device and method, a custom-fittable variation
US7156862B2 (en) 2000-05-19 2007-01-02 Coapt Systems, Inc. Multi-point tension distribution system device and method of tissue approximation using that device to improve wound healing
US6485503B2 (en) 2000-05-19 2002-11-26 Coapt Systems, Inc. Multi-point tissue tension distribution device, a brow and face lift variation, and a method of tissue approximation using the device
US6575976B2 (en) 2000-06-12 2003-06-10 Arthrex, Inc. Expandable tissue anchor
US8158143B2 (en) 2000-07-14 2012-04-17 Helmholtz-Zentrum Geesthacht Zentrum Fuer Material- Und Kuestenforschung Gmbh Systems for releasing active ingredients, based on biodegradable or biocompatible polymers with a shape memory effect
US6746443B1 (en) 2000-07-27 2004-06-08 Intuitive Surgical Inc. Roll-pitch-roll surgical tool
JP3471004B2 (en) 2000-08-09 2003-11-25 株式会社医研工業 Manufacturing method of suture needle with thread
EP1309279A4 (en) 2000-08-17 2008-04-09 Tyco Healthcare Sutures and coatings made from therapeutic absorbable glass
US20020029011A1 (en) 2000-09-05 2002-03-07 Dyer Wallace K. Methods and devices for surgery
US6746458B1 (en) 2000-09-07 2004-06-08 William G. Cloud Mesh material to repair hernias
ATE290107T1 (en) 2000-10-03 2005-03-15 Ethicon Inc MULTIFILAMENT YARN AND PRODUCTION PROCESS
US6994725B1 (en) 2000-10-03 2006-02-07 Medicinelodge, Inc. Method and apparatus for reconstructing a ligament
US6527795B1 (en) 2000-10-18 2003-03-04 Ethicon, Inc. Knotless suture anchor system and method of use
US20020161168A1 (en) 2000-10-27 2002-10-31 Shalaby Shalaby W. Amorphous polymeric polyaxial initiators and compliant crystalline copolymers therefrom
AU2001218090A1 (en) 2000-10-31 2002-05-21 East Carolina University Tissue lockable connecting structures
WO2002064012A2 (en) 2000-11-07 2002-08-22 Artemis Medical, Inc. Target tissue localization assembly and method
US6506197B1 (en) 2000-11-15 2003-01-14 Ethicon, Inc. Surgical method for affixing a valve to a heart using a looped suture combination
US6463719B2 (en) 2000-12-13 2002-10-15 Ethicon Suture winding machine, suture tray package, and method of winding sutures
DE10062881A1 (en) 2000-12-16 2002-07-11 Inst Textil & Faserforschung Suture material for surgery, process for its manufacture and use
US20020111641A1 (en) 2001-01-08 2002-08-15 Incisive Surgical, Inc. Bioabsorbable surgical clip with engageable expansion structure
RU2175855C1 (en) 2001-01-22 2001-11-20 Московская медицинская академия им. И.М. Сеченова Device for guiding ligature
USD462766S1 (en) 2001-02-16 2002-09-10 Coapt Systems, Inc. Brow lift device
US6783554B2 (en) 2001-02-20 2004-08-31 Atrium Medical Corporation Pile mesh prosthesis
US20040254609A1 (en) 2001-03-14 2004-12-16 Esplin Vermon S. Soft tissue anchor
US7048748B1 (en) 2001-03-21 2006-05-23 Uestuener Emin Tuncay Automatic surgical suturing instrument and method
GB0107175D0 (en) 2001-03-22 2001-05-09 Michel David Chassis for grass treatment machine
CA2380689A1 (en) 2001-04-05 2002-10-05 Mcgill University Shape memory surgical polypectomy tool
US6776789B2 (en) 2001-04-16 2004-08-17 Todd Bryant Cinch suture and method for using
US20020173803A1 (en) 2001-05-01 2002-11-21 Stephen Ainsworth Self-closing surgical clip for tissue
US20020173822A1 (en) 2001-05-17 2002-11-21 Justin Daniel F. Threaded suture anchor
CA2449055C (en) 2001-05-29 2010-03-02 Microvention, Inc. Method of manufacturing expansile filamentous embolization devices
US20040153153A1 (en) 2001-05-31 2004-08-05 Elson Robert J. Anterior cruciate ligament reconstruction system and method of implementing same
US20050065533A1 (en) 2001-05-31 2005-03-24 Magen Hugh E. Apparatus for assembling anterior cruciate ligament reconstruction system
AU2002305748A1 (en) 2001-05-31 2002-12-09 Coapt Systems, Inc. Anterior cruciate ligament reconstruction system
GB0113697D0 (en) 2001-06-06 2001-07-25 Smith & Nephew Fixation devices for tissue repair
US7144401B2 (en) 2001-06-07 2006-12-05 Olympus Optical Co., Ltd. Suturing device for endoscope
US7033379B2 (en) 2001-06-08 2006-04-25 Incisive Surgical, Inc. Suture lock having non-through bore capture zone
CA2450662C (en) 2001-06-14 2010-06-15 Suturtek Incorporated Apparatus and method for surgical suturing with thread management
US6712859B2 (en) 2001-06-28 2004-03-30 Ethicon, Inc. Hernia repair prosthesis and methods for making same
US7056331B2 (en) 2001-06-29 2006-06-06 Quill Medical, Inc. Suture method
US6599310B2 (en) 2001-06-29 2003-07-29 Quill Medical, Inc. Suture method
GB0116247D0 (en) 2001-07-04 2001-08-29 Univ Loughborough Surgical techniques and devices
WO2003010198A1 (en) 2001-07-26 2003-02-06 Kenton Srl Identification of specific tumour antigens by selection of cdna libraries with sera and use of said antigens in diagnostic techniques
US6848152B2 (en) 2001-08-31 2005-02-01 Quill Medical, Inc. Method of forming barbs on a suture and apparatus for performing same
BE1014364A6 (en) 2001-09-07 2003-09-02 Collette Michel Surgical suture has wire with hooks which can be deployed when inserted in tissue
US6716234B2 (en) 2001-09-13 2004-04-06 Arthrex, Inc. High strength suture material
US20050055051A1 (en) 2001-09-13 2005-03-10 Grafton R. Donald High strength suture with silk trace
US6860891B2 (en) 2001-09-28 2005-03-01 Ethicen, Inc. Arrangement and method for vascular anastomosis
US7294357B2 (en) 2001-09-28 2007-11-13 Tyco Healthcare Group Lp Plasma coated sutures
US6648921B2 (en) 2001-10-03 2003-11-18 Ams Research Corporation Implantable article
US6645227B2 (en) 2001-11-21 2003-11-11 Stryker Endoscopy Suture anchor
US6749616B1 (en) 2001-11-21 2004-06-15 Baylor College Of Medicine Surgical system for repairing and grafting severed nerves and methods of repairing and grafting severed nerves
US7182771B1 (en) 2001-12-20 2007-02-27 Russell A. Houser Vascular couplers, techniques, methods, and accessories
US7640173B2 (en) 2002-01-17 2009-12-29 Applied Medical Software, Inc. Method and system for evaluating a physician's economic performance and gainsharing of physician services
US20030149447A1 (en) 2002-02-01 2003-08-07 Morency Steven David Barbed surgical suture
DE10208211A1 (en) 2002-02-26 2003-09-11 Mnemoscience Gmbh Polymer networks
EP1482841B1 (en) 2002-03-14 2005-12-07 Yeung, Jeffery E. Suture anchor and approximating device
JP3841710B2 (en) 2002-03-26 2006-11-01 泉工医科工業株式会社 Vascular clip
WO2003082119A1 (en) 2002-03-26 2003-10-09 Ethicon, Inc. System and method for biopsy management
US7070610B2 (en) 2002-03-30 2006-07-04 Samyang Corporation Monofilament suture and manufacturing method thereof
DE10217351B3 (en) 2002-04-18 2004-02-12 Mnemoscience Gmbh Interpenetrating networks
US8303625B2 (en) 2002-04-18 2012-11-06 Helmholtz-Zentrum Geesthacht Zentrum Fuer Material- Und Kuestenforschung Gmbh Biodegradable shape memory polymeric sutures
DE10217350C1 (en) 2002-04-18 2003-12-18 Mnemoscience Gmbh polyesterurethanes
US6951565B2 (en) 2002-04-24 2005-10-04 Linvatec Biomaterials Ltd. Device for inserting surgical implants
US20030204193A1 (en) 2002-04-25 2003-10-30 Stefan Gabriel Suture anchor insertion tool
US6960233B1 (en) 2002-12-10 2005-11-01 Torax Medical, Inc. Methods and apparatus for improving the function of biological passages
EP1359087A1 (en) * 2002-04-30 2003-11-05 Campagnolo S.R.L. Toothed wheel of a chain transmission for a bicycle
EP1501444B1 (en) 2002-04-30 2014-05-07 Cook Medical Technologies LLC Sling for supporting tissue
DE10219860A1 (en) 2002-05-03 2003-11-20 Ethicon Gmbh Surgical thread and surgical implant with such a thread
GB0212976D0 (en) 2002-06-06 2002-07-17 Tonejet Corp Pty Ltd Ejection method and apparatus
US7416556B2 (en) 2002-06-06 2008-08-26 Abbott Laboratories Stop-cock suture clamping system
CN1630537A (en) 2002-06-07 2005-06-22 马里恩·安德烈耶维奇·苏拉马尼泽 Surgical thread for cosmetic surgery
RU2268752C2 (en) 2002-06-07 2006-01-27 Марлен Андреевич Суламанидзе Surgical thread "artos" for cosmetic operations
CA2486550C (en) 2002-06-12 2011-05-24 Scimed Life Systems, Inc. Suturing instruments
US8287555B2 (en) 2003-02-06 2012-10-16 Guided Delivery Systems, Inc. Devices and methods for heart valve repair
US7125413B2 (en) 2002-06-20 2006-10-24 Scimed Life Systems, Inc. Endoscopic fundoplication devices and methods for treatment of gastroesophageal reflux disease
US6726705B2 (en) 2002-06-25 2004-04-27 Incisive Surgical, Inc. Mechanical method and apparatus for bilateral tissue fastening
US8074857B2 (en) 2002-06-25 2011-12-13 Incisive Surgical, Inc. Method and apparatus for tissue fastening with single translating trigger operation
US7950559B2 (en) 2002-06-25 2011-05-31 Incisive Surgical, Inc. Mechanical method and apparatus for bilateral tissue fastening
US7112214B2 (en) 2002-06-25 2006-09-26 Incisive Surgical, Inc. Dynamic bioabsorbable fastener for use in wound closure
EP1532942A4 (en) 2002-07-10 2006-08-02 Marlen Andreevich Sulamanidze Endoprosthesis for reparative anaplastic surgery
EP1545326B1 (en) 2002-07-17 2012-05-30 Tyco Healthcare Group LP Union stress needle
US8016881B2 (en) 2002-07-31 2011-09-13 Icon Interventional Systems, Inc. Sutures and surgical staples for anastamoses, wound closures, and surgical closures
US6773450B2 (en) 2002-08-09 2004-08-10 Quill Medical, Inc. Suture anchor and method
US7413571B2 (en) 2002-08-21 2008-08-19 Kci Licensing, Inc. Flexible medical closure screen and method
US7410495B2 (en) 2002-08-21 2008-08-12 Kci Licensing, Inc. Medical closure clip system and method
US7413570B2 (en) 2002-08-21 2008-08-19 Kci Licensing, Inc. Medical closure screen installation systems and methods
US7351250B2 (en) 2002-08-21 2008-04-01 Kci Licensing, Inc. Circumferential medical closure device and method
US7381211B2 (en) 2002-08-21 2008-06-03 Kci Licensing, Inc. Medical closure screen device and method
US8074654B2 (en) 2002-09-06 2011-12-13 Koninklijke Philips Electronics N.V. Implantable devices, systems, and methods for maintaining desired orientations in targeted tissue regions
US20080066764A1 (en) 2002-09-06 2008-03-20 Apneon, Inc. Implantable devices, systems, and methods for maintaining desired orientations in targeted tissue regions
US7845356B2 (en) 2002-09-06 2010-12-07 Koninklijke Philips Electronics N.V. Implantable devices, systems, and methods for maintaining desired orientations in targeted tissue regions
US8707959B2 (en) 2002-09-06 2014-04-29 Koninklijke Philips N.V. Implantable devices, systems, and methods for maintaining desired orientations in targeted tissue regions
US20040088003A1 (en) 2002-09-30 2004-05-06 Leung Jeffrey C. Barbed suture in combination with surgical needle
WO2004030600A2 (en) 2002-09-30 2004-04-15 Damage Control Surgical Technologies, Inc. Rapid deployment chest drainage
US8100940B2 (en) 2002-09-30 2012-01-24 Quill Medical, Inc. Barb configurations for barbed sutures
US20040068294A1 (en) 2002-10-04 2004-04-08 Howard Scalzo Braided antimicrobial suture
US6877934B2 (en) 2002-10-28 2005-04-12 Rem Sales, Inc. Milling head for thread whirling
DE10253391A1 (en) 2002-11-15 2004-06-03 Mnemoscience Gmbh Amorphous polymer networks
RU2241389C2 (en) 2002-12-15 2004-12-10 Зотов Вадим Александрович Method and device for suturing cutaneous wounds
DE10300271A1 (en) 2003-01-08 2004-07-22 Mnemoscience Gmbh Photosensitive polymer networks
US20040138683A1 (en) 2003-01-09 2004-07-15 Walter Shelton Suture arrow device and method of using
GB0303362D0 (en) 2003-02-13 2003-03-19 Enact Pharma Plc Tissue regeneration
US20040167572A1 (en) 2003-02-20 2004-08-26 Roth Noah M. Coated medical devices
JP4096758B2 (en) 2003-02-26 2008-06-04 日産自動車株式会社 Navigation device
DE602004018908D1 (en) 2003-03-31 2009-02-26 Memry Corp MEDICAL DEVICES WITH MEDICAMENT ELUTION PROPERTIES AND METHOD OF PREPARATION THEREOF
US6996880B2 (en) 2003-04-01 2006-02-14 Velcro Industries B.V. Fastener elements and methods of manufacture
DE10316573A1 (en) 2003-04-10 2004-11-04 Mnemoscience Gmbh Blends with shape-memory properties
WO2004096305A1 (en) 2003-04-29 2004-11-11 The University Of Hong Kong Coded surgical aids
US7803574B2 (en) 2003-05-05 2010-09-28 Nanosys, Inc. Medical device applications of nanostructured surfaces
US7624487B2 (en) 2003-05-13 2009-12-01 Quill Medical, Inc. Apparatus and method for forming barbs on a suture
US7081135B2 (en) 2003-06-09 2006-07-25 Lane Fielding Smith Mastopexy stabilization apparatus and method
US7150757B2 (en) 2003-06-11 2006-12-19 Fallin T Wade Adjustable line locks and methods
WO2004112853A1 (en) 2003-06-20 2004-12-29 Trevino Schwarz Jose Surgical threads with anchoring teeth
US7144412B2 (en) 2003-06-25 2006-12-05 Wolf Medical Enterprises, Inc. Gold suture and method of use in wound closure
USD532107S1 (en) 2003-06-25 2006-11-14 Incisive Surgical, Inc. Tissue fastening instrument
US20040267309A1 (en) 2003-06-27 2004-12-30 Garvin Dennis D. Device for sutureless wound closure
US7972347B2 (en) 2003-06-27 2011-07-05 Surgical Security, Llc Device for surgical repair, closure, and reconstruction
US20050004602A1 (en) 2003-07-02 2005-01-06 Applied Medical Resources Corporation Interlocking suture clinch
EP1646327A2 (en) 2003-07-14 2006-04-19 Dexteus Guard for forceps to avoid accidental needle pricks
US7021316B2 (en) 2003-08-07 2006-04-04 Tools For Surgery, Llc Device and method for tacking a prosthetic screen
US6915623B2 (en) 2003-08-14 2005-07-12 Ethicon, Inc. Method for assembling a package for sutures
CN2640420Y (en) 2003-08-19 2004-09-15 邵立 Face care zigzag line
JP4266749B2 (en) 2003-08-27 2009-05-20 Necディスプレイソリューションズ株式会社 Digital data broadcast receiving method and digital data broadcast receiving apparatus
WO2005034763A1 (en) 2003-09-11 2005-04-21 Nmt Medical, Inc. Devices, systems, and methods for suturing tissue
US7481826B2 (en) 2003-09-30 2009-01-27 Ethicon, Inc. Fluid emitting suture needle
US7678134B2 (en) 2003-10-10 2010-03-16 Arthrex, Inc. Knotless anchor for tissue repair
US7682374B2 (en) 2003-10-21 2010-03-23 Arthrocare Corporation Knotless suture lock and bone anchor implant method
US20050096698A1 (en) 2003-10-29 2005-05-05 Lederman Andrew B. Suture needles and methods of use
US20050113936A1 (en) 2003-10-30 2005-05-26 Brustad John R. Surface treatments and modifications using nanostructure materials
WO2005065079A2 (en) 2003-11-10 2005-07-21 Angiotech International Ag Medical implants and fibrosis-inducing agents
US20050154255A1 (en) 2003-11-20 2005-07-14 The Children's Hospital Of Philadelphia Surgical device
US8257393B2 (en) 2003-12-04 2012-09-04 Ethicon, Inc. Active suture for the delivery of therapeutic fluids
EP1708655A1 (en) 2003-12-09 2006-10-11 GI Dynamics, Inc. Apparatus to be anchored within the gastrointestinal tract and anchoring method
US7357810B2 (en) 2003-12-18 2008-04-15 Ethicon, Inc. High strength suture with absorbable core and suture anchor combination
KR20050072908A (en) 2004-01-08 2005-07-13 황연희 Multi-directional multi-density wrinkle remove suture
PL1670362T3 (en) 2004-01-23 2011-05-31 Apollo Endosurgery Inc Implantable device fastening system and methods of use
AU2005210668A1 (en) 2004-01-30 2005-08-18 Angiotech International Ag Compositions and methods for treating contracture
US20060058799A1 (en) 2004-02-10 2006-03-16 Robert Elson Ligament repair apparatus and method
US20050197699A1 (en) 2004-02-10 2005-09-08 Jacobs Daniel I. Tissue repair apparatus and method
US20050209612A1 (en) 2004-03-02 2005-09-22 Nakao Naomi L Endoscopic suturing assembly and associated methodology using a temperature biased suture needle
US7057135B2 (en) 2004-03-04 2006-06-06 Matsushita Electric Industrial, Co. Ltd. Method of precise laser nanomachining with UV ultrafast laser pulses
EP1726317B1 (en) 2004-03-15 2012-07-04 Marlen Andreevich Sulamanidze Surgical means for cosmetic surgery
US20050199249A1 (en) 2004-03-15 2005-09-15 Karram Mickey M. Apparatus and method for incision-free vaginal prolapse repair
US20050209542A1 (en) 2004-03-16 2005-09-22 Jacobs Daniel I Tissue approximation sling and method
US8236027B2 (en) 2004-04-07 2012-08-07 Tze Liang Woffles Wu Surgical thread
WO2005096955A1 (en) 2004-04-07 2005-10-20 Tze Liang Woffles Wu Surgical thread
WO2005096956A1 (en) 2004-04-07 2005-10-20 Tze Liang Woffles Wu Surgical thread
ES2638301T3 (en) 2004-05-14 2017-10-19 Ethicon Llc Suture devices
US7862583B2 (en) 2004-05-27 2011-01-04 Ethicon Endo-Surgery, Inc. Fusible suture and method for suturing therewith
AU2005254105B2 (en) 2004-06-14 2012-01-12 Boston Scientific Limited Systems, methods and devices relating to implantable supportive slings
MXPA06015146A (en) 2004-06-24 2007-10-23 Philip L Gildenberg Semi-robotic suturing device.
US7468068B2 (en) 2004-06-30 2008-12-23 Alwin Kolster Suture for wound closure, tissue approximation, tissue support, suspension and/or fixation
US7582105B2 (en) 2004-06-30 2009-09-01 Silhouette Lift Societad Limitada Suture for wound closure, tissue approximation, tissue support, suspension and/or fixation
BRPI0402762C1 (en) 2004-07-13 2006-04-11 Jose Antonio Encinas Beramendi flexible wire for repair surgery and device for its manufacture
US20060058844A1 (en) 2004-09-13 2006-03-16 St. Jude Medical Puerto Rico B.V. Vascular sealing device with locking system
US7244270B2 (en) 2004-09-16 2007-07-17 Evera Medical Systems and devices for soft tissue augmentation
GB2418159B (en) 2004-09-17 2008-02-13 Quill Internat Ind Plc A blasting nozzle
US20060085016A1 (en) 2004-10-15 2006-04-20 Sorin Eremia Suture instrument and method of suturing in cosmetic surgery
US20060089672A1 (en) 2004-10-25 2006-04-27 Jonathan Martinek Yarns containing filaments made from shape memory alloys
US7144415B2 (en) 2004-11-16 2006-12-05 The Anspach Effort, Inc. Anchor/suture used for medical procedures
ITRM20040599A1 (en) 2004-12-06 2005-03-06 Promoitalia Internat S R L SURGICAL THREAD FOR PLASTIC, DERMATOLOGICAL, AESTHETIC AND SURGICAL SURGERY OPERATIONS.
US7572275B2 (en) 2004-12-08 2009-08-11 Stryker Endoscopy System and method for anchoring suture to bone
US20060142784A1 (en) 2004-12-28 2006-06-29 Stavros Kontos Device and method for suturing internal structures puncture wounds
DE102005004317B3 (en) 2005-01-31 2006-06-01 Ethicon Gmbh Polypropylene tissue connector comprises a longitudinal core having active substances, helical structures as a rear cut thread spirally coiled around the core and needle type applicator with ends covered by casing
DE102005004318A1 (en) 2005-01-31 2006-08-10 Ethicon Gmbh Surgical seam system
DE102005006718A1 (en) 2005-02-04 2006-08-17 Aesculap Ag & Co. Kg Resorbable suture material
US7992567B2 (en) 2005-02-08 2011-08-09 Koninklijke Philips Electronics N.V. System and method for percutaneous glossoplasty
US8652215B2 (en) 2005-03-07 2014-02-18 Georgia Tech Research Corporation Nanofilament scaffold for tissue regeneration
WO2006099703A2 (en) 2005-03-21 2006-09-28 Jose Antonio Encinas Beramendi Surgery thread and surgery thread manufacturing device
US7981140B2 (en) 2005-03-30 2011-07-19 Arthrex, Inc. Knotless fixation of tissue to bone with suture chain
US7591850B2 (en) 2005-04-01 2009-09-22 Arthrocare Corporation Surgical methods for anchoring and implanting tissues
US20060229671A1 (en) 2005-04-08 2006-10-12 Musculoskeletal Transplant Foundation Suture anchor and suture anchor installation tool
US7833244B2 (en) 2005-04-20 2010-11-16 Arthroscopic Innovations Llc Suture fixation device and method for surgical repair
US7467710B2 (en) 2005-05-04 2008-12-23 Ethicon, Inc. Molded package
US20060253126A1 (en) 2005-05-04 2006-11-09 Bernard Medical, Llc Endoluminal suturing device and method
US10555775B2 (en) 2005-05-16 2020-02-11 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US20060276808A1 (en) 2005-06-06 2006-12-07 Arnal Kevin R Minimally Invasive Methods and Apparatus for Accessing and Ligating Uterine Arteries with Sutures
US20060272979A1 (en) 2005-06-07 2006-12-07 Lubbers Lawrence M Surgical Tray
US9545191B2 (en) 2005-06-13 2017-01-17 Ethicon Endo-Surgery, Inc. Method for suture lacing
US20060287675A1 (en) 2005-06-15 2006-12-21 Prajapati Rita T Method of intra-operative coating therapeutic agents onto sutures composite sutures and methods of use
US20060287676A1 (en) 2005-06-15 2006-12-21 Rita Prajapati Method of intra-operative coating therapeutic agents onto sutures, composite sutures and methods of use
US20060286289A1 (en) 2005-06-15 2006-12-21 Rita Prajapati Method of intraoperative coating therapeutic agents onto sutures
US8663277B2 (en) 2005-06-29 2014-03-04 Ethicon, Inc. Braided barbed suture
US8267961B2 (en) 2005-06-29 2012-09-18 Ethicon, Inc. Barbed suture
AU2006202427A1 (en) * 2005-07-13 2007-02-01 Tyco Healthcare Group Lp Monofilament sutures made from a composition containing ultra high molecular weight polyethylene
US20070027475A1 (en) 2005-08-01 2007-02-01 Ancel Surgical R&D, Inc. Scaled suture thread
KR100956727B1 (en) 2005-09-02 2010-05-06 후지쯔 가부시끼가이샤 Rf tag and method for manufacturing rf tag
ATE487503T1 (en) 2005-10-18 2010-11-15 Cook Biotech Inc MEDICAL DEVICE WITH FIXATIVE AGENTS
WO2007053812A2 (en) 2005-10-31 2007-05-10 Ethicon, Inc. Delivery system for a barbed fastener
US7322105B2 (en) 2005-11-18 2008-01-29 Ultradent Products, Inc. Methods for manufacturing endodontic instruments by milling
US20070135840A1 (en) 2005-12-14 2007-06-14 Arthrex, Inc. High strength suture formed of UHMWPE and PBT
US20070156175A1 (en) 2005-12-29 2007-07-05 Weadock Kevin S Device for attaching, relocating and reinforcing tissue and methods of using same
US20070151961A1 (en) 2006-01-03 2007-07-05 Klaus Kleine Fabrication of an implantable medical device with a modified laser beam
US20080009902A1 (en) 2006-01-30 2008-01-10 Angiotech Pharmaceuticals, Inc. Sutures and fibrosing agents
EP1978930A2 (en) 2006-01-31 2008-10-15 Angiotech Pharmaceuticals, Inc. Sutures and anti-scarring agents
EP1832238A3 (en) 2006-03-07 2008-03-26 Arthrex, Inc. Tapered suture
US20070224237A1 (en) 2006-03-24 2007-09-27 Julia Hwang Barbed sutures having a therapeutic agent thereon
US20070227914A1 (en) 2006-03-30 2007-10-04 Cerwin Robert J Suture package
US7763036B2 (en) 2006-03-31 2010-07-27 Ethicon Endo-Surgery, Inc. Endoscopic instrument with secondary vacuum source
WO2007131019A2 (en) 2006-05-04 2007-11-15 Ethicon, Inc. Tissue holding devices and methods for making the same
DE602006020077D1 (en) 2006-05-16 2011-03-24 Marlen Andreevich Sulamanidze SURGICAL SEAM MATERIAL
WO2007145614A2 (en) 2006-06-08 2007-12-21 Eremia Sorin M D Suture instrument and method of suturing in cosmetic surgery
WO2008002409A2 (en) 2006-06-26 2008-01-03 Vance Products Incorporated Doing Business As Cook Urological Incorporated Tension free pelvic floor repair
US20080046094A1 (en) 2006-06-27 2008-02-21 Kwang Hee Han Linear tension material for plastic surgery
US9718190B2 (en) 2006-06-29 2017-08-01 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US8151661B2 (en) 2006-06-30 2012-04-10 Intuituve Surgical Operations, Inc. Compact capstan
US8870916B2 (en) 2006-07-07 2014-10-28 USGI Medical, Inc Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use
US7923075B2 (en) 2006-07-17 2011-04-12 The Hong Kong University Of Science And Technology Methods for preparing nanotextured surfaces and applications thereof
US8480557B2 (en) 2006-07-27 2013-07-09 Refine, Llc Nonaugmentive mastopexy
WO2008014491A1 (en) 2006-07-28 2008-01-31 Angiotech Pharmaceuticals, Inc. Cosmetic breast and nipple lift device and method
ES2329092T3 (en) 2006-09-06 2009-11-20 Tyco Healthcare Group, Lp PUAS SUTURES.
AU2007303137B2 (en) 2006-10-03 2014-04-10 Sinclair Pharmaceuticals Limited Minimally invasive tissue support
US8353931B2 (en) 2006-11-02 2013-01-15 Covidien Lp Long term bioabsorbable barbed sutures
US20080132943A1 (en) 2006-12-05 2008-06-05 Nicholas Maiorino Knotless wound closure device
US20080215072A1 (en) 2007-02-15 2008-09-04 Graham Kelly Methods and apparatus for utilization of barbed sutures in human tissue including a method for eliminating or improving blood flow in veins
US20080221618A1 (en) 2007-03-09 2008-09-11 Gaoyuan Chen Co-extruded tissue grasping monofilament
US20080255612A1 (en) 2007-04-13 2008-10-16 Angiotech Pharmaceuticals, Inc. Self-retaining systems for surgical procedures
EP2712555B1 (en) 2007-05-29 2017-08-23 Ethicon LLC Suture packaging
US8747436B2 (en) 2007-06-13 2014-06-10 Ethicon, Inc. Bi-directional barbed suture
US8562644B2 (en) 2007-08-06 2013-10-22 Ethicon, Inc. Barbed suture with non-symmetric barbs
US8161618B2 (en) 2007-09-17 2012-04-24 Tyco Healthcare Group Lp Method of forming barbs on a suture
ES2488406T3 (en) 2007-09-27 2014-08-27 Ethicon Llc Self-retaining sutures that include tissue retention elements with enhanced strength
US20090099597A1 (en) 2007-10-12 2009-04-16 Isse Nicanor G Suture assembly with tissue engaging elements
CA2999355C (en) 2007-10-17 2020-12-15 Davol Inc. Fixating means between a mesh and mesh deployment means especially useful for hernia repair surgeries and methods thereof
US20090112236A1 (en) 2007-10-29 2009-04-30 Tyco Healthcare Group Lp Filament-Reinforced Composite Fiber
US8225673B2 (en) 2007-10-31 2012-07-24 Ethicon, Inc. Method of manufacturing and testing monofilament and multi-filaments self-retaining sutures
US20090112259A1 (en) 2007-10-31 2009-04-30 Angiotech Pharmaceuticals, Inc. Recombinant expressed bioadsorbable polyhydroxyalkonate monofilament and multi-filaments self-retaining sutures
JP2009118967A (en) 2007-11-13 2009-06-04 Daitaro Fukuoka Thread for plastic operation
DE102007058256A1 (en) 2007-11-26 2009-05-28 Aesculap Ag Surgical thread mesh
US9439746B2 (en) 2007-12-13 2016-09-13 Insightra Medical, Inc. Methods and apparatus for treating ventral wall hernia
CN101902974B (en) * 2007-12-19 2013-10-30 伊西康有限责任公司 Self-retaining sutures with heat-contact mediated retainers
DE102008004574A1 (en) 2008-01-09 2009-07-16 Aesculap Ag Surgical suture with anchoring elements
WO2009097556A2 (en) 2008-01-30 2009-08-06 Angiotech Pharmaceuticals, Inc. Appartaus and method for forming self-retaining sutures
US8222564B2 (en) 2008-02-13 2012-07-17 Tyco Healthcare Group, Lp Methods of altering surgical fiber
US8273105B2 (en) 2008-02-20 2012-09-25 Tyco Healthcare Group Lp Compound barb medical device and method
BRPI0907787B8 (en) 2008-02-21 2021-06-22 Angiotech Pharm Inc method for forming a self-retaining suture and apparatus for raising the retainers in a suture to a desired angle
US20090248066A1 (en) 2008-03-28 2009-10-01 David Hjalmar Wilkie Elastic barbed suture and tissue support system
US8932327B2 (en) 2008-04-01 2015-01-13 Covidien Lp Anchoring device
US10376261B2 (en) 2008-04-01 2019-08-13 Covidien Lp Anchoring suture
US8256613B2 (en) 2008-04-07 2012-09-04 Tyco Healthcare Group Lp Suture packaging for barbed sutures
US8864776B2 (en) 2008-04-11 2014-10-21 Covidien Lp Deployment system for surgical suture
US20090259251A1 (en) 2008-04-11 2009-10-15 Cohen Matthew D Loop suture
US9011489B2 (en) 2008-05-14 2015-04-21 Boston Scientific Scimed, Inc. Surgical composite barbed suture
US20110264138A1 (en) 2008-05-16 2011-10-27 Angiotech Pharmaceuticals, Inc. Coded heterofunctional sutures and methods
US7967841B2 (en) 2008-06-02 2011-06-28 Ethicon, Inc. Methods for using looped tissue-grasping devices
US8888796B2 (en) 2008-06-07 2014-11-18 Ethicon, Inc. Devices for tensioning barbed sutures and methods therefor
US8403947B2 (en) 2008-06-17 2013-03-26 Derek H. OCHIAI Method of suturing
US8821539B2 (en) 2008-07-23 2014-09-02 Ethicon, Inc. Collapsible barbed sutures having reduced drag and methods therefor
US10016196B2 (en) 2008-09-11 2018-07-10 Covidien Lp Tapered looped suture
US8056599B2 (en) 2008-09-24 2011-11-15 Tyco Healthcare Group Lp System and method of making tapered looped suture
US8403017B2 (en) 2008-10-27 2013-03-26 Covidien Lp System, method and apparatus for making tapered looped suture
DE102008057218A1 (en) 2008-11-06 2010-05-12 Aesculap Ag Surgical sutures with barbs incised in the unstretched state
US20100140115A1 (en) 2008-12-08 2010-06-10 David Kirsch Suture Packaging
US9398943B2 (en) 2009-11-30 2016-07-26 Covidien Lp Ventral hernia repair with barbed suture
JP5823498B2 (en) 2010-04-29 2015-11-25 エシコン・エルエルシーEthicon, LLC High density self-holding suture, manufacturing apparatus and method thereof
CN104706390B (en) 2010-05-04 2017-05-17 伊西康有限责任公司 Laser cutting system and methods for creating self-retaining sutures

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5053047A (en) * 1989-05-16 1991-10-01 Inbae Yoon Suture devices particularly useful in endoscopic surgery and methods of suturing
US5084063A (en) * 1989-09-27 1992-01-28 United States Surgical Corporation Surgical needle-suture attachment
US5102418A (en) * 1989-09-27 1992-04-07 United States Surgical Corporation Method for attaching a surgical needle to a suture
US6241747B1 (en) * 1993-05-03 2001-06-05 Quill Medical, Inc. Barbed Bodily tissue connector
US5931855A (en) * 1997-05-21 1999-08-03 Frank Hoffman Surgical methods using one-way suture

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP1560683A2 *

Cited By (45)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US10779815B2 (en) 2004-05-14 2020-09-22 Ethicon, Inc. Suture methods and devices
US10548592B2 (en) 2004-05-14 2020-02-04 Ethicon, Inc. Suture methods and devices
US11723654B2 (en) 2004-05-14 2023-08-15 Ethicon, Inc. Suture methods and devices
US7850894B2 (en) 2006-05-04 2010-12-14 Ethicon, Inc. Tissue holding devices and methods for making the same
US8216497B2 (en) 2006-05-04 2012-07-10 Ethicon, Inc. Tissue holding devices and methods for making the same
US10098633B2 (en) 2006-09-06 2018-10-16 Covidien Lp Bioactive substance in a barbed suture
US8348973B2 (en) 2006-09-06 2013-01-08 Covidien Lp Bioactive substance in a barbed suture
US9307983B2 (en) 2006-09-06 2016-04-12 Covidien Lp Bioactive substance in a barbed suture
US8353931B2 (en) 2006-11-02 2013-01-15 Covidien Lp Long term bioabsorbable barbed sutures
WO2008157142A2 (en) 2007-06-13 2008-12-24 Ethicon, Inc. Bi-directional barbed suture
WO2008157142A3 (en) * 2007-06-13 2009-08-27 Ethicon, Inc. Bi-directional barbed suture
US8747436B2 (en) 2007-06-13 2014-06-10 Ethicon, Inc. Bi-directional barbed suture
US8562644B2 (en) 2007-08-06 2013-10-22 Ethicon, Inc. Barbed suture with non-symmetric barbs
DE102007058256A1 (en) 2007-11-26 2009-05-28 Aesculap Ag Surgical thread mesh
US9788832B2 (en) 2008-02-20 2017-10-17 Covidien Lp Compound barb medical device and method
US9713467B2 (en) 2008-02-20 2017-07-25 Covidien Lp Compound barb medical device and method
US8273105B2 (en) 2008-02-20 2012-09-25 Tyco Healthcare Group Lp Compound barb medical device and method
US11660088B2 (en) 2008-02-20 2023-05-30 Covidien Lp Compound barb medical device and method
US8888810B2 (en) 2008-02-20 2014-11-18 Covidien Lp Compound barb medical device and method
US9050082B2 (en) 2008-02-20 2015-06-09 Covidien Lp Compound barb medical device and method
US8454653B2 (en) 2008-02-20 2013-06-04 Covidien Lp Compound barb medical device and method
US10729429B2 (en) 2008-02-20 2020-08-04 Covidien Lp Compound barb medical device and method
US8739389B2 (en) 2008-02-20 2014-06-03 Covidien Lp Compound barb medical device and method
US10376261B2 (en) 2008-04-01 2019-08-13 Covidien Lp Anchoring suture
US9358002B2 (en) 2008-04-01 2016-06-07 Covidien Lp Anchoring device
US10058326B2 (en) 2008-04-01 2018-08-28 Covidien Lp Anchoring device
US9034011B2 (en) 2008-04-01 2015-05-19 Covidien Lp Anchoring device
US8932327B2 (en) 2008-04-01 2015-01-13 Covidien Lp Anchoring device
US11234689B2 (en) 2008-11-03 2022-02-01 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US10441270B2 (en) 2008-11-03 2019-10-15 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US9044224B2 (en) 2010-04-12 2015-06-02 Covidien Lp Barbed medical device and method
US10952721B2 (en) 2010-05-04 2021-03-23 Ethicon, Inc. Laser cutting system and methods for creating self-retaining sutures
US11234692B2 (en) 2010-05-04 2022-02-01 Cilag Gmbh International Self-retaining system having laser-cut retainers
US10420546B2 (en) 2010-05-04 2019-09-24 Ethicon, Inc. Self-retaining systems having laser-cut retainers
US9955962B2 (en) 2010-06-11 2018-05-01 Ethicon, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US8496465B2 (en) 2010-10-28 2013-07-30 Covidien Lp Suture containing barbs
US8303881B2 (en) 2010-10-28 2012-11-06 Covidien Lp Suture containing barbs
US11007296B2 (en) 2010-11-03 2021-05-18 Ethicon, Inc. Drug-eluting self-retaining sutures and methods relating thereto
US8414612B2 (en) 2010-11-08 2013-04-09 Covidien Lp Multifilament barbed suture
US9675341B2 (en) 2010-11-09 2017-06-13 Ethicon Inc. Emergency self-retaining sutures and packaging
US10492780B2 (en) 2011-03-23 2019-12-03 Ethicon, Inc. Self-retaining variable loop sutures
US11690614B2 (en) 2011-03-23 2023-07-04 Ethicon, Inc. Self-retaining variable loop sutures
US9220492B2 (en) 2012-02-01 2015-12-29 Covidien Lp Wound closure device
US9107660B2 (en) 2012-02-01 2015-08-18 Covidien Lp Wound closure device

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