Surgical Implant and Process of Manufacturing Thereof

Abstract

A surgical implant (20) comprises a flexible, areal basic structure (22) having a first face and a second face and being provided with pores (26) extending from the first face to the second face. A barrier layer (24) having a first face and a second face is placed, with its second face, at the first face of the basic structure (2) and attached to the basic structure (22). The barrier layer (24) is deformed into at least part of the pores (26) where it forms, in a respective pore (10), a barrier region (28).

Claims

1-18. (canceled)

19. A process of manufacturing a surgical implant according to claim 1, characterized by the steps: providing a flexible, areal basic structure having a first face and a second face and being provided with pores extending from the first face to the second face, providing a barrier layer having a first face and a second face, placing the basic structure onto a hard support, the second face of the basic structure facing the support, placing the barrier layer, with its second face, onto the first face of the basic structure, placing a pad onto the barrier layer, the pad being softer than the support, applying heat and pressure, thereby softening the material of the barrier layer, urging it into pores of the basic structure, and attaching the barrier layer to the basic structure.

20. A process according to claim 19, characterized in that a bonding material, which has a melting temperature lower than the melting temperature of at least part of the material of the basic structure and lower than the melting temperature of at least part of the material of the barrier layer, is included in the basic structure provided, preferably in the form of filaments comprising poly-p-dioxanone.

21. A process according to claim 19, characterized in that a bonding material, which has a melting temperature lower than the melting temperature of at least part of the material of the basic structure and lower than the melting temperature of at least part of the material of the barrier layer, is included in the barrier layer provided, preferably as a sub-layer comprising poly-p-dioxanone and laminated to a sub-layer comprising barrier material having a higher melting point than poly-p-dioxanone.

22. A process according to any one of claim 19, characterized in that, after applying heat and before the pressure is relieved, the basic structure and the barrier layer are cooled.

23. A process of intraperitoneally placing a surgical implant according to any one of claim 1 in a patient's body, comprising the steps: introducing the surgical implant via a trocar sleeve into the body, deploying the surgical implant, the second face of the basic structure facing a patient's peritoneum, clinging the surgical implant to the peritoneum, fixing the implant on the peritoneum.

Description

[0047] In the following, the invention is further explained by means of examples. The drawings show in

[0048] FIGS. 1A, 1B and 1C a schematic illustration of an embodiment of the process of manufacturing a surgical implant according to the invention, in longitudinal sections, i.e. in part FIG. 1A is an arrangement of a basic structure and a barrier layer placed in a set-up comprising a hard support and a soft pad, in part FIG. 1B is the arrangement of part FIG. 1A after exerting pressure and elevated temperature and after removing the soft pad, and in part FIG. 1C is the surgical implant taken from the support,

[0049] FIG. 2 an exploded three-dimensional view of an embodiment of the surgical implant according to the invention,

[0050] FIGS. 3A and 3B show three-dimensional scanning microscopic images of two embodiments of the surgical implant according to the invention, which differ slightly due to manufacturing conditions, seen from the side where a film (barrier layer) is attached, and

[0051] FIG. 4 a schematic depth profile contour map of the embodiment according to FIG. 3A.

[0052] The structure of the surgical implant according to the invention can be best understood by means of an example illustrating a manufacturing process of the implant, see FIGS. 1A, 1B and 1C in which the finished surgical implant is designated by reference numeral 1. FIGS. 1A, 1B and 1C shows schematic views in longitudinal section.

[0053] In FIG. 1A, an arrangement of a basic structure 2 and a barrier layer 4 is placed between a hard support 6 and a pad 8, which is softer than the support 6.

[0054] The basic structure 2 may be designed as, e.g., a surgical mesh or a mesh-like sheet. In any case, it is areal (i.e. generally flat) and flexible. In FIGS. 1A, 1B and 1C, the dimension of the area of the basic structure 2 not shown in the figure extends perpendicularly to the plane of the paper. Moreover, the basic structure 2 comprises pores 10 surrounded by material 12. The pores 10 extend from a first face (side) 14 to a second face (side) 16 of the basic structure 2. In the embodiment, the basic structure 2 is designed as a mesh-like sheet (made, e.g., by injection-molding or laser-cutting of polymeric films) so that the first face 14 and the second face 16 are essentially plan. If the basic structure is, e.g., a warp-knitted or crocheted surgical mesh, the material 12 will be provided by filaments (monofilaments and/or multi-filaments), and the first face 14 and the second face 16 will be somewhat rougher because of the intersections of the filaments.

[0055] In the embodiment, the barrier layer 4 is made from a thin absorbable film without pores. In other embodiments, the barrier layer may comprise pores, which are generally smaller than the pores 10 of the basic structure 2, however. According to FIG. 1A, the barrier layer 4 is placed onto one side of the basic structure 2, which by definition is the first face 14.

[0056] In the manufacturing process, the arrangement of the basic structure 2 and the barrier layer 4 is heated and submitted to external pressure, as indicated by the arrow in FIG. 1A. The materials of the basic structure 2 and the barrier layer 4 are appropriately selected such that the basic structure 2 essentially keeps its shape while the material of the barrier layer 4 get soft enough at the raised temperature so that it is urged, by the relatively soft pad 8, into the pores 10 of the basic structure 2. Examples including more precise information on the materials and the processing conditions are given further below. The soft pad 8 largely adapts to the depressions provided by the pores 10, while the support 6 defines a plane at the level of the second face 16 of the basic structure 2 which is not traversed by the material of the barrier layer 4.

[0057] FIG. 1B shows the result after the arrangement has been cooled to room temperature and the pad 8 has been removed. Inside the pores 10, the barrier layer 4 forms barrier regions 18, which are largely plane and have their outer face located (within tolerances due to the manufacturing process and the initial surface roughness of the basic structure 2) at the level of the second face 16 of the basic structure 2. At the edge zones of a given barrier region 18, the barrier layer 4 rises, assuming a rather steep slope, and adjusts to the shape provided by the basic structure 2. The areas of the barrier layer 4 emerging from adjacent pores 10 are connected to each other at the level of the first face 14 so that the barrier layer 4 is coherent and able to fulfill its barrier function. FIG. 1C displays the finished surgical implant 1 when taken away from the support 6.

[0058] FIG. 2 is an exploded three-dimensional view of an embodiment of the surgical implant, here designated by 20. The surgical implant 20 may be the surgical implant manufactured as explained by means of FIGS. 1A, 1B and 1C. It comprises a basic structure 22 designed, in the embodiment, as a flexible mesh-like sheet, and a barrier layer 24. It is well visible in FIG. 2 how the deformed regions of the barrier layer 24 fit into pores 26 of the basic structure 22. In FIG. 2, the barrier regions in the individual pores 26 are designated by 28. To improve the adherence of the barrier layer to the basic structure, a bonding material can be used, which has a melting temperature lower than the melting temperature of at least part of the material of the basic structure and lower than the melting temperature of at least part of the material of the barrier layer. In the manufacturing process, the bonding material melts or gets very soft so that it acts as a kind of melt glue connecting the barrier layer to the basic structure. The bonding material may be incorporated in the basic structure and/or the barrier layer, see also the following examples.

EXAMPLE 1

[0059] A large-pored composite mesh of polypropylene monofilament fibers and poly-p-dioxanone (PDS) monofilament fibers serving as a basic structure was placed on a tenter frame form on top of a hard support surface. An approximately 10 m thick film of MONOCRYL (see above) serving as a barrier layer was placed on top of the basic structure, followed by a soft silicone foam pad covered by a metal plate. This assembly was placed in a hot press at 10 bar heated up to 120 C. for a couple of minutes and cooled down at the same pressure. Under these conditions, the poly-p-dioxanone fibers of the basic structure acted as a melt glue to attach the barrier layer to the basic structure.

[0060] The barrier layer entered the pores of the basic structure, as described above (FIGS. 1A, 1B and 1C). Typical dimensions in the pore area of the surgical implant obtained in this way were: pore diameter (clear width) 1.71 mm, pore diameter (width measured between the centers of the mesh filaments defining the pore) 2.47 mm, diameter of largely flat barrier region in the pore 1.53 mm (about 90% of pore diameter).

[0061] In an optional second step, a marker cut from a thick film (150 m) of violet poly-p-dioxanone was heat-laminated on top of the barrier layer in order to enable an easy distinction of both faces of the implant.

[0062] In a marker-free area, the thickness of this surgical implant was mechanically determined to be about 340 m, about 10 m thereof contributing to the film. The depressions in the pores forming the barrier regions had a depth, measured from the side of the first face (see FIGS. 1A, 1B and 1C) of up to 270 m (when measured down from maxima due to raised structures like knots of the mesh), with an average depression depth of about 60% of the thickness of the implant. When seen from the other side, i.e. the side of the second face, some fibers and knots of the basic structure where exposed beyond the second face of the film layer by up to about 185 m.

[0063] The average roughness S.sub.a, defined as explained in detail further above, of both sides of the implant was determined by means of an optical scanning microscope of the type Keyence Macroscope VR-3200 using standard settings adapted to measure the average roughness. On the side of the first face (film side, visceral side), the average roughness was 49 m; on the side of the second face (mesh side, parietal side), it was 28 m. For both sides, the mean surfaces were determined independently of each other. Thus, on the parietal side, the implant was considerably smoother, in spite of the fibers and knots emerging relatively far from the second face of the film layer. Generally, these fibers and knots are relatively small structures and do not contribute much to the average roughness as defined above.

[0064] An oval test article of about 15 cm10 cm was cut from this surgical implant and was intraperitonially placed in a pig, with the second face, i.e. the side on which the filaments of the basic structure were exposed (reference numeral 16 in FIG. 1C), facing to the peritoneum. The implant easily attached to the peritoneum, holding its own weight including a marker, but could be repositioned and placed at different locations (more centrally and more laterally) without problems. The area weight of this test article was 68 g/m.sup.2.

EXAMPLE 2

[0065] A surgical mesh of polypropylene filaments (basic mesh of Physiomesh hernia repair implant of Ethicon, i.e. Physiomesh without MONOCRYL, film) serving as a basic structure was placed on a supported hard silicon film covered by a baking paper in a form having pins for mesh fixation. After a corona treatment of the polypropylene mesh, a pre-laminate containing an 8-m PDS film (serving as melt glue) and a 20-m MONOCRYL film (serving as barrier layer) was placed on the mesh, with the PDS side facing to the mesh. This assembly was covered with a soft silicone pad, and the form was closed with a metal plate. After a heat lamination step in a press at 120 C. for 5 minutes, the assembly was taken out of the press, cooled down between two cold metal plates for about 20 minutes, and finally taken out of the form.

[0066] In the resulting surgical implant, the MONOCRYL film had assumed a mesh-like texture, as determined by the basic structure, with basically flat barrier regions in the respective pores having a width of about 1.5 mm and a depth (measured from the first face 14, see FIG. 1C) of about 200 m to 230 m.

[0067] The average roughness S.sub.a (see Example 1) of this surgical implant was 44 m on the film side and 37 m on the mesh side.

EXAMPLE 3

[0068] A TiO.sub.2Mesh of Biocer GmbH (large-pored mesh warp-knitted from polypropylene monofilaments having their surface coated with titan dioxide) serving as a basic structure was covered with a pre-laminate composed of a 5-m PDS film (serving as a melt-glue) and a 20-m MONOCRYL film serving as a barrier layer, with the PDS film side facing to the mesh. Any further surface treatment was not performed. This assembly was placed between a baking paper (mesh side) and a soft pad (film side) in a heat press at 10 bar, heated up to 120 C. for several minutes and cooled down under pressure to about 50 C.

[0069] After removing the surgical implant obtained in this way from the press, it was macroscopically evaluated. The film side felt rough and the mesh side felt smooth. Mesh and film were firmly connected to each other. On the film side, the topography of the film followed the essentially drop-like shape of the mesh pores, with flat barrier regions essentially filling the pores completely.

[0070] The surgical implant had a total thickness (mechanically determined) of 556 m. The basically flat barrier regions of the film were located at a depth of up to 487 m. The areal weight of the surgical implant was 90 g/m.sup.2.

[0071] When placed at an abdominal wall with the mesh side facing the abdominal wall, the clinging effect of this surgical implant is due not only to the barrier regions in the pores, but also to the hydrophilicity of the TiO.sub.2 coating of the mesh. In a test with a moist peritoneum of a pig, the implant adhered good enough to hold its own weight.

[0072] FIG. 3A shows a close-up three-dimensional view of the surgical implant (designated by reference numeral 30) manufactured as described above, taken by a scanning microscope from the film side (first face 14 according to FIG. 1C). The shape of the basic structure 32 is clearly visible because the barrier layer 34 closely attaches to the filaments 36 of the basic structure 32. Since the basic structure 32 is warp-knitted, points 38 of intersecting filaments form peaks. In the pores 40, barrier regions 42 of the barrier layer 34 located generally at the level of the other side of the basic structure 32 (second face 16 according to FIG. 1C) are relatively large, filling most of the area of a respective pore 40.

[0073] A surgical implant 30 shown in FIG. 3B was manufactured in almost the same way as the surgical implant 30 of FIG. 3A, the manufacturing conditions being only slightly different. Since a baking paper was not used, the barrier regions were slightly smoother. And since the pressure was somewhat lower, the barrier layer did not approach the sides of the filaments as closely as in the example according to FIG. 3A.

[0074] The average roughness S.sub.a (see Example 1) of the surgical implant 30 (FIG. 3A) was 79 m on the film side and 48 m on the mesh side. For the implant 30 (FIG. 3B), it was 83 m on the film side and 60 m on the mesh side.

[0075] In surgical test procedures with pigs, both implants 30 and 30 adhered to the peritoneum.

[0076] FIG. 4 is a depth profile contour map of the surgical implant according to FIG. 3A.

EXAMPLE 4

[0077] Omyra Mesh (B. Braun), an orientated cPTFE film having multiple pores in the mm range, as a basic structure was coronatreated on one side in order to render the surface acceptable for lamination and was covered with a pre-laminate composed of a 5-m PDS film and a 20-m MONOCRYL film with the PDS film side facing to the cPTFE film, the MONOCRYL film serving as a barrier layer and the PDS film serving as a bonding material. The assembly was placed between a hard pad (metal plate covered by baking paper on the cPTFE side) and a soft pad (MONOCRYL film side) in a heat press at 10 bar, heated up to 120 C. and cooled down under pressure to about 50 C. After taking the surgical implant obtained in this way out of the press, the barrier layer was dimpled.

[0078] Laser scan microscopic evaluation showed film depressions of up to 178 m and a total implant thickness of 201 m, which means that the barrier layer film having a thickness of about 20 m was completely impressed into the pores of the basic structure. Backside measurement demonstrated that the cPTFE struts, i.e. the material between the pores, were almost within the basically flat barrier regions of MONOCRYL. Starting from such a barrier region, the out-of-plane angles of the barrier layer increased when approaching the struts, depending on the location within the pore, e.g. from about 35 to 39 and up to 48 or, in narrow sections of the pore, being in the order of 12 to 14. The largely flat barrier regions in the central area of a pore had small out-of-plane angles, in the order of less than 1, and a typical size of 0.9 mm.

[0079] The average roughness S.sub.a (see Example 1) of this surgical implant was 48 m on the film side and 24 m on the side of the basic structure.

[0080] In a test, this implant was placed at a moist peritoneum of a pig, with the cPTFE side facing the peritoneum. In spite of the general hydrophobicity of PTFE, the adhesion forces between the peritoneum and the implant were large enough to hold the weight of the implant (245 g/m.sup.2), due to the clinging effect of the barrier regions of the barrier layer.

EXAMPLE 5

[0081] Samples of a surgical implant comparable to that of Example 1 were prepared in a rectangular size of 3 cm5 cm with slightly rounded edges. Additionally, a circular dyed (violet) PDS film disk of about 150 m thickness was laminated centrally on top of the barrier layer of an implant.

[0082] Using samples of this implant, a rabbit peritoneal defect model was applied, as described in U.S. Pat. No. 8,629,314 B. Adhesion was evaluated after 2 weeks, see Table 1.

[0083] When a sample was correctly placed, with the smooth mesh side (second face 16 in FIG. 1C) to the abdominal wall and the ridged (rough) barrier layer side (first face 14 in FIG. 1C) to the viscera, almost no adhesions occurred. Only one implantation site showed minor grade 1 adhesion (12.5% incidence), the remaining test sites were free of adhesion. When the implant was wrongly positioned, with the mesh side facing to the viscera, in 87.5% of the cases adhesion occurred, and in more severe grades from 1 to 4.

[0084] Thus, the surgical implant according to the invention exhibited a good adhesion reduction when correctly placed with the rough barrier layer side facing the viscera.

TABLE-US-00001 TABLE 1 In-vivo performance of samples of the surgical implant according to Example 5 in rabbits Treatment groups Adhesion Adhesion extent for (n = 8) incidence Grades 0 to 4 Sham control 8/8 (100%) 1: (2/8), 2: (4/8), 3: (1/8), 4: (1/8) Barrier layer to viscera 1/8 (12.5%) 0: (7/8), 1: (1/8) Mesh side to viscera 7/8 (87.5%) 0: (1/8), 1: (3/8), 2: (2/8), 4: (2/8)