Medical device

Abstract

A soft tissue implant comprises a condensed surgical mesh having a plurality of monofilament biocompatible fibers 12. Condensing of the fibers reduces the void space between adjacent fibers 12 in the mesh and reduces the surface area of the fibers 12 available for contact with tissue. Condensation of the fibers 12 may be achieved by applying mechanical pressure, and/or vacuum, and/or heat to the mesh.

Claims

1. A soft issue implant comprising a surgical mesh formed of intertwined biocompatible monofilament fibres, wherein the mesh has a void space between adjacent fibres in the mesh, and the mesh comprises a plurality of condensation zones, each condensation zone comprising a plurality of monofilament fibre stitch loop intersections, wherein substantially all of the monofilament fibres are flattened around a circumference of the monofilament fibers on an exterior surface of the mesh at one or more of the condensation zones, wherein each flattened fibre has a cross section defining a perimeter and a cross-sectional area at the condensation zone, wherein at least one of the fibres in each condensation zone is condensed to alter the perimeter of said cross section of the fibres available for contact with tissue while maintaining the cross-sectional area of said cross section of the fibres constant, thereby providing at each condensation zone a reduced void space between the fibres of the mesh and a reduced surface area of the fibres available for contact with tissue as compared to uncondensed monofilament fibre stitch loop intersections.

2. The implant of claim 1, wherein each condensation zone comprises at least part of at least one fibre outside of a monofilament fibre stitch loop intersection, and wherein along a condensed part of a fibre, void space between the fibre and its adjacent fibre is reduced as compared to adjacent uncondensed fibres.

3. The implant of claim 2, wherein the distance between adjacent fibres in the mesh is in the range of from approximately 5 m to approximately 500 m.

4. The implant of claim 2, wherein along the condensed part of the fibre: $\frac{A_V}{A_F}1.5$ where: A.sub.V=area of the void between adjacent fibres in the mesh available for tissue infiltration; and A.sub.F=cross-sectional area of the fibre.

5. The implant of claim 4, wherein: $\frac{A_V}{A_F}1.0.$

6. The implant of claim 5, wherein: $\frac{A_V}{A_F}\mathrm{is}\mathrm{approximately}\mathrm{equal}\mathrm{to}0.6.$

7. The implant of claim 1, wherein a surface area of the mesh at each condensation zone available for contact with tissue is less than the sum of total surface area of overlapping fibres.

8. The implant of claim 1, wherein the fibres comprise a polymer, a copolymer, or any combination thereof.

9. The implant of claim 8, wherein the polymer or copolymer is bioabsorbable.

10. The implant of claim 8, wherein the polymer or copolymer is non-bioabsorbable.

11. The implant of claim 1, wherein the fibres comprise polypropylene.

12. The implant of claim 1, wherein the mesh is condensed substantially uniformly.

13. The implant of claim 1, wherein the mesh comprises a condensed region and an uncondensed region.

14. The implant of claim 1, wherein the mesh comprises at least two regions that are differentially condensed.

15. The implant of claim 1, wherein the implant is configured for attachment to tissue.

16. The implant of claim 15, wherein the mesh comprises one or more attachment points.

17. The implant of claim 16, wherein the mesh is reinforced in a region of the one or more attachment points.

18. The implant of claim 16, wherein the implant is configured to couple an attachment element to the mesh.

19. The implant of claim 18, wherein the one or more attachment points comprise an attachment opening in the mesh to receive the attachment element.

20. The implant of claim 18, wherein the attachment element comprises a suture, a staple, an adhesive, or any combination thereof.

21. The implant of claim 15, wherein the mesh comprises one or more engagement formations for attachment of the mesh to tissue.

22. The implant of claim 21, wherein the one or more engagement formations comprise a protrusion.

23. The implant of claim 22, wherein the mesh comprises a plurality of protrusions configured in a wave-like or dimple like pattern.

24. The implant of claim 1, wherein at least part of the mesh is treated to increase the coefficient of friction of the mesh.

25. The implant of claim 1, wherein the mesh is configured to maintain a position of the mesh relative to tissue.

26. The implant of claim 25, wherein the mesh comprises one or more engagement formations for engaging tissue.

27. The implant of claim 1, wherein the thickness of the mesh is substantially constant across the mesh.

28. The implant of claim 1, wherein the thickness of the mesh varies across the mesh.

29. The implant of claim 1, wherein the density of the mesh varies across the mesh.

30. The implant of claim 1, wherein the mesh comprises pores of varying size across the mesh.

31. The implant of claim 1, wherein at least some of the mechanical properties of the mesh are substantially omnidirectional.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 is a flow chart illustrating some of the steps in a method for producing an implant for treating tissue defects;

(2) FIGS. 2A and 2B are cross sectional diagrams of an uncondensed surgical mesh implant;

(3) FIG. 2A depicts the round and oval perimeters of monofilament fibres and the fibre cross sections;

(4) FIG. 2B depicts the perimeters and illustrates the area of the mesh available to contact tissue once implanted into a patient also referred to as the area of void for tissue infiltration;

(5) FIGS. 3A and 3B are cross sectional diagrams of the surgical mesh implant of FIGS. 2A and 2B following condensation;

(6) FIG. 3A depicts the altered perimeters and FIG. 3B illustrates the reduced area of the mesh available for tissue contact;

(7) FIGS. 4A-4C are scanning electron micrographs of a surgical mesh before (FIG. 4A) and after (FIG. 4B) condensation and with an attached non-elastic element (FIG. 4C). The implant shown in FIG. 4C may be referred to as a composite implant sling;

(8) FIGS. 5A and 5B are scanning electron micrographs of Prolene Soft Mesh (no condensation) 35 and Mersilene Mesh (no condensation) 35, respectively;

(9) FIGS. 6A-6C are scanning electron micrographs of a polypropylene mesh made as described in Example 3, with no condensation, at 35, 80, and 70, respectively. FIG. 6D is a light micrograph of a polypropylene mesh made as described in Example 3, with no condensation, cross section shown at 125.

(10) FIGS. 7A-7C are scanning electron micrographs of a polypropylene mesh made as described in Example 4, with condensation at a force of 10 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 7D is a light micrograph of a polypropylene mesh made as described in Example 4, with condensation at a force of 10 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(11) FIGS. 8A-8C are scanning electron micrographs of a polypropylene mesh made as described in Example 5, with condensation at a force of 25 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 8D is a light micrograph of a polypropylene mesh made as described in Example 5, with condensation at a force of 25 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(12) FIGS. 9A-9C are scanning electron micrographs of a polypropylene mesh made as described in Example 6, with condensation at a force of 50 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 9D is a light micrograph of a polypropylene mesh made as described in Example 6, with condensation at a force of 50 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(13) FIGS. 10A-10C are scanning electron micrographs of a polypropylene mesh made as described in Example 7, with condensation at a force of 75 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 10D is a light micrograph of a polypropylene mesh made as described in Example 7, with condensation at a force of 75 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(14) FIGS. 11A-11C are scanning electron micrographs of a polypropylene mesh made as described in Example 8, with condensation at a force of 100 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 11D is a light micrograph of a polypropylene mesh made as described in Example 4, with condensation at a force of 100 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(15) FIGS. 12A-12C are scanning electron micrographs of a polypropylene mesh made as described in Example 9, with condensation at a force of 125 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 12D is a light micrograph of a polypropylene mesh made as described in Example 9, with condensation at a force of 125 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(16) FIGS. 13A-13C are scanning electron micrographs of a polypropylene mesh made as described in Example 10, with condensation at a force of 250 N/cm.sup.2, heat application, and vacuum, at 35, 80, and 70, respectively. FIG. 13D is a light micrograph of a polypropylene mesh made as described in Example 10, with condensation at a force of 250 N/cm.sup.2, heat application, and vacuum, cross section shown at 125.

(17) FIGS. 14A-14D are light micrographs of hematoxylin and eosin (H&E) stained 6 mil polypropylene meshes in cross section;

(18) FIGS. 14A and 14C show a non-condensed mesh after implantation for 28 days at 100 and 200, respectively;

(19) FIGS. 14B and 14D show a mesh condensed at a force of 75 N/cm.sup.2, heat application, and vacuum, after implantation for 28 days at 100 and 200, respectively;

(20) FIGS. 15A-15D are light micrographs of trichrome stained 6 mil polypropylene meshes in cross section;

(21) FIGS. 15A and 15C show a non-condensed mesh after implantation for 28 days at 100 and 200, respectively; and

(22) FIGS. 15B and 15D show a mesh condensed at a force of 75 N/cm.sup.2, heat application, and vacuum, after implantation for 28 days at 100 and 200, respectively.

DETAILED DESCRIPTION

(23) Referring to the figures, FIG. 1 illustrates one embodiment of the present methods. While the methods are described further below, they can include the steps of extruding and orienting a polymer into a monofilament fibre; converting the fibre into a surgical mesh; heat setting the surgical mesh; condensing the surgical mesh to a predetermined density; reducing the thickness, void area, and surface contact area of the surgical mesh; forming the surgical mesh into a three-dimensional structure (a subassembly); converting the subassembly into a predetermined shape; cleaning the implant; and packaging and sterilizing the implant.

(24) It will be appreciated that the method described with reference to FIG. 1 is one method according to the invention. However other methods, including only some of the steps described with reference to FIG. 1, also fall within the scope of the invention is suit. It is not essential that all of the steps described with reference to FIG. 1 be included in the method of the invention.

(25) Referring to FIGS. 2A and 2B, schematics of an uncondensed surgical mesh in cross section corresponding to the surgical mesh described in Example 3 and shown in FIG. 6D, monofilament fibres 10 have substantially round or oval perimeters and varying cross sectional area 12 depending upon the plane of the section. Upon implantation, monofilament fibres 10 are in contact with surrounding tissue 14. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(26) Referring to FIGS. 3A and 3B, schematics of a condensed surgical mesh in cross section corresponding to the surgical mesh described in Example 6 and shown in FIG. 10D, the perimeters of monofilament fibres 10 have been altered relative to those of the uncondensed mesh while the total cross sectional area remains constant. Thus, the value of the perimeter in contact with tissue upon implantation and the void area 18 within the implant available for tissue infiltration are both reduced in a condensed mesh relative to an uncondensed mesh.

(27) Referring to FIG. 4A, a scanning electron micrograph of uncondensed polypropylene surgical mesh, monofilament fibres 10 are used to knit a mesh of large pore 20 construction that permits tissue ingrowth upon implantation. Stitch loop intersections 22 are created during the knitting process. The surgical mesh is sold as Prolene Mesh (Ethicon, Somerville, N.J., USA). Referring to FIG. 4B, condensation zones 24 are created at stitch loop intersections 22 following the application of vacuum, heat, and pressure, which compresses monofilament fibres 10 into shapes having lower profiles. Nonelastic fibres 26 are applied to the surgical mesh of FIG. 4C to generate a composite implant.

(28) Referring to FIG. 5A, a scanning electron micrograph of uncondensed polypropylene surgical mesh, monofilament fibres 10 are used to knit a mesh of large pore 20 construction that permits tissue ingrowth upon implantation. Stitch loop intersections 22 are created during the knitting process. The surgical mesh is sold as Prolene Soft Mesh (Ethicon, Somerville, N.J., USA). Referring to FIG. 5B, a scanning electron micrograph of uncondensed polypropylene surgical mesh, multifilament fibres 28 are used to knit a mesh of large pore 20 construction that permits tissue ingrowth upon implantation. Stitch loop intersections 22 are created during the knitting process. The surgical mesh is sold as Mersilene Mesh (Ethicon, Somerville, N.J., USA).

(29) Referring to FIGS. 6A and 6B, scanning electron micrographs of uncondensed polypropylene mesh are shown at 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth upon implantation. Stitch loop intersections 22 are created during the knitting process. Referring to FIG. 6C, a scanning electron micrograph of uncondensed polypropylene mesh, the surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 from a first side to a second side of the surgical mesh (e.g., from the back to the front). Referring to FIG. 6D, a light micrograph of an uncondensed surgical mesh cross section shown at 10. The area of void for tissue infiltration is identified and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(30) Referring to FIGS. 7A and 7B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 10 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are beginning to appear. Referring to FIG. 7C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 10 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 7D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 10 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(31) Referring to FIGS. 8A and 8B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 25 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are shown. Referring to FIG. 8C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 25 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 8D, a light micrograph of a surgical mesh cross section Condensed under vacuum, heat, and a force of 25 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(32) Referring to FIGS. 9A and 9B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 50 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are readily apparent. Referring to FIG. 9C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 50 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 9D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 50 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(33) Referring to FIGS. 10A and 10B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 75 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are readily visible. Referring to FIG. 10C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 75 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 10D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 75 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(34) Referring to FIGS. 11A and 11B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 100 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are readily visible. Referring to FIG. 11C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 100 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 11D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 100 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(35) Referring to FIGS. 12A and 12B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 125 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are readily visible. Referring to FIG. 12C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 125 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 12D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 125 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(36) Referring to FIGS. 13A and 13B, scanning electron micrographs of polypropylene mesh condensed under vacuum, heat, and a force of 250 N/cm.sup.2, magnified 35 and 80, respectively. Monofilament fibres 10 are used to knit the mesh into a large pore 20 construction which permits tissue ingrowth. Stitch loop intersections 22 are created during the knitting process. Condensation zones 24 are readily visible. Referring to FIG. 13C, a scanning electron micrograph of a cross section of a polypropylene mesh condensed under vacuum, heat, and a force of 250 N/cm.sup.2, magnified 70. The surgical mesh thickness profile 30 is determined by the distance between monofilament fibres 10 at the front and back of the condensed surgical mesh. Referring to FIG. 12D, a light micrograph of a surgical mesh cross section condensed under vacuum, heat, and a force of 250 N/cm.sup.2 shown at 10. The area of void for tissue infiltration is outlined and the monofilament fibres 10 having substantially round or oval perimeters and varying cross-sectional area 12 depending on the plane of the section. Where monofilament fibres 10 are in direct contact, a portion of the perimeter 16 is unavailable to contact surrounding tissue 14.

(37) Referring to FIGS. 14A and 14C, a light micrograph of an H&E stained 6 mil uncondensed polypropylene mesh placed subcutaneously in tissue for 28 days, at magnifications of 100 and 200, respectively. Monofilament fibres 10 and the cross sectional areas therein 12 are visible. Inflammatory cells 40 are present in surrounding tissue 14. Fewer inflammatory cells 40 are present around monofilament fibres 10 not in direct contact with tissue 16. Referring to FIGS. 14B and 14D, a light micrograph of an H&E stained 6 mil polypropylene mesh condensed under vacuum, heat, and a force of 75 N/cm.sup.2 and placed subcutaneously in tissue for 28 days, at magnifications of 100 and 200, respectively. Monofilament fibres 10 and the cross sectional areas therein 12 are visible. Inflammatory cells 40 are present in surrounding tissue 14. Fewer inflammatory cells 40 are present around monofilament fibres 10 not in direct contact with tissue 16.

(38) Referring to FIGS. 15A and 15C, a light micrograph of a trichrome stained 6 mil uncondensed polypropylene mesh placed subcutaneously in tissue for 28 days, at magnifications of 100 and 200, respectively. Monofilament fibres 10 and the cross sectional areas therein 12 are visible. Collagen/scar tissue formation 42 is present around the perimeter of monofilament fibres 10 in contact with tissue 14. Referring to FIGS. 15B and 15D, a light micrograph of a trichrome stained 6 mil polypropylene mesh condensed under vacuum, heat, and a force of 75 N/cm.sup.2 and placed subcutaneously in tissue for 28 days, at magnifications of 100 and 200, respectively. Monofilament fibres 10 and the cross sectional areas therein 12 are visible. Collagen/scar tissue formation 42 is present around the perimeter of the fibres in contact with tissue 14. The thickness of the surgical mesh influences the amount of collagen/scar tissue formation 42 as the body responds to an implant by filling voids. The density and organization of the collagen/scar tissue formation is higher for thinner implants with reduced surface area.

(39) Preliminary studies suggest the implants described herein have better properties than many existing devices. Some of the parameters described below are useful in characterizing the improvements.

(40) Void Area Ratio=A.sub.v/A.sub.f where A.sub.f is the area of the fibre cross sections and A.sub.v is the area of void for tissue infiltration. This ratio is particularly important at fibre intersections within the surgical mesh fabric because A.sub.v can increase in these regions when a stitch loop intersection is created. Consequently, a reduced void area is present in the condensed surgical mesh, which can lead to reduced levels of inflammation and scar tissue formation. The devices of the invention can have a Void Area Ratio of 1.50 or lower, whether calculated for the device as a whole or a portion thereof (e.g., at stitch loop intersections or in certain regions of the surgical mesh).

(41) Surface Contact Ratio=P.sub.fc/P.sub.f where P.sub.fc is the perimeter of fibres in contact with tissue for a cross section of the surgical mesh implant and P.sub.f is the perimeter of fibre for a cross section of the surgical mesh implant. This ratio is particularly important at fibre intersections within the surgical mesh fabric because the amount of fibre can increase in these regions when a stitch loop intersection is created. For uncondensed surgical meshes, the Surface Contact Ratio is estimated to approach 1.00 as the fibres are in direct contact only at isolated points and the majority of the fibres present are in contact with tissue. Reduced surface contact between the fibre and tissue is present in the condensed surgical mesh, which can lead to reduced levels of inflammation and scar tissue formation. The devices described herein can have a Surface Contact Ratio of 0.80 or lower whether calculated for the device as a whole or a portion thereof (e.g., at stitch loop intersections or in certain regions of the surgical mesh).

(42) The geometry of the surface contact area of surgical mesh can also be important. The geometry of the condensation zone within condensed surgical meshes is more uniform and distributes force to tissue more evenly. The value for surface contact area under a controlled load can be measured using pressure sensitive film. The surgical mesh is placed adjacent to a pressure sensitive film (e.g., a film containing microcapsules that change colour under certain loads). Film for measuring such values is available under the trade name Prescale (Fujifilm). The surface contact area of the condensed surgical mesh under a controlled load can be measured in this manner. Surface contact areas for surgical meshes of a known density can be compared at different loads. Ideally, a light weight and low surface area surgical mesh with a low area density would have an increase in surface contact area with tissue under a given load to minimize irritation at isolated points. Increased surface contact area in the outer portion of low weight surgical meshes with improved void area ratios and surface contact ratios, may reduce inflammation, tissue reaction, and the erosion of the surgical mesh into adjacent tissue.

(43) The material within the implants described herein can have uniform or non-uniform properties. For example, one or more of the physical attributes described above (e.g., the void area ratio or surface contact ratio) can vary at one or more points within the implant or along the implant's peripheral edge to improve suture or staple retention strength. For example, where the implant is a sheet of mesh, the periphery (e.g., about to about inches around the perimeter of the device) can remain uncondensed or be condensed to a lesser extent than the mesh within the periphery. The strength of material along the peripheral edges (e.g., the tensile strength), or at other selected points within the device, may be higher to improve the physical properties in this region so that sutures or other fixation devices do not pull out and cause failure. The material content in these regions can also be increased relative to that of the starting mesh to improve the physical properties of the device (e.g., additional material can be added to reinforce one or more points within the device). In one embodiment, attachment points such as reinforced areas or openings are created within the device (e.g., along the device's edge) for receiving sutures, staples, adhesives, and the like. The attachment points can also be used to attach separate panels to one another to create the surgical mesh implant. Accordingly, in specific embodiments, the devices can include means to facilitate coupling of an attachment element to the device (e.g., an opening for receiving an attachment element). In some instances, the device can further include all or part of an attachment element (e.g., a staple, suture, or adhesive) to facilitate attachment of the device to body tissue of a patient. The adhesive can be any biological glue or physiologically acceptable adhesive.

(44) Alternatively, or in addition, the implant can include areas that have been adapted to increase the coefficient of friction and thereby inhibit the implant's movement in the tissue. Supporting materials, which may be included to facilitate attachment to a fastener or to generally reinforce the implant, can be shape memory materials (e.g., shape memory alloys such as Nitinol). More generally, any of the implants can include a shape memory material such as Nitinol to facilitate sizing, attachment, and implantation.

(45) The means to maintain the device in position relative to a patient's tissue (i.e., an engagement means) can be employed after implantation or deployment. Where the shape of the device alone is not sufficient to maintain its position, the engagement means can be employed after implantation or deployment. The engagement means can include one or more protrusions (e.g., a plurality of protrusions arranged in a wave-like or dimple-like pattern). Undulating elements may be in phase, with force-displacement characteristics suitable for placement and support.

(46) The overall shape of the implants can vary tremendously and will be selected for use depending upon the size of the individual to be treated and/or the tissue to be repaired. The overall length, width, and shape of the implants can be varied and designed to support a certain area. In one embodiment, the implant includes separate panels that are positioned individually to support a tissue defect. Devices made by the methods described herein can be produced in various three-dimensional forms to facilitate placement and sizing. Generally, the implant can be configured to conform to the shape of the tissue requiring repair. For example, an implant having a curvature can be used to construct a substantially conical shape, and materials can be readily configured to extend circumferentially around a tissue. Essentially any substantially two-dimensional soft tissue implant can be thermoformed into a three-dimensional shape after condensing the surgical mesh.

(47) In one case, a portion of the biocompatible material is movable from a delivery configuration to a deployment configuration. Preferably the delivery configuration is of a lower-profile than the deployment configuration. The device comprises means to support the portion of the biocompatible material in the deployment configuration.

(48) Biocompatible materials useful in monofilament fibre 10 or multifilament fibre 28 can include non-absorbable polymers such as polypropylene, polyethylene, polyethylene terephthalate, polytetrafluoroethylene, polyaryletherketone, nylon, fluorinated ethylene propylene, polybutester, and silicone, or copolymers thereof (e.g., a copolymer of polypropylene and polyethylene); absorbable polymers such as polyglycolic acid (PGA), polylactic acid (PLA), polycaprolactone, polydioxanone and polyhydroxyalkanoate, or copolymers thereof (e.g., a copolymer of PGA and PLA); or tissue based materials (e.g., collagen or other biological material or tissue obtained from the patient who is to receive the implant or obtained from another person or source (e.g., an animal source)). The polymers can be of the D-isoform, the L-isoform, or a mixture of both. An example of a biocompatible fibre 10 suitable for producing the surgical mesh implant is polypropylene. Non-absorbable polymers and copolymers are not substantially resorbed by the body over time, whereas absorbable polymers degrade, to at least some appreciable extent, over time. Polymers and copolymers within commercially available surgical products, including currently available surgical meshes, are suitable for use with the present implants.

(49) One or more layers or pieces of absorbable and non-absorbable mesh can be joined within the implant. For example, an implant can include a nonabsorbable material and an absorbable material of the same size and shape as the nonabsorbable material or a portion thereof. The absorbable material can be configured to reduce the elasticity of the implant and can be thermally attached to the nonabsorbable material.

(50) In some embodiments, biocompatible material within the implant is shaped to distribute the stabilizing and/or supporting force exerted against tissue. The biocompatible material may comprise a surface that distributes forces against the tissue evenly.

(51) Given the woven or knitted configuration of the mesh, the devices can facilitate tissue ingrowth and/or cellular infiltration and are porous. The pores within the devices can be arranged in regular or irregular patterns. For example, a material can include a plurality of pores of a first type (e.g., a first size and/or shape) arranged into a first pattern and of a second type (e.g., a second size or shape) arranged into a second pattern. The size of the pores can vary, and can be greater than 50 m. In specific embodiments, one or more of the pores in the plurality has a diameter, measured along the longest axis of the pore, of about 10 to about 10,000 m (e.g., about 10, 50, 100, 200, 500, 1,000, 2,500, 5,000, 6,000, 7,000, 8,000, or 9,000 m). The pores can vary in shape and, either before or after condensation, may be essentially round, oval, hexagonal or diamond-shaped. One or more of the pores of the plurality may be substantially the same shape as the pores shown in FIG. 6.

(52) The biocompatible material can have a relatively high burst and tensile strength and can have a relatively low co-efficient of friction. In another case, a portion of the base biocompatible material can have a relatively high co-efficient of friction. The devices may also comprise means to determine the magnitude and/or direction of a force (e.g., a force applied to a portion of the biocompatible material when in contact with a patient's tissue). Preferably, the device comprises means to determine the magnitude and/or direction of a force applied to the material by visual inspection. In some embodiments, the geometrical configuration of at least part of the portion of the biocompatible material can be altered in response to a change in the magnitude and/or direction of a force applied. For example, a coloured filament can be incorporated into any of the materials to create a geometry, and one may use an instrument to measure the magnitude and/or direction of a force applied to the device. The soft tissue implant may comprise areas that distribute the force transmitted to the surrounding tissue more evenly. For example, at the fibre intersections, raised fibres can create rough areas that increase the force transmitted to tissue in select areas. Similarly, the implants can include regions that have reduced cross sectional areas, which can reduce inflammation and scar tissue build up. This is especially true at fibre intersections where raised fibres can increase the cross sectional area.

(53) The thickness of the implant can also vary and can be less than about 0.040 inches. For example, a single porous layer of mesh within the device can be less than about 0.039 inches, 0.038 inches, 0.037 inches, 0.036 inches, 0.035 inches, 0.034 inches, 0.033 inches, 0.032 inches, 0.031 inches, 0.030 inches, 0.029 inches, 0.028 inches, 0.027 inches, 0.026 inches, 0.025 inches, 0.024 inches, 0.023 inches, 0.022 inches, 0.021 inches, 0.020 inches, 0.019 inches, 0.018 inches, 0.017 inches, 0.016 inches, 0.015 inches, 0.014 inches, 0.013 inches, 0.012 inches, 0.011 inches, 0.010 inches, 0.009 inches, 0.008 inches, 0.007 inches, 0.006 inches, 0.005 inches, 0.004 inches, 0.003 inches, 0.002 inches, or about 0.001 inch. However, a given implant can include more than one layer of mesh or regions in which some portion of the mesh is covered with a second layer. For example, an implant can include a first porous biocompatible surgical mesh and a second porous biocompatible surgical mesh, the thickness of the implant being less than about 0.080 inches.

(54) The implants can be produced by extruding a biocompatible polymer into a fibre and forming a surgical mesh implant using a textile based process. As noted, the implants are designed to engage a tissue defect and can include a bioresorbable or biodegradable material that will stay in position and support the tissue defect over a predetermined time. The implants can be produced by a number of different methods. In one embodiments, the implants are produced by extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; heat setting the surgical mesh fabric; applying a nonelastic biocompatible material to the surgical mesh fabric; compressing the surgical mesh fabric to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape. In this method or any other, the method may further include the steps of cleaning and/or sterilizing the implant. Once formed, the implants can be packaged for sale or distribution.

(55) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; compressing the mesh fabric for a controlled period of time to a predetermined density using a combination of heat and pressure; heat setting the surgical mesh fabric; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(56) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; compressing the mesh fabric for a controlled period of time to a predetermined density using a combination of heat and pressure with a vacuum source; heat setting the surgical mesh fabric; compressing the surgical mesh fabric to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(57) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; stretching the surgical mesh fabric under a predetermined load; heat setting the surgical mesh fabric; applying a nonelastic biocompatible material to the surgical mesh fabric; compressing the surgical mesh fabric to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(58) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; heat treating the surgical mesh fabric in a manner that creates a mesh with varying pore dimensions; applying a nonelastic biocompatible material to the surgical mesh fabric; compressing the surgical mesh fabric to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(59) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; heat setting the surgical mesh fabric; applying a nonelastic biocompatible material to the surgical mesh fabric; selectively compressing the surgical mesh fabric in certain regions to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(60) Other methods include: extruding a first biocompatible polymer to form a fibre; forming a surgical mesh fabric from the fibre; heat setting the surgical mesh fabric; applying a nonelastic biocompatible material to the surgical mesh fabric; selectively compressing the surgical mesh fabric to varying degrees in certain regions to a predetermined density; reducing the thickness and roughness of the surgical mesh fabric; forming the surgical mesh fabric into a three-dimensional structure; and cutting the soft tissue implant into a predetermined shape.

(61) A soft tissue implant can be created with a surface that has controlled texture and geometry by subjecting the mesh fabric to the above processes while in contact with a textured surface and shaped geometry at temperatures and pressures that are sufficient to permanently alter the surgical mesh implant characteristics.

(62) Medical applications for the soft tissue implant technology described herein include but are not limited to procedures for treating stress urinary incontinence, pelvic floor prolapse, and hernia repair. The soft tissue implant can be produced or selected in a variety of shapes and sizes and from a variety of materials for a particular indication. For example, a surgeon may select a non-absorbable implant for patients that require permanent treatment with an implant having long-term durability and strength. Alternatively, the surgeon may select an absorbable soft tissue implant for patients that require temporary treatment and tissue remodelling. Generally, absorbable implants are chosen when possible to avoid the potential complications associated with a permanent implant. Consistent with the properties described herein, the surgeon can move the devices from a delivery configuration to a deployment configuration, the delivery configuration being of a lower-profile than the deployment configuration. Implants with a reduced profile can be produced and implanted in a minimally invasive fashion; as they are pliable, they can be placed or implanted through smaller surgical incisions. As the devices are also porous, they are expected to have improved optical properties, allowing the surgeon to visualize underlying tissue through the implant.

EXAMPLES

Example 1

(63) We constructed an implant using polypropylene surgical mesh. A section of PML Prolene Mesh (Ethicon, Somerville, N.J., USA) was combined with a #2 SurgiPro polypropylene suture (Tyco Healthcare, North Haven, Conn., USA) to create a composite implant. The suture material was woven between the surgical mesh in 5 mm increments. The assembly was brought under vacuum to 160 C. under a force of 100 N/cm.sup.2 between two layers of Apical 5 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press. The surgical mesh had a thickness of 0.0193 inches before the pressure and heat treatment and a thickness of 0.0093 inches after the treatment. In addition, the composite assembly exhibited a lower elasticity compared to the untreated (uncondensed) surgical mesh.

Example 2

(64) A section of SPMXXL Prolene Mesh (Ethicon, Somerville, N.J., USA) was combined with a #2 SurgiPro polypropylene suture (Tyco Healthcare, North Haven, Conn., USA) to create a composite implant. The suture material was woven between the surgical mesh in 5 mm increments. The assembly was brought under vacuum to 160 C. under a force of 100 N/cm.sup.2 between two layer of Apical 5 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press. The surgical mesh had a thickness of 0.0159 inches before the pressure and heat treatment and a thickness of 0.0090 inches after the treatment. In addition, the composite assembly exhibited a lower elasticity compared to the original surgical mesh.

Example 3

(65) We constructed a knitted polypropylene surgical mesh implant using 4 mil monofilament polypropylene fibre. The fibre was produced using Marlex HGX-030-01 polypropylene homopolymer. The knitted surgical mesh had elasticity in the machine and transverse directions. A warp knit was employed to give the mesh exceptional tensile strength and to prevent runs and unravelling. A suitable mesh is produced when employing the following pattern wheel or chain drum arrangements: front guide bar, 1-0/1-2/2-3/2-1 and back guide bar, 2-3/2-1/1-0/1-2. Examples 4-10 are similar. They differ in the amount of force applied to the mesh, from 10 N/cm.sup.2 to 250 N/cm.sup.2, respectively.

Example 4

(66) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 10 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 5

(67) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 25 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 6

(68) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 50 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 7

(69) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 75 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 8

(70) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 100 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 9

(71) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 125 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

Example 10

(72) The surgical mesh implant disclosed in Example 3 was condensation treated. The surgical mesh implant was brought to 155 C. under 250 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press.

(73) The void area ratio of the materials described in Examples 3-10 was measured according to method described previously. The void area ratio measures the ratio of the area of the fibre cross sections and the area of void for tissue infiltration. This ratio was measured at fibre intersections within the surgical mesh fabric. A reduced void area is present in the condensed surgical mesh. It should be noted, however, that an increase in the force applied to the monofilament surgical mesh can cause damage to the fibres, which results in higher void area ratios.

(74) Void Area Ratio

(75) TABLE-US-00002 Force Void Area Product (N/cm.sup.2) Ratio Example 3 0 3.26 Example 4 10 1.74 Example 5 25 1.22 Example 6 50 0.68 Example 7 75 0.70 Example 8 100 0.56 Example 9 125 2.00 Example 10 250 1.71

(76) The surface contact ratio of the materials described in Examples 3-10 was measured according to the method described previously. The surface contact ratio measures the ratio of the perimeter of fibres in contact with tissue to the perimeter of fibres for a cross section. This ratio was measured at fibre intersections within the surgical mesh fabric. A reduced surface contact area is present in the condensed surgical mesh.

(77) Surface Contact Ratio

(78) TABLE-US-00003 Force Surface Contact Product (N/cm.sup.2) Ratio Example 3 0 0.88 Example 4 10 0.91 Example 5 25 0.69 Example 6 50 0.70 Example 7 75 0.52 Example 8 100 0.46 Example 9 125 0.62 Example 10 250 0.76

(79) The dimensions of the materials described in Examples 3-10, Prolene Soft mesh, and Mersilene Mesh were measured according to ASTM D5947-03 Standard Test Methods for Physical Dimensions of Solid Plastics Specimens. The thickness of the materials impacts the cross sectional area of the surgical mesh implants. In addition, the density of the material provides a measurement to determine the amount of material as it relates to cross sectional area. The density should correlate to the Void Area Ratio described above for condensed surgical mesh implants. The thickness decreases and the density increases with an increase in the condensation force applied per unit area.

(80) Thickness

(81) TABLE-US-00004 Force Thickness Product (N/cm.sup.2) (cm) Prolene Soft Mesh 0 0.040 Mersilene Mesh 0 0.024 Example 3 0 0.039 Example 4 10 0.026 Example 5 25 0.021 Example 6 50 0.019 Example 7 75 0.016 Example 8 100 0.015 Example 9 125 0.014 Example 10 250 0.011
Density

(82) TABLE-US-00005 Force Density Product (N/cm.sup.2) (g/cm.sup.3) Prolene Soft Mesh 0 0.081 Mersilene Mesh 0 0.130 Example 3 0 0.086 Example 4 10 0.097 Example 5 25 0.114 Example 6 50 0.123 Example 7 75 0.143 Example 8 100 0.171 Example 9 125 0.208 Example 10 250 0.237

(83) The burst strength of the materials described in Examples 3-10, Prolene Soft mesh, and Mersilene Mesh was measured according to ASTM D3787-01 Bursting Strength of Textiles (Constant Rate of Transverse). Test specimens measuring 90.0 mm wide and 90.0 mm long were loaded into a Zwick tensile test machine with a grip to grip separation of 1.0 mm and a test speed of 305 mm/min. Burst strength provides a measurement of the force required to rupture the surgical mesh implants. In addition, the ratio of density/thickness to burst strength provides a measurement of surgical mesh implant strength as it relates to the cross sectional area. The burst strength increased moderately with increase in the condensation force applied per unit area up to 125 N/cm.sup.2. The sample with a condensation force of 250 N/cm.sup.2 showed a decrease in burst strength.

(84) Burst

(85) TABLE-US-00006 Force Burst Product (N/cm.sup.2) (Fmax N) Prolene Soft Mesh 0 274 Mersilene Mesh 0 129 Example 3 0 194 Example 4 10 222 Example 5 25 210 Example 6 50 225 Example 7 75 223 Example 8 100 209 Example 9 125 227 Example 10 250 195
Density/Burst Ratio

(86) TABLE-US-00007 Force Density (g/cm.sup.3)/Burst Product (N/cm.sup.2) (Fmax N) Prolene Soft Mesh 0 0.00030 Mersilene Mesh 0 0.00101 Example 3 0 0.00044 Example 4 10 0.00044 Example 5 25 0.00054 Example 6 50 0.00055 Example 7 75 0.00064 Example 8 100 0.00082 Example 9 125 0.00092 Example 10 250 0.00121

(87) The suture retention of the materials described in Examples 3-10, Prolene Soft mesh, and Mersilene Mesh was measured according to ASTM D882-02 Standard Test Method for Tensile Properties of Thin Plastic Sheeting. Test specimens measuring 25.4 mm wide by 75.0 mm long were loaded into a Zwick tensile test machine with a grip to grip separation of 3.0 mm and a test speed of 500 mm/min. Materials were tested in the machine and transverse directions. Suture retention provides a measurement of the force required to disrupt the edge of the material. The suture retention strength was maintained with an increase in the condensation force applied per unit area up to 75 N/cm.sup.2. The samples with a condensation force of 100 and 125 N/cm.sup.2 showed a moderate decrease in suture retention strength and the samples with a condensation force of 250 N/cm.sup.2 showed a more significant decrease.

(88) Suture Machine

(89) TABLE-US-00008 Force Suture Machine Product (N/cm.sup.2) (Fmax N) Prolene Soft Mesh 0 24.8 Mersilene Mesh 0 10.0 Example 3 0 21.2 Example 4 10 20.0 Example 5 25 22.4 Example 6 50 17.4 Example 7 75 20.5 Example 8 100 16.2 Example 9 125 15.6 Example 10 250 9.3
Suture Transverse

(90) TABLE-US-00009 Force Suture Transverse Product (N/cm.sup.2) (Fmax N) Prolene Soft Mesh 0 28.4 Mersilene Mesh 0 11.7 Example 3 0 21.4 Example 4 10 20.8 Example 5 25 18.8 Example 6 50 20.2 Example 7 75 20.0 Example 8 100 20.3 Example 9 125 17.3 Example 10 250 12.0

(91) The stiffness of the materials described in Examples 3-10, Prolene Soft mesh, and Mersilene Mesh was measured according to ASTM D4032-94 Stiffness of Fabric by the Circular Bend Procedure. Test specimens measuring 102.0 mm wide and 204.0 mm long were loaded into a Zwick tensile test machine with a grip to grip separation of 1.0 mm and a test speed of 300 mm/min. The test measures the force required to move a specimen through a circular area. It should be noted that stiffer materials may cause more irritation to surrounding tissues. The stiffness values of the condensed surgical mesh were equivalent to the uncondensed with increase in the condensation force applied per unit area up to 125 N/cm.sup.2. The sample with a condensation force of 250 N/cm.sup.2 showed an increase in stiffness.

(92) Stiffness

(93) TABLE-US-00010 Force Stiffness Product (N/cm.sup.2) (Fmax N) Prolene Soft Mesh 0 3.13 Mersilene Mesh 0 0.55 Example 3 0 2.35 Example 4 10 1.90 Example 5 25 2.35 Example 6 50 2.16 Example 7 75 2.03 Example 8 100 2.37 Example 9 125 2.34 Example 10 250 2.98

(94) The tensile strength of the materials described in Examples 3-10, Prolene Soft mesh, and Mersilene Mesh was measured according to ASTM D882-02 Standard Test Method for Tensile Properties of Thin Plastic Sheeting. Test specimens measuring 10.0 mm wide and 100.0 mm long were loaded into a Zwick tensile test machine with a grip to grip separation of 50.0 mm and a test speed of 500 mm/min. Materials were tested in the machine and transverse directions. Tensile strength provides a measurement of the force required to rupture the surgical mesh implants under tension. The tensile strength was maintained with an increase in the condensation force applied per unit area up to 75 N/cm.sup.2. The samples with a condensation force of 100 and 125 N/cm.sup.2 showed a moderate decrease in tensile strength and the samples with a condensation force of 250 N/cm.sup.2 showed a more significant decrease.

(95) Tensile Machine

(96) TABLE-US-00011 Force Tensile Machine Product (N/cm.sup.2) (N/cm) Prolene Soft Mesh 0 27.75 Mersilene Mesh 0 27.16 Example 3 0 21.76 Example 4 10 21.70 Example 5 25 23.14 Example 6 50 21.46 Example 7 75 24.37 Example 8 100 21.20 Example 9 125 19.94 Example 10 250 15.31
Tensile Transverse

(97) TABLE-US-00012 Force Tensile Transverse Product (N/cm.sup.2) (N/cm) Prolene Soft Mesh 0 20.97 Mersilene Mesh 0 15.04 Example 3 0 17.37 Example 4 10 16.69 Example 5 25 17.55 Example 6 50 18.02 Example 7 75 16.29 Example 8 100 16.41 Example 9 125 15.40 Example 10 250 12.39

Example 11

(98) We constructed a knitted polypropylene surgical mesh implant using 4 mil monofilament polypropylene fibre. The fibre was produced using Marlex HGX-030-01 polypropylene homopolymer. A warp knit was employed to give the mesh exceptional tensile strength and to prevent runs and unravelling. A suitable mesh is produced when employing the following pattern wheel or chain drum arrangements: front guide bar, 1-0/1-2/2-3/2-1 and back guide bar, 2-3/2-1/1-0/1-2. The knitted surgical mesh had elasticity in the machine and transverse directions. The elasticity, however, was not uniform in the machine and transverse directions. The elasticity was higher in the transverse direction compared to the machine direction. To compensate for this difference, a sample measuring 33 cm in the machine direction and 45 cm in the transverse direction was stretched to 48 cm in the transverse direction while being held at 33 cm in the machine direction. The surgical mesh implant, while being held under tension, was condensation treated. The surgical mesh implant was brought to 155 C. under 75 N/cm.sup.2 with vacuum between two layers of Kapton 2 mil polyimide film using a Lauffer RLKV 40/1 vacuum lamination press. The difference in elasticity between the transverse and machine directions was reduced.

(99) A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention.