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    • 专利摘要:
    EMERGENCY PACKAGING AND SELF-RETENTION SUTURES. The present invention relates to a removable self-retaining suture system and methods for using it in emergency situations. The system comprises one or more self-retaining suture segments and a gripping engagement element. The system can be used for temporary wound closure in a trauma victim, and can be easily removed if appropriate medical care is available for the victim.
    公开号:BR112013011582B1
    申请号:R112013011582-3
    申请日:2011-11-09
    公开日:2020-10-20
    发明作者:William L. D'agostino；Matt Merkel；Ron Bowser；Mark Hoyt
    申请人:Ethicon Llc；
    IPC主号:
    专利说明:

    [0001] This application claims the benefit under 35 USC § 119 (e) of provisional patent application No. US 61 / 411,918 filed on November 9, 2010, and provisional patent application No. US 61 / 412,389, filed on 10 November 2010, whose provisional requests are hereby incorporated by reference in their entirety. FIELD OF THE INVENTION
    [0002] The present invention relates, in general, to filaments for surgical procedures, methods of making filaments for surgical procedures, and the use thereof. BACKGROUND OF THE INVENTION
    [0003] Wound closure devices such as sutures, staples and pins have been widely used in superficial and deep surgical procedures in humans and animals for wound closure, repair of traumatic injuries or defects, joining tissues together (approximating the separated tissues, closing an anatomical space, fixing layers of single or multiple tissues, creating an anastomosis between two hollow / luminous structures, adjacent tissues, fixation or refixation of tissues in their correct anatomical location), fixation of elements foreign to the tissues (fixation medical implants, devices, prostheses and other functional or support devices), and for repositioning tissues in new anatomical locations (repairs, tissue elevations, tissue grafting and related procedures), to name just a few examples.
    [0004] Sutures are often used as devices for closing wounds. Sutures typically consist of a filamentary suture thread attached to a needle with a sharp tip. Suture threads can be produced from a variety of materials including bioabsorbable materials (ie, decompose completely in the body over time), or non-absorbable materials (permanent; non-degradable). It has been observed that absorbable sutures are particularly useful in situations where suture removal could impair repair or when the natural healing process makes the support provided by the suture material unnecessary after the wound has completed healing; as, for example, when finishing a skin closure without complications. Non-degradable (non-absorbable) sutures are used on wounds where healing can be expected to take a long time or where suture material is needed to provide physical support to the wound over long periods of time; such as, for example, deep tissue repairs, high-tension wounds, many orthopedic repairs and some types of surgical anastomoses. In addition, a wide variety of surgical needles are available, and the shape and size of the needle body and the needle tip configuration are typically selected based on the needs of the specific application.
    [0005] To use a common suture, the suture needle is moved through the desired tissue on one side of the wound and then through the adjacent side of the wound. The suture is then formed into a "loop", which is completed by tying a knot in the suture to fix the closed wound. Tying the knot takes some time and causes a range of complications, including, but not limited to, (i) expulsion (a condition in which the suture, usually a knot, pushes through the skin after a subcutaneous closure), (ii ) infection (bacteria are often able to settle and grow in the spaces created by the node), (iii) volume / mass (a significant amount of suture material left in a wound is the portion that comprises the node), (iv) slip (the nodes may slip or come loose), and (v) irritation (the nodes serve as a bulky "foreign body" in an injury). The suture ties associated with knot tying can lead to ischemia (the knots can create tension points that can strangle tissue and limit blood flow to the region) and increase the risk of dehiscence or rupture in the wound. Tying the knot is also labor intensive and can comprise a significant percentage of the time it takes to close a surgical wound. Additional operating procedure time is not only bad for the patient (complication rates increase with time spent on anesthesia), but also contributes to the total cost of the operation (many surgical procedures are estimated at between $ 15 and $ 30 per minute of operating time).
    [0006] Self-retaining sutures (including barbed sutures) differ from conventional sutures in that self-retaining sutures have numerous retaining tissues (such as splinters) that anchor the self-retaining suture in a tissue after positioning and resist movement of the suture in the opposite direction the ones that the retainers are facing, thus eliminating the need to tie the knots to fix the adjacent fabrics together (a "knotless" closure). Knotless tissue approximation devices that have splinters have previously been described in, for example, U.S. Patent No. 5,374,268, featuring reinforced anchors that have splinter-like projections, while sets of sutures that have barbed side members have been described. in US Patent Nos. 5,584,859 and 6,264,675. Sutures that have a plurality of barbs positioned along a larger portion of the suture are described in US Patent No. 5,931,855, which features a unidirectional barbed suture, and US Patent No. 6,241,747, which features a bidirectional barbed suture. . Methods and apparatus for forming splinters in sutures have been described, for example, in US Patent Nos. 6,848,152. Self-retaining systems for wound closure also result in a better approximation of the wound edges, evenly distribute the tension along the length of the wound (reducing areas of tension that can break or lead to ischemia), reduce the volume of the suture material remaining in the wound (by removing the knots) and reduce expulsion (the extrusion of suture material - typically knots) across the skin surface. All of these features are designed to reduce the formation of scars, improve cosmesis, and increase wound resistance in relation to wound closure with simple sutures or staples. Thus, self-retention of sutures, since such sutures prevent knot tying, allows patients to experience a better clinical outcome, and also saves time and costs associated with prolonged surgery and follow-up treatments. It is noted that all patents, patent applications and patent publications identified throughout the present description are hereby incorporated by reference in their entirety.
    [0007] The ability of self-retaining sutures to anchor and fix tissues in place, even in the absence of tension applied to the suture by a knot, is a feature that also provides superiority over simple sutures. When closing a wound that is under tension, this advantage manifests itself in several ways: (i) the self-retaining sutures have a multiplicity of retainers that can dissipate the tension along the entire length of the suture (by providing hundreds of stitches " anchor ", this produces a superior cosmetic result and reduces the chance that the suture will" slide "or pass through) as opposed to sutures interrupted with knots that concentrate tension at different points; (ii) complicated wound geometries can be closed (circles, arcs, uneven edges) evenly with more precision and accuracy than those obtained with interrupted sutures; (iii) self-holding sutures eliminate the need for a "third hand", which is often necessary to maintain tension throughout the wound during traditional suturing and knot tying (to prevent "slipping" when the tension is released momentarily during mooring); (iv) self-retaining sutures are superior in procedures where knot tying is technically difficult, such as for deep wounds or laparoscopic / endoscopic procedures; and (v) self-retaining sutures can be used to approximate and fix the wound before definitive closure. As a result, self-retaining sutures provide easier handling in anatomically tight or deep locations (such as the pelvis, abdomen and chest) and facilitate the approximation of tissues in laparoscopic / endoscopic and minimally invasive procedures; all without having to hold the knot closed. Greater precision allows the self-retaining sutures to be used in more complex closure systems (such as those with unpaired diameters, larger defects or pouch thread sutures) that can be performed with simple sutures.
    [0008] The advantages of greater precision and time savings provided by self-retaining sutures may be more evident when surgical conditions are less than ideal. In areas of armed conflict, natural disaster zones, terrorist attack sites and other emergency situations, wound closure (and other tissue approach) can be performed more quickly, easily and effectively with self-retaining sutures than with your conventional counterparts and could potentially potentially save more lives. Eliminating the need for us would not only allow the first person to provide help to close a wound more quickly, but it would also allow a nurse, surgeon or other health care team to remove the temporary or emergency closure more quickly in order to treat the victim. of trauma.
    [0009] For example, to treat soldiers with traumatic injuries on a battlefield, a military doctor needs to quickly close external wounds and quickly transport the injured patient to the nearest field hospital. Then, at the field hospital, medical personnel need to remove the sutures from the wound and start surgery. Knotless wound closure made possible by self-retaining sutures provides a significant advantage for rapid closure in the field. Similarly, the self-retaining sutures can be easily and quickly removed from the tissue by locating the transition segment of a bidirectional suture, moving it apart, and then removing the remaining suture segments through each distal end. , or positioning, of the segment. (Similarly, in the case of a unidirectional suture, the anchor can be removed and the suture segment removed from the tissue through its positioning end). Given the time constraints presented by the consequences of the battle, in which victims of multiple traumas would be brought in for treatment at once, in surgical conditions sometimes less than ideal, as well as the potentially complex nature of wounds carried by those injured in combat, the Rapid identification of the restriction point of the self-retaining suture in a wound closure can be difficult.
    [00010] A self-holding suture can be unidirectional, which has one or more retainers oriented in one direction along the length of the suture; or bidirectional, typically having one or more retainers oriented in one direction along one portion of the thread, followed by one or more retainers oriented in another (often opposite) direction over a different portion of the thread (as described in relation to the retainers barbed wire in US Patent Nos. 5,931,855 and 6,241,747). Although any number of sequential or intermittent retainer configurations is possible, a common form of bidirectional self-holding suture involves a needle at one end of a suture that has burrs that have tips projecting "away" from the positioning end of suture (which can be sharpened enough to penetrate the tissue itself or can have a needle attached to it) until the transition portion of the suture is reached; in the transition portion, the burr configuration is inverted by about 180 ° (so that the burrs are now facing the opposite direction) along the remaining length of the suture prior to attachment to a second needle at the opposite end ( with the result that the burrs on that portion of the suture also have points protruding "away" from the nearest needle). Projecting "away" from the needle means that the tip of the burr is further away from the needle and the suture portion comprising the burr can be pulled more easily along the fabric in the direction of the needle than in the opposite direction. In other words, the splinters in both "halves" of a typical two-way self-holding suture have points that point in the middle direction, with a transition segment (without splinters) interposed between them, and with a needle attached to either end. BRIEF SUMMARY OF THE INVENTION
    [00011] Given the advantages of self-retaining sutures, we want to provide improved self-retaining sutures and methods useful in emergency situations, for wound closure and tissue approximation in suboptimal surgical conditions, such as and areas of armed conflict and disaster Natural.
    [00012] According to one aspect, the present invention provides bidirectional self-holding sutures that have gripping engagement elements to facilitate suture positioning and subsequent removal.
    [00013] According to another aspect, the present invention provides unidirectional self-retaining sutures that have gripping engagement elements to facilitate suture positioning and subsequent removal.
    [00014] In another aspect, the present invention provides multidirectional self-retaining sutures that have gripping engagement elements to facilitate suture positioning and subsequent removal.
    [00015] In another aspect, the present invention provides methods of positioning and subsequently removing self-retaining sutures that have gripping engagement elements.
    [00016] In another aspect, the present invention provides self-retaining sutures that have detachable gripping elements.
    [00017] The following are exemplary modalities of the present invention:
    [00018] Mode 1: Removable bidirectional self-holding suture, the suture comprising: a. a first end, a second end and a periphery; B. a plurality of retainers, wherein the retainers in a first portion of the suture between the first suture end and a first axial location in the suture allow movement of the suture along the tissue in a direction of movement of the first end and prevent movement of the suture at the along the tissue in a direction opposite to the direction of movement of the first end, and the retainers in a second portion of the suture between the second end of the suture and a second axial location in the suture allow movement of the suture along the tissue in a direction of movement from the second end and avoid movement of the suture along the tissue in a direction opposite to the direction of movement of the second end; and c. a gripping engagement element between the first and the second axial locations.
    [00019] Mode 2: The suture of mode 1, the gripping element comprising a loop.
    [00020] Mode 3: The suture of mode 2, the loop being discontinuous.
    [00021] Mode 4: The suture of mode 1, the gripping element comprising a flap.
    [00022] Mode 5: The suture of mode 1, the gripping element comprising a suture segment that has a lock at each end of it, to prevent entry of said suture segment in the tissue.
    [00023] Mode 6: The suture of mode 1, with the gripping element comprising a different color from the rest of the suture.
    [00024] Mode 7: The suture of mode 6, the suture additionally comprising a frangible portion between the gripping engaging element and the first and second axial locations to facilitate removal of the gripping engaging element from the suture.
    [00025] Mode 8: The suture of mode 6, the gripping element comprising, additionally, an intensified gripping surface.
    [00026] Mode 9: The suture of mode 1, the gripping element having a periphery superior to the periphery of the suture.
    [00027] Mode 10: The suture of mode 9, the suture additionally comprising a frangible portion between the gripping engaging element and the first and second axial locations to facilitate removal of the gripping engaging element from the suture.
    [00028] Mode 11: The suture of mode 9, the grip element comprising, additionally, an intensified grip surface.
    [00029] Mode 12: The suture of mode 1, the gripping element comprising, additionally, an intensified gripping surface.
    [00030] Mode 13: The suture of mode 1, the suture additionally comprising a frangible portion between the gripping engagement element and the first and second axial locations to facilitate removal of the gripping engagement element from the suture.
    [00031] Mode 14: The suture of mode 1, which additionally comprises a detachable connector that connects the gripping element and the suture.
    [00032] Mode 15: The suture of mode 1, the gripping element being, at least in part, flexible.
    [00033] Mode 16: The suture of mode 1, the gripping element being, at least in part, rigid.
    [00034] Mode 17: The suture of mode 1, the gripping element comprising a material different from the rest of the suture.
    [00035] Mode 18: The suture of mode 2, the loop configuration being selected from the class comprising circles, ellipses and polygons.
    [00036] Mode 19: Removable multidirectional self-holding system comprising: a. a gripping engagement element; B. at least three suture segments, each suture segment having a plurality of retainers between the first end of the suture segment and the second end of the suture segment allows movement of the suture along the tissue in a direction of movement of the first end and prevents movement of the suture segment along the tissue in a direction opposite to the direction of movement of the first end, and a second end of each suture segment is attached to the gripping engagement element.
    [00037] Mode 20: The system of mode 19, with the gripping element comprising a loop.
    [00038] Mode 21: The system of mode 20, the loop being discontinuous.
    [00039] Mode 22: The system of mode 19, the gripping element comprising a flap.
    [00040] Mode 23: The system of mode 19, the gripping element comprising a suture segment that has a lock at each end of it, to prevent entry of said suture segment into the tissue.
    [00041] Mode 24: The system of mode 20, the loop being circular.
    [00042] Mode 25: The system of mode 20, the loop being elliptical.
    [00043] Mode 26: The system of mode 20, the loop being polygonal.
    [00044] Mode 27: Emergency wound closure method comprising: a. provide a bidirectional self-holding suture that has a plurality of retainers, where the retainers in a first portion of the suture between the first end of the suture and a first axial location in the suture allow movement of the suture along the tissue in a direction of movement of the and prevent movement of the suture along the tissue in a direction opposite to the direction of movement of the first along the tissue in a direction of movement of the second end and prevent movement of the suture along the tissue in a direction opposite to the direction of movement of the second end; B. insert the first end of the suture into the tissue at a first insertion point between the first and second ends of the wound; ç. extracting the first end of the suture towards the first end of the wound along a first positioning path along the tissue on alternate sides of the wound to a first exit point; d. insert the second end of the suture into the tissue at a second insertion point between the first and second ends of the wound, leaving a portion of the suture between the first and second insertion points; and. extracting the second end of the suture in the direction of the second end of the wound along a second positioning path along the tissue on alternate sides of the wound to a second exit point; and, f. spread the suture along the portion between the first and second insertion points to remove the suture from the wound before providing permanent treatment.
    [00045] Mode 28: The method of mode 27, the step of inserting the second end of the suture into the tissue is carried out before the step of extracting the first end of the suture in the direction of the first end of the wound.
    [00046] Mode 29: Emergency wound closure method, comprising: a. provide a unidirectional self-holding suture, in which the suture has a plurality of retainers between a first and a second suture ends to allow movement of the suture along the tissue in a direction of movement of the first end and to prevent movement of the suture along the tissue in a direction opposite to the direction of movement of the first end, and a gripping engagement element at the second end of the suture; B. positioning the gripping engagement element, at least in part, out of the wound; ç. insert the first end of the suture into the tissue at an insertion point in the wound; and, d. extract the first end of the suture in the direction of one end of the wound along a positioning path along the tissue on alternate sides of the wound to an exit point outside the tissue.
    [00047] Mode 30: The method of mode 29, with the unidirectional suture additionally comprising a frangible portion proximal to the gripping engagement element.
    [00048] Mode 31: Emergency wound closure method comprising: a. providing a multidirectional self-holding system, wherein the system has a gripping engagement element and at least two suture segments, each suture segment having a plurality of retainers between a first end of the suture segment and a second end of the suture segment to allow movement of the suture along the tissue in a direction of movement of the first end and to prevent movement of the suture segment along the tissue in a direction opposite to the direction of movement of the first end, and a second end of each suture segment is attached to the gripping engagement element; B. positioning the gripping engagement element, at least in part, out of the wound; ç. inserting the first end of a first suture segment into the tissue at a first insertion point in the wound; d. extracting the first end of the first suture segment in the direction of a first wound end along a first positioning path along the tissue on alternate sides of the wound to a first exit point; and. inserting the first end of a second suture segment into the tissue at a second insertion point proximal to the first insertion point; and, f. extracting the first end of the second suture segment in the direction of a second wound end along a second positioning path along the tissue on alternate sides of the wound to a second exit point.
    [00049] Mode 32: The method of mode 31, the self-holding system comprising at least a third suture segment that has a plurality of retainers between a first end of the suture segment and a second end of the suture segment to allow movement of the suture along the tissue in a direction of movement of the first end and to prevent movement of the suture segment along the tissue in a direction opposite to the direction of movement of the first end, where the second end of the third suture segment is fixed to the gripping coupling element. Mode 33: The method of mode 32, which further comprises inserting the first end of the third suture segment into the tissue at a third insertion point proximal to at least one of the first and second insertion points, and extracting the first end from the third suture segment towards a third wound end along a third positioning path along the tissue on alternate sides of the wound to a third exit point. Modality 34: The method of modality 312, with the gripping element comprising the connection between the suture segments.
    [00050] Mode 35: Method of performing an emergency closure of a star-like wound that has at least three tissue apexes, comprising:
    [00051] a. provide a multidirectional self-holding system, in which the system has a gripping engagement element and at least three suture segments, each suture segment having a plurality of retainers between a first end of the suture segment and a second end of the suture segment to allow movement of the suture along the tissue in a direction of movement of the first end and to prevent movement of the suture segment along the tissue in a direction opposite to the direction of movement of the first end, and in which a second end each suture segment is attached to the gripping engagement element; B. position the engaging element proximal to the tissue apexes; ç. inserting the first end of a first suture segment into a first apex of tissue and extracting the first end of the first suture segment of the tissue; d. inserting the first end of a second suture segment into a second apex of tissue and extracting the first end of the second suture segment from the tissue; and is. insert the first end of a third suture segment into the tissue at a third apex of tissue and extract the first end of the third suture segment from the tissue.
    [00052] Mode 36: Method of removing an emergency self-retaining suture from the tissue, in which the suture has at least one self-retaining suture segment, the suture segment having a first end connected to the gripping engagement element and a second end, the method comprising: a. moving the gripping member away from the suture segment; and, b. extract the suture segment of the tissue through its second end.
    [00053] Mode 37: A package for retaining a suture device that has a gripping engagement element attached to at least one suture segment that has a distal end, the package comprising a. a base that has at least one surface; and, b. a segment retainer for releasably securing the suture segment to the base; and, c. a gripper engaging member retainer to releasably clamp the gripping engaging element to the base.
    [00054] Mode 38: The packaging of mode 37, with the segment retainer and the gripping coupling element retainer being positioned to segregate the segment and the gripping coupling element.
    [00055] Mode 39: The packaging of mode 37, which additionally includes an additional segment retainer.
    [00056] Mode 40: The packaging of mode 39, the additional segment retainer being adapted to segregate an additional segment of the segment and the gripping coupling element.
    [00057] Modality 41: The packaging of modality 37, the retainer of the gripping element being adapted to place the device in contact or close to the gripping element while securing the gripping element to the base.
    [00058] Mode 42: The 37 or 38 mode packaging, with the segment retainer being adapted to place the device in contact or close to the distal end of the segment while securing the segment to the base.
    [00059] Mode 43: The 37 or 38 mode packaging, with at least one retainer comprising multiple sections.
    [00060] Mode 44: The 37 or 38 mode packaging, at least one retainer is removable from the packaging.
    [00061] Mode 45: The 37 or 38 mode package, which additionally comprises a segment guide for positioning a portion of the at least one suture segment.
    [00062] Mode 46: The packaging of mode 37, the segment retainer being a space for a needle.
    [00063] Mode 47: The packaging of mode 37, which additionally comprises an external housing.
    [00064] Mode 48: The packaging of mode 47, the outer housing being adapted to retain at least one of a needle driver and scissors.
    [00065] Mode 49: A trauma kit comprising: d. an external housing; and. a suture package containing a self-retaining suture that has a gripping member attached to at least one suture segment.
    [00066] Mode 50: The kit of mode 49, which additionally comprises at least one of a needle driver and scissors.
    [00067] Mode 51: Removable bidirectional self-holding suture, the suture comprising: a. a suture body having a first end, a second end and a periphery; B. a plurality of retainers, wherein the retainers in a first portion of the suture between the first suture end and a first axial location in the suture allow movement of the suture along the tissue in a direction of movement of the first end and prevent movement of the suture at the along the tissue in a direction opposite to the direction of movement of the first end, and the retainers in a second portion of the suture between the second end of the suture and a second axial location in the suture allow movement of the suture along the tissue in a direction of movement from the second end and avoid movement of the suture along the tissue in a direction opposite to the direction of movement of the second end; and c. a gripping engaging element between the first and second axial locations, wherein the gripping engaging element has at least two openings through which the suture body is threaded between the first and the second axial locations.
    [00068] Mode 52: The suture of mode 51, with at least one opening of the gripping element comprising a sharp edge.
    [00069] Details of one or more modalities are presented in the description below. Other characteristics, objectives and advantages will be apparent from the description, drawings, and claims. In addition, the descriptions of all patents and patent applications mentioned herein are hereby incorporated by reference in their entirety. DESCRIPTION OF THE DRAWINGS
    [00070] The characteristics of the invention, its nature and various advantages will be apparent from the attached drawings and the detailed description below of various modalities.
    [00071] FIG. 1 is a view of an emergency bidirectional suture, according to an embodiment of the present invention, in which the suture has a closed-loop gripping engagement element.
    [00072] FIG. 2 is a view of an emergency bidirectional suture, according to another embodiment of the present invention, wherein the suture has a closed-loop gripping engagement element.
    [00073] FIG. 3 is a view of an emergency bidirectional suture, according to another embodiment of the present invention, in which the suture has a tab gripping engagement element.
    [00074] FIG. 4 is a view of an emergency bidirectional suture, according to another embodiment of the present invention, in which the suture has an open polygonal gripping engagement element.
    [00075] FIG. 5 is a view of an emergency bidirectional suture, according to yet another embodiment of the present invention, in which the suture has an open loop gripping engagement element.
    [00076] FIG. 6 is a view of an emergency bidirectional suture, according to yet another embodiment of the present invention, in which the gripping engagement element includes tissue locks.
    [00077] FIG. 7 is a view of an emergency bidirectional suture, in accordance with yet another embodiment of the present invention, including a detachable gripping engagement element.
    [00078] FIGS. 8a and 8b are seen in perspective of the use of a modality, according to the present invention of an emergency bidirectional suture.
    [00079] FIG. 9 is a perspective view of the use of a modality, in accordance with the present invention of an emergency bidirectional suture.
    [00080] FIG. 10 is a view of an emergency unidirectional suture, according to an embodiment of the present invention.
    [00081] FIG. 11 is a view of an emergency multidirectional suture, according to an embodiment of the present invention.
    [00082] FIG. 12 is a view of an emergency multidirectional suture, according to an embodiment of the present invention.
    [00083] FIG. 13 is a view of a use of a modality in accordance with the present invention of an emergency multidirectional suture.
    [00084] FIGS. 14A, 14B and 15 are views of the emergency positioning suture according to the invention, where the suture is shown in the context of the optional packaging material for the suture, where FIG. 14B is an enlarged view of a portion of the suture shown in FIG. 14A.
    [00085] FIG. 16 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures.
    [00086] FIG. 17 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures.
    [00087] FIG. 18 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures.
    [00088] FIG. 19 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures.
    [00089] FIG. 20 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures.
    [00090] FIG. 22 is a view of the packaging of the invention that can be used to store and transport emergency positioning sutures and ancillary materials. DESCRIPTION OF THE INVENTION Definitions
    [00091] Definitions of certain terms that can be used later in this document include the following.
    [00092] The term "self-holding system" refers to a self-holding suture together with devices for positioning the suture in the tissue. Such positioning devices include, without limitation, suture needles and other positioning devices, as well as ends sufficiently rigid and sharp in the suture itself to penetrate tissue.
    [00093] The term "self-retaining suture" refers to a suture that comprises elements on the suture filament to engage the tissue without the need for a suture knot or anchor.
    [00094] The term "tissue retainer" (or simply "retainer") or "burr" refers to a physical feature of a suture filament that is adapted to mechanically engage the tissue and resist movement of the suture in at least one axial direction, and preferably avoid such movement. By way of example only, the fabric retainer or retainers may include hooks, projections, splinters, darts, extensions, protrusions, anchors, lumps, spurs, bumps, stitches, teeth, fabrics, traction devices, surface roughness, surface, surface defects, edges, facets and the like. In certain configurations, the tissue retainers are adapted to engage the tissue to resist movement of the suture in a direction other than the direction in which the suture is positioned on the tissue by the physician, as they are oriented so that they are substantially facing the direction positioning. In some embodiments, the retainers remain flat when pushed in a direction of positioning and open or "spread" when pushed in a direction contrary to the direction of positioning. As the penetrating end of the fabric of each retainer turns away from a positioning direction when moving through the fabric during placement, the fabric retainers must not grab or grip the fabric during this phase. Once the self-holding suture has been positioned, a force exerted in another direction (often substantially opposite the positioning direction) causes the retainers to be displaced from the positioning position (that is, resting substantially along the body of the suture) , forces the ends of the retainer to open (or "spread") from the suture body in a way that grabs and penetrates the surrounding tissue, and results in a tissue being trapped between the retainer and the suture body; "anchoring" or fixing the self-retaining suture in place. In one embodiment, the emergency sutures described in this document are prepared from one or more filament segments that each comprise a plurality of cuts, that is, cuts were made in the filament using a blade or a laser or another suitable cutting instrument, and these cuts create and provide retainers that can spread from the filament. Retainers formed in this way are advantageous since, when the segment is pushed along the tissue, the retainers can retract into the body of the filament and thus contribute little, and preferably without resistance to the movement of the suture segment through of the tissue, during the time when the suture segment is positioned in the wound or other area that needs a suture. The cuts made in the filament are preferably not very deep, in order to minimize a reduction in the tensile strength of the filament caused by the presence of the cuts, where the cutting depths less than about 5%, or less than about 10 %, 15%, 20% or 25% of the distance in cross section of the filament are provided in different optional modalities of the invention, with 5 to 25% or 5 to 20% or 5 to 15% in the ranges present in the optional modalities of the invention. The retainers created by cutting a filament will have an upper side composed of the outer surface of the filament, and a lower side formed by the cut and composed of the material that forms the inner side of the filament. In several optional embodiments of the present invention, a specific cut can create a retainer that has a bottom side resting on a single plane, that is, the cut can be a single straight cut, or the cut can create a retainer that has a bottom side based on two planes, that is, the cut for following a first trajectory for a first distance and, then, a second trajectory for a second distance. Retainers that have undersides seated on two different planes can be advantageous where the first plane cuts to and in the direction of the center of the filament, typically with some concurrent cut along the longitudinal axis of the filament, effectively establishing a depth of cut, the subsequent second plane runs along the longitudinal axis of the filament, but with little or no movement towards the center of the filament, effectively establishing a retainer length. When filaments having a plurality of cuts are used to provide segments comprising retainers, the underside of the retainer will join the filament along a baseline, where that baseline can be straight or can be arched. An arched baseline can be beneficial in helping the retainer to "spread out". In certain other embodiments, tissue retainers can be configured to allow movement of the suture in one direction and resist movement of the suture in the other direction without spreading or positioning. In certain other configurations, the tissue retainer can be configured or combined with other tissue retainers to resist movement of the suture filament in both directions. Typically, a suture that has such retainers is positioned through a device, such as a cannula that prevents contact between the retainers and the tissue until the suture is in the desired location.
    [00095] The term "retainer configurations" refers to fabric retainer configurations and may include characteristics such as size, shape, flexibility, surface characteristics, and so on. They are sometimes called "barbed configurations".
    [00096] The term "transition segment" or "transition portion" refers to a retainer-free (burr-free) portion of a bidirectional suture located between a first set of retainers (burrs) oriented in one direction and one second set of retainers (burrs) oriented in another direction. The transition segment may be around the midpoint of the self-holding suture, or closer to one end of the self-holding suture to form an asymmetric self-holding suture system.
    [00097] The term "suture thread" refers to the filamentary body component of the suture. The suture thread can be a monofilament, or it can comprise multiple filaments such as in a braided suture. The suture thread can be manufactured from any suitable biocompatible material, and can be additionally treated with any suitable biocompatible material, whether to enhance strength, resilience, longevity, or other qualities of the suture, or to equip the sutures to fulfill functions additional to the joining of the fabrics, repositioning of the fabrics, or fixing the different elements to the fabrics.
    [00098] The term "monofilament suture" refers to a suture comprising a monofilament suture.
    [00099] The term "braided suture" refers to a suture comprising a multifilament suture. The filaments in these sutures are typically twisted, twisted, or woven together.
    [000100] The term "degradable suture" (also called "biodegradable suture" or "absorbable suture") refers to a suture that, after introduction into the tissue, is decomposed and absorbed by the body. Typically, the degradation process is at least partially mediated by, or performed in, a biological system. The term "Degradation" refers to a chain splitting process by which a polymer chain is cleaved into oligomers and monomers. Chain splitting can occur through several mechanisms, including, for example, by chemical reaction (for example, hydrolysis, oxidation / reduction, enzymatic mechanisms or a combination thereof) or by a thermal or photolytic process. The degradation of the polymer can be characterized, for example, using gel permeation chromatography (GPC), which monitors changes in the molecular weight of the polymer during erosion and degradation. Degradable suture material may include polymers such as polyglycolic acid, copolymers of glycolide and lactide, copolymers of trimethylene carbonate and glycolide with diethylene glycol (eg MAXONTM, Tyco Healthcare Group), terpolymer composed of glycolide, trimethylene carbonate and dioxanone ( e.g. BIOSYNTM [glycolide (60%), trimethylene carbonate (26%) and dioxanone (14%)], Tyco Healthcare Group), glycolide copolymers, caprolactone, trimethylene carbonate and lactide (e.g. CAPROSYNTM, Tyco Healthcare Group). A dissolvable suture may also include a partially deacetylated polyvinyl alcohol. Polymers suitable for use in degradable sutures can be linear polymers, branched polymers or multiaxial polymers. Examples of multiaxial polymers used in sutures are described in US Patent Application Publications No. 20020161168, 20040024169 and 20040116620. Sutures produced from degradable suture material lose tensile strength as the material degrades. Degradable sutures can be in barbed multifilament or monifilament.
    [000101] The term "non-degradable suture" (also called "non-absorbable suture") refers to a suture that comprises material that is not degraded by chain splitting, such as chemical reaction processes (for example, hydrolysis, oxidation / reduction, enzymatic mechanisms or a combination of these) or by a thermal or photolytic process. Non-degradable suture material includes polyamide (also known as nylon, such as nylon 6 and nylon 6.6), polyester (eg, polyethylene terephthalate), polyethylene tetraphthalo (eg, expanded polytetrafluoroethylene), polyether ester as polybutester ( block copolymer of butylene terephthalate and polytetra methylene ether glycol), polyurethane, metal alloys, metal (for example, stainless steel wire), polypropylene, polyethylene, silk, and cotton. Sutures made of non-degradable suture material are suitable for applications where the suture must remain permanently or must be physically removed from the structure.
    [000102] The term "suture diameter" refers to the diameter of the suture body. It should be understood that a variety of suture lengths can be used with the sutures described herein and that although the term "diameter" is often associated with a circular periphery, it should be understood in the present invention to indicate a cross-sectional dimension associated with a periphery of any shape. The size of the suture is based on the diameter. The American Pharmacopoeia ("USP") designation of the suture size ranges from 0 to 7 in the largest range and from 1-0 to 11-0 in the smallest range; in the shortest interval, the higher the value that precedes the hyphenated zero, the smaller the suture diameter. The actual diameter of the suture will depend on the material of the suture, so that, for example, a suture of size 5-0 and made of collagen will have a diameter of 0.15 mm, while sutures that have the same designation size USP but made of absorbable synthetic material or a non-absorbable material will each have a diameter of 0.1 mm. The selection of the suture size for a specific purpose depends on factors such as the nature of the tissue to be sutured and the importance of cosmetic care; while smaller sutures can be more easily manipulated through restricted surgical sites and are associated with less scarring, the tensile strength of the suture made from a given material tends to decrease with decreasing size. It should be understood that the sutures and methods for making the sutures presented herein are suitable for a variety of diameters, including, but not limited to, 7, 6, 5, 4, 3, 2, 1, 0, 1- 0, 2-0, 3-0, 4-0, 5-0, 6-0, 7-0, 8-0, 9-0, 10-0 and 11-0.
    [000103] The term "needle fixation" refers to the fixation of a needle in a suture that requires the same placement in the tissue, and can include methods such as crimping, pinching, using adhesives, and so on. The suture thread is attached to the suture needle using methods such as crimping, bonding and adhesives. The fixation of sutures and surgical needles is described in US Patent Nos. 3,981,307, 5,084,063, 5,102,418, 5,123,911, 5,500,991, 5,722,991, 6,012,216 and 6,163,948, and in the publication US patent application No. US 2004/0088003). The connection point between the suture and the needle is known as pinching.
    [000104] The term "suture needle" refers to needles used to position sutures in the fabric, which are available in many formats, shapes and compositions. There are two main types of needles, traumatic needles and atraumatic needles. Traumatic needles have perforated grooves or ends (ie holes or eyelets) that are supplied separately from the suture and are threaded in place. Atraumatic needles are eyelet-free and are attached to the suture at the factory by pinching or other methods, so that the suture material is inserted into a channel at the blind end of the needle which is then deformed to a final shape to fix the suture and the needle together. In this way, atraumatic needles do not require extra time at the threading site and the suture end at the needle fixation site is generally smaller than the needle body. In the traumatic needle, the thread comes out of the needle hole on both sides and the suture often tears the tissues to some extent as it passes through it. More modern sutures are embedded with atraumatic needles. Atraumatic needles can be permanently embedded in the suture or can be designed to come out of the suture with a straight, sharp movement. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied. For barbed sutures, which are uninterrupted, these atraumatic needles are preferred.
    [000105] Suture needles can also be classified, according to the geometry of the tip or point of the needle. For example, needles can be (i) "tapered" so that the needle body is round and tapers slightly to a point; (ii) the term "cutting" when the needle body is triangular and has a sharp cutting edge on the inside; (iii) the term "cut in reverse" so that a cutting edge is on the outside; (iv) the term "trocar point" or "narrow cut" so that the needle body is round and tapered, but ends at a small triangular cut point; (v) "Blind" stitches for sewing friable fabrics; (vi) The term "side cut" or "spatula points" so that the needle is horizontal at the top and bottom with the cut end along the front to one side (These are typically used in eye surgery).
    [000106] Suture needles can also be of various shapes including, (i) straight, (ii) half curved or ski, (iii) 1/4 circle, (iv) 3/8 circle, (v) 1 / 2 circle, (vi) 5/8 circle, (v) and compound curve.
    [000107] Suture needles are described, for example, in US patents 6,322,581 and 6,214,030 (Mani, Inc., Japan); and 5,464,422 (W.L. Gore, Newark, DE, USA); and 5,941,899; 5,425,746; 5,306,288 and 5,156,615 (US Surgical Corp., Norwalk, CT, USA); and 5,312,422 (Linvatec Corp., Largo, FL, USA); and 7,063,716 (Tyco Healthcare, North Haven, CT, USA). Other suture needles are described, for example, in US Patent Nos. 6,129,741; 5,897,572; 5,676,675; and 5,693,072. The sutures described here can be installed with a variety of types of needles (including without limitation curved, straight, long, short, micro, and so on), the needle cutting surfaces (including without limitation, cut, tapered, and and so on), and needle fixation techniques (including without limitation, pierced, crimped ends, and so on). In addition, the sutures described herein may include ends that are sufficiently rigid and sharp to dispense the need for positioning the needles together.
    [000108] The term "needle diameter" refers to the diameter of a positioning needle in the suture at a point wider than the needle. Although the term "diameter" is often associated with a circular periphery, it should be understood in the present invention as indicating a cross-sectional dimension associated with a periphery of any shape.
    [000109] The term "suture positioning end" refers to an end of the suture to be positioned in the tissue; One or both ends of the suture may be ends of positioning the suture. The positioning end of the suture may be attached to a positioning device, such as a suture needle, or it may be sufficiently sharp and rigid to penetrate the tissue itself.
    [000110] The term "wound closure" refers to a surgical procedure to close a wound. An injury, specifically one where the skin or other internal or external surface is cut, torn, punctured, or otherwise broken is known as an injury. An injury usually occurs when the integrity of all tissue is compromised (for example, cut or burn skin, muscle lacerations), or bone fractures. An injury can be caused by an act, such as a puncture, fall, or surgical procedure; by an infectious disease; or because of an underlying medical condition. The surgical closure of the wound facilitates the biological healing event by joining, or approaching the edges of, those wounds where the tissue has been torn, cut or otherwise separated. The surgical closure of the wound directly opposes or approximates the tissue layers, which serves to minimize the volume of new tissue formation needed to fill the gap between the two edges of the wound. The closure can serve both aesthetic and functional purposes. These purposes include eliminating dead spaces by approaching subcutaneous tissues, minimizing the formation of scars by careful epidermal alignment, and avoiding deep scarring by precisely eversing the edges of the skin. Emergency self-holding systems and sutures
    [000111] According to particular modalities, the present invention provides emergency self-retaining suture systems that are unidirectional, bidirectional and multidirectional. The sutures and systems of the present invention include a gripping engagement element to facilitate removal of the suture or emergency system; In some embodiments, the gripping engagement element can be adapted to engage fingers, although in other embodiments, it can be adapted to engage surgical tools (such as tweezers). This is also configured to be easily detectable, due to its size, shape, color, texture or any combination thereof. To remove a suture or emergency system of the present invention from a wound closure, the grasping engagement element may, in some embodiments, be secured (again, by fingers or surgical tools) and removed from the rest of the suture, and thus allows each self-holding segment to be removed from the tissue in the direction it was originally positioned. In other embodiments, the gripping latch element can then be gripped and then each self-holding segment removed from the gripping latch element and with each other to facilitate the subsequent removal of the self-gripping segments. The gripping elements can be provided in any number of configurations, including continuous loops (including circular and elliptical loops), polygons, handled loops, flaps, partial loops and partial polygons. They include fabric locks at each end, to inhibit the passage of the gripping engagement element to the fabric. They can be rigid or flexible.
    [000112] In accordance with particular embodiments of the present invention, such emergency sutures and suture systems and / or sections thereof can be unmarked, marked or differentially marked by one or more types of markers or combination of markers to facilitate the differentiation of the element of hold the rest of the device.
    [000113] To serve the purpose of allowing the soldier or medical personnel to identify the gripping engagement element, any visible marking used should be readily recognized and distinguished by the soldier or medical personnel under the conditions under which the suture is used. For example, for a battlefield or field hospital, the marking of the gripping hitch element would, desirably, be readily visible to the naked eye in low light conditions.
    [000114] Markers can be provided in various forms that can be identified and distinguished from each other. Markers can comprise distinguishable patterns, shapes, lengths, color sizes, directions and layouts. Markers can include different colors such as red, green, orange, yellow, green, blue, etc. Such colors can be used in a uniform density or variant density in which case the grading of the color density can be used to designate, for example, an orientation. The markers can be included along the entire length of the self-retaining suture system, at several different points, or just at the ends or transition section of the self-holding suture. In some cases, it may be desirable to use a marker color that is unusual in the operating environment. For example, it may be desirable to use green markers because green is not common in the human body.
    [000115] Markers can be formed by several conventional methods. For example, the markers may be coated, sprayed, glued, dyed, stained or otherwise affixed to the self-holding suture systems or components thereof. Traditional dye application processes include, but are not limited to, dipping, spraying (by, for example, an ink jet), painting, printing, applying and / or coating dyes on the suture section of interest. Critical fluid extraction (such as carbon oxide) can also be used to add dye locally to all or part of the section to be marked. Alternatively, the dye (s) for the suture section of interest can be included in a portion of the suture material that is used to form the suture body, that portion being in the section of interest of the manufactured suture.
    [000116] Additionally, the dye (s) used to demarcate the suture section of interest can be included in a biocompatible plastic material that is applied to the suture in the section of interest. Such a layer may be absorbable, such as a polyglycolide coating that has a dye to mark the suture section of interest, or it may be a non-absorbable material, such as silicone. The colored material can be synthetic or it can be derived from a natural source (either the modified or unmodified material), such as collagen.
    [000117] Alternatively, the suture section of interest can be inversely marked, so that where the suture body is already visibly colored, the dye may be missing from all or part of the suture section of interest so that at least one portion of the section of interest is optically distinguishable by the surgeon from the rest of the suture. Such a suture can be manufactured by including a dye-free portion of suture material in the suture section of the area of interest during fabrication of the suture body (for example, by extrusion) or by removing dye from the suture section of interest after the suture body has been manufactured, before or after the retainers have been formed in the suture body. The dye can be removed locally, for example, by extraction of critical fluid such as (for example, carbon oxide). It is not necessary to remove all dye from the suture section of interest as long as there is a difference detectable by a surgeon between the section of interest and the rest of the suture.
    [000118] Another example of an inversely marked suture is one that lacks a colored layer that is present in the rest of the suture body. A biocompatible plastic material that carries a dye can be applied to the other sections of the suture, and at least where the other sections delimit the section of interest. Examples of such materials are discussed above. As in the aforementioned examples, demarcating the suture section of interest can be performed in the suture manufacturing process before or after retainer formation.
    [000119] Another example of an inversely marked suture is one that has a coaxial structure in which each coaxial layer that has a different color, and a portion of the outermost layer (s) is removed to visually expose a layer below. For example, a double layer monofilament polypropylene suture can be produced with a white inner core (intercoaxial layer) with a blue outer coaxial layer, and portions of the outer layer can be removed to visually expose the white inner monofilament to mark the section. suture of interest.
    [000120] Yet another example of an inversely marked suture is one in which an outer covering is removed (or partially removed) from the suture in the suture section of interest, and where the base covering or suture has a contrasting color difference. This technique of removing (or partially removing) material in the suture section of interest can also create a tactile demarcation of the suture section of interest.
    [000121] As described above, the gripping engagement element or detachment regions can be marked to allow the section to be identified and distinguished from other sections rather than, or in addition to, marking the suture filament itself. If such marking is present in a wavelength range, in addition to the visible wavelength range, a detector would be used to locate and image the non-visible marker so that field hospital personnel would have the use and benefit of this highlighter. Bidirectional emergency sutures
    [000122] The modalities of bidirectional emergency sutures in accordance with the present invention are shown in FIGS. 1 to 7. In FIG. 1, suture 100 includes a first self-holding suture segment 102a, a second self-holding suture segment 102b and a gripping engagement element 106 comprising a ring 106a. In general, ring 106a can be of any shape that allows someone to put their finger through the ring so as to allow the individual to then push the ring away from the first and second self-holding suture segments 102a and 102b. For example, the ring can be round, as shown in FIG. 1, or it could be oval or polygonal or another shape, as long as the ring comprises an entrance or opening. The gripping member 106 is joined to the proximal end 108b of segment 102b and to the proximal end 108a of segment 102a, preferably at different locations along ring 106a as shown in FIG. 1. The first self-retaining suture segment 102a includes a plurality of retainers 103a oriented to, when in the tissue, allow movement of segment 102a along the tissue in a direction of movement of the distal end or positioning 104a and resist movement of the suture along the tissue in a direction opposite to the direction of movement of the distal end 104a. Conversely, the second self-retaining suture segment 102b includes a plurality of retainers 103b oriented to, when in the tissue, resist movement of segment 102b along the tissue in a direction of movement of the distal end or positioning 104b of the second segment 102b and resist movement of the segment along the fabric in a direction opposite to the direction of movement of the end 104b. Optionally, segment 102a can be attached to a needle 112a, and, optionally, segment 102b can be attached to a needle 112b, where one or both of the needles can optionally be curved as shown in FIG. 1.
    [000123] FIG. 2 illustrates another embodiment of an emergency suture that has a loop gripping engagement element. A suture 200 includes a first self-retaining suture segment 202a, a second self-retaining suture segment 202b and a gripping member 206 (in the form of an ellipse 206a at the end of a cable 206b) at the proximal ends 208a and 208b segments 202a and 202b, respectively. The first self-retaining suture segment 202a includes a plurality of retainers 203a oriented to, when in the tissue, allow movement of segment 202a along the tissue in a direction of movement of the distal end 204a of segment 202a, and resist movement of the suture along the fabric in a direction opposite to the direction of movement of the distal end 204a. Conversely, the second self-retaining suture segment 202b includes a plurality of retainers 203b oriented to, when in the fabric, allow movement of segment 202b along the fabric in a direction of movement of the distal end 204b of the second segment 202b and resist to the movement of segment 202b along the fabric in a direction opposite to the direction of movement of the distal end 204b. Optionally, segment 202a can be attached to a needle 212a, and, optionally, segment 202b can be attached to a needle 212b, where one or both needles can optionally be curved as shown in FIG. two.
    [000124] An embodiment of an emergency suture, according to the present invention illustrated in FIG. 3 and includes a gripping engagement element 306 in the form of a flap, located between the end 308a of a first self-holding suture segment 302a and the end 308b of a second self-holding suture segment 302b. The gripping engaging element 306 is provided with a variablely textured surface 310 to enhance an individual's ability to pick up the gripping engaging element 306, where the texturing may take the form of protruding ridges or other uneven surface as illustrated in FIG. 3. The first self-retaining suture segment 302a includes a plurality of retainers 303a oriented, when, in the fabric, to allow movement of segment 302a along the fabric in a direction of movement of the distal end 304a of segment 302a, and to resist movement of segment 302a along the fabric in a direction opposite to the direction of movement of the distal end 304a. Conversely, the second self-retaining suture segment 302b includes a plurality of retainers 303b oriented to, when in the fabric, allow movement of segment 302b along the fabric in a direction of movement of the distal end 304b of the second segment 302b and resist to the movement of the segment along the fabric in a direction opposite to the direction of movement of the distal end 304b. Optionally, segment 302a can be attached to a needle 312a, and, optionally, segment 302b can be attached to a needle 312b, where one or both needles can be optionally curved as shown in FIG. 3.
    [000125] Providing texture differences to all or part of the gripping engagement element 306 includes providing a plurality of areas of increased and / or decreased suture body diameter along the gripping engagement element 306. For example, a plurality of indentations, a plurality of relief configurations, and any combinations thereof, can be provided in the section of interest, by methods that include, without limitation, compaction, cutting, coating, application of agents such as abrasives, polymerizers, acidic media, basic means, and so on.
    [000126] FIGS. 4 and 5 illustrate modalities that have gripping elements 406 and 506, respectively, in two variations in an open loop shape. In FIG. 4, the gripping engagement element 406 is an open polygon and is located between the proximal end 408a of a first self-holding suture segment 402a and the proximal end 408b of a second self-holding suture segment 402b. The first self-retaining suture segment 402a includes a plurality of retainers 403a oriented to, when in the tissue, allow movement of segment 402a along the tissue in a direction of movement of the distal end 404a and resist movement of segment 402a along the tissue in a direction opposite to the direction of movement of the distal end 404a. Conversely, the second self-retaining suture segment 402b includes a plurality of retainers 403b oriented to, when in the tissue, allow movement of segment 402b along the tissue in a direction of movement of the distal end 404b of the second segment 402b and resist to the movement of the segment along the tissue in a direction opposite to the direction of movement of the distal end 404b. Optionally, segment 402a can be attached to a needle 412a, and, optionally, segment 402b can be attached to a needle 412b, where one or both needles can be optionally curved as shown in FIG. 4.
    [000127] In FIG. 5, the gripping engagement element 506 is shown as an open loop and is located between the proximal end 508a of a first self-holding suture segment 502a and the proximal end 508b of a second self-holding suture segment 502b. The first self-retaining suture segment 502a includes a plurality of retainers 503a oriented, when in the tissue, to allow movement of the segment 502a along the tissue in a direction of movement of the distal end 504a and resist movement of the segment along the tissue in a direction opposite to the direction of movement of the distal end 504a. Conversely, the second self-retaining suture segment 502b includes a plurality of retainers 503b oriented to, when in the fabric, allow movement of segment 502b along the fabric in a direction of movement of the distal end 504b of the second segment 502b and resist to the movement of segment 502b along the fabric in a direction opposite to the direction of movement of the distal end 504b. In some modalities that have an open loop or open polygon engaging element, the element can be produced from rigid or semi-rigid materials, or it can be coated to effect stiffness or partial stiffness. Optionally, segment 502a can be attached to a needle 512a, and, optionally, segment 502b can be attached to a needle 512b, where one or both needles can be optionally curved as shown in FIG. 5.
    [000128] FIG. 6 illustrates another embodiment of an emergency suture that has an open loop gripping engagement element. A suture 600 includes a first self-holding suture segment 602a, a second self-holding suture segment 602b and a gripping engagement element 606. Gripping engaging element 606 is provided with tissue locks 610a and 610b, adjacent to the ends proximal 608a and 608b of the first and second self-retaining suture segments 602a and 602b, respectively. The fabric locks 610a and 610b each have a cross-sectional distance that is greater than the cross-sectional distance of the adjacent proximal ends 608a and 608b, respectively, and are thus configured to prevent slipping of the engagement element hold 606 in the tissue when suture 600 is located in the tissue and functioning in a wound closure. The first self-retaining suture segment 602a includes a plurality of retainers 603a oriented, when in the fabric, to allow movement of the segment 602a along the fabric in a direction of movement of the distal end 604a and resist movement of the segment along the fabric in a direction opposite to the direction of movement of the distal end 604a. Conversely, the second self-retaining suture segment 602b includes a plurality of retainers oriented, when, in the fabric, to allow movement of the segment 602b along the fabric in a direction of movement of the distal end 604b of the second segment 602b and to resist the movement of segment 602b along the fabric in a direction opposite to the direction of movement of the distal end 604b. Optionally, segment 602a can be attached to a needle 612a, and, optionally, segment 602b can be attached to a needle 612b, where one or both needles can be optionally curved as shown in FIG. 6.
    [000129] In yet another embodiment, as illustrated in FIG. 7, the gripping engagement element is 706 of the suture 700 is bounded by detachment elements 710a and 710b, which are adjacent to the proximal ends 708a and 708b of the first and second self-holding suture segments 702a and 702b, respectively. Detachment elements 708a and 708b are adapted to require only a sharp effort to induce removal of element 706 from suture 700, and may comprise frangible material, a smaller diameter of suture material (thus having less tensile strength than adjacent portions of the suture). suture), or detachable connectors. The first self-retaining suture segment 702a includes a plurality of retainers 703a oriented, when in the tissue, to allow movement of the segment 702a along the tissue in a direction of movement of the distal end 704a and resist movement of the segment along the tissue in a direction opposite to the direction of movement of the distal end 704a. Conversely, the second self-retaining suture segment 702b includes a plurality of retainers 703b oriented to, when in the fabric, allow movement of segment 702b along the fabric in a direction of movement of the distal end 704b of the second segment 702b and resist to the movement of the segment along the tissue in a direction opposite to the direction of movement of the distal end 704b. Optionally, segment 702a can be attached to a needle 712a, and, optionally, segment 702b can be attached to a needle 712b, where one or both needles can be optionally curved as shown in FIG. 7.
    [000130] FIGS. 14A, 14B and 15 include representations of yet another embodiment of an emergency positioning suture according to the invention, where the suture is shown in the context of the optional packaging material for the suture. Bidirectional suture 1401 in FIG. 14A includes first and second self-holding suture segments 1403a and 1403b, respectively, with needles 1409a and 1409b at their respective distal ends 1411a and 1411b. In one embodiment, the gripping engagement element 1405 attaches to the proximal ends 1413a and 1413b of the first and second self-retaining suture segments 1403a and 1403b, respectively, when being tied or otherwise joined to the openings 1407a and 1407b of the element gripping coupling 1405. In an alternative embodiment, illustrated in FIG. 14B, the proximal ends 1413a and 1413b each attach to one end of a transition segment shown as dashed line 1415, where transition segment 1415 can be free retainer filament or some other filament, thus joining the proximal ends 1413a and 1413b, where, in this embodiment, suture 1401 crosses openings 1407a and 1407b at or near the transition segment. FIG. 14B shows regions 1417a and 1417b, which are optionally present as part of gripping engagement element 1405, where regions 1417a and 1417b are frangible regions of gripping element 1405 and are thus adapted to be readily divided or separated. To remove a suture like 1401 that has a gripping engagement element 1405 with two frangible regions 1417a and 1417b, from a wound closure, the gripping engagement element 1405 could be broken and the resulting pieces kept separate to expose the suture, for example, the transition segment 1415, for easy cutting. Similarly, in FIG. 15, bidirectional suture 1401 as described with reference to FIG. 14A is renumbered 1501 and includes the gripping engagement element 1505 which has openings 1507a and 1507b that engage the suture 1501 at or near a transition segment of the suture 1501. Optionally, the gripping engagement element 1505 can contain one, of preferably, two, or more than two frangible regions, and thus can be adapted to be divided or separated. In some embodiments, one or more sutures openings of a gripping engagement element, such as that illustrated in FIGS. 14 and 15, may include a sharp edge that would allow an individual to remove the gripping engagement while moving the suture apart, thus allowing easy suture removal from an injury closure.
    [000131] The gripping engagement element 806 is shown in FIGS. 8a and 8b. With reference to FIG. 8a, the gripping engagement element 806 is engaged with each of the first and second self-retaining suture segments 802a and 802b, respectively, and is positioned outside wound 801. A first self-retaining suture segment 802a of suture 800 is positioned at a subcuticular point through wound edges 801b, starting about the central portion 801a of wound 801 and moving towards an end 801c of wound 801, and then suture 800 is pulled in the positioning direction (or (ie, the direction of the wound end 801c) to approximate the wound edges 801a. The dashed line 802a illustrates the first self-retaining suture segment 802a positioned below the tissue. Then, as illustrated in FIG. 8b, the process is repeated for the remainder of the wound with the second self-retaining suture segment 802b (shown as a dashed line, representing its location in the tissue), resulting in a closed wound. When, in the second half of the wound closure, suture 800 is extracted through the tissue to bring the wound edges closer to the open remainder of the wound, the act of pulling suture 800 in the second positioning direction (that is, in the direction of the second wound end 801 e) comprises the clamping force necessary for the plurality of retainers in segment 802a, thereby causing tissue engagement. Conversely, when suture 800 is pulled tightly enough to close the second half of the wound, the tissue engagement force exerted against the plurality of retainers in the first segment 802a secures the plurality of retainers to the second segment 802b. To remove the suture from the tissue, the grasping engagement element 806 is secured and the suture segments 802a and 802b are moved away from each other and from the element 806. Then, the suture segment 802a is pulled from the fabric at the exit point of suture 801 of the suture segment 802b is pulled similarly from the tissue of the respective suture exit point 801 f.
    [000132] Another use of an emergency bidirectional suture is illustrated in FIG. 9, to bring high tension wounds closer together to keep them in place until a definitive surface closure can be performed. In a very open wound (or a wound that would be difficult to put together due to the tension along it), a 900 bidirectional emergency suture is positioned to bring the tissues closer together. In this procedure, the gripping engagement element 906 is positioned about the midpoint of the wound and the self-retaining segment 902 is inserted through the wound edge, passed radially out of the wound, and removed at a distance from the wound edge at the point of injury. exit 908; the distance is selected to suit the nature of the wound and surrounding tissues, while considering that the further the distance, the greater the retention resistance. The procedure is then repeated on the other side of the wound with the self-retaining segment 904. For major injuries, several sutures may be required. The fabric can then be progressively "placed in the shape of a ratchet" over the retainers until it is as close as necessary (or prudent). Having a gripping engagement element between the self-retaining segments 902 and 904 not only facilitates removal of the posterior suture, but also increases the anchoring of the self-retaining segments on each side of the wound, thereby increasing the amount of tension that the suture can withstand without pull through the fabric. One-way emergency sutures
    [000133] The sutures of the invention also include unidirectional embodiments, as in the example shown in FIG. 10. A suture 1000 includes a self-holding suture segment 1002 and an anchor element 1006 adjacent to a detachment element 1008 at a proximal end of segment 1002. Self-holding suture segment 1002 includes a plurality of retainers 1003 oriented towards, when in the tissue, allow movement of segment 1002 along the tissue in a direction of movement of the sharp end 1004 and resist movement of the suture along the tissue in a direction opposite to the direction of movement of the end 1004. When the suture is completely positioned on the fabric, the gripping anchor 1006 acts to resist the movement of the suture in one direction towards the end 1004. The detaching element 1008 is adapted to require a rupture movement such as sharp effort, flexion or torsion to cause the removal of element 1006 from segment 1002, and may comprise frangible material, a smaller diameter of suture material (thus m less tensile strength than other portions of the suture), or detachable connectors. Multidirectional emergency suture systems
    [000134] Self-retaining suture systems can comprise more than two suture segments. A self-holding suture system can have one, two or more suture segments including up to about ten suture segments or more, depending on the application. For example, as shown in FIG. 11, a suture system 1100 has five self-retaining suture segments 1102a-e radiating from a central ring 1106. Each suture segment 1102a-e has a needle at its positioning end 1104a-e, and a connector 1108a-e at its other end, each connector joining its respective suture segment to the ring 1106. The connectors can be manufactured wholly or partially from a frangible material, to facilitate the removal of the ring and subsequent removal of the suture segments from a wound closure temporary once the most satisfactory medical care becomes available to the patient. Alternatively, the connectors can be removed from the suture segments before removal of the suture system.
    [000135] Another embodiment of a multidirectional emergency suture system is illustrated in FIG. 12. The 1200 suture system has three self-holding suture segments 1202a-c. Each of the segments 1202a-c is joined at one end, i.e., the proximal end, to a gripping engagement element 1206, which can be of any suitable shape, for example, circular, oval, or as shown in FIG. 12, polygonal. Each of the segments 1202a-c also has a needle 1204a-c at the other end, that is, the distal end. The gripping engagement element 1206 is not a separate component in the 1200 system, but is instead joined with self-holding segments 1202a-c. They can be joined by melting, gluing, welding or the like or they can be formed in one piece. As shown in FIG. 12, the self-retaining suture segment 1202a has a larger diameter than segments 1202b and 1202c (and, consequently, has a larger and differently configured needle attached to it). FIG. 12 illustrates an option in a wide range of variations that are possible in self-retaining suture systems with multiple arms such as 1200. The suture system arms can be individually selected based on the tissue on which they will be positioned. Note that the retainers 1203a on a suture segment such as 1202a are configured so that the retainers allow the segment to be positioned in the direction of the needle attached to that arm, that is, in the distal direction, and to resist movement of the suture segment in the direction in the direction of the gripping element, that is, in the proximal direction, which acts as an anchor as well as facilitating the last removal of the suture system from a temporary wound closure. In this way, the suture segments can be positioned along the tissue and the approximate tissue in the direction of element 1206, and the retainers will then retain the tissue in the approximate position and resist movement of the tissue away from element 1206. Note that in multiple arm systems, it may be desirable to have some arms without retainers.
    [000136] Self-holding systems that have more than two suture segments are useful in applications where it is desirable to have a plurality of suture lines that radiate from a common point. Such self-retaining suture systems are useful, for example, small puncture wounds, star-like wounds and other non-linear wounds. Such injuries can be produced by blunt trauma, gunshot wounds, explosions and the like and are very difficult to close with regular suture techniques. FIG. 13 illustrates a closure of a star-like wound with a 1300 multidirectional emergency suture system. Star-like wounds are non-linear wounds where several slits along the tissue meet at a common point and are difficult to close with regular suture techniques. However, such a wound can be promptly closed using a multidirectional system that has a self-retaining suture segment for each apex of tissue. As shown in FIG. 13, the system 1300 comprises four self-holding suture segments 1302a-d, each having a needle 1312a-d at one end, i.e., the proximal end, and joined to a gripping engagement member 1306 at the other end, i.e. that is, the distal end. Each needle 1312 is inserted at the apex 1314a-d of a tissue ear and extracted through the tissue to an exit point 1310a-d located at a distance from the wound. After closing the central wound, the remaining linear wounds can be closed additionally, if necessary, using standard techniques, such as with conventional or self-retaining sutures (unidirectional or bidirectional). Emergency self-retaining suture packaging
    [000137] The sutures and systems described in this document can be loaded in adapted packaging to avoid intertwining of the suture segments, ends and gripping elements, and to provide easy removal of the suture or packaging system.
    [000138] One embodiment of a package is shown in FIG. 14A, where the packaging is shown retaining the emergency self-retaining suture systems. A package includes a base 1400, gripper engagement retainers 1404 and suture segment retainers 1402 positioned at some distance from each other on the base 1400. The retainers can be provided with multiple sections; for example, suture segment retainer 1402 provides multiple passages 1402a and 1402b so that each needle in a suture can be segregated from one another. Similarly, the gripping member retainer 1404 can be provided with multiple sections by placing multiple passages 1404a and 1404b so that the suture segments 1403 can be segregated from each other (to avoid entanglement of the burrs), as it is shown on the gripper retainer 1404. The base 1400 is configured to be folded along lines A and B, and closed in the flap / slot combination 1406b. The base can also be folded along line C to protect the end of a longer suture, and closed in the flap / slot combination 1408b.
    [000139] In another embodiment shown in FIG. 15, the package includes a base 1500, gripper engaging retainers 1504 and suture segment retainers 1502 positioned some distance from each other on base 1500. Grip engaging retainers 1504 and suture segment retainers 1502 they are provided with multiple sections, allowing the suture segments of each 1501 suture to be wound (in an oval or alternating arrangement) through the retainers and thus reducing the overall size of the suture / package combination. Base 1500 is configured to be folded and closed in flap / slot combinations 1505a, b. The base can also be folded to protect the end of a longer suture, and closed in the flap / slot combination 1506a, b.
    [000140] The embodiment in FIG. 16 includes a base 1600 which has three multi-section retainers 1602a-c arranged so that two of the retainers (1602 a and b) are perpendicular to a central retainer (1602c), where this arrangement of retainers allows suture 1601 to be rolled up in a spiral, with the clamping element 1605 in the center of the spiral. Needles 1609 at the ends of the suture are attached to the base on retainer 1604, positioned some distance from retainers 1602a-c. The base 1600 additionally includes one or more ears 1606, 1608, 1610 and 1612 which can be folded over to further protect the suture 1601. An alternative arrangement having only two multi-section retainers 1602 is also an embodiment of the invention.
    [000141] FIG. 17 illustrates a modality in which a suture 1701 can be secured in a back and forth arrangement, using two extended multi-section retainers 1702a and 1702b. The needles 1709a and 1709b are attached at some distance from the gripping latch 1705 using the multiple section retainer 1710, and one or more of the optionally present ears 1706, 1707, 1708 and 1711 can be folded over the suture in order to provide additional protection.
    [000142] FIG. 18 illustrates a modality in which sutures 1801 can be secured in a "C" shaped arrangement with multiple section retainers 1802a-d. Needles 1809a and 1809b are secured with a multi-section retainer next to the 1805 gripping latch element, which is held in place with a multiple section retainer 1804, but are arranged far enough to avoid entanglement. The base 1800 can be folded along line "A" in the direction shown by "B", and optionally along one or both lines C1 and C2, to reduce the size of the total package.
    [000143] FIG. 19 illustrates an embodiment in which a suture 1901 can be attached in a backward and forward arrangement along extended multi-section retainers 1904a and 1904b. Needles 1909a and 1909b are secured with the multi-section retainer 1902 at some distance from the gripping latch element 1905. Additionally, insert 1910 that secures suture 1911 in a similar manner can be seated on base 1900, and the ears 1906 and 1908 can be folded over the insert to completely cover this.
    [000144] FIG. 20 illustrates a modality for packaging unidirectional sutures, with the 2000 packaging base retaining unidirectional sutures 2001a and 2001b, the packaging including retainers 2002a and 2002b for the gripping elements 2005a and 2005b, respectively, as well as retainers for multiple sections 2004a and 2004b for needles 2009a and 2009b, respectively. FIG. 21 illustrates a multidirectional suture package on base 2100, in which the various segments of suture device 2101 are segregated from each other in separate pairs; therefore, there is only one 2105 gripper retainer securely held in place with the multiple section retainer 2104, and multiple suture segment retainers 2012a and 2102b that retain needles 2009a, 2009b, 2009c and 2009d.
    [000145] FIG. 22 illustrates packaging 2200 comprising an outer sleeve 2201 in which packaged emergency sutures can be placed, along with related devices such as scissors 2202a and 2202b (although a single pair of scissors may be included), and / or needle drivers 2203a and 2203b (although a single needle driver could be included). Materials
    [000146] The suture threads described herein can be produced by any suitable method, including, without limitation, injection molding, stamping, cutting, laser, extrusion, and so on. Regarding the cut, the polymeric threads or filaments can be manufactured or acquired for the suture body, and the retainers can be subsequently cut over the suture body; the retainers can be cut by hand, laser, or mechanically cut with a machine using blades, cutting wheels, grinding wheels, and so on. During cutting, the cutting device or suture can be moved relative to each other, or both can be moved to control the size, shape and depth of the cut 210. Particular methods for cutting barbs in a filament are described in US Patent Application Serial No. 09 / 943,733 entitled "Method of Forming Barbs On A Suture And Apparatus for Performing Same" by Genova et al., and US Patent Application Serial No. 10 / 065,280 entitled "Barbed Sutures" by Leung et al. in which both are incorporated by reference. Sutures can be manufactured from any suitable biocompatible material, and can additionally be treated with any suitable biocompatible material, whether to enhance strength, resilience, longevity, or other qualities of the suture, or to equip the sutures to fulfill additional functions in addition joining fabrics, repositioning fabrics, or fixing different elements to fabrics.
    [000147] The gripping coupling elements described in this document can be produced by any suitable method, including without limitation, injection molding, stamping, cutting, laser, extrusion, and so on. They can be integrally formed with the suture threads, or the threads and gripping elements can be assembled after the manufacture of each component. They can be made of cloth, felt, mesh, plastic (absorbable and non-absorbable), metallic materials, or other materials, and can be glued, knotted, crimped or otherwise fixed to the suture threads. In some embodiments, they can be made of stainless steel or other radio opaque materials. In some modalities, they can be configured to comfortably accommodate a finger of a typical adult; ranges of suitable diameter can be 1.91 cm (0.75 ”) to 3.81 cm (1.5”), and between 2.5 cm (1 ”) to 3.18 cm (1.25”) .
    [000148] The packaging described in this document can be produced from any suitable material, such as a combination of paper and synthetic materials, or synthetic materials only, or paper only. Needle retainers can be made from foam or other materials that can safely engage needles. External gloves can be made of any suitable materials, including exchangeable materials for sterilizing gas (such as ethylene dioxide) while preventing contamination by microorganisms, materials that are compatible with gamma radiation sterilization, materials that are resistant to moisture (such as foil) metallic), and any combinations thereof.
    [000149] Additionally, the sutures and systems described in this document can be provided with compositions to promote healing and avoid undesirable effects such as scar formation, infection, pain and so on. This can be accomplished in a variety of ways, including for example: (a) fixing a formulation directly to the suture (for example, by spraying the suture with a polymer / drug film, or by immersing the suture in a polymer / drug solution), (b) coating the suture with a substance such as a hydrogel that, in turn, will absorb the composition, (c) inserting the coated thread with formulation (or the polymer itself formed in a thread) in the suture structure in the case of multifilament sutures, (d) insert the suture into a glove or mesh that is comprised of, or coated with, a formulation, or (e) build the suture itself with a composition. While compositions including analgesic agents, anti-infective agents, anti-healing agents, lubricating agents, and anti-inflammatory agents may be useful, in general, in the emergency situations discussed in the present invention, other such compositions may include without limitation antiproliferative agents, antiangiogenic agents, fibrosis-inducing agents, echogenic agents, cell cycle inhibitors, analgesics, and antimicrotubule agents. For example, a composition can be applied to the suture before the retainers are formed, so that when the retainers engage, the engagement surface is substantially free of the coating. In this way, the tissue being sutured comes into contact with a coated suture surface while the suture is introduced, but when the retainer engages, an uncoated surface of the retainer comes into contact with the tissue. Alternatively, the suture can be coated after or during the formation of retainers in the suture if, for example, a fully coated suture instead of a selectively coated suture is desired. In yet another alternative, a suture can be selectively coated during or after formation of retainers by exposing only selected portions of the suture to the coating. The specific purpose for which the suture is to be placed or the composition can determine whether a fully coated or selectively coated suture is appropriate; for example, with lubricating coatings, it may be desirable to selectively coat the suture, leaving, for example, the tissue engaging surfaces of the uncoated sutures in order to avoid the tissue engaging function of those impaired surfaces. On the other hand, coatings such as those that comprise such compounds as anti-infective agents can be suitably applied to the entire suture, although coatings such as those that comprise fibrosis inducing agents can be properly applied to all or part of the suture (such as surfaces coupling). The coatings can also include a plurality of compositions together or in different portions of the suture, where multiple compositions can be selected for different purposes (such as combinations of pain relievers, anti-infective and anti-healing agents) or for synergistic effects.
    [000150] Although the present invention has been shown and described in detail with respect 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 presented. Various combinations of features, and various modifications, omissions and additions can be made to the revealed modalities without departing substantially from the teachings and innovative advantages of the invention, particularly in light of the aforementioned teachings. Consequently, it is intended to cover all these modifications, omissions, additions, and equivalents that may be included in the spirit and scope of the present invention, as defined by the following claims.
    权利要求:
    Claims (5)
    [0001]
    1. Removable multidirectional self-holding system comprising: a. a gripping coupling element (06,206,1206,1306); B. a plurality of suture segments (102a, 102b, 202a, 202b, 1202,1302), each suture segment having a periphery and a plurality of retainers (103a, 103b, 203a, 203b, 1203) between a first end of the suture segment and a second end of the suture segment to allow movement of the suture along the tissue in a direction of movement of the first end and prevents movement of the suture segment along the tissue in a direction opposite to the direction of movement of the first end , and a second end of each suture segment is attached to the gripping engagement element; wherein the gripping engaging element comprises a loop characterized by the fact that the gripping engaging element is integrally formed with the plurality of suture segments.
    [0002]
    2. System, according to claim 1, characterized by the fact that the plurality of suture segments consists of two suture segments.
    [0003]
    3. System, according to claim 1, characterized by the fact that the gripping engagement element has a larger periphery than the periphery of each suture segment.
    [0004]
    4. System according to claim 1, characterized by the fact that the gripping engaging element comprises a different material than the rest of the suture.
    [0005]
    5. System according to claim 1, characterized by the fact that the plurality of suture segments comprises at least three suture segments (1202,1302).
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    同族专利:
    公开号 | 公开日
    EP3138506A1|2017-03-08|
    US9675341B2|2017-06-13|
    CA2817036A1|2012-05-18|
    US20130226233A1|2013-08-29|
    WO2012064902A3|2012-08-02|
    MX2013005247A|2013-09-16|
    JP6013352B2|2016-10-25|
    WO2012064902A2|2012-05-18|
    CA2817036C|2019-01-15|
    ZA201304203B|2014-12-23|
    BR112013011582A2|2016-08-09|
    EP2637574B1|2016-10-26|
    EP2637574A2|2013-09-18|
    KR101886614B1|2018-08-09|
    RU2013126423A|2014-12-20|
    EP2637574A4|2014-09-24|
    ES2612757T3|2017-05-18|
    KR20130140766A|2013-12-24|
    AU2011326446B2|2016-03-03|
    JP2014500069A|2014-01-09|
    MX342984B|2016-10-19|
    NZ704801A|2015-10-30|
    CN103200882A|2013-07-10|
    NZ704802A|2015-12-24|
    NZ610348A|2015-03-27|
    RU2580479C2|2016-04-10|
    AU2011326446A1|2013-05-23|
    EP3138506B1|2020-08-26|
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    法律状态:
    2017-07-11| B25A| Requested transfer of rights approved|Owner name: ETHICON ENDO-SURGERY LLC (US) |
    2017-07-18| B25F| Entry of change of name and/or headquarter and transfer of application, patent and certif. of addition of invention: change of name on requirement|Owner name: ETHICON ENDO-SURGERY LLC (US) |
    2017-07-25| B15G| Petition not considered as such [chapter 15.7 patent gazette]|
    2017-08-08| B15G| Petition not considered as such [chapter 15.7 patent gazette]|
    2017-12-12| B25D| Requested change of name of applicant approved|Owner name: ETHICON LLC (US) |
    2018-12-18| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-09-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-06-02| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2020-10-20| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 09/11/2011, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US41191810P| true| 2010-11-09|2010-11-09|
    US61/411,918|2010-11-09|
    US41238910P| true| 2010-11-10|2010-11-10|
    US61/412,389|2010-11-10|
    PCT/US2011/060069|WO2012064902A2|2010-11-09|2011-11-09|Emergency self-retaining sutures and packaging|
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