Prosthetic fabric

A prosthetic fabric comprises a sheet textile structure capable of two different shapes, one being a flat, unfolded arrangement and the other being an ordered, gathered arrangement, and at least one continuous filiform element having two free gripping ends. The continuous filiform element is connected to the sheet structure by a plurality of catching points distributed over a surface of the sheet, along and on either side of a neutral axis that is parallel to one of the principal dimensions of the sheet. The structure of the fabric is such that pulling on the two gripping ends of the continuous filiform element generates the folded arrangement wherein the sheet is ordered transversely and on either side of the neutral axis and pulling on only one gripping end of the continuous filiform element extracts the continuous filiform element from the sheet.

The present invention relates to a prosthetic fabric, which can be used 
especially as an implantable parietal prosthesis in a human being, for 
example for a laparoscopic herniorrhaphy, via an extraperitoneal route. 
In accordance with document WO-A-92 06639, a prosthetic fabric has been 
described which comprises: 
a sheet with a textile structure, consisting of an interlacing or 
interweaving of wrap and weft threads, defining between them meshes which 
may possibly be blocked, the density of which is chosen in order to obtain 
an airy textile structure; the sheet, having a quadrangular general shape, 
is capable of adopting two different conformations, one being a compact 
conformation suitable for passing through a trocar, in which conformation 
the various parts of the sheet are gathered together into a form other 
than substantially plane, especially tubular, and the other being a 
deployed conformation, in which the same parts of the sheet open out 
substantially flat; 
a continuous filiform element, joined onto the textile structure of the 
sheet while at the same time remaining free with respect to the latter, 
describing, when flat, a continuous line in the form of a loop, extending 
along the two dimensions of the sheet, being held on the latter in a 
plurality of catching points distributed along said continuous line. 
The filiform element of WO-A-92 06639 constitutes in fact a reinforcement 
of the sheet, being at a same time rigid and flexible, although free with 
respect to the latter. This reinforcement makes it possible to direct the 
movements and orientation of the sheet, but not its change into the 
compact conformation (cf. FIG. 7), which requires an external action. 
Moreover, the problem of the sheet as described in this document is that 
the folding is preformed irregularly, by the external action of 
withdrawing the loop through the insertion tubing. In this case, the loop 
takes the form of a drop or a tear, which means that the fabric is not 
folded in an ordered manner. This causes problems when it is freed in the 
extraperitoneal space, since it does not unfolding a uniform manner 
either, requiring additional positioning movement on the part of the 
surgeon, using the semi-rigid loop to direct the sheet to the correct 
place; this increases the risks of rupturing the peritoneum and of 
perforating the organs. 
Other documents, especially document GB-A-2,200,379 and documents U.S. Pat. 
No. 3,791,436, in the field of domestic textiles, especially textiles for 
furnishing, describe various ways of folding fabrics to confer on them 
merely a particular decorative effect. 
Those skilled in the art of prosthetic fabrics, and skilled in the surgical 
and medical art, would fail to identify and find in the field of ordinary 
textiles useful solutions in the field of surgical prostheses. 
The object of the present invention is to improve a prosthetic fabric as 
described in document WO-A-92 06639, and more particularly to make it 
easier to change in an ordered manner from the deployed conformation to 
the compact conformation of the sheet with a textile structure. 
In accordance with the present invention, the catching points holding the 
filiform element onto the sheet are distributed over the surface of the 
latter, along and on either side of a neutral axis, parallel to one of the 
principal dimensions of said sheet, so that any pulling of said filiform 
element via a free gripping end, with said element sliding with respect to 
the conformationally free sheet, generates positively an ordered folded 
arrangement of said sheet, in its compact conformation, transversely and 
on either side of said neutral axis. 
In fact, one of the advantages of the prosthetic fabric according to the 
present invention is that it allows order gathering of the sheet which, in 
its compact conformation, is subsequently inserted easily into a trocar or 
inserting tube. Furthermore, the specific folded arrangements of the sheet 
make it easier to position it, for example in the extraperitoneal space, 
since the surgeon has only to withdraw the gathering thread and the sheet 
deploys in a regular manner at the correct place, without requiring 
particular intervention by the surgeon. This is because the filiform 
element is neither braked nor blocked when extracting it from the sheet in 
its compact conformation, but lets itself be easily withdrawn without 
puckering or blocking. 
A prosthetic fabric according to the present invention therefore 
incorporates a positive means for changing from the depolyed conformation 
to the compact conformation, while maintaining, moreover, the other 
properties or functions of said prosthetic fabric.

In accordance with FIGS. 1 to 3, a prosthetic fabric according to the 
invention comprises: 
a sheet 6 with a textile structure S, consisting of a fabric, and 
consequently an interlacing of warp threads 1 and of weft threads 2, 
producing between them meshes 10; the sheet 6 has a quadrangular and more 
particularly rectangular general shape; and, as shown in FIGS. 1 and 2, it 
is capable of adopting two different conformations, one being a compact 
conformation (cf. FIG. 2) in which various longitudinal parts or portions 
of the sheet are gathered together and folded into a form other than 
substantially plane, for example an elongate parallepipedal shape, and the 
other being a deployed conformation (cf. FIG. 1), in which the same 
longitudinal parts of the sheet open out substantially flat; 
at least one continuous filiform element 5 for bringing together, in the 
compact conformation, the various longitudinal parts of the sheet, 
comprising two free ends 5a and 5b, respectively at the two longitudinal 
ends of the sheet, forming one and the same thread with the free gripping 
ends 5a and 5b, which is, as described hereinbelow, joined onto the 
textile structure S of the sheet, while at the same time remaining free to 
slide with respect to the latter. 
When the sheet 6 is used for a laparascopic herniorrhaphy it has, in its 
central part, an opening 3 connected to a longitudinal edge by a 
transverse slit 4. The density of the textile structure S is chosen so as 
to obtain an airy structure, through the meshes of which the previously 
described filiform element 5 can pass freely , successively above and 
below the sheet 6. The warp threads 1 and the weft threads 2 are 
biocompatible and may have a certain degree of elasticity giving the sheet 
6 a memory of the shape in the deployed conformation. In some cases, the 
threads 1 and 2 may be chosen from an absorbable material, it being 
understood that the airy structure of the sheet allows colonization and 
fixation by cells in vivo. By way of example, the threads 1 and 2 may be 
made of polyester and are coated with collagen or with any other substance 
having a trophic effect with respect to cells. 
The filiform element 5, separate from the warp threads 1 and the weft 
threads 2, describes, when flat, a continuous line alternating, 
pseudo-sinusoidally, along the length and the width of the sheet, 
occupying virtually the entire surface of the latter. The filiform element 
5 is held on the textile structure S in a plurality of catching points 8, 
each corresponding to the filiform element passing through a mesh, toward 
the top or the bottom of the structure S, and these catching points 8 are 
distributed uniformly along the pseudo-sinusoidal continuous line 9. As 
shown in FIG. 3, the catching points 8 are uniformly spaced apart along 
the width of the sheet 6, by equal intervals E and G, this modality being 
of a secondary nature. 
In accordance with the invention, and as may be more clearly seen by 
comparing FIGS. 1 and 2, the sheet 6 has a neutral axis 11 on the textile 
structure 6, parallel to the length of the latter, and passing 
substantially through the middle of the said sheet. The catching points 8 
defined above are distributed, as described hereinbelow, over the surface 
of the sheet 6 and with respect to the neutral axis 11 so that pulling, 
along the direction of the arrows F1 and F2 in FIG. 2, on the two gripping 
ends 5a and 5b respectively, preferentially generates a translationally 
ordered folded arrangement of the sheet 6, transversely with respect to 
the neutral axis 11 and on either side of the latter. 
The neutral axis 11 lies parallel to the warp threads 1 which are 
themselves arranged along the length of the sheet 6, in such a way that 
threads 1 can act as folding initiators. The neutral axis 11 could lie 
parallel to the waft threads 2, these lying along the width of the sheet 
6. 
As shown in FIG. 1, the catching points 8 of the filiform element 5 are 
distributed on either side of the neutral axis 11, and along the latter. 
More precisely, the catching points 8 define, in pairs, transverse 
sections 5c, 5d, 5e, 5n, arranged perpendicular to the neutral axis 11 and 
distributed along the latter; these transverse segments are continuously 
joined at their ends, on the one hand, to the two gripping ends 5a and 5b 
with regard to the first segment 5c and last segment 5n respectively and, 
on the other hand, to each other, alternately, by longitudinal segments 5p 
and 5q parallel to the neutral axis. Given the above arrangement, the 
catching points 8 define two lines of connection 12 with the textile 
structure S of the sheet 6, these lines being parallel to and on either 
side of the neutral axis 11; these lines of connection 12 are 
substantially equidistant from the neutral axis 11. The transverse 
segments 5c to 5n may or may not be equal, and the same applies to the 
longitudinal segments 5p and 5q. 
The filiform element 5 and the sheet 6 are arranged freely with respect to 
each other in order to allow extraction of the filiform element in the 
compact conformation of the sheet shown in FIG. 2, for example by pulling 
on the end 5b in the direction of the arrow F1. The embodiment in FIGS. 4 
to 6 differs from that shown in FIGS 1 to 3 only by the following 
characteristics: 
filiform means 7, for bringing together the sheet into the compact 
conformation, comprise two opposed filiform elements 51 and 52, each 
describing, when flat, approximately a sinusoid or a zigzag, on either 
side of the neutral axis of the textile structure S, the two sinusoids or 
zigzags, in phase opposition as it were, crossing each other in a 
plurality of points 13 which lie on the neutral axis 11; 
each filiform element 51 or 52 has its own gripping ends, namely 51a and 
51b, or 52a and 52b, which may possibly be linked to each other in order 
to distribute the pulling force; 
the two opposed filiform elements 51 and 52 form a geometrical figure which 
is symmetrical with respect to the neutral axis. 
By pulling on the ends 52a and 51a, in opposition to the pulling force 
exerted at the same time on the ends 52b and 51b, the prosthetic fabric 
firstly adopts a conformation as shown in FIG. 5, and then the fully 
compact conformation shown in FIG. 6, which is compatible with passing 
through a trocar for example. Then, by extracting the filiform elements 51 
and 52, after passing through the trocar, the fabric may once again be 
deployed, for example in the peritoneal cavity. 
In another application example, the sheet in its compact conformation may 
also be first of all inserted into a tubular guide, which is itself 
subsequently inserted into a trocar so as to make it easier to position 
the sheet. 
Finally, it will be noted that the prosthetic fabric as described above can 
be used in other surgical interventions, for example in gynecology, and 
using the same folding principle, with however the modification that the 
fabric is firstly attached to the edges of a muscle tear, such as in the 
uterine wall, in its already-deployed conformation, and that subsequently 
the ends of the filiform element are pulled so as to gather the sheet and 
thus bring the edges of said muscle tear together. In this case, the 
threads of the filiform element, which may be biocompatible or absorbable, 
are not cut but remain inside the body.