# Patent

## Title
Haemostatic patch and method of preparation

## Abstract

The present invention relates to a haemostatic patch comprising a porous layer based on oxidized cellulose and a neutralized film based on chitosan, said film comprising a free face and a face fixed on one of the faces of the porous layer, and to the method of preparing said patch comprising the following steps: —a°) preparing a porous layer based on oxidized cellulose, —b°) preparing a film based on chitosan starting from an acidic aqueous solution of chitosan, —c°) fixing the film obtained in b°) on one face of the porous layer, —d°) neutralizing the film obtained in b°), —where step c°) can be carried out before or after step d°), characterized in that: the neutralizing step d°) comprises treatment of said film with a neutralizing composition comprising at least ethanol and ammonium hydroxide (NH4OH).

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a National Stage Application of PCT/EP13/069957 under 35USC §371 (a), which claims priority of French Patent Application Serial No. 12/58965 filed Sep. 25, 2012, the disclosures of each of the above-identified applications are hereby incorporated by reference in their entirety.
BACKGROUND
1. Technical Field
The present invention relates to a method of preparing a haemostatic patch comprising a porous layer, for example a textile, based on oxidized cellulose and a film based on neutralized chitosan fixed on one of the faces of the porous layer.
2. Description of Related Art
Haemostatic patches are implantable medical devices for stopping the flow of biological fluids such as blood during surgery. For this purpose, they are generally composed of an absorbent porous layer, which is intended to trap the biological fluids, and a barrier known as a haemostatic barrier, which is intended to block the passage of the biological fluids.
Some haemostatic patches can be completely bioabsorbable, i.e. they are made to disappear in vivo after implantation, after a few weeks for example, when their function of stopping the effusion of biological fluids is no longer necessary.
Oxidized cellulose is of interest as a bioabsorbable material that can constitute the absorbent porous layer of a haemostatic patch: in fact, oxidized cellulose possesses intrinsic haemostatic properties.
Chitosan is a polysaccharide obtained by deacetylation of chitin. Chitin is one of the most widespread naturally occurring polysaccharides and is extracted from the exoskeletons of arthropods, from the endoskeletons of cephalopods as well as from fungi.
Chitosan has properties, such as biodegradability, bioabsorbability, biocompatibility, non-toxicity, and mechanical properties, that make it particularly interesting for medical applications. Thus, it would be interesting to combine a porous layer of oxidized cellulose with a film based on chitosan with a view to preparing a haemostatic patch. Chitosan in fact offers a good compromise, taking into account the properties that are required, for a haemostatic barrier, namely good biocompatibility and good mechanical properties.
However, chitosan is generally soluble in an acid environment. Thus, the films obtained from acid solutions based on chitosan are still highly laden with salts and still have their acid character. A chitosan film obtained from an acidic solution of chitosan can thus degrade and disintegrate when it is brought in contact with water or biological fluids. Therefore it can no longer perform its function of haemostatic barrier.
Accordingly, in order to be used in medical devices, especially in haemostatic patches, chitosan films must be neutralized. Generally this neutralization is obtained by treating these films with a strong base such as sodium hydroxide.
However, this treatment with sodium hydroxide can affect the integrity of the part of the patch supporting the chitosan film: thus, in the case of a haemostatic patch with an absorbent porous layer based on oxidized cellulose, treatment of the chitosan barrier film with sodium hydroxide would destroy the porous layer of oxidized cellulose.
Thus, it would be desirable to employ a method of preparing a haemostatic patch comprising a porous layer based on oxidized cellulose and a barrier film based on chitosan, which would avoid the phenomenon of degradation of the porous layer during the necessary neutralization of the chitosan film.
SUMMARY
The present invention relates to a method of preparing a haemostatic patch comprising a porous layer based on oxidized cellulose and a neutralized film based on chitosan, said film comprising a free face and a face fixed on one of the faces of the porous layer, comprising the following steps:

    
    
        a°) preparing a porous layer based on oxidized cellulose,
        b°) preparing a film based on chitosan starting from an acidic aqueous solution of chitosan,
        c°) fixing the film obtained in b°) on one face of the porous layer,
        d°) neutralizing the film obtained in b°),
        where step c°) can be carried out before or after step d°), characterized in that:
    
    


the neutralizing step d°) comprises treatment of said film with a neutralizing composition comprising at least ethanol and ammonium hydroxide (NH4OH).
With the method according to the invention it is possible to obtain haemostatic patches based on a porous layer of oxidized cellulose and a chitosan barrier film without the risk of the chitosan film dissolving in contact with biological fluids, in particular in contact with blood. According to the method of the invention, firstly a film based on chitosan is manufactured starting from an acidic solution, then this film, alone or already fixed on the porous layer based on oxidized cellulose, is treated in order to neutralize it and obtain a final product usable in contact with biological fluids, without destroying the porous layer to which this film is attached. Regardless of the order of steps) c°) and d°) of the method according to the invention, the neutralizing composition of the method of the invention, comprising at least ethanol and ammonium hydroxide (NH4OH), makes it possible to neutralize the chitosan-based film without damaging the porous layer based on oxidized cellulose. In particular, neutralization by means of a neutralizing composition comprising at least ethanol and ammonium hydroxide (NH4OH) makes it possible to neutralize the chitosan-based film both at the surface and throughout its thickness, whether or not it is already fixed to the porous layer based on oxidized cellulose, without damaging said porous layer. With the method of the invention, it is possible to obtain a haemostatic patch having a film of neutralized chitosan as barrier, with a porous layer fixed to this film, said porous layer being based on oxidized cellulose, or said porous layer consisting of oxidized cellulose.
The present invention further relates to a haemostatic patch comprising a porous layer based on oxidized cellulose and a film based on chitosan fixed to one face of said porous layer, characterized in that said film is in neutralized form.
The present invention further relates to a haemostatic patch obtained by the method herein described, comprising a porous layer based on oxidized cellulose and a film based on chitosan fixed to one face of said porous layer, characterized in that said film is in neutralized form.
In one embodiment of the invention, the treatment in step d°) comprises a succession of operations of contacting at least the face that is free, or is intended to be free, of the film with said neutralizing composition. For example, if the film is fixed to the porous layer before it is neutralized, the treatment in step d°) will essentially consist of contacting only the free face of the film with the neutralizing composition, preferably without contacting the porous layer, on which the film will already be fixed: in fact, contact of the porous layer with the neutralizing composition could affect the integrity of the latter. Alternatively, if the film is neutralized before being fixed to the porous layer, the treatment in step d°) can comprise immersing the whole film, i.e. both of its faces, in a bath of the neutralizing composition. In both cases, the chitosan-based film is neutralized effectively at the surface and through its thickness, and the integrity of the porous layer is unaffected by the neutralizing composition comprising ethanol and ammonium hydroxide (NH4OH).
In one embodiment of the invention, step d°) further comprises a step of washing of said face of said film that is free, or intended to be free, after said treatment with the neutralizing composition. For example, the washing step comprises one or more operations of rinsing of at least said face of said film that is free, or intended to be free, with an ethanol/water composition followed by washing with water. Thus, if the film is fixed to the porous layer before it is neutralized, only its free face will be washed after application of the neutralizing composition. Alternatively, if the film is neutralized before being fixed on the porous layer, the whole film can be immersed in an ethanol/water composition and/or in water.
In one embodiment of the invention, the fixing step c°) is carried out before the neutralizing step d°). In such a case, for example, according to step b°), the acidic aqueous solution of chitosan is poured into a mould in the form of one or more layers, which are left to dry by evaporation of the water from said solution in order to obtain a film, then, according to step c°), before the end of the drying step of step b°), one face of the porous layer of oxidized cellulose is deposited on said film, complete drying of the film thus resulting in fixation of the porous layer on the film. In fact, when the porous layer is deposited on the film that is still in the course of drying, it penetrates superficially into the film under the action of the force of gravity. Thus, as drying is completed, the film traps the portion of the porous layer that has thus sunk slightly, thus providing fixation of the porous layer on the film. According to this embodiment of the invention, the treatment in step d°) comprises application of said neutralizing composition on the free face of the film, said neutralizing composition further comprising water. In such an embodiment of the invention, said neutralizing composition can for example consist of an ethanol/water/ammonium hydroxide mixture in the proportions 80/16/14 by weight. This formulation for the neutralizing composition of the method of the invention makes it possible to achieve effective neutralization of the film on its surface and through its thickness while avoiding causing shrinkage of the film, without damaging the integrity of the porous layer on which the film is already fixed.
In such an embodiment of the invention, for example, the neutralizing composition is applied on the free face of the film one or more times using a brush. For example, the bristles of a brush are soaked in neutralizing composition consisting of an ethanol/water/ammonium hydroxide mixture in the proportions 80/16/14 by weight and the free face of the film is brushed: several passes of the brush can be carried out, for example 3 passes. The film is thus neutralized. The film is then washed, as described above: for example, another brush is used, which is soaked with an ethanol/water composition, for example in the proportions 50/50 by weight. Several passes of the brush can be carried out, for example three. A last pass with a brush soaked in just water can be carried out to finalize the washing.
In another embodiment of the invention, the neutralizing step d°) is carried out before the fixing step c°). In such a case, for example, according to step b°), the acidic aqueous solution of chitosan is poured into a mould in the form of one or more layers, which are left to dry by evaporation of the water until a film is obtained, which is removed from the mould, then, according to step d°), the treatment of the film obtained in b°) comprises immersing said film in said neutralizing composition, preferably for 30 minutes. In such an embodiment, for example, once the film is completely dry and can be handled, it is immersed completely in a bath of neutralizing composition. Thus, in such a case, both faces of the film are treated with the neutralizing composition. In such an embodiment of the invention, the neutralizing composition can consist of an ethanol/ammonium hydroxide mixture in the proportions 80/20 by weight. This formulation for the neutralizing composition of the method of the invention makes it possible to carry out effective neutralization of the film without damaging the integrity of the porous layer when the film is to be fixed on the porous layer in the next step.
After immersion in a bath of the neutralizing composition as described above, the chitosan-based film is thus neutralized. The film can then be washed, as described above: for example, the film is immersed one or more times in baths of an ethanol/water composition, for example in the proportions 50/50 by weight, until a pH close to 7 is obtained for the washing baths. The film can then be submitted to a last bath of water only, to finalize the washing.
In such an embodiment, according to step c°), the neutralized film obtained at the end of step d°) can be fixed on one face of the porous layer of oxidized cellulose by means of a glue obtained starting from an acidic solution of chitosan. For example, said glue is spread on one face of the porous layer and/or on the face of the film intended to be fixed to the porous layer, and the film is fixed to the porous layer by application of the film on said face of the porous layer with pressure. The integrity of the porous layer based on oxidized cellulose is not affected during this fixing step.
Regardless of the order of steps c°) and d°) described above, a plasticizer, for example glycerol, can be added to the acidic aqueous solution of chitosan intended to form said chitosan-based film. With such an embodiment, a chitosan film can finally be obtained that has excellent mechanical properties.
In one embodiment of the invention, the porous layer is a textile, preferably a three-dimensional knitted fabric. Said porous layer, in the form of three-dimensional knitted fabric, gives excellent absorption of biological fluids, especially of blood.



BRIEF DESCRIPTION OF THE DRAWINGS
The invention and its advantages will become clearer from the following detailed description and the drawings in which:
FIGS. 1A-1C are sectional views showing the various steps of a first implementation of the method according to the invention,
FIGS. 2A-2E are sectional views showing the various steps of a second implementation of the method according to the invention.



DETAILED DESCRIPTION
According to a first step of the method according to the invention, step a°), a porous layer based on oxidized cellulose is provided. “Based on oxidized cellulose” means, according to the present application, that the main component of the porous layer is oxidized cellulose. The porous layer can further comprise other biocompatible, preferably bioabsorbable, materials. For example, the porous layer can comprise, as other bioabsorbable materials, synthetic polymers such as polylactic acid and/or polymers of natural origin such as chitosan.
Oxidized cellulose is a known bioabsorbable material. It can for example be selected from oxidized cellulose, where the C6 primary alcohol is partially or fully oxidized to carboxylic acid, for example to give polyglucuronic acid, oxidized cellulose in the form of polyaldehydes by periodic acid, and mixtures thereof. The cellulose used for oxidation can be obtained from type I cellulose or can be regenerated.
Several types of regenerated cellulose have been developed industrially. We may mention for example the “viscose” process, which is based on the solubility of cellulose xanthate in a dilute solution of sodium hydroxide. We may also mention the so-called “cupro-ammonium process” employed for example by the company Bemberg in Italy or the company Asahi Chemical Industries in Japan, which consists of dissolving cellulose in an ammoniacal solution of copper. Another method of preparing regenerated cellulose suitable for the present invention is the method of organic-phase dissolution of cellulose by N-methylmorpholine oxide (N.M.M.O.), called the “Lyocell® process”, employed for example by the company Lenzing in Austria.
In the present application, “porous layer” means a layer having pores, or voids, cells, holes, orifices, distributed regularly or irregularly, not only on the surface but also within the thickness of said layer, and more or less interconnected. Said porous layer is particularly effective for absorbing biological fluids such as blood.
In one embodiment, the porous layer based on oxidized cellulose is in the form of a textile openwork based on oxidized cellulose.
According to the present application, “textile” means any arrangement or assemblage of biocompatible threads, fibres, filaments and/or multifilaments, for example obtained by knitting, weaving, braiding, or alternatively non-woven. The arrangement of threads of the textile according to the invention defines at least two opposite faces, a first face and a second face.
In the present application, “textile openwork” means any textile whose arrangement of threads of which it is constituted determines openings, cells or voids in the thickness of the textile and on the faces of the textile, and these openings, cells or voids can constitute channels with openings on either side of the textile. This textile openwork gives good absorption of biological fluids.
The textile can be in the form of a two-dimensional or three-dimensional knitted fabric.
“Two-dimensional knitted fabric” means, in the sense of the present application, a knitted fabric having two opposite faces joined together by stitches but lacking cross-members giving it a certain thickness: a knitted fabric of this kind can be obtained for example by knitting threads on a warp knitting machine or Raschel machine using two guide bars. Examples of knitting of two-dimensional knitted fabrics suitable for the present invention are given in document WO2009/071998.
“Three-dimensional knitted fabric” means, according to the present application, a knitted fabric having two opposite faces joined together by a cross-member giving the knitted fabric a significant thickness, said cross-member itself being formed of additional connecting threads supplementary to the threads forming the two faces of the knitted fabric. This knitted fabric can be obtained for example on a warp knitting machine or double-bed Raschel machine using several guide bars. Examples of knitting of three-dimensional knitted fabrics suitable for the present invention are given in documents WO99/05990, WO2009/031035, WO2009/071998.
This kind of three-dimensional knitted fabric, with the presence of a cross-member giving it a significant thickness, provides excellent absorption of biological fluids such as blood and is particularly suitable for manufacture of the haemostatic patch of the invention.
A knitted fabric, in particular three-dimensional, based on oxidized cellulose, can be obtained by knitting firstly threads of unoxidized regenerated cellulose, then submitting the knitted fabric thus obtained to oxidation.
In fact, when spun through a perforated plate, viscose sets in an acid medium and forms long continuous filaments of regenerated cellulose, which are dried and combined in multifilament threads. A regenerated cellulose thread is obtained that has good mechanical strength.
Generally this regenerated cellulose thread is not absorbable. However, it has good mechanical strength allowing it to be used for manufacturing a knitted fabric. As an example, we may mention, as regenerated cellulose thread suitable for manufacturing a knitted fabric suitable for the porous layer of the patch of the invention, the 90 decitex multifilament thread marketed under the name “CUPRO® Cusio” by the Italian company Bemberg.
The knitted fabric obtained is then oxidized in order to form a porous layer based on oxidized cellulose suitable for the haemostatic patch and for the method of preparing said patch according to the present invention.
In a preferred embodiment of the method of the invention, the porous layer based on oxidized cellulose is a three-dimensional knitted fabric made from oxidized cellulose.
According to a second step of the method according to the invention, step b), a film based on chitosan is prepared starting from an acidic aqueous solution of chitosan.
“Based on chitosan” means, according to the present application, that the main component of the film is chitosan. The chitosan-based film can further comprise other compounds. For example, the chitosan-based film can comprise a plasticizer, for example glycerol, to improve the mechanical properties of the film.
Chitosan is a biocompatible biopolymer obtained by deacetylation of chitin. Chitin is extracted from exoskeletons of arthropods such as the lobster, crab, prawn, the endoskeleton of cephalopods such as the squid, or from fungi. Extraction of chitin involves steps of hydrolysis of the proteins and lipids, depigmentation and demineralization. Hydrolysis of the proteins and lipids is usually carried out in the presence of sodium hydroxide, and demineralization requires the use of hydrochloric acid.
Once the chitin has been extracted, chitosan is obtained by a deacetylation step, which consists of hydrolysis of the acetamide groups. This reaction is generally carried out at high temperature in an alkaline solution, for example a 48% solution of sodium hydroxide (NaOH) in water, at 90° C. Chitosan is a compound that is soluble in aqueous solution and can have a degree of acetylation (DA) of up to 70%.
The following publications describe processes for deacetylation of chitin to obtain chitosan: “Lamarque, G., C. Viton, and A. Domard, New Route of Deacetylation of α- and β-Chitins by means of Freeze-Pump Out-Thaw Cycles. Biomacromolecules, 2005. 6 (3): p. 1380-1388.”, “Lamarque, G., C. Viton, and A. Domard, Comparative Study of the First Heterogeneous Deacetylation of α- and β-Chitins in a Multistep Process. Biomacromolecules, 2004. 5 (3): p. 992-1001.”, “Lamarque, G., C. Viton, and A. Domard, Comparative Study of the Second and Third Heterogeneous Deacetylations of α- and β-Chitins in a Multistep Process. Biomacromolecules, 2004. 5 (5): p. 1899-1907.”, “Tolaimate, A., et al., Contribution to the preparation of chitins and chitosans with controlled physicochemical properties. Polymer, 2003. 44 (26): p. 7939-7952.”
Chitosan is a bioabsorbable compound. The degree of acetylation of chitosan can have an influence on the kinetics of degradation of chitosan. Thus, depending on the kinetics of biodegradation desired for the film of the haemostatic patch prepared according to the method of the invention, the chitosan will have to have a degree of acetylation of 2, 10, 20, 30, 40, 50, 60 or 70%.
In one embodiment of the method according to the invention, the degree of acetylation of the chitosan ranges from 2 to 70%. With this chitosan it is possible to obtain a film having optimum degradation kinetics for the manufacture of haemostatic patches.
The chitosan solution in step b) of the method according to the invention is generally prepared starting from a solution of chitosan in water, with the concentration of chitosan in said solution ranging for example from 0.25% to 10%, by weight, relative to the total weight of the solution, to which an acid is added in stoichiometric proportion, said acid being selected for example from acetic acid, hydrochloric acid and mixtures thereof. For a chitosan of molecular weight 500 000 Da (500 000 g/mol), for example, the concentration of chitosan in the starting aqueous solution can range from 0.25% to 5%, by weight, relative to the total weight of the solution.
With these chitosan concentrations it is possible to obtain, finally, a film that has good mechanical properties.
In one embodiment of the method according to the invention, the pH of the acidic aqueous solution of chitosan is from 2.5 to 5.5.
In order to form the chitosan-based film of the method of the invention, the acidic aqueous solution of chitosan is poured into a mould in order to form a layer. The acidic aqueous solution can be cast in the mould in the form of one or more layers, depending on the final thickness that is desired for the barrier film of the haemostatic patch. Generally, the mould is of rectangular shape having dimensions compatible with the use of the film obtained as part of a haemostatic patch.
The layer or layers of acidic aqueous solution are left to dry for evaporation of the water present in the acidic aqueous starting solution. Generally this drying step is carried out under a laminar-flow hood.
Drying of the layer or layers of acidic aqueous solution by evaporation of the water as stated above will make it possible to obtain the chitosan-based film used in the method according to the invention.
During step b°) of formation of the chitosan-based film, the water of the acidic aqueous starting solution is evaporated but the acid remains in the film. The film obtained is therefore of an acidic character. This film cannot be used as it is for forming the barrier of the haemostatic patch of the invention, as it would disintegrate very rapidly merely in contact with biological fluids.
Thus, besides a step of fixing the film to the porous layer based on oxidized cellulose, the method according to the invention comprises a step of neutralizing the film obtained in b°), and this neutralizing step can be carried out before or after the fixing step.
In the rest of the description, a first embodiment of the method according to the invention will be described first, according to which, firstly, the film is fixed to the porous layer based on oxidized cellulose, then it is neutralized, while it is already fixed on the porous layer based on oxidized cellulose. A second embodiment of the method according to the invention will then be described, according to which the film is neutralized first, then it is fixed to the porous layer based on oxidized cellulose.
According to the first embodiment of the method according to the invention, before the end of the drying step in step b°) of formation of the film, the porous layer of oxidized cellulose, in particular the three-dimensional knitted fabric, is deposited on the last layer of acidic aqueous solution based on chitosan that is cast. Under the action of gravity, the porous layer, for example the three-dimensional knitted fabric, penetrates superficially within the last layer cast that is drying. In final drying by evaporation of the water that remains in the last layer cast, the film traps the portion of the porous layer, for example of the three-dimensional knitted fabric, that had slightly penetrated into said last layer cast, and the porous layer is thus fixed to the film.
In the case when the film is fixed to the porous layer before it is neutralized, the neutralizing treatment is carried out on the face of the film that has been left free, i.e. on the face of the film that is not attached to the porous layer, in particular to the textile or knitted fabric based on oxidized cellulose.
In this first embodiment of the invention, for example, the neutralizing composition is applied on the free face of the film one or more times with a brush, taking care that the neutralizing composition does not come in contact with the porous layer based on oxidized cellulose. For example, the bristles of a brush are soaked with neutralizing composition consisting of an ethanol/water/ammonium hydroxide mixture in the proportions 80/16/14 by weight and the free face of the film is brushed or painted: several passes of the brush can be carried out, for example 3 passes. This formulation for the neutralizing composition makes it possible to avoid shrinkage of the film during this neutralizing step. Moreover, said formulation for the neutralizing composition and said number of passes make it possible to carry out effective neutralization of the chitosan-based film, both at the surface and throughout its thickness, without damaging the integrity of the porous layer on which the film is already fixed. The film thus loses its acid character and is neutralized.
The film can then be washed: for example, another brush is used, which is soaked with an ethanol/water composition, for example in the proportions 50/50 by weight, and which is brushed over the free face of the film, still without contacting the porous layer, for example the three-dimensional knitted fabric, based on oxidized cellulose. Several passes of the brush can be carried out, for example three, or up to five. A last pass with a brush soaked in water only can be carried out to finalize the washing.
According to the second embodiment of the method according to the invention, the cast layers of acidic aqueous solution from step b°) of formation of the thread are left to dry by complete evaporation of the water and until a film is obtained that can easily be removed from the mould and handled.
The chitosan-based film thus obtained, which has not been neutralized, can be submitted to one or more operations of immersion in baths of said neutralizing composition. For example, the film can be immersed in a bath of neutralizing composition preferably for 30 minutes. Thus, in this second embodiment of the method according to the invention, both faces of the chitosan-based film are treated with the neutralizing composition. In such an embodiment of the invention, the neutralizing composition can consist of an ethanol/ammonium hydroxide mixture in the proportions 80/20 by weight. This formulation for the neutralizing composition of the method of the invention makes it possible to carry out effective neutralization of the film, both on the surface of the film and in its thickness, without damaging the integrity of the porous layer during the next step of fixation of the film on the porous layer based on oxidized cellulose.
After immersion in a bath of the neutralizing composition as described above, the chitosan-based film has lost its acid character and it is neutralized. The film can then be washed: for example, the film is immersed one or more times in baths of an ethanol/water composition, for example in the proportions 50/50 by weight, until a pH close to 7 is obtained for the washing baths. The film can then be submitted to a last bath of water only to finalize the washing.
In this second embodiment, according to step c°), the neutralized film obtained at the end of step d°) can be fixed on one face of the porous layer of oxidized cellulose, for example on the three-dimensional knitted fabric, by means of a glue obtained starting from an acidic solution of chitosan. For example, said glue is spread on one face of the porous layer and/or on the face of the film intended to be fixed to the porous layer, and the film is fixed to the porous layer by application of the film on said face of the porous layer with pressure. The integrity of the porous layer based on oxidized cellulose is not affected during this fixing step.
Regardless of which embodiment described above is used, a patch is obtained comprising a porous layer based on oxidized cellulose, for example a three-dimensional knitted fabric, and a film based on chitosan fixed to one face of this porous layer, the film being in neutralized form. This patch can be used effectively as a haemostatic patch for stopping effusion of blood during a surgical operation. Moreover, this patch can be completely bioabsorbable: it can thus disappear in the weeks following its implantation, for example in less than 4 weeks, once its haemostatic function is no longer required. This thus avoids introducing a foreign body into a patient's body permanently.
EXAMPLES
Example 1
The fixation of a film based on neutralized chitosan on a textile of oxidized cellulose is described in the present example, referring to FIGS. 1A-1C.
A textile of oxidized cellulose 1, which is a porous three-dimensional knitted fabric, as shown in FIG. 1A, is provided. This textile is bioabsorbable.
An acidic solution based on chitosan is prepared by adding acetic acid in stoichiometric proportions to a solution of chitosan with a degree of acetylation of 50% and with a molecular weight of 550 000 Da at 10 wt % in water. 25 wt % of glycerol is added. The presence of glycerol in the acidic starting solution of chitosan then makes it possible to obtain a film that has good mechanical properties.
The acidic solution thus obtained 2 is poured into a rectangular mould 3 as shown in FIG. 1A: for example, from 8 to 30 ml of acidic solution is poured into a mould with dimensions of 10×15 cm. After evaporation of the water present in the solution, a film is obtained.
The solution can be cast in the mould in the form of several successive layers so that a thicker film is finally obtained. For example, three successive layers of acidic solution can be cast.
Before drying the last layer cast of the acidic solution 2, one face of the textile of oxidized cellulose 1, cut to the dimensions of the mould, is deposited on this layer as shown in FIG. 1. Thus, during drying of the last layer cast, the textile becomes fixed to the film obtained once the water has evaporated. A textile of oxidized cellulose 1 with a film 4 of chitosan fixed on one of its faces is thus obtained, as shown in FIG. 1B. At this stage, the chitosan film still has an acidic character and has not been neutralized.
A neutralizing composition is prepared, consisting of an ethanol/water/ammonium hydroxide mixture in the proportions 80/16/14 by weight. A brush 5 is soaked with this neutralizing composition and is applied on the free face of the chitosan film 4, i.e. on the face of the chitosan film which is not attached to the textile of oxidized cellulose 1, as shown in FIG. 1C.
During said application, care is taken not to bring the textile of oxidized cellulose 1 into contact with the neutralizing composition.
The neutralizing composition is applied on said face of the film at least three times. This formulation for the neutralizing composition makes it possible to avoid shrinkage of the film during this neutralizing step.
The neutralization is effective: the film can then be washed with aqueous solutions without risk of redissolving.
Thus, the neutralized film is rinsed by application of a brush soaked in an ethanol/water mixture in proportions of 50/50 by weight. This mixture can be applied several times, preferably up to three times. The film is then washed with water (100% water), either by application of a brush soaked with water, or by immersing in a water bath.
We thus obtain a textile of oxidized cellulose with a chitosan film fixed on one of its faces, said film having been neutralized. With the method of the invention, the textile of oxidized cellulose has not been damaged by the step of neutralization of the chitosan film and this textile has preserved its integrity. Moreover, the chitosan-based film has kept its initial dimensions, even after neutralization.
The textile thus obtained, with one of its faces covered with a film of neutralized chitosan, can be used as haemostatic patch 6 and can be implanted in a human body without risk of the chitosan film disintegrating and disappearing in contact with biological fluids.
The textile part, which is a three-dimensional knitted fabric of oxidized cellulose 1, thus forms a porous layer capable of absorbing blood. The film of neutralized chitosan, for its part, does not degrade in contact with biological fluids, and it acts as a haemostatic barrier.
The whole patch 6, namely the textile part and the film, is bioabsorbable and disappears in less than 4 weeks after implantation.
Said patch 6 is particularly useful for stopping effusions of blood during surgery. Said patch is completely bioabsorbable and disappears in less than 4 weeks after implantation, when its haemostatic function is no longer required.
Example 2
The fixation of a film based on neutralized chitosan to a textile of oxidized cellulose is described in the present example, referring to FIGS. 2A-2E.
An acidic solution based on chitosan is prepared by adding acetic acid in stoichiometric proportions to a solution of chitosan with a degree of acetylation of 50% and a molecular weight of 550 000 Da at 10 wt % in water. 25 wt % of glycerol is added. The presence of glycerol in the acidic starting solution of chitosan then makes it possible to obtain a film that has good mechanical properties.
The acidic solution 2 thus obtained is poured into a rectangular mould 3 as shown in FIG. 2A: for example, from 8 to 30 ml of acidic solution is poured into a mould with dimensions of 10×15 cm. After evaporation of the water present in the solution, a film 4 is obtained, as shown in FIG. 2B.
The solution can be cast in the mould in the form of several successive layers so that a thicker film is finally obtained. For example, three successive layers of acidic solution are cast.
The layers are left to dry until the water has evaporated completely and a dry film 4 is obtained (FIG. 2B), which can easily be manipulated by hand. For example, the layers are left to dry for 2 h at room temperature.
The chitosan film 4 obtained is of an acid character and has not been neutralized. In order to neutralize it, it is immersed in a neutralizing composition 5 consisting of an ethanol/ammonium hydroxide mixture in the proportions 80/20 by weight: for example, film 4 is immersed in said composition for 30 minutes in an orbital stirrer 6, as shown in FIG. 2C.
The neutralization is effective: the film can then be washed in aqueous solutions without risk of redissolving.
Thus, the neutralized film is rinsed by successive operations of immersion, for example three times, in baths of an ethanol/water mixture in proportions of 50/50 by weight until a pH of 7 is obtained for the rinsing mixture. The film is then washed by immersing in a water bath (100% water).
The film is then left to dry in spread-out form to avoid the formation of creases in the film.
The film of neutralized chitosan thus obtained 7 is then fixed on one face of a textile of oxidized cellulose by means of a glue based on chitosan as explained below, referring to FIGS. 2D and 2E.
To prepare the glue, acetic acid is added in stoichiometric proportions to a solution of chitosan with a degree of acetylation of 50% and a molecular weight of 550 000 Da at 10 wt % in water.
The glue obtained 8 is spread on one face of the film of neutralized chitosan 7 as shown in FIG. 2D. Alternatively, the glue could be spread on the face of the textile for fixing to the film, or both on one face of the film and on the face of the textile to be attached to the film.
A textile of oxidized cellulose 9 is provided, which is a porous three-dimensional knitted fabric as shown in FIG. 2E. This textile is bioabsorbable.
The textile of oxidized cellulose 9 is applied with pressure on the glue 8, as shown in FIG. 2E, and the film 7 of neutralized chitosan is thus fixed to the textile 9.
The “textile+film” assembly can then be dried under a laminar-flow hood.
A textile of oxidized cellulose is thus obtained with a chitosan film fixed on one of its faces, said film having been neutralized. With the method of the invention, the textile of oxidized cellulose has not been damaged by the step of neutralization of the chitosan film and this textile has preserved its integrity. Moreover, the chitosan-based film has a good, smooth and crease-free appearance.
The textile thus obtained, with one of its faces covered with a film of neutralized chitosan, can be used as haemostatic patch 10 and can be implanted in a human body without risk of the chitosan film 7 disintegrating and disappearing in contact with biological fluids.
The textile part, which is a three-dimensional knitted fabric of oxidized cellulose, thus forms a porous layer capable of absorbing blood. The film of neutralized chitosan, for its part, does not degrade in contact with biological fluids, and it acts as a haemostatic barrier.
The whole of patch 10, namely the textile part and the film, is bioabsorbable and disappears in less than 4 weeks after implantation.
Said patch 10 is particularly useful for stopping effusions of blood during surgery. This patch is completely bioabsorbable and disappears in less than four weeks after implantation, when its haemostatic function is no longer required.

## Claims

1. A method of preparing a haemostatic patch comprising a porous layer including oxidized cellulose and a film including neutralized chitosan, the film comprising a first free face and a second face fixed on a first face of the porous layer, comprising the following steps:
a) preparing a porous layer including oxidized cellulose,
b) preparing a film including chitosan starting from an acidic aqueous solution of chitosan,
c) fixing the film obtained in b) on a face of the porous layer,
d) neutralizing the film obtained in b), wherein step c) is carried out before or after step d) and the neutralizing step d) comprises treating the film with a neutralizing composition comprising at least ethanol and ammonium hydroxide.

2. The method according to claim 1, wherein step d) comprises a succession of operations of contacting at least the first free face of the film with the neutralizing composition.

3. The method according to claim 1, wherein step d) further comprises washing the first free face of the film after treating with the neutralizing composition.

4. The method according to claim 3, wherein the washing comprises one or more operations of rinsing at least the first free face of the film with a composition comprising ethanol and water followed by a washing with water.

5. The method according to claim 1, wherein step c) is carried out before step d).

6. The method according to claim 1, wherein step b) comprises pouring the acidic aqueous solution of chitosan into a mold as at least one layer, and drying the at least one layer by evaporation of water from the acidic aqueous solution to obtain the film.

7. The method according to claim 6, wherein step c) comprises depositing the face of the porous layer of oxidized cellulose on the film prior to the drying of step b) being complete, and allowing the film to dry completely to provide fixation of the porous layer on the film.

8. The method according to claim 7, wherein step d) comprises applying the neutralizing composition to the first free face of the film and the neutralizing composition further comprises water.

9. The method according to claim 8, wherein the neutralizing composition consists of an ethanol/water/ammonium hydroxide mixture in a proportion of 80/16/14 by weight.

10. The method according to claim 7, wherein step d) comprises applying the neutralizing composition on the first free face of the film one or more times using a brush.

11. The method according to claim 1, wherein step d) is carried out before step c).

12. The method according to claim 11, wherein step b) comprises pouring the acidic aqueous solution of chitosan into a mold as at least one layer, and drying the at least one layer by evaporation of water from the acidic aqueous solution until the film is obtained and removed from the mold.

13. The method according to claim 12, wherein step d) comprises immersing the film obtained in step b) in the neutralizing composition.

14. The method according to claim 13, wherein the film obtained in step b) is immersed in the neutralizing composition for 30 minutes.

15. The method according to claim 13, wherein the neutralizing composition consists of an ethanol/ammonium hydroxide mixture in a proportion of 80/20 by weight.

16. The method according to claim 13, wherein step c) comprises fixing the film obtained at the end of step d) on the face of the porous layer of oxidized cellulose by using a glue comprising an acidic solution of chitosan.

17. The method according to claim 16, wherein the glue is spread on the face of the porous layer and/or on the second face of the film intended to be fixed to the porous layer, and the film is fixed to the porous layer by application of the film on the face of the porous layer with pressure.

18. The method according to claim 1, wherein the acidic aqueous solution of chitosan of step b) further comprises a plasticizer.

19. The method according to claim 18, wherein the plasticizer comprises glycerol.

20. The method according to claim 1, wherein the porous layer is a textile.

21. The method according to claim 1, wherein the porous layer is a three-dimensional knitted fabric.

22. A haemostatic patch obtained by the method according to claim 1, comprising a porous layer including oxidized cellulose and a film including chitosan fixed to one face of the porous layer, wherein the film is in a neutralized form.