# Patent

## Title
Cellular control and tissue regeneration systems and methods

## Abstract

A system for in-vivo and ex-vivo tissue regeneration and cellular control, manipulation and management includes a source of cell manipulating factors, which are administered to a therapy zone via active pressure-differential components including a pump and a controller, or pulse-waves generated passively. A plate comprising tissue or an inert, bio-compatible material is provided in the therapy zone in proximity to a fluid flow manifold and tissue scaffolding. A tissue regeneration and cellular control method includes the steps of providing a cell manipulation factor source, providing one or more factors to a therapy zone and forming a pressure wave with a mechanical component or an in-vivo pressure wave source, such as the circulatory or lymphatic system.

## Background
CROSS-REFERENCE TO RELATED APPLICATION
This application claims priority in U.S. provisional patent application Ser. No. 61/386,380, filed Sep. 24, 2010, which is incorporated herein by reference.


BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates generally to tissue repair, regeneration and engineering, cellular management devices and methods, and in particular to internal implantable and external surface-mount tissue generative devices accommodating cellular manipulative influence factors, which collectively can be introduced into and applied to tissue generation zones.
2. Description of the Related Art
In the medical field, which is broadly defined to include medicine, dentistry, veterinary medicine, etc., tissue reconstruction, closure, healing and repair are important aspects of many medical procedures. Such broad intentions generally involve control and manipulation at the cellular level, including the application of various influence factors known to signal cells to grow, reproduce, migrate, align and otherwise respond positively. Applying properly indicated influence factors, including pharmacological, chemical, antimicrobial, electromagnetic force (EMF), pressure differential (negative and positive), bioengineered cells for seeding, thermal energy, acoustic energy (e.g., ultrasound), mechanical and other influence factors, has been shown to significantly improve patient outcomes across a wide range of medical conditions and treatment procedures.
The prior art includes technologies and methodologies for positively influencing cellular migration and regeneration. For example, the Zamierowski U.S. Pat. No. 4,969,880; U.S. Pat. No. 5,100,396; U.S. Pat. No. 5,261,893; U.S. Pat. No. 5,527,293; and U.S. Pat. No. 6,071,267 are incorporated herein by reference and disclose the use of pressure gradients, i.e., vacuum/negative and positive pressure, to effect wound closure and fluid drainage from wounds, including surgical incision sites. Such pressure gradients can be established by applying porous foam material either internally or externally to a wound, covering same with a permeable, semi-permeable, or impervious membrane, and connecting a suction vacuum source thereto. Fluid drawn from the patient is collected for disposal. Such fluid control methodologies have been shown to achieve significant improvements in patient outcomes. Another aspect of fluid management, postoperative and otherwise, relates to the application of fluids to wound sites for purposes of irrigation, infection control, pain control, growth factor application, etc. Wound drainage devices are also used to achieve fixation and immobility of the tissues, thus aiding healing and closure. This can be accomplished by both internal closed wound drainage and external vacuum devices. Fixation of tissues in apposition can also be achieved by bolus tie-over dressings (e.g., Stent dressings), taping, strapping and (contact) casting.
Cells can be subjected to physical forces and/or chemical signals in order to achieve desired endpoints or therapy goals. For example, mechano-transduction force signal characteristics are known to influence cell behavior. Tension, compression and shear mechanical forces can be applied to encourage tissue regeneration and wound closure. Still further, electro-magnetic force (EMF) is known to encourage cellular growth and closure.
Cellular movement or “migration” is an important aspect of healing. The present invention applies various forces and other influences to accomplish cell migration in order to achieve closure and healing. In order for a cell to accomplish repair of an injured tissue, it must “migrate” into the defect and replace the missing cells and/or their functions in the damaged tissue. The same property is required for tissue engineering schema. Cells must multiply and migrate into desired shapes, beds or scaffolding to create a desired engineered tissue result. The present invention addresses regenerating and repairing a wide range of tissue types in connection with a virtually unlimited range of medical treatment procedures and desired outcomes.
Heretofore, there has not been available a cellular control system and method with the advantages and features of the present invention, including the combination of inter-tissue devices with influence factors.
SUMMARY OF THE INVENTION
In the practice of one aspect of the present invention, a medical device is provided for implanting in a tissue space wherein regeneration is indicated under one or more influence factors. The implantable device can include a plate providing a differentiating barrier for controlling pressure, fluid flow, cells and other influence factors as input and output to an in-situ therapy zone, which can be internal or external or both relative to the patient. The plate can be absorbable or non-absorbable and autologous or non-autologous. Tissue regeneration/healing/repair scaffolding provides an interface between the plate and a tissue contact layer and can facilitate tissue regeneration with a matrix composition. An external cell-manipulating factor interface comprises fluid-conveying tubing, pressure (positive and negative) application components and EMF connections with the therapy zone.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic diagram of a cellular control system embodying an aspect of the present invention.
FIG. 2 is a perspective view of an inter-tissue application of the cellular control system, including a fluid/pressure interface subsystem and an endotube.
FIG. 3 shows an alternative aspect including a cover adapted for rolling or furling on an access line or conduit.
FIG. 3A shows a conduit of the cellular control system extending through an incision in the skin surface.
FIG. 4 shows an implanted plate and a conduit position for placing a furled cover.
FIG. 5 shows the cover extending over a therapy zone.
FIG. 6 is a cross-sectional view thereof taken generally along line 6-6 in FIG. 5.
FIG. 7 shows another alternative aspect including fluid/pressure inlet and outlet conduits with manifolds engaging the plate.
FIG. 8 shows a flexible barrier film furled on a conduit and in position for extending over the plate.
FIG. 9 shows the flexible barrier film extending over the plate.
FIG. 10 shows the therapy zone closed by a tissue overlay.
FIG. 11 is a cross-sectional view taken generally along line 11-11 and FIG. 10.
FIG. 12 shows another alternative aspect including scaffolding installed with an endotube.
FIG. 13 shows an absorbable fabric hemostatic layer being applied over the scaffolding via the endotube.
FIG. 14 shows the completed assembly of the system in the therapy zone.
FIG. 15 shows the therapy zone covered by a tissue trapdoor plate.
FIG. 16 shows another alternative aspect of the present invention with inflow/outflow conduits extending into the therapy zone.
FIG. 17 is a cross-sectional view taken generally along line 17-17 in FIG. 16.
FIG. 18 shows another alternative aspect of the present invention with scaffolding located in the therapy zone including couplings.
FIG. 19 shows another aspect of the invention with multiple bellows-type pumps or pillars in the therapy zone.
FIG. 20 shows another aspect of the invention with a closed-loop endotube assembly in the therapy zone.
FIG. 21 is a cross-sectional view taken generally along line 21-21 in FIG. 20.
FIG. 22 is a schematic diagram similar to FIG. 1 showing another tissue regeneration and cellular control system embodying an alternative aspect of the present invention.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
I. Introduction and Environment
As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure.
Certain terminology will be used in the following description for convenience in reference only and will not be limiting. For example, the words “upwardly”, “downwardly”, “rightwardly” and “leftwardly” will refer to directions in the drawings to which reference is made. The words “inwardly” and “outwardly” will refer to directions toward and away from, respectively, the geometric center of the embodiment being described and designated parts thereof. The words “horizontal” and “vertical” generally mean side-to-side and top-to-bottom, respectively. Said terminology will include the words specifically mentioned, derivatives thereof and words of a similar import.
Referring to the drawings in more detail, the reference numeral 2 generally designates a medical cellular control or tissue regeneration system embodying an aspect of the present invention. A primary intention of the cellular control system and method disclosed herein is tissue regeneration, which is broadly used to include tissue engineering, organ construction and tissue culture manufacturing. For example and without limitation on the generality of useful applications of the control system 2, a primary application disclosed herein is for controlling cellular regeneration and closure in an inter-tissue or intra-tissue space 4, which can be generally located between a contact layer 6 and an in-situ tissue surface 8, and is generally referred to as a “therapy zone.” The therapy zone 4 can be located at various treatment sites in or on a patient, although typically it will be at a pathology location which is the object of a medical procedure involving cellular manipulation by one or more of the factors identified at 12, including mechano/transductive, electro-magnetic force (EMF), pharmacological, chemical/antimicrobial, fluidic, bioengineered cells for seeding, thermal energy, acoustic energy (e.g., ultrasound), osmotic, oncotic, fluid pressure differential and others.
FIG. 1 shows a general interface 10 for applying the factors 12 to the therapy zone 4. The interface 10 includes a supply or inlet side 14 and an outlet side 16. By way of example and without limitation, the inlet side 14 can include a preprogrammed, digital controller 18 connected to and controlling a pump 20, which delivers the contents of a supply reservoir 22 to an inflow manifold 24 for application to tissue regeneration/healing/repair scaffolding 26. A suitable inlet conduit subsystem 28 is provided for delivering factors 12 via the inlet side 14. The inlet side 14 also includes a positive pressure conduit 30, which can be connected to a plate structure 32 in a plate area 27 of the therapy zone 4 via the controller 18 and the pump 20. Fluid flow in the plate area 27 can be influenced and directed by the plate structure 32.
An outlet side 16 of the interface 10 includes an outlet conduit subsystem 34 connected to an outflow manifold 36 from the scaffolding 26 and discharging to a collection reservoir 38. A negative pressure (NP) pressure conduit 40 connects the plate structure 32 to the factors 12, which can include a negative pressure source. For example, one or more pumps 20 can be located on either or both sides of the plate structure 32.
FIG. 2 shows a general configuration for the system 2 including a tissue bed 42 forming the tissue contact layer 6 and located below a skin surface 44. The inflow and outflow sides 14, 16 of the interface 10 can include respective inflow and outflow conduits 30, 40 extending through openings 45 in the skin surface 44 under the scaffolding 26 to the therapy zone 4. The scaffolding 26 can be retained in place on the tissue bed 42 by suitable anchors, such as scaffolding anchor clips 50, which can comprise staples, sutures or other suitable in-situ fasteners. An endotube 52 also extends through a skin surface opening 45 and is secured in place by endotube fasteners 54 (staples are shown) adjacent to scaffolding 56 located over the therapy zone 4. The endotube 52 is adapted for serving multiple functions, including placing and anchoring the scaffolding 56, and introducing multiple factors 12 into the therapy zone 4 via a lumen 53.
FIG. 3 shows a cellular control system 60 comprising another aspect of the invention with scaffolding 61 secured to the tissue bed 42 by the scaffolding fasteners 50 and positioned between inflow and outflow manifolds 62, 64, which are connected to inflow and outflow conduits 30, 40. The manifolds 62, 64 can be perforated, porous, semi-permeable or otherwise configured for communicating factors 12 with the scaffolding 61. A tissue flap or trapdoor plate 66 can be surgically opened by the incision 67 for access to the therapy zone 4 and closed as shown in FIG. 4 with a suture line 68 with the conduits 30, 40 extending through the flap incision lines 67 on either side of the tissue flap plate 66. A furled cover 72 is wrapped around an endotube 70 with an endotube bore 71 for placement in the therapy zone 4 and can be extended to a covering position generally over the scaffolding 61 (FIG. 5). As shown in FIG. 6, the cover 72 is adapted for covering the suture line 68 during healing and can comprise various suitable wound-dressing materials, including membranes and bio-absorbable dressings.
FIGS. 7-11 show another aspect of the invention comprising a cellular control system 80 with a fluid transfer element 81 inflow and outflow manifolds 82, 84 connected to conduits 30, 40 respectively and including respective manifold branches 86, 88 penetrating scaffolding 89 for communicating fluids, pressure and other factors 12. The fluid transfer element 81 can comprise open-cell foam or some other suitable fluid-transferring material. As shown in FIGS. 8, 9 and 10, an endotube 70 with a furled cover 72 can be placed within the therapy zone 4 and covered by the tissue flap 66 whereby the cellular control system 60 is substantially contained within the enclosed therapy zone 4. Within such a closed environment, the cover 72 can be unfurled and extended by rotating the endotube 70 (FIG. 11).
FIGS. 12-17 show a cellular control system 90 comprising another aspect of the invention and including scaffolding 92 adapted for placement in the therapy zone 4 on the tissue bed 6, which can be surgically exposed by lifting a tissue flap plate or trapdoor 94. As shown in FIG. 12, the scaffolding 92 can be placed with the endotube 52, which is positioned in the therapy zone 4 and in turn positions the scaffolding 92 over the tissue bed 6. An absorbable fabric hemostatic layer 96 is extended over the scaffolding 92 as shown in FIG. 13 and is secured to the tissue bed 6 with suitable fasteners 50, such as sutures or staples. The trapdoor 94 functions as the plate in this configuration and is placed over the scaffolding 92, the endotube 52 and the fabric hemostatic layer 96, as shown in FIG. 15. The tissue flap trapdoor plate 94 can be sutured in place over the therapy zone 4.
Inflow and outflow conduits 30, 40 are inserted through openings 45 in the tissue flap plate 94 as shown in FIG. 16 and can underlie the scaffold 94. Alternatively, the flow conduits 30, 40 can be placed before the scaffolding 92 is placed. The tissue flap plate 94 can be formed in subcutaneous tissue, with the flow conduits 46, 48 extending through skin surface openings 98 and penetrating to an appropriate depth to reach the therapy zone 4. Alternatively, in a surface application the tissue flap plate 94 can comprise the dermal and epidermal layers.
As shown in FIG. 17, the hemostatic fabric layer 96 can be wrapped around the endotube 52 for placement over the scaffolding 92. The endotube 52 can be slotted at 98 for accessing the lumen 53, which can receive the scaffolding 92 in a compression-rolled configuration 92a for unrolling into the therapy zone 4, for example, by a flexible rod extending through the endotube 52 for twisting externally to the patient.
FIG. 18 shows a cellular control system 102 comprising another modified aspect of the invention and including scaffolding 104 with inflow and outflow female couplings 106, 108, which connect to the inflow and outflow conduits 30, 40 respectively via male couplings 110, 112. A barbed-strand, self-anchoring surgical suture 114 is shown being extended into the therapy zone 4 from the endotube 52. Such sutures are available from Quill Medical, Inc. of Research Triangle Park, N.C. See, for example, U.S. Pat. No. 7,056,331, which is incorporated herein by reference. The endotube 52 facilitates inserting the barbed suture 114 and “setting” its prongs by tugging on the outer end extending from the endotube 52 external to the patient for self-anchoring the suture 114.
FIG. 19 shows a cellular control system 120 comprising another modified aspect of the present invention and including multiple bellows-action pillars 122 located below the scaffold 104 and fluidly connected to the inflow and outflow conduits 30, 40 respectively. The pillars 122 can reciprocably compress and expand in response to various pressures associated with the therapy zone 4. Such pressures can be externally-generated, e.g., by one or more of the factors 12, or internal pressures generated by the patient. Such pillars 122 can facilitate a “pumping” action with the cellular control system 120 by alternately expanding and contracting in order to move fluid into and out of the therapy zone 4.
FIGS. 20 and 21 show a cellular control system 130 with a continuous loop endotube 132 forming the scaffolding 26 within a therapy zone 134 generally formed along the path of the endotube 132 through tissue 136. The endotube 132 includes a lumen 138, which can function as a conduit for introducing pharmacological and other substances 140, and/or extracting fluid from the patient. For example, the endotube 132 can be preloaded with cells for seeding the therapy zone 134. The endotube 132 forms inflow and outflow conduits 142, 144 with interchangeable functions. The endotube 132 includes an outer contact surface 146, which is adapted for engaging the tissue 136. The endotube 132 can be bioabsorbable, permanently implanted or extracted after completing a procedure. Moreover, the endotube 132 can be fabricated from a wide range of suitable materials chosen for compatibility with the therapeutic objectives of particular procedures. For example, semi-permeable materials can form pressure differentials and selectively transfer fluids. The endotube 132 can be perforated or slotted for fluid collection or dispersal. The external conduits 142, 144 can be connected to negative and/or positive pressure sources external to the therapy zone 134. Placement of the endotube 132 can be accomplished with a Trocar instrument, by surgical incision or placement under a tissue flap or trapdoor 66.
An open mesh 148 comprising a matrix of threads or capillary-type tubes 150 forms a cellular control sleeve 152 over an endotube outer contact surface 146. The mesh 148 can introduce cells, facilitate cellular ingrowth, channel fluid evacuation, enhance tissue contact interaction and otherwise facilitate the treatment objectives. The range of suitable materials includes bioabsorbable materials, pharmacological release materials (e.g., antibiotics, growth factors, antiseptics, imaging materials and other suitable materials) and hollow tubes for communicating fluids. The mesh 148 can be extracted with the endotube 132, or left in place after extraction. Still further, the mesh 148 can comprise closure members, such as the barbed suture strands 114 available from Quill Medical, Inc., which are described above.
The tubular or thread configuration shown in FIGS. 20 and 21 includes the system and method embodiments described above, with their components formed in tubular shapes. These embodiments can include conduit size components (cm to mm range diameters), capillary size (mm range diameters) and nano size (micron diameters). Length can generally be any suitable length. The endotubes 132 can be fabricated and installed in various configurations, including straight, linearly-connected (series), parallel configurations, spiral, coil, circular, wave-like, etc. with the intention of optimizing recipient tissue bed positioning and ease of installation. Installation can be accomplished manually by palpation, visually, with imaging techniques, endoscopically assisted or using open surgical techniques. Manipulative factors 12 can be introduced or applied, typically at one or both ends of the conduits 142, 144 with external (percutaneous) connections of the tubes, conduits or threads. The outer barrier or sheath of the tube (equivalent to the plate described above) and the makeup of the inner core (equivalent to the scaffolding described above) depend on the therapy intentions and the method of introduction, including placement, manipulation and control. With the system in a tubular configuration, the outer barrier is also the contact layer.
The tube can be placed in solid tissue, such as muscle or the liver using imaging techniques with a series of guide wires, followers and dilators, similarly to techniques for endovascular access. In long muscles such as the quadriceps, both entrance and exit areas are more feasible and more easily accomplished with a single guide wire or thin trocar. Input and output can thus be provided at opposite poles as the simplest and most efficient system for fluid manipulation. For example, in the liver, without open or endoscopic assistance, a single external conduit could serve as both input and output ports by alternating the functions or by use as a conduit carrying side-by-side smaller input/output lines that would travel in a preconfigured fashion through the outer sheath and inner core whereby the input would be instilled at one end and the output would be withdrawn from the opposite end and these functions could travel side-by-side in the single conduit separately contained.
Once the tube, conduit or thread has been placed, a series of rinses alternating with suction would be instituted to clear the space of the debris of the trauma of placement and to draw the surrounding tissue tightly against the thread and then to stimulate neovascular ingrowth to start. The outer sheath could have a pore size sufficient to be able to remove the blood and cell damage from placement. This could take an estimated one to two days or until the effluent is clear. The cell seeding then starts and is continued until it also comes out the effluent. The inner core is a scaffolding material that is biodegradable and chosen for its affinity to the cells to be seated. The outer sheath is in removed and the inner core, now seeded with cells, is left in place to grow and “take” as a graft of bioengineered tissue grown in-situ. If a single port is used, the inner core can be cut below the skin line and allowed to retract. If a double (2-ended) port is used, the output port is cut below the skin line and the outer sheath is then pulled out through the outer port. If the core is in the port, it is also cut off below the skin and allowed to retract. The end result is that the nonabsorbable outer sheath is removed and the absorbable scaffolding is left in a subcutaneous (inter-tissue) position.
FIG. 22 shows a modified control system 202 comprising an alternative aspect of the present invention. The system 202 includes an inter-tissue space/therapy zone 204, which also defines a flow layer(s) for fluids generated internally and/or introduced externally. The tissue contact layer 6 can be located anywhere appropriate for treatment with the systems 2 and 202, including subdermal, subcutaneous, externally and internally; and in or on body cavities, organs, muscle fibers, ligamentous and osseous (skeletal) structure, etc. A plate/tissue component 208 can comprise a physical structure, such as a biocompatible material adapted for placement in or on the therapy zone 204. Alternatively, the component 208 can comprise a patient's tissue layer, such as the dermis, epidermis, etc. Functionally the component 208 cooperates with a pressure differential manifold 232 to facilitate and direct the flow of fluid, microbial agents, medications, irrigation, and other substances in the therapy zone 204. Either or both of the tissue scaffolding 226 and the pressure differential manifold 232 can comprise cellular matrices, synthetic tissue, living tissue or derivatives of living tissue.
The system 202 can include a variety of configurations with the plate/tissue component 208 cooperating with the manifold 232 and scaffolding 226 to form the pressure differential zone 204. Fluid pulse waves can be introduced to the therapy zone 204 by cycling a pump 220 with a controller 218 and pulsing fluid through various tubing and manifold configurations, including those shown in FIGS. 2-21. A sensor suite 242 is connected to the controller 218 and can include multiple sensor suite feeds 244 extending to various components and areas of the therapy zone 204. The sensor suite 242 can include sensors for monitoring various operating parameters, including pressure, temperature, microbial activity, chemical composition (e.g., oxygen and CO2 levels), etc. Sensor inputs to the controller 218 can be digitized for processing by the microprocessor controller 218. The sensor signal input information can be utilized by the controller 218 for controlling various operating parameters of the system 202, such as the pump 220, the inflow/outflow lines 230/240 and the factor source 212.
The tubing and manifold elements shown therein can be rearranged and reconfigured as necessary to achieve a wide range of alternative systems for accommodating various patient conditions and treatment objectives.
Relatively small-amplitude pressure changes of, for example, a few mm Hg, can be sufficient for achieving desired therapeutic results. More specifically, such pressure changes can stimulate cellular activity, reepithelialization, cell migration, regeneration and other physiological changes associated with the healing process. Alternatively or additionally, components of the system 202, such as the bellows-equipped pillars 122 shown in FIG. 19, can provide or supplement such pressure waves, for example with the blood pressure cycles of the circulatory system or similar pressure-varying, dynamic physiological functions, such as musculature, lymphatic, respiratory, etc. The system 202 can thus operate using the dynamic pulsations naturally occurring in-vivo, and/or with externally-applied forces, such as the pump 220.
In addition the to in-vivo systems and methodologies described herein, the system 202 is adaptable for benchtop, tissue culture, tissue engineering, ex-vivo and other applications for a wide range of research, bioengineering, tissue culture and other useful applications, which share a common element of cellular control and manipulation.
A general interface 210 can comprise a wide range of suitable component/patient interface constructions, such as internal/external dressings, closure screens, etc. For examples, see Zamierowski U.S. Pat. No. 4,969,880; U.S. Pat. No. 5,100,396; U.S. Pat. No. 5,261,893; U.S. Pat. No. 5,527,293; and U.S. Pat. No. 6,071,267; and U.S. Patent Publications No. 2008/0228221 and No. 2008/0228222, which are incorporated herein by reference. An exemplary list of cell manipulating factors as shown at 212 for application to the therapy zone 204 via the interface 210, and is not to be construed as limiting. Various other cell manipulating factors can be employed for achieving desired therapeutic and other beneficial results. On a supply/input side 214 of the system 202, a controller 218 can be provided for preprogramming to control various components and operating parameters of the system 202, such as a pump 224 for delivering fluids and other factors from the source 212 to the pressure differential manifold 232 via inlet lines 228 and to tissue scaffolding 226 via therapy inflow input lines 230. Likewise on the outlet side 216, line 234 is connected to the pressure differential manifold 232 and returns to the source 212. The therapy outflow line 240 is connected to the tissue scaffolding 226 and returns to the source 212.
An optional supply reservoir 222 can be connected to the therapy inflow line 230 and can provide a secondary or alternative source of pharmacological and other factors for input to the therapy zone 204 via the therapy inflow line 230. A corresponding collection reservoir 238 can receive fluid from the therapy zone 204 via the therapy outflow line 240. Of course, collected waste fluid can be disposed of using established medical waste disposal procedures.
These systems 2 and 202 shown and described above comprise exemplary aspects of the invention, which may be embodied in various other forms. For example, the planar orientations of the system components can be rearranged and reconfigured in-situ as determined by the medical practitioner. Alternative orientations can include inverted, vertical, horizontal, etc. Moreover, the orientations discussed above are for illustration and could vary depending upon the position of the patient. Still further, the pressure differential manifold 232 could be formed within or below the tissue scaffolding 226 and in various spatial relationships to the plate/tissue 208. The component configurations can assume any appropriate configuration, such as tubular, spiral, circular, etc.
It is to be understood that while certain aspects and embodiments of the invention are described and shown, the invention is not limited thereto and can assume a wide range of other, alternative aspects and embodiments.

## Claims

1. A medical cellular control system for a tissue therapy zone, which system comprises:
a cell manipulating factor source;
a plate adapted to be located in the therapy zone;
a pressure differential manifold adapted to be positioned in proximity to the plate and adapted to be located in the therapy zone;
a therapy inflow line adapted for connection to the factor source and to the pressure differential manifold;
said therapy inflow line being adapted for supplying a factor from said factor source to said pressure differential manifold;
a tissue scaffolding component adapted to be located in the therapy zone and adapted for fluidic connection to said factor source via the pressure differential manifold and the inflow line;
an endotube adapted for fluidic connection to the therapy zone and the factor source;
a flexible cover furled around the endotube; and
said flexible cover having a retracted position and a covering position and being extendable from said endotube from said retracted position to said covering position over said tissue scaffolding component.

2. The system according to claim 1 wherein said plate comprises in-situ tissue or an inert, biocompatible material and is adapted for containing pressure and directing fluid flow in said therapy zone.

3. The system according to claim 1 wherein said factors are chosen from the group comprising: fluid pressure gradient; osmolar; osmotic; oncotic; mechano/transductive; electro-magnetic field (EMF); pharmacological; chemical/antimicrobial; fluidic; bioengineered cells for seeding; thermal; and ultrasound.

4. The system according to claim 1, which includes:
a pump adapted for connection to the factor source and the inflow line; and
a controller adapted for connection to the pump and adapted for controlling the operation of the pump in response to therapy zone conditions.

5. The system according to claim 1, which includes:
a manifold including a fluid-permeable foam material; and
manifold tubing adapted for fluidic connection to the foam material and to the inflow line and an outflow line.

6. The system according to claim 1, which includes:
a barbed surgical suture within said endotube; and
said barbed surgical suture having an engaged position extending from said endotube into said therapy zone.

7. The system according to claim 1, which includes:
an inflow manifold adapted for connection to said inflow line;
said inflow manifold being adapted for connection to said therapy zone and distributing a cellular control factor therein;
an outflow manifold adapted for connection to said outflow line; and
said outflow manifold being adapted for connection to said therapy zone and extracting fluid from said therapy zone.

8. The system according to claim 7, which includes:
said inflow and outflow manifolds including multiple manifold branches extending from respective inflow and outflow lines to multiple locations in said therapy zone.

9. The system according to claim 1, which includes:
multiple sutures or clips adapted for anchoring said scaffolding to a fluid bed in said therapy zone.

10. The system according to claim 1, which includes a pulse wave generator adapted for generating a pulse wave in said therapy zone via said inflow tubing.

11. The system according to claim 1, which includes said therapy zone being configured for applying a pulse-wave with in-vivo pressure differential from a circulatory, lymphatic or respiratory system.

12. A medical cellular control system for a tissue therapy zone, which system comprises:
a cell manipulating factor source;
a plate adapted to be located in the therapy zone;
a pressure differential manifold adapted to be positioned in proximity to the plate and adapted to be located in the therapy zone;
a therapy inflow line adapted for connection to the factor source and to the pressure differential manifold;
said therapy inflow line being adapted for supplying a factor from said factor source to said pressure differential manifold;
a tissue scaffolding component adapted to be located in the therapy zone and adapted for fluidic connection to said factor source via the pressure differential manifold and the inflow line;
an endotube adapted for fluidic connection to the therapy zone and the factor source;
a barbed surgical suture within said endotube; and
said barbed surgical suture having an engaged position extending from said endotube and adapted to extend into said therapy zone.

13. The system according to claim 12, which includes:
a flexible cover adapted to be furled around the endotube; and
said flexible cover having a retracted position and a covering position and being extendable from said endotube from said retracted position to said covering position over said tissue scaffolding component.