MEANS AND METHOD OF IMPLANTING BIOPROSTHETICS

Abstract: Means and method for implanting bioprosthetic material surgically, in humans or animals. The means comprise lengths of connective tissue such as mammalian tendons (10, 14) which are covered entirely or partially with a synthetic, loose weave mesh (44) which is stitched to the tendon and which augments the strength of the finished heterograft (or xenograft) by permitting the existing live tissue to grow around the mesh to provide a living bond. Another implementation of the basic idea involves the use of planar patch material such as porcine pericardium (22) to which the mesh (20) is bonded on one side, or part of one side, this patch being used in various ways, for example, hernia repairs, dural patches, arthroplasties, tendon pulleys, gliding surfaces, and blood vessel anastamoses.

Description: D-escription Means and Method of Implanting Biop_rostheϋcs Background of the ]_cιvent__on The invention is in the field of pro_£hetics and more particularly bioprosthetics, per taming specifically to repair and 5 replacement of connective tissue structures through use of heterαlogous animal ti≡sue covered in whole cr in part by a grid or medi of synthetic fabric which is bonded to t e heterologous tissue to provide the oppo r tunity for host tissue ingrowth to define a living bond between the host tissue and the heterograft (cr zenograft.) •3-D This method would also be applicable to homologous tissue. The use of prosthetic devices within the body, such as artificial .pints and pϋa∑fcLc or metal implants of various kinds is besoming increasingly common a d represents a technical field of intense activity. The use of biologically incrganic materials, such as metal 15 or plastics, in the body creates basic engineering or mechanical problems, some of which can be overcome by the use of bioprosthetic There are materials which are produced by t e bam an body or in animals which are intrinsically superior to man-made materials 20 in their durability, toughness, sϋpperyness, or a certain combination of desired traits. Fcr example, it has been found that heart valve replacement can be done using porcine heart valves. Although * » ≠ y β • ■ •", -jA-r t NAL -?_ mechanical valves have been developed, the porcine heart valve combines the char^teristi-cs of durability, reliability, and relative silence in operation and is included in the spectrum of todays prosthetic valve replacements. Porcine pericardium has alsD been used both to repair injured human pericardium and, at least once, to replace a single cusp in a defective heart valve. Unitl recently, because of the antigenic nature of non- autjologous tissue utilization of porcine heart valves and other b_opro_±hetic material had not been posible due to rejection. Currently, however, heteraLogcus and homologous tissue m ay be rendered stable and non-antagenic by fixation with such compounds as glutaraldelyde to permit their use as heterografts in humans. As pointed out below, the ability to use heterogeous animal ti_sue possessing similar bio mechanical properties as those tisues being replaced or augmented has certain advantages, such as similar modulus of elasticity and the potential for -eventual biologic bonding. Summary of the Inrention The instant invention takes advantage of the development of the glutaraldelT de fixation technique and basically utilizes stock heterolcgous animal tissue combined with synthetic mesh as body bui ing materials. Although the tissue used is often referred to in this ■specification and claims as heterologσus, it will be understood that in all instances this term will be read broadly enough to cover 5 homologous tissue from human cadavers. Si one main embodiment, the heterologous animal tissue comprises tendons cr ligaments from cows or other animals which are used to replace h an tendons or ligaments. After being fixed, the tendons or Hgamaits are covered aU or in part, depending on 10 which surfaces need to slide and which need to be gripped by surrcunding tissue, by the synthetic mesh, which would ordir rily be stitched into place. In the event of a tendon or ligameni to-bone junction, the mesh-covered end of the heterologous tissue would be drawn into a bore or notched opening in the bone, where it is secured 15 by sutures or other fixation. The presence of the mesh on the end of tile biopro_theas permits ingrowth of connective tissue to define a living bond with the bioprosthetic im lant. Other embodiments revolve around the use of a flat tissue such as the pericardium of pigs, which is prepared on one side, or 20 part of one side, by the bonding of synthetic me^π thereto. The resisting product can be used in a number of applications, the basis of its use lying in the fact that those areas of the pericardium or other heterdogeous patching tissue which need to bond to host tissue are covered with synthetic me_£_ to encourage host tissue ingrowth and tighter bonding, whereas those areas of the patch which will be in contact with organs, or covering defects, or wuL act as sliding or bearing surfaces for moving body parts, will be left free of the me =h so that the nafurally smooth, slippery pericardia! tissue surface is utilized. Brief Description αf the Drawings Figure 1 diagram maticalLy illustrates the replacement of a finger tendon with a bioprosthetic tendon; Figure 2 is a sectional detail illustrating the connection of the heterograft to the fingerbone; Figure 3 illustrates the juncture between ho t and heterologous connective tissue before binding with the pericardium patch; Figure 4 represents the juncture of Figure 3 after binding with the pericardium sleeve; Figure 5 is a section through Hne 5-5 of Figure 1 illustrating one means of pulley installation; Figure 5 is a section taken thr ugh line 6-6 of Figure 1 representing another eans of pulley creation; Figure 7 is a section through a bored bone low g a -slightly modified technique of connecting bone to connective tissue; Figure 8 is an elevation view of the musculature and bone structure utilizing the connective technique of Figure 7; Figure 9 Illustrates a simple tend en repair utilizing pericardium laminate, or the protective sheathing of a muscle or tendon; Figure 10 is a detail, of the repair shown in Figure 9; Figure 11 illustrates two typ-es of ligament heterografts Figure 12 • _Di.ist_ra.tes a pre-wrapped heterograft specimen; Figure 13 represents a heterograft -specimen as that of Figure 12 but with me__h surrounding tήe tips only; Figure 14 is a side elevation view of a heterograft utilizing an animal ligament which is removed from the animal complete with bone fragm ents at the end; Figure 15 is a section through a hand indicating the use of the pericardium laminate as a sϊding surface over the hand bones and to prevent the formation of scar tissue connecting tendon repairs to the bones; Figure 16 diagram maϋcaHy illustrates a duial patch; Figure 17 is a perspective of a repair of a defect such as in a flat muscle; . ,. . . _ .*» BAD ORIGINAL -e- Figure 18 illustrates utilization of the pericardium laminate in j->int anthroplasiies; Figure 19 is a front eLevation with a portion cut away of a typical pericardium laminate; Figure 20 is a section taken through line 20-20 of Figure 19; Figure 21 is a front elevation view of the pericardium laminate with a variant mesh pattern; Figure 22 is a view similar to 21 with yet another variant of the mesh pattern; 1J3 Figure 23 illustrates utilization of the laminate in blood vessel anastomosis, or bioprosthetic graft to a blood vessel anastomosis; Figure 24 is a sectional view of a completed blood vessel anasto mosis. Detailed Description of the Preferred Embodiment -^ Uses of the instant technicque include applications in hu ans cr other species utilizing heterologαis ligaments as replacement for or augmentation of previously exi_Ξtir_g ligaments, and reconstruction of tendons about the extremities, such as the wrist, hand, cr lower extremities. R eccnstruction of a finger and hand tendon is shown 20 in Figure 1, wherein the existing tendon is shown at 10. The existing tendon, which originally connected to the end of the middle finger, OMrl BAP ORIGINS ? :? ° r now terminates at the new juncture 12, at which point an artificial tendon 14 is connected. The artificial tendon is a specim en of connective tissue such as a tendon or ligament, from a cow or other animal which has been treated with glutaraldehyde or the like to 5 render it nonantigenic and stable. The artificial tendon, being actual mam malian connective ti_sue, may function quite adequately as a finger tendon, but needs to be anastamosed to the distal phalanx of the finger and to the proximal tendon stump 10. To connect to the exi__ting tendon, as •10 shown in Figure 3 . a suture 16 can be used to join the two ends. The Figure makes the point that the two ends are sutured together and does not necessarily indicate the optimal suturing technique. In order to both strengthen and smooth over the juncture between the two tendon ends, and to encourage the ingrowth of •15 ti_sue from the existing tendon 10, the juncture 12 is wrapped with a layer of me £_-backed peric__rdium 18, with the mεsh 20 being on the inside, and the pericardium 22 being outside. It is an apparent characteristic of the pericardium that it wϋl provide a very effective, smooth gliding surface to which live tissue will not grow, so that 20 scar tissue forming around tiie injured area wxCL not adhere to the tendon and prevent its subseque t gliding. " ,M j The laminate is wrapped around the juncture as shown in Figure 4, and can then be stitch ed to the respective tendon and artificial tendon with through stitches 24, which pass through the connective tissue, and loop Pitching 26 to fasten down the end 5 edges. An additional Figure 8 stitch 28 could be included to add extra strength. As indicated above, the resulting connection wϋL ha e a smooth exterior surface because of the external surf ace of the pericardium, and wϋl also may exhibit strength that is greater than the =traight ID end-to-end stitch which would otherwise be used. Turning to the other end of the aritificial tendon 14, Figure 2 illustrates a finger bone 32 through which has been drilled a tunnel 34. The distal end of the artificial tendon 14 is covered with a mesh cap or sleeve 3β, which is sutured to the underlying artificial 15 tendon as will be detailed below. The me__h, much as the me__n 20 stitched to the pericardium in Figures 3 and 4, permits the ingrowth of surrounding tissue. This mesh tip is puUed through the tumel 34 and maintained in place by sutures 33 which extend through the naϋ 40 and are tied around a button 42. These sutures may be 20 made as a part of a manufactured bioprosthetic tendon, or they can OMPI D ORIGINAL be added at the tim e of the operation. They remain in place long enough for the bone and/or connective tissue to adhere to the artificial tendon 14, which is greatly strengthened by the ingrowth of the bone tissue into the grid work of the mesh cap 36. Either the sutures 38 are abssrbable or they may be removed once connective tissue into the end of the bioprothesis is sufficiently strong. Thus it can be seen that the combination of heterologous animal tissue with a mesh cover can be effectively us-ed both to strengthen a graft and to permit tissue ingrowth, and thus foster live tissue bonding. An additional use of the general concept of heterologous tissue backed by me-sh can be sen in Figures 1, 5 and 6 wherein the final structural members required to complete the construction of the finger tendon shown in Figure 1 are detailed. These are the pulleys -44 in Figure 5 and pulley 46 detailed in Figure 6, which exists in a natural human hand and prevent bow-π ringing of the tendon as the finger is flexed. Although there is no reason pulleys 44 and 46 should differ fhom one another, they are .hown different to illustrate two embodim ents. Pulley 44 utilizes a strip of peric-ardium -48 with me_£L bands 50 across the ends of one sid-e. -i0- With the me__n side in, the pulley is stitched to the perio_ϋum of the phalanx 52, where in a manner similar to that detailed with reference to Figure 2, connective tissue ingrowth around the me__rn 50 win create a strong bond over a period of time. The mesh terminates well short of the artificial tendon 24 so that the smooth pericardium surface provides a suck bearing surface for the ' longitudinal motion which the tendon requires. Figure 6 illustrates an arrangement that is identical to Figure 5 except that the ends cf the heterograft overlap and are stitched together in their overlapping ends. They would be stitched to the periostium as well to prevent migration and to foster connective tissue ingrowth as was the cas in Figure 5- Thus the -sequence of procedure =hown in Figures 1 through 6, u-sed to reconstruct a hand tendon, provide a basic, coherent ϋu^ration of all of the techniques and materiaZs used in the instant procedures. Tendon anastomosis illustrated in Figures 3 and 4 utilizes the laminate or patch 18 to provide a strengthening, smooth sϋeeve across tine point of anastomosis. At the other end, the heterologous tendon with the synthetic mesh sleeve is pulled into a bone tumel, illustrating a bioprosthesis-to-bone connection. Intermediate the two ends, the utilization of the pericardium for low-firiction sliding -31- purposes is illustrated. The product used in this instance is similar to the .laminate 18, but of course does not have a continiσus cover' of me_-h, but only two bands of mesh across either end of one side. Figures 7 and 8 iHusstrate a procedure similar to that ∑shown 5 in Figure 2, but on an arm. In this instance, the end of a real or artificial tendon 54 is covered with a mesh sleeve 56 and insserted part way through a bone tunnel 58. To maintain the end in place pending healing, ssutures 60 are puled through a pair of small holes drilled in the bone ad^cent the main tumel 58. A pair of transverse 10 bone plugs 62 have been inserted through the ends of the tendon for tine purpose of contacting the bone alongside the bone tumel 58, s=o that it will fusse together over time. The bone plugs may be inserted into incisions made in tine ends of the tendon when the operation is taking place. The bone fragments used for the plugs 15 may be obtained from local or areas of t e recipient's skeletal structure, or may be ho mologous or hetsrologα_s. Additionally, a similar res-ult could be achieved by passing absaorbable ssutures through the ends of the bioprosthetic. As these stitches slowly dissolve, they wϋl leave passageways for the ingrowth of ssurroαndirig tissue. 20 This technique m ay be used with other fcrms of the bioprossthetic dnown herein as well or the tendon and ligament graftss. •42- Figures 9 and 10 illustrate a simple tendon anastomosas utilizing the laminate 18 in the same fashion as illustrated in Figures 3 and 4. In this instance, there is no need for an artificial tendon as both ends of the original tendon are present. Once the two ends are sutured, the sleeve is wrapped around and connected to itsslf and to the underlying tendons with sutures. Tendon adhεrance to the mesh is again desired, and the external pericardium surface will again provide a smooth, non^ondirg surface to permit some motion of surrounding tissue across the pericardial surface and prevent scar ID tissue adherance. Figure 9 can also iHus&rate the sheathing of an existing unbroken musscLe with the laminate to reduce friction at a sore cr injured point. The same could be done to a peripheral nerve with the laminate bioprosthetic sutured to the epineuriuπi to prevent abrasion, chaffing or ti-≡sue ingrowth from surrσinding tissue. • 1 in Figure 11 a knee joint is shown having two artificial, ligament grafts illustrating two variant means of connection of the ligament ends to the bone structure. The coUateral ligament 66 connects to the bone on opposite sides of the .pint in windows 68 cut into the bone with an osteoto e. This ligament is shown in 20 more detail in Figure 13- The boσy of the ligament replacement, that is the tissue itself, would ordinarily be a tendon or ligament from a cow or other animaL At each end a mesh cap or sleeve 70 is securely stitched to the tendon or ligament tissue. A suture 72 extends from each end, and as can be seen from Figure 11 these 5 sutures are drawn through the bone and tied as indicated at 74 to initially hold the, ligament in place. Additional strength can be achieved by utilization of a staple 76 which drives straight through the bone flap or 78 which was cut by the osteotome and into tine metaphysϊs. ID Over' a period of time, the windows 68, of course, fUL in with bone, and in doing s© grow interstitially among the fibers of the mesh caps 70 so that a permanent, strong and secure artificial ligament connection is effected. Tunning to the other ligament in Figure 11 , this is a cruciate 15 ligament replacement, and the replacement element is indicated at 80 and is de ailed in Figure 12. Here again, a bovine tendon or ligament would ordinarily be used. B ecause there is no sliding or shipping of the ligament across another -surface, the entire length of the graft can be covered with the mesh 82, which, again, is 20 securely stitched to the underlying tissue. Sutures 84 extend from the ends of the heterograft. 4.4- When installed in the bone as shown in Figure 11 , a continuous tunnel 86 is fcrmed with a surgical drill, and the artificial ligament 80 is extended through this bore with the ssutures 84 being drawn through small suture holes 88 and tied at 90. Again, over time bone ingrowth should essentially fill all interior sspace. To expedite this ingrowth process, as a matter of surgical technique often bone powder and chips from the drilling, which form a kind of paste, are inserted in the ends of the bore 86 to implement formation of a contiguous bone mass. The heterografts shown in Figures 12 and 13 are exemplary of off-the-^nelf items which could be provided in different sshapes and sizes by surgical companies and selected from an array of different types for use by the surgeon. Although created in large part from actual animal tissue, they are made into products and sold as such. A similar product 92 is indicated in Figure 14. This item , also representing an artificial ligament, is an actual ligament from an animal, but in this instance the Eganent is removed from the donor bone along with its bony attachments 94. Use of this specimen might require development of further techniques for rendering the bone tissue non-antigeriie. This ligament would need to be removed along with its bony attachments so that these bone fragments are nccrDorated as an integral, organic part of the entire 45- sstructure. Subsequently, the collagen portion of the ligament is wrapped with the mesh as indicated at 96 which is securely sutured in place. Turning from the implementation of the invention as 5 connective tϊsssue, structural replacement cr augm entation, Figures 15 and 18 illustrate use of the basic laminate 18 to define sliding c sϋppery bearing ssurfacess. 3h Figure 15, a cross section of a hand is shown wherein the wrist bones 98 are covered with a segment 100 of the pericardium-mesh laminate with the mesh down so that •10 t wϋl bond to the bone and/or perioste . The top surface of the laminate is the pericardium, and just above this surface are the tendons 102 of the hand, which are beneath the skin 104. By the utilization of the pericardium laminate between the bone and the tendons, not only is a smooth surface defined which may eliminate ■15 problems with roughness occuring in the underlying bone, but, more importantly, the growth of scar tisssue around any tendon repairs above the bioprosthetic pericardium will not bond to the pericardium as it would to the underlying bone and soft tissue, and thus will not limit the motion of the hand as would otherwise be a problem in 0 hand reconstruction. This implementation is similar in principle to that involving the pulleys -44 and 46 indicated in Figures 5 an 6. •46- ]h both instances, the mesh is used to form a firm tis∑sue bond, and the pericardium itself is used to define a sliding surface. Another sOiding ssurface is defined in Figure 18 wherein an ar hroplasϊty is perf-crmed on a pint 106. The .pint may have become roughened or weakened with s, and a portion is removed to define a relieved area 108 which is capped with a section 110 of the laminate, of course with the face down to bond to the underlying bone. In this instance, the upper surface of the laminate which to this point has been described as pericardium, could possibly be cartilage insstead of pericardium . In either instance, a smooth bearing surface is provided which was otherwise lacking in that particular surface of the pint. In yet another general implementation of the technique, Figures 16 and 17 illustrate 'patching" of defective planar tissue in the body by use of the pericardium and mesh structure. Si Figure 16, the dura 112 has a defect 114, which may ressult from a head injury cr surgical intervention. Merely ssuturing the edges of the parted dura around the hole together is not adequate to cover the opening. Therefore, a patch 116 is util zed having a peripheral sstrip 118 of the mesh around the inner surface to bond to the dura alongside, but not covering, the opening 114. The patch is isutured 4.7- into place, and over time the dura forms a stronger bond to the mesh trim 1 18, and the central, smooth portion 120 of the patch overlies the brain. A similar configuration is shown in Figure 17 wherein a patch 5 1 16 is numbered identically. In this instance, an elongated fascia! defect 122 of the muscle tissue 124 requires repair. This situation m ay also be present in hernias, wherein the nature of the defect precludes sutoring existing tissue together sufficiently to provide a satisfactory repair. 10 Figures 19 through 22 detail to so me extent the product used in the patching implem ntations of the invention discussed above. The patch of Figures 16 and 17 is illustrated in Figure 22, and the similar numbers are retained. Nateirally, the shape of the patch need not be ssquare and would ordinarily be trim med by the surgeon 15 in use. A variety of different sizes, shapes, and relative proportions of mesh versus unobstructed smooth space 120 would need to be provided if the item is to be used off the shelf, or substantially off the shelf, with some modification. The basic laminate 18 is shown in Figure 19, having a 20 pericardium face 22 with the mesh backing 20. Ordinarily, the mesh would be connected to the pericardium with suitable sutures 1 __6 so 4.8- that the pericardium surface is not penetrated or marred. Figure 21 is an enlargement of the configuration used in Figures 5 and 6 for the pulley construction, deariy other geometric arrangements of the basic structure would be required fcr different specialized uses, although a basic variety of sizes and shapes and configurations might easily be adapted by cutting and tri ming at the operation site to achieve the precise heterograft desired. One further use of the laminate is shown in Figures 23 and 24. In this instance, a rectangular patch is used in a manner very similar to that indicated in Figures 3 and 4. However, instead of pining tendons, blood vessels 127 and 128 are connected, fird. with direct -sutures 129 between the blood vessel ends proper, and secondly with the laminate sleeve 130. The sleeve' may be -sutured to one blood vessel end as shown in Figure 23 and rolled back, subsequent to which the blood vessels are ined. Once the direct ssuturing between the blood vessels is finished, the sleeve 130 can be rolled flat as shown in Figure 24, and saαtured to the second blood vessel as shown. Vessel 128 could also be a bioprosthetic blood vessel. In this insstance, it could be provided off the shelf with the sleeve already fastened in place, and possibly rolled back as shown in Figure 23. Thus it can be seen that a basic concept, involving the bonding together of a synthetic mesh with hetereogecus tissue, to make a heterograft, naturally expands into a variety of different applications requiring modified heterograft products. The mesh itself could be 5 made of Dacron or any other ssuitable synthetic material woven or otherwise fabricated to meet -specific requirements, and the heterogeous tissue cculd be other than porcine. Undoubtedly other ap Hcatiαns will become apparent as the invention is implemented. Falϋng within the generalized disclosϊure and the claims appended 10 hereto, a product is provided comprising bioprosthetic material bonded to synthetic mesh, surgically implanted in such manner as to foster or* promote host tissue ingrowth and subsequent fixation of t e bioprosthesis. While I have described the preferred embodiment of the •15 invention, other embodiments may be devised and different uses may be achieved without departing from the spirit and scope of the appended claims.

Claims: 1. A method of implanting bioprosthetic material in the body utilizing a tissue specimen having a mesh bonded to at least a portion of same, said method comprising the following steps: (a) positioning said specimen in place with at least part of the portion having the mesh bonded thereto contacting uving tissue, and (b) fastening aid tissue specimen in pla e to permit growth of uve tissue into said mesh to define a uving bond. 2. A method according to Claim 1 and including at least one abs=orbat_Le ssuture passing through said tissue -specimen at a point thereon in which bonding to living tissue is desirable to permit ingrowth of Uving tissue as the suture dissolves. 3. A method according to Claim 1 wherein said ti__sue sspecimen comprises a length of connective tissue with said mesh bonded around one end thereof, and step (a) comprises inserting said one end into a tunnel bored into a bone. 4. A method according to Claim 2 and including the step of inserting at least one bone plug into said one end of .said length of connective _ OMPI tissue and bringing said bone plug into contact with the sides cf said tunnel djring -step (a) so that fusion of bone between said plug and tunnel walls will eventually occur. 5. A method according to Claim 1 wherein aid tissue specimen comprises a generally planar sheet of tisssue having said mesh bonded to a subs3tantial portion of one side thereof, there being live tissue comprising the firee end of a length of connective tissue which is to be connected to the free end of a second length of connective 10 tisssue, and steps (a) and (b) comprise abutting said ends, ssuturing same together, wrapping same around the abutted juncture with said specimen having the mesh thereon inside, and stitching said sspecimen and mesh into place. - • ^ 6. A method according to Claim 1 wherein said tissue specimen comprises a generally planar sheet of tissue having mesh bonded to one ssurface thereof, and step (a) comprises wrapping said specimen arcund an existing muscle cr peripheral nerve with the mesh on the inside to prevent abrasion. 20 7. A method according to Claim 1 wherein the method is used in anastomosis of blood vessseL ends, said tissue specimen comprises a planar sheet of heterologeous tissue having mesh bonded to one surface thereof, step (a) comprises abutting the ends of said blood vessels and wrapping the abutted juncture with said specimen having the mesh on the inner side thereof. 8. A method according to Claim 1 wherein said specimen comprisses a length of connective tissue with patches of mesh bonded to each end, and step (a) comprises wrapping said specimen at least partially around a bone and encircling a tendon to act as a tendon pulley. 9. A method according to Claim 8 wherein step (b) comprises stitching the ends of said length of connective tissue to said bone, with the mesh lying against the bone. 10. A method according to Claim 1 wherein said specim n comprises a patch of generally planar tissue having mesh trim around at least a portion of the periphery of one side thereof, there being live tissue defining a surface having a defect therein, and step (a) compris-es laying said sspeci en over said defect with said mesh trim OMPI lying against said surface around said defect. 11. A method according to Claim 1 for creating a smooth bearing surface utilizing a specimen comprising a patch of generally planar 5 heterologecus ti≤εsue having mesh bonded to at least one portion of one side thereof, wherein step (a) comprises placing said patch with the mesh face-down over a body bearing surface, and sstep (b) comprises stitching said patch to said ssurface. 1Ω 12. A method according to Clai m 11 wherein said body bearing surface cσmpr_ses a joint surface and including the further step prior to sstep (a) of reducing said surface to define a relieved portion substantially the same depth as said specimen to define a generally cαntinucus bearing surface across the juncture of said patch with 15 the adpining un-reHeved tissue. 13. A modified biopros-thaesis comprising: (a) a tjsssue specimen; and (b) a mesti bonded to at least one portion of the -surface of 20 said -specimen such that said modified bioprosthesis can be placed with at least a portion of said mesh against a living tisssue surface and held in place, and said living tis-sue will grow into said mesh to define a living bond therewith. 14. Structure according to Claim 11 wherein said tissue specimen comprises a length of connective tissue substantially completely encaps_ulted in a mesh cover. 15. Structure according to Claim 13 wherein said tisssue specimen comprises a length of connective tissue having the ends thereof wrapped with mesh caps. 16. Structure according to Claim 13 wherein said sspecimen comprises a length of connective tissue and including at least one connecting suture extending from an end of said specimen. 17. Structure according to Claim 13 wherein said specimen comprises a length of connective tissue stϋL cαnn-ected at at least one end to the bony attachment from the donor, and said mesh substantially surrounds said connective tissue. OMPI /4 _, IPO 18. Structure according to Claim 17 wherein said specimen comprisses a cow tendon. 19. Structure according to Claim 13 wherein said tisssue specimen 5 comprises a flat patch and said mesh is bonded to one side thereof. 22. Structure according to Claim 19 wherein said mesh comprisses a loose weave synthetic fabric stitched to said patch. 10 21. Structure according to Claim 19 wherein said tisssue comprises porcine pericardium. 20. Structure according to Claim 19 wherein said mesh defines a continuous trim around the peripheral portion of one side of said 15 patch to define an open central area of said pjatoh clear of said mesh to overle gaps cr injuries in live tissue in use. 23- Structure according to Claim 17 wherein said mesh defines two .strips across opposite ends of one side of said patch to permit use 20 of a modified bios-prothesis' as a tendon pulley.

Inventors: KURLAND KENNETH Z
Applicants: KURLAND KENNETH Z
Application year: 1982
Main classification: A61F1
IPC codes: A61B17, A61F2, A61L27