Abstract:
A method for making a lightweight surgical mesh, having the steps of applying a first set of filaments in a first wale direction and forming a first series of loops at each of a plurality of courses. Applying a second set of filaments in the first wale direction and forming a second series of loops at a first adjacent wale to the first wale direction and a third series of loops at a second adjacent wale opposite the first adjacent wale along the plurality of courses. Further, applying a third set of filaments in the first wale direction so that the second series of loops are formed at the second adjacent wale and the third series of loops are formed at first adjacent wale along the plurality of courses. Additionally, applying a fourth set of filaments that interlace repeatedly with the first set of filaments along the first wale direction.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation-in-part of U.S. application Ser. No. 12/454,308 filed May 15, 2009, which further claims priority under 35 U.S.C. §119 to Italian Patent Application No. MI2008A001186, filed Jun. 27, 2008. The entireties of both applications are incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates to a textile material and, in particular, to a surgical mesh of knit construction fabricated using a quadrilateral pattern forming an isotropic mesh. 
       BACKGROUND 
       [0003]    Hernia repairs are among the more common surgical operations which may employ a mesh fabric prosthesis. Such mesh fabric prostheses are also used in other surgical procedures including the repair of anatomical defects of the abdominal wall, diaphragm, and chest wall, correction of defects in the genitourinary system, and repair of traumatically damaged organs such as the spleen, liver or kidney. 
         [0004]    The prosthetic surgical meshes can be implanted in either an open surgical procedure or through laparocsopic procedures (i.e. inserting specialized tools into narrow punctures made by the surgeon in the surrounding tissue). 
         [0005]    Mesh fabrics as well as knitted and woven fabrics constructed from a variety of synthetic fibers can be used to form the mesh used in surgical repair. It is desirable for a surgical mesh fabric to exhibit certain properties and characteristics. In particular, a mesh suitable for surgical applications should have a tensile strength sufficient to ensure that the mesh does not break or tear after it is implanted in a patient. The mesh should also have a pore size which allows tissue to penetrate or “grow through” the mesh, after the mesh has been implanted into a patient. In addition, the mesh should be constructed so as to maximize flexibility. Increased flexibility helps the mesh mimic the physiological characteristics of the bodily structure it is replacing or reinforcing. An added benefit of increased flexibility facilitates the insertion of the mesh prosthesis into a patient during a surgical operation. 
         [0006]    There are competing mesh design concepts one of which is whether to employ a heavyweight mesh with small pores or a lightweight mesh with large pores. The heavyweight meshes are designed to provide the maximum strength for a durable and persistent repair of the hernia. Heavyweight meshes are formed using thick fibers, tend to have smaller pores, and a very high tensile strength. However, the heavyweight mesh may cause increased patient discomfort due to the increase in scar tissue formation. 
         [0007]    Lightweight, large pore meshes are better adjusted to the physiological requirements of the body and permit proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid formerly known mesh complications. 
         [0008]    However, lightweight meshes have other drawbacks. First, they typically have a lower minimum tensile strength due to the smaller diameter of filament used and the “open” weave. This is also aggravated by the fact that such meshes are formed anisotropic and the differential between the tensile strength in any one of the directions of force can vary significantly. Another drawback to using lightweight meshes is that the anisotropic nature of the mesh has the tendency to cause the mesh to twist or deform when placed under tension, making placement more difficult. 
         [0009]    Further, it is desirable for a surgical mesh fabric to have a tensile strength sufficient to ensure that the mesh does not break or tear after implantation into a patient. The minimum tensile strengths for meshes implanted for the augmentation and reinforcement of an existing bodily structure should be at least 16 N/cm. The tensile strength needed for meshes implanted to repair large abdominal hernias can increases to as much 32 N/cm. 
         [0010]    These and other objects and advantages of the invention will become more fully apparent from the description and claims, which follow or may be learned by the practice of the invention. 
       SUMMARY 
       [0011]    The invention is a lightweight knitted surgical mesh which includes a first axis, a second axis perpendicular to the first axis, a third axis offset approximately 30° to 60° from the first axis, and a fourth axis perpendicular to the third axis. Further the mesh has a first weave running parallel to the first axis, a second weave running parallel to the second axis, a third weave running parallel to the third axis, and a fourth weave running parallel to the fourth axis. In an embodiment, the third axis is offset 45° from the first axis. 
         [0012]    The first weave of the lightweight knitted surgical mesh can include a plurality of parallel filaments, wherein the filaments can be equidistantly or randomly spaced. Alternately, at least two of the first, second, third, and fourth weaves include a plurality of parallel filaments, wherein the filaments for the weaves are equidistantly or randomly spaced. In one embodiment, the filaments for the first weave, the second weave, the third weave, and the fourth weave are all equidistantly spaced to form an isotropic mesh. 
         [0013]    The first, second, third, and fourth weaves can include filaments which are at least one of monofilaments and multi-filaments. The filaments can have a diameter of 46 dTex and/or a diameter of 60 μm to 180 μm. The filaments can also have a tenacity of 20% to 35% elongation. The lightweight knitted surgical mesh formed of the fibers can have a specific weight of approximately 25 to 200 g/m 2  and a tensile strength greater than 16 N/cm or 32 N/cm. 
         [0014]    The first, second, third, and fourth weaves can include clear filaments and dyed filaments. The spacing between dyed filaments can ½ inch to 2 inches to formed a striped pattern. Further, a region of the mesh can be dyed to increase visibility. 
         [0015]    The filaments of the lightweight knitted surgical mesh can be made of polypropylene, polyester, or polyvinylidene fluoride. Further, the filament can be absorbable filaments and/or non-absorbable filaments. Additionally, the filaments can be coated with at least one of expanded poly-tetrafluoroethene/poly-tetrafluoroethylene, Teflon®, and biocompatible synthetic material. 
         [0016]    The mesh can also be coated with at least one of a biocompatible synthetic material, titanium, silicone, anti microbial agents, absorbable collagen, non-absorbable collagen, and harvested material. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    The above and still further objects, features and advantages of the present invention will become apparent upon consideration of the following detailed description of a specific embodiment thereof, especially when taken in conjunction with the accompanying drawings wherein like reference numerals in the various figures are utilized to designate like components, and wherein: 
           [0018]      FIG. 1  is a plan view of the surgical mesh of the present invention; 
           [0019]      FIG. 2  is a detail view of the mesh of  FIG. 1 ; 
           [0020]      FIGS. 3A ,  3 B,  3 C,  3 D, and  3 E are weaving patterns of separate examples; 
           [0021]      FIG. 4  is a plan view of a sling for urinary incontinence (male or female) made of the mesh of the present invention; 
           [0022]      FIG. 5  is a plan view of a sling for urinary incontinence in females associated with a cystocele made of the mesh of the present invention; 
           [0023]      FIG. 6  is a plan view of a sling for urinary incontinence in females and for vaginal vault support made of the mesh of the present invention; 
           [0024]      FIG. 7  is a plan view of an inguinal hernia repair in men made of the mesh of the present invention; 
           [0025]      FIG. 8  is a plan view of another inguinal hernia repair in men made of the mesh of the present invention; 
           [0026]      FIG. 9  is a plan view of an abdominal wall hernias made of the mesh of the present invention; 
           [0027]      FIG. 10  is a plan view of a sling for pelvic floor repair made of the mesh of the present invention; 
           [0028]      FIG. 11  is a plan view of another sling for pelvic floor repair made of the mesh of the present invention; 
           [0029]      FIG. 12  is a plan view of a further sling for urinary incontinence and pelvic floor repair made of the mesh of the present invention; 
           [0030]      FIG. 13  is a plan view of a sling for urinary incontinence made of the mesh of the present invention; and 
           [0031]      FIG. 14  is a plan view of another sling for urinary incontinence made of the mesh of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0032]    Referring to  FIG. 1 , a surgical mesh  100  of the present invention is illustrated. Surgical mesh  100  can be surgically implanted in a patient to treat urinary or fecal incontinence resulting from urethral hypermobility or intrinsic sphincter deficiency (ISD). Further, surgical mesh  100  can be implanted to reinforce soft tissue deficiencies. This includes, but is not limited to, pubourethral support and bladder support, urethral and vaginal prolapse repair, pelvic organ prolapse, colon and rectal prolapse repair, incontinence, reconstruction of the pelvic floor, sacral-colposuspension, abdominal wall hernias and chest wall defects. To accomplish the necessary support, mesh  100  can be made into pre-shaped designs, slings, three-dimensional plugs or flat sheets, as needed for each ailment to be corrected. 
         [0033]    Surgical mesh  100  is a two bar warp knitted structure. The mesh  100  is subject to numerous forces in tension. Forces are typically applied to the mesh along the X and Y axes X-X; Y-Y. Further, forces can be applied to the mesh along intermediate vectors between the X and Y axes. As illustrated, forces can be applied in T and W axes T-T, W-W. The angle between the X and W axes can be between 30° and 60°, and in one preferred embodiment, 45°. The angle between the Y and T axes can be between 30° and 60°, and in one preferred embodiment, 45°. When the angles between the X and W, and Y and T axes are 45°, the mesh is isotropic. One of ordinary skill in the art can realize that the angle can similarly be measured between the X and T axes and the Y and W axes. 
         [0034]    Referring to  FIG. 2 , mesh  100  is formed from a first weave  102  and a second weave  104 . The first and second weaves  102 ,  104  are long filaments directed along two opposing axes. For example, the weaves  102 ,  104  can be directed along the X and Y or W and T axes.  FIGS. 1 and 2  illustrate the first and second weaves  102 ,  104  directed along the W and T axes. In one embodiment, the W and T axes are perpendicular and the weaves are spaced equidistant from each other along each axis. As illustrated in  FIGS. 1 and 2 , the first and second weaves  102 ,  104  can form a square or diamond shape. In alternate examples, the first weave  102  spacing can differ from the second weave  104  spacing and the two weaves can form rectangles. 
         [0035]    In addition to the first and second weaves  102 ,  104 , a third weave  106  and a fourth weave  108  are woven along the remaining two axes. In the illustrated embodiment, third weave  106  is woven along the X-axis and the fourth weave  108  is woven along the Y-axis. In one embodiment, the third and fourth weaves  106 ,  108  can be perpendicular to each other. Again, the third and fourth weaves  106 ,  108  can form a square, diamond, or rectangular shapes based on their positioning and the spacing between adjacent weaves on the same axis and the opposing axis. 
         [0036]    At or near the points of intersection  110  of the first and second weaves  102 ,  104  the third and fourth weaves  106 ,  108  also intersect the first and second weaves  102 ,  104 . Thus, in one embodiment, all four weaves  102 ,  104 ,  106 ,  108  are interwoven with at least one other weave  102 ,  104 ,  106 ,  108  at the intersection points  110 . This interweaving adds to the strength of the surgical weave along the four axes X, Y, T, W and provides the mesh  100  with an isotropic pattern, when the weaves are properly spaced. 
         [0037]      FIGS. 3A-3E  illustrate different weaving examples that can be employed to form mesh  100 . The pattern chain for the weaving pattern  200  is as illustrated.  FIG. 3A  shows weaving pattern  200  which represents a surgical mesh that can be manufactured on a single needle bed thanks to the use of four bars whose movements are represented in the same figure. The first yarn  202  creates wale structure, conferring stability to the fabric in the vertical direction. The two yarns of the wale,  204  and  206 , interlace with the first yarn  202  creating a structure which is elastic and uniform. The last yarn  208  is the course that interlacing repeatedly to yarn  202  adds stability to the fabric in the transversal direction. 
         [0038]      FIG. 3B  illustrates a second weaving pattern  210 . First, second, and third filaments  202 ,  204 ,  206  perform the same structural purposes as previously discussed. However, the first, second, and third filaments  202 ,  204 ,  206  have slightly different bar patterns and the fifth filament  212  (the fourth for pattern  210 , but distinguished from fourth filament  208 ) is woven in a separate pattern. The pattern chain for the weaving pattern  210  is as illustrated. 
         [0039]      FIG. 3C  is a third weaving pattern  214 . First, second, and third filaments  202 ,  204 ,  206  remain the same as previously discussed in  FIG. 3B , however, sixth filament  216  (the fourth for pattern  214 , but distinguished from fourth filament  208  and fifth filament  212 ) is woven in a separate pattern. The pattern chain for the weaving pattern  214  is as illustrated. 
         [0040]      FIG. 3D  is a fourth weaving pattern  218 . First, second, and third filaments  202 ,  204 ,  206  remain the same as previously discussed in  FIG. 3B , however, seventh filament  220  (the fourth for pattern  218 , but distinguished from fourth filament  208 , fifth filament  212 , and sixth filament  216 ) is woven in a separate pattern. The pattern chain for the weaving pattern  218  is as illustrated. 
         [0041]      FIG. 3E  is a fifth weaving pattern  222 . First filament  202  is weaved similar to first filament  202  in  FIG. 3A  while the second and third filaments  204 ,  206  remain the same as previously discussed in  FIG. 3B . However, eighth filament  224  (the fourth for pattern  218 , but distinguished from fourth filament  208 , fifth filament  212 , sixth filament  216 , and seventh filament  220 ) is woven in a separate pattern. The pattern chain for the weaving pattern  222  is as illustrated. 
         [0042]    Relating the filaments (first through eighth,  202 ,  204 ,  206 ,  208 ,  212 ,  216 ,  220 ,  224 ) to the weaves (first through fourth,  102 ,  104 ,  106 ,  108 ), the first filament  202  forms the third weave  106 . The second and third filaments  204 ,  206  form the first and second weaves  102 ,  104  and the fourth filament  208 , fifth filament  212 , sixth filament  216 , seventh filament  220 , and eighth filament  228  form the fourth weave  108 . 
         [0043]    Each filament (first through eighth,  202 ,  204 ,  206 ,  208 ,  212 ,  216 ,  220 ,  224 ) can be a monofilament comprising a single strand of yarn or a multi-filament yarn. The diameter of the filaments can be between 60 μm and 180 μm. The diameter of the individual filaments (first through eighth,  202 ,  204 ,  206 ,  208 ,  212 ,  216 ,  220 ,  224 ) can be the same or different, depending on the use. In an embodiment, the filaments can be made from polypropylene (PP), polyester, or polyvinylidene fluoride (PVDF). The individual filaments can be coated in expanded poly-tetrafluoroethene/poly-tetrafluoroethylene (ePTFE), Teflon® and/or other biocompatible synthetic material. Further, certain sections of the filaments can be coated on one or both sides depending on use. 
         [0044]    In another embodiment, the filaments can be an interwoven combination of PP and an absorbable polymer filament such as polyglactin (PGLA), poly-1-lactide acid (PLLA), polydioxanone/poly-p-dioxanone (PDO or PDS), polycaprolacton or polyglecaprone. This embodiment reduces the amount of PP that remains in the body. In this regard, one or more of the filaments (first through eighth,  202 ,  204 ,  206 ,  208 ,  212 ,  216 ,  220 ,  224 ) can be PP while the remaining filaments are an absorbable polymer. Alternately, the PP mesh implant can be coated with an absorbable or non-absorbable polymer (PLLA, PGLA) on one or both sides or a portion of the implant mesh. Also, the PP mesh implant can be coated with titanium, silicone, or anti microbial agents. 
         [0045]    In a further embodiment, the PP mesh implant can be coated, on one side or both, in the entirety or on only a portion, with a natural material such as collagen. The collagen can be equine, porcine or bovine and either is absorbable or non-absorbable. In an alternate embodiment, the PP mesh can be layered, either in whole or a portion, with harvested material (i.e. human cadaver tissue, or suitable non-human tissue). The use of collagen or harvested material prevents erosion of the tissue with which the mesh is in contact. 
         [0046]    The coating of the filaments and/ or mesh serves different purposes. The implantation of a mesh into the human body is best between two or more muscles. Surgical mesh implanted in contact with organs or tissue can form adhesions or erosions. Certain coatings above reduce the likelihood that the mesh will form adhesions or erode the organ or tissue it contacts. Part of the erosion problem is that when the mesh is trimmed to size, the cut edges remain rough and can cause tissue/organ damage over time. Also the texture of PP mesh itself causes a foreign body reaction so when it is in contact with organs or in a sub-cutaneous position the rates of adhesions and/or erosions are greater. However, coating too much of the surface of the mesh can reduce the mesh&#39;s ability to be integrated into the surrounding tissue, it is the foreign body reaction (FBR) of the PP mesh which causes the in growth of fibrous tissue into prosthetic material and the actual mesh fixation. 
         [0047]    The use of absorbable coatings and filaments serves the purpose to increase the structural stability of the mesh, with out adding to the total load of PP in the patient. The additional absorbable fibers/coatings stiffen the mesh to make it easier for the surgeon to implant. The absorbency of the material is such that within a set period of time after the mesh in implanted (i.e. days to months) the material is absorbed into the body. This now gives the mesh a desired flexibility which can lead to reduced erosion and added comfort to the patient because the reduced FBR which results in a less dense fibrous tissue. 
         [0048]    Regardless of the filament material and/or coating, one or more of the filaments (first through eighth,  202 ,  204 ,  206 ,  208 ,  212 ,  216 ,  220 ,  224 ) can be colored. The colored filaments can be spaced apart to form stripes to improve visibility of the mesh  100  after it has become wet with body fluids. The spacing of the colored filament can be ½ inch to 2 inches apart. Additionally, a portion of the mesh can be colored to aid in positioning the center of the mesh where it is necessary. For example, for placement of the mesh under the urethra, the central portion (2-4 cm 2 ) of the mesh can be colored. The coloring can be an FDA approved color for PP and in one embodiment, the filaments can be colored blue. In another embodiment, certain materials and finishes of the filaments can lead to a greater light reflectance. Filaments of higher reflectivity can be interwoven to form the same stripe or center identification pattern as coloring. 
         [0049]    As discussed above, the diameter of the filaments can be between 60 μm and 180 μm. In one embodiment, the filament is 80 μm±10%. This filament diameter corresponds to approximately 46 dTex. The filament can be spun to have a tenacity of approximately 4.5 cN/dTex. Further, the filament can have an elongation at break once stretched. In one embodiment, the tenacity can be from 20% to 35% elongation. The woven mesh can vary in thickness from 0.25 to 0.80 millimeters and in one embodiment is 0.32 mm±10%. The mesh can have customarily weights approximately 30 g/m 2 ±8%. The specific weight of the mesh can vary between approximately 25 and 200 g/m 2 . The tensile strength of the mesh is at least 16 N/cm and can further be 32 N/cm. In one embodiment, the tensile strength is greater than 20 N/cm while still retaining an elasticity of 20%-35%. 
         [0050]      FIGS. 4-14  illustrate different examples of surgical slings made of the mesh of the present invention. The dimensions noted in the Figures are below in Table 1.  FIG. 4  illustrates a sling for urinary incontinence (male or female).  FIG. 5  illustrates a sling for urinary incontinence in females associated with a cystocele.  FIG. 6  illustrates a sling for urinary incontinence in females and for vaginal vault support.  FIG. 7  illustrates an inguinal hernia repair in men and the same configuration without the hole is for inguinal repair in women.  FIG. 8  illustrates another inguinal hernia repair in men.  FIG. 9  illustrates an abdominal wall hernia repair.  FIG. 10  illustrates a device for pelvic floor repair.  FIG. 11  illustrates another device for pelvic floor repair.  FIG. 12  illustrates a further sling for urinary incontinence and pelvic floor repair.  FIG. 13  illustrates a sling for urinary incontinence.  FIG. 14  illustrates another sling for urinary incontinence. 
         [0000]    
       
         
               
               
               
             
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 FIG. 
                 Dimension 
                 Length (mm) 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 4 
                 A 
                 20 to 50 
               
               
                 4 
                 B 
                 12 to 30 
               
               
                 4 
                 C 
                  9 to 20 
               
               
                 5 
                 D 
                 20 to 50 
               
               
                 5 
                 E 
                  9 to 20 
               
               
                 5 
                 F 
                 30 to 40 
               
               
                 5 
                 G 
                 20 to 30 
               
               
                 6 
                 H 
                 20 to 50 
               
               
                 6 
                 I 
                  9 to 20 
               
               
                 7 
                 L 
                 40 to 65 
               
               
                 7 
                 M 
                  90 to 140 
               
               
                 7 
                 N 
                  9 to 13 
               
               
                 8 
                 O 
                 40 to 60 
               
               
                 8 
                 P 
                  0 to 15 
               
               
                 8 
                 Q 
                  9 to 13 
               
               
                 9 
                 R 
                 25 to 75 
               
               
                 9 
                 S 
                 12 to 45 
               
               
                 9 
                 T 
                  9 to 30 
               
               
                 9 
                 U 
                  30 to 140 
               
               
                 9 
                 V 
                  30 to 140 
               
               
                 10 
                 X 
                  9 to 20 
               
               
                 10 
                 Y 
                 100 to 140 
               
               
                 10 
                 Z 
                 30 to 60 
               
               
                 10 
                 DD 
                 20 to 50 
               
               
                 11 
                 K 
                 30 to 50 
               
               
                 11 
                 W 
                 50 to 90 
               
               
                 11 
                 AA 
                 50 to 90 
               
               
                 11 
                 BB 
                 20 to 50 
               
               
                 11 
                 CC 
                  9 to 20 
               
               
                 12 
                 RR 
                 20 to 80 
               
               
                 12 
                 EE 
                 40 to 80 
               
               
                 12 
                 FF 
                  6 to 20 
               
               
                 12 
                 GG 
                 130 to 210 
               
               
                 13 
                 HH 
                 10 to 40 
               
               
                 13 
                 LL 
                 200 to 450 
               
               
                 14 
                 MM 
                 20 to 80 
               
               
                 14 
                 NN 
                 150 to 300 
               
               
                 14 
                 PP 
                 20 to 80 
               
               
                 14 
                 QQ 
                 10 to 20 
               
               
                   
               
             
          
         
       
     
         [0051]    While there have been shown, described, and pointed out fundamental novel features of the invention as applied to a preferred embodiment thereof, it will be understood that various omissions, substitutions, and changes in the form and details of the devices illustrated, and in their operation, may be made by those skilled in the art without departing from the spirit and scope of the invention. For example, it is expressly intended that all combinations of those elements and/or steps which perform substantially the same function, in substantially the same way, to achieve the same results are within the scope of the invention. Substitutions of elements from one described embodiment to another are also fully intended and contemplated. It is also to be understood that the drawings are not necessarily drawn to scale, but that they are merely conceptual in nature. It is the intention, therefore, to be limited only as indicated by the scope of the claims appended hereto.