Abstract:
An implantable port includes a bottom portion having a needle-penetrable region running continuously along a majority of a perimeter of the implantable port. A method for customized suturing of an implantable port also includes creating a port pocket, and advancing a suture needle through the needle-penetrable region. The needle-penetrable region could be a self-sealing elastomer, such as silicone. The method could include the step of determining suture locations after the port pocket is created.

Description:
FIELD OF THE INVENTION 
       [0001]    This invention relates generally to implanted medical devices used to access subcutaneous regions within a body, such as vasculature. 
       BACKGROUND OF THE INVENTION 
       [0002]    Long term access to a patient&#39;s body is required for many medical treatments including antibiotic therapy, hemodialysis access, chemotherapy regimens, and other treatments that require repeated administration, withdrawal, or exchange of fluids. In some cases, internal access to the patient is required for years. 
         [0003]    Subcutaneously implanted access ports are one type of medical device that can be used for this purpose. These medical devices often either include or are attached to a catheter used for the administration, withdrawal, and/or exchange of fluids from the patient. A pocket is made in the subcutaneous tissue, and the medical device is placed into the pocket. 
         [0004]    Access ports generally have a molded or rigid housing, with a fixed number of suture holes. These suture holes protrude from the housing of the medical device, causing it to have a larger overall size than it otherwise would have. During implantation, a physician is thus required to create an incision in the body of sufficient size to allow insertion of the device. Further, rigid appendages on the housing of the medical device can make manipulation of the device within the body of a patient difficult for a physician. 
         [0005]    Suturing of such a device can be performed by the physician to secure or stabilize the device. A number of factors determine whether or not the medical device is sutured in place, including the pocket configuration, the type of training received by the physician, and the physician&#39;s preference. Once the device is properly positioned and secured, the pocket is closed. 
         [0006]    There is a wide range of preferences among physicians regarding the number and location of suture holes. Some physicians prefer one, two, three, four, or more suture holes. Some physicians prefer not to have any suture holes, and yet others prefer to have any suture holes that are present filled with a material such as silicone to minimize fibrin ingrowth into the suture holes, thereby facilitating subsequent removal of the device. 
         [0007]    After suturing has been completed, the rigid housing of the medical device and the associated suture holes do not readily accommodate movement of the patient. Movement of the patient causes the tissue to which the medical device has been sutured to move. The rigidity of the device thus results in increased tension on the sutures, resulting in discomfort and irritation to the patient. 
       SUMMARY OF THE INVENTION 
       [0008]    In one aspect, the invention features an implantable medical device for percutaneous access to a body comprising a flexible member and a housing defining an entry site for the administration, withdrawal, or exchange of fluids. The flexible member is attached to a surface of the housing and stabilizes placement of the medical device within the body. An adhesive is disposed on a first surface of the flexible member and attaches the flexible member to the housing surface. The flexible member can comprise suture locations, and the suture locations can define one or more suture holes. The suture holes can be filled with a material to minimize tissue ingrowth, such as fibrin. The material can be silicone or a biocompatible polymer, and is preferably penetrable by a suture needle. 
         [0009]    The flexible member can have a perimeter region penetrable by a suture needle, which can be formed of materials including polyurethane, thermoplastics, elastomers, and fiber reinforced elastomers. The flexible member can also include tabs, which can be located about a perimeter of the flexible member. The tabs can define one or more suture holes. 
         [0010]    The flexible member can be coated with a tissue growth substance and can be shaped and/or textured to conform to tissue within the body. A second surface of the flexible member can include an adhesive for attaching the device to tissue within the body. The flexible member can be preformed to mate with the housing. It can also be shaped to surround a perimeter of the housing. 
         [0011]    Another aspect of the invention features a flexible member for stabilizing the placement of a medical device within a body. The flexible member includes a flexible substrate that mates with the medical device, one or more suture locations formed on the flexible substrate, and an adhesive. The flexible member can be formed from a material penetrable by a suture needle. Materials such as polyurethanes, thermoplastics, elastomers, and fiber-reinforced elastomers can be used to form the flexible member. 
         [0012]    The flexible member can comprise one or more suture locations, and these can each define one or more suture holes. The suture holes can be filled with a tissue growth substance that inhibits tissue growth. The suture holes can be filled with substances such as silicone and biocompatible polymers. In one embodiment, the substance is penetrable by a suture needle. 
         [0013]    The flexible member can also include tabs, and the tabs can be disposed about the perimeter of the flexible member. The tabs can be flexible and can be penetrable by a suture needle. The flexible member can be coated with a substance to inhibit tissue growth. It can also be preformed to mate with the perimeter of a surface of the medical device and can have a second surface shaped to conform to subcutaneous tissue within the body. 
         [0014]    At least a portion of the perimeter of the flexible member can follow a perimeter of the surface of the medical device to which the flexible member is attached. The flexible member can include an adhesive to secure the flexible member to the medical device. The adhesive can include methoxy-perfluoropropane, thixotropic sealants, and water-based adhesives. 
         [0015]    Another aspect of the invention features a method of manufacturing an implantable medical device that comprises providing a housing defining an entry site for the administration, withdrawal, or exchange of fluids, and attaching a flexible member thereto, for stabilizing placement of the housing within the body. The flexible member can be formed by cutting a sheet of polymer. The method can include applying an adhesive to the flexible member by at least one of spray coating, slot coating, spiral spraying, melt-blowing, pattern coating, layering, dipping and drying, and ion deposition. 
         [0016]    Another aspect of the invention features a method of fabricating a flexible member which includes forming a shape for mating with an implantable medical device, forming suture locations about the shape of the flexible member, and applying an adhesive to the shape. The shape can be formed by cutting from a sheet of polymer, and suture holes can be formed in the flexible member. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    These and other features of the invention are more fully described below in the detailed description and accompanying drawings of which the figures illustrate an apparatus and method for securing an implantable medical device within a body. 
           [0018]      FIG. 1  illustrates a prior art device used to provide access to provide access to subcutaneous regions within a body, such as vasculature. 
           [0019]      FIG. 2  illustrates another prior art device with only one entry site. 
           [0020]      FIG. 3  illustrates a side elevation view of an embodiment of the invention. 
           [0021]      FIG. 4  illustrates a side and top view of another embodiment of the invention. 
           [0022]      FIGS. 5-8  are a top view of other embodiments of the invention. 
           [0023]      FIGS. 9 and 10  are perspective views that show different ways the flexible member can be attached to a surface of a medical device. 
           [0024]      FIGS. 11-14  are top views illustrating additional embodiments of the invention. 
           [0025]      FIG. 15  is a side view of a flexible member shaped to conform to tissue within the body. 
           [0026]      FIG. 16  is a side view of a flexible member that is preformed to mate with a medical device. 
           [0027]      FIGS. 17-18  illustrate embodiments of the invention with different thickness characteristics. 
           [0028]      FIGS. 19 and 20  each illustrate an embodiment of the invention with different surface textures. 
           [0029]      FIG. 21  is a flow chart illustrating steps that can be used to manufacture a flexible member of the invention. 
           [0030]      FIG. 22  is a flow chart illustrating steps that can be used by a physician to prepare the flexible member for use. 
           [0031]      FIG. 23  is a flow chart illustrating steps that can be used to implant a medical device of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0032]      FIG. 1  shows a prior art access port used by a physician to provide access to subcutaneous regions within the body, such as vasculature. The medical device  10  includes a housing  11  and an entry site  12  for the administration, withdrawal, or exchange of fluids. The entry site can be a septum. The needle of a syringe, for example, can be used to administer or withdraw fluids through the septum. The medical device can be surgically implanted beneath the skin of a patient. 
         [0033]    The medical device can also include a predetermined number of suture holes  14  disposed about the base of the housing in fixed locations. The suture holes can be molded into the housing  11  as shown. A physician can tie a suture through the suture hole, thus securing the medical device  10 , for example, to adjacent tissue. The medical device shown has two entry sites  12 . 
         [0034]      FIG. 2  illustrates another prior art access port with a single entry site  12 . A catheter  22  is attached to the medical device  10 . Suture holes  14  are disposed about the base of the housing  11  at fixed locations. 
         [0035]      FIG. 3  is an illustration of an embodiment of an access port incorporating principles of the invention. The medical device  10  comprises housing  11  and an entry site  12 . The shape of the housing  11  defines the entry site  12 , as shown. The entry site is used to administer, withdraw, or exchange fluids with a body, and can comprise a septum. A physician can penetrate the septum with the needle of a syringe. 
         [0036]    A flexible member  30  is attached to a surface  32  of the housing. A perimeter region  35  of the member  30  is non-rigid and flexible. When flexed, the size of the incision required for insertion of the medical device in a body can be reduced. Suture locations  38  are disposed along the perimeter region  35  of the flexible member  30 . 
         [0037]      FIG. 4  illustrates a flexible member  30  having a first surface  41  and a second surface  44 . The first surface  41  comprises an adhesive, which allows the flexible member to be attached to the surface of the housing  32 . In one embodiment, the flexible member is preformed tape, having an adhesive surface that easily adheres to the surface of the housing  32 . The tape can take various shapes, forms, thicknesses, and orientations. The flexible member  30  can be attached to the housing surface  32  before surgery. Adhesively attaching the flexible member  30  to housing surface  32  of medical device  10  allows a physician to implant the medical device within a body using an incision of reduced size. Alternatively, the flexible member can be attached to the housing surface after implantation into a body. This is accomplished by attaching the flexible member  30  to the housing  32  after each has been inserted into the body through the incision. In this embodiment, the incision size can be reduced still further. 
         [0038]    The flexibility of the member  30  also enhances the manipulation and placement attributes of the device, providing a physician with increased capabilities and reducing aggravation and irritation to a patient. Patient recovery and comfort are thus enhanced. The flexible member also results in improved comfort and reduced irritation to the patient after the medical device has been implanted. Movement of a patient causes the tissue to which the medical device has been sutured to move. The resiliency of the flexible member thus reduces the stress to the body tissues of the patient during movement of the patient. This results in reduced irritation to the body and increased patient comfort. If sutures are present (discussed below), the benefit of this feature is increased. 
         [0039]    The perimeter region  35  of the flexible member  30  can extend beyond the perimeter  47  of the housing surface. As shown, the perimeter region  35  of the flexible member  30  can extend beyond the perimeter of the housing surface  47  on all sides. In other embodiments, the perimeter region  35  can extend beyond the perimeter  47  of the housing surface on fewer than all sides. 
         [0040]      FIGS. 5-8  show a top view of different embodiments of the invention.  FIGS. 5 and 6  illustrate a flexible member comprising a perimeter region  35 . This perimeter region  35  can extend beyond the perimeter of the housing surface  47  when the flexible member is attached to surface  32  of housing  11 . The perimeter region  35  can extend beyond the housing perimeter  47  in all directions, as shown. In other embodiments, it extends beyond the housing perimeter  47  in fewer directions. In any of these embodiments, a plurality of suture locations  38  can be disposed about the perimeter region  35  of the flexible member  30 . 
         [0041]      FIGS. 7 and 8  illustrate flexible members  30  comprising preformed tabs  72  that extend beyond the perimeter of the housing surface  47 . Each of these tabs  72  can include one or more suture locations  38 . 
         [0042]    Each of the embodiments found in  FIGS. 5-8  can be formed as a preformed flexible member. The shapes illustrated in these figures are intended to conform generally to the perimeter of the housing surface  47  to which they can be attached. In other embodiments, however, the flexible member may not conform to the perimeter of the housing. 
         [0043]      FIG. 9  illustrates the manner in which an embodiment of the flexible member  91  can be joined with the housing surface  32 A of medical device  10 . Tabs  72  comprising suture locations  38  extend beyond the perimeter of the housing surface  47 A providing locations to which a suture can be conveniently attached. 
         [0044]      FIG. 10  illustrates a perspective view of another embodiment of a flexible member  101  that can be joined with the housing surface  32 A of medical device  10 . Tn this embodiment, the perimeter region  35  comprises suture locations  38  and extends beyond the perimeter of the housing surface  47 A. As shown in  FIGS. 9 and 10 , both embodiments of the flexible member ( 91 ,  101 ) can be effectively attached to housing surface  32 A and efficiently mate with the perimeter  47 A of the housing surface. When attached to the housing surface  32 A, both embodiments ( 91  and  101 ) of the flexible member adhere to the entire housing surface  32 A. In other embodiments, this may not be required. Rather, the flexible member can be shaped to adhere to only a portion of the housing surface. This is useful if it is necessary to stabilize only a portion of the medical device. 
         [0045]      FIG. 11  illustrates an asymmetrical embodiment of the invention. In particular, the perimeter region  35  extends further in the direction labeled as “A” than in the other directions. Thus, the dimension of the perimeter region  35  of the flexible member  30  is larger in direction A than in the other directions shown. This embodiment includes a plurality of suture locations disposed in the perimeter region  35 . The presence, location, and number of suture locations are determined by the needs and preferences of the physician using the device. 
         [0046]      FIG. 12  illustrates an embodiment of the flexible member  30  comprising suture locations  38  disposed both in a perimeter region  35  and on tabs  72 . It is not necessary for all or any of the suture locations  38  to be sutured by a physician. This embodiment also illustrates that more than one suture location  38  can be present on a tab  72 . 
         [0047]      FIG. 13  illustrates an embodiment of the flexible member  30  comprising a hole  131  in the center of the flexible member. Further, the suture locations  38  are asymmetrically disposed about the perimeter region  35  of the flexible member  30 . This and other embodiments of a flexible member can be used to fulfill customized surgical requirements. 
         [0048]      FIG. 14  illustrates a bottom view of an embodiment in which the flexible member  30  extends beyond the perimeter of the housing surface  47  at two areas, labeled as X′ and X″ on the figure. Suture locations  38  are present at perimeter regions  35 ′ and  35 ″. As shown, portions of the housing surface  32  are not in contact with the flexible member  30 . A physician can also use this embodiment to meet varying surgical requirements and preferences. For example, in this embodiment exposed housing surfaces  142  and  143  are not in contact with flexible member  30 . Thus, a physician can grasp these surfaces directly and use them to manipulate the medical device during implantation of the medical device into a body. The desirability and utilization of this and other specific embodiments of the invention varies widely among physicians. 
         [0049]      FIGS. 15-18  illustrate various thickness characteristics of the flexible member  30  of the invention. Each of these embodiments can include tabs  72  and perimeter regions  35 . In  FIG. 15 , the thickness of the flexible member  30  varies along its length. The medical device  10  is illustrated as being surgically positioned between a cutaneous layer  151  and a tissue layer  154 . The flexible member  30  includes a region of increased thickness  156  and a region of lower thickness  157 . The varying thickness of the flexible member allows it to fit snugly between the surface of the housing  32  and the tissue layer  154 . As shown, the contour of the second surface  44  of the flexible member is shaped to conform to the shape of the tissue layer  154 . Although the first surface  41  of the flexible member can also be contoured, this is not necessary in all embodiments. 
         [0050]      FIG. 16  illustrates a flexible member  30  having a non-uniform variation in its thickness. Thickness variations such as these are used to match the shape of muscle, other tissue found within the body, and the like. This feature can used to improve the placement stability of the medical device within a body. 
         [0051]      FIG. 17  illustrates a bottom view of yet another embodiment in which the second surface of the flexible member  44  comprises ridges  171  for stabilizing placement of the medical device  10 . Ridges such as these are useful for preventing longitudinal motion of the flexible member when in contact with the body tissue. 
         [0052]    Referring to  FIG. 18 , the shape of the flexible member can be preformed to mate with a perimeter of the medical device. The flexible member  30  comprises extensions  182  that are formed to mate with the surface of the housing  32 , and are positioned at points about the perimeter  47  of the housing surface. In one embodiment, these extensions  182  form a continuous ridge on the first surface  41  of the flexible member, encircling the perimeter  47  of housing surface  32  and facilitating accurate alignment with the housing  11 . The first surface  41  can be coated with an adhesive to facilitate attachment to the surface of the housing  32 . 
         [0053]      FIGS. 19 and 20  illustrate embodiments comprising a second surface  44  of the flexible member with different textures. These textures can include, for example, bumps or hair-like tentacles. These textures can be unidirectional (as shown in  FIG. 20 ) or can be oriented in multiple directions. Textures can be formed as an integral part of the flexible member, or they can be attached to a surface of the flexible member after it has been formed. Although  FIGS. 19 and 20  show the entire second surface  44  of the flexible member covered with a texture, in some embodiments only a portion of the second surface  44  is covered. Moreover, combinations of the different types of textures can be used on the same flexible member. The first surface  41  of the flexible member can also have a texture, although a smooth surface is generally preferred to promote more effective adhesion with the housing surface  32 . 
         [0054]    The suture locations  38  can be an important element of some embodiments of the invention. In one embodiment, the suture locations  38  comprise permeable portions of the perimeter region  35  of the flexible member  30 , such as a permeable membrane. For example, the suture locations in each of the embodiments described above comprising a perimeter region  35  can have one or more suture locations  38  including a permeable membrane. A permeable membrane is any biocompatible material that a physician can penetrate with a suture needle, either before or during implantation of the medical device within the body of a patient. A perimeter region  35  can comprise zero, one, or a plurality, of suture locations. Furthermore, in some embodiments the entire perimeter region  35  can be penetrable by a suture needle, and thus can function as a large suture location  38 . In still other embodiments, the entire flexible member  30  can be penetrable by a suture needle. 
         [0055]    For embodiments comprising a permeable membrane, the suture location  38  is generally made of a material that closes back about the suture or suture needle after the material has been penetrated. Suture locations such as these can be penetrated one time or multiple times by a suture needle. Generally, a physician penetrates a given point within a suture location only once with a suture needle, although the same point on a suture location can be penetrated multiple times. However, a suture location can readily be sutured multiple times by a physician if multiple sutures are to be attached to that suture location, and these sutures can be positioned at the same or different points. The suture location thus comprises a permeable membrane that can be penetrated at multiple different locations. Multiple sutures can thus be located adjacent to each other, can be scattered about the suture location  38 , or can be scattered about the perimeter region  35 , all at the discretion of the physician. This is a useful feature in that a physician does not have to determine before surgery if or how many, sutures are needed, or precisely at what locations about the medical device  10  they will be placed. 
         [0056]    The decision to attach any sutures to the medical device at all is at the discretion of the physician. Stabilization of the placement of the medical device  10  within a body using the flexible member  30 , without suturing, and either with or without the presence of suture locations, represents a preferred embodiment for some physicians. 
         [0057]    In other embodiments, suture holes  14  may be punched into suture locations  38 . Suture locations  38  in each of the embodiments described above can have one or more suture holes  14 . The use of suture holes  14  eliminates the need for a physician to force a suture needle through the material of the suture location  38 . More than one hole may be located in a suture location, and suture holes can be conveniently punched into the flexible member  30  before surgery using simple tools. Alternatively, suture holes  14  can be preformed at suture locations  38  about the perimeter region  35  of flexible member  30  at the time of manufacture. 
         [0058]    In some embodiments prepunched patterns are formed, for example, in the perimeter region  35  or on the tabs  72  of the flexible member  30  to facilitate the creation of suture holes  14 . Holes prepunched in this manner each have an easily removable plug, the removal of which creates suture holes  14  ready for use by a physician. 
         [0059]    Although reference to sutures, suturing, and suture needles has been made above, the invention is equally applicable to staples, hooks, and other devices and means known to those of skill in the art for placing, securing, or attaching devices within a body. Use of the terms suture and suturing is intended to include these other devices and methods. 
         [0060]    Furthermore, the above discussion has centered on suture locations  38  disposed within the perimeter region  35  specifically, and generally within the flexible member  30 . However, the invention also includes suture locations  38  disposed within tabs  72 , as discussed above. These suture locations can include suture holes  14 , or not. As with the flexible member  30  and the flexible region  35 , these tabs are preferably foldable and flexible. 
         [0061]    In embodiments, the suture holes  14  can be filled with a filling material. This filling material can be added to the suture hole  14  before surgery, and preferably during manufacture of the flexible member  30 . The filling material should be formed of a soft material such as silicone that can be penetrated by a suture needle, and that will close about a suture after suturing. Other materials can be used to fill the suture holes  14 , such as CORETHANE® (registered mark of Corvita Corporation, Miami, Fla.), polyurethane, and bionate polycarbonate urethanes. Materials with a Durometer reading of 50-55 are preferred for this purpose. Such materials are relatively soft, and can be conveniently punctured with a needle. An appropriate material thickness should be used, as is apparent to one of ordinary skill in the art. The suture holes  14  can be filled or prefilled with the filling material. The presence of the filling material in the suture hole  14  minimizes tissue ingrowth into the suture hole, making subsequent removal of the medical device less difficult. 
         [0062]    Additionally the flexible member  30 , and the medical device, can be coated with a material, for example, to inhibit tissue ingrowth. Suitable coatings include but are not limited to antimicrobial coatings for the prevention of microbial biofilming, hydrogel coatings, zinc oxide coatings for preventing surface irritation, various block copolymers, tackifying resins, and polybutene. The medical device and the flexible member can also be impregnated with an antimicrobial substance, preferably at least in a portion of the device that will be located near the cutaneous layer  151 . 
         [0063]      FIG. 21  is a flow chart illustrating steps that can be used to manufacture a flexible member. First the desired shape, thickness, contours, and textures of the flexible member are determined (step  211 ). The locations of all the desired suture locations  38  are next determined (step  212 ). Which suture locations  38  will comprise tabs  72  and which will comprise perimeter regions  35  is next determined. Since tabs can easily be removed later, additional tabs can be included that perhaps might not be used during implantation of the device. A pattern can be created for the flexible member (step  214 ) and a suitable polymer sheet selected (step  215 ). Preferably, the thickness regions  156 ,  157 , extensions  182 , surface textures, and contours of the flexible member are achieved by selecting a polymer sheet possessing the desired characteristics. 
         [0064]    A shape corresponding to the pattern can then be cut from a polymer sheet (step  216 ), such as silicone. Any pre-planned suture holes  14  can next he added to the tabs  72  and the perimeter regions  35  (step  217 ). These can be added, for example, by puncturing. Optionally, any suture holes  14  that have been formed in step  217  can be filled with a substance to inhibit tissue growth into the suture hole (step  218 ). Finally, at the discretion of the physician, additional suture holes can be added to suture locations  38  and any unwanted tabs  72  can be severed from the flexible member, at the time of surgery (step  219 ). 
         [0065]    To complete the manufacture of a medical device, a housing, such as that of an implantable port, is provided. The flexible member is then attached to a surface of the medical device. When implanted within the body, the medical device exhibits improved placement stability. 
         [0066]    Other embodiments of the manufacturing process are also possible. For example, an adhesive coating can be applied to the flexible member after it has been cut from the polymer sheet, or the polymer sheet can comprise an adhesive material before the cutting is performed. Preferably, the adhesive is applied to the sheet of polymer material by at least one of slot coating, spiral spraying, melt blowing, pattern coating, layering, dipping/drying, and ion deposition. 
         [0067]    Suitable biocompatible adhesives are known to those of ordinary skill in the art, and include water-based adhesives, methoxy-perfluoropropane, and thixotropic sealants. Such adhesives can be coated continuously or discontinuously, and are compatible with muscle, tissue, skin surfaces, and the like. The first surface  41  of the flexible member comprises such an adhesive, for contacting the housing surface  32 . Optionally, the same or a different adhesive can be applied to the second surface  44  of the flexible member, for contacting tissue layer  154 . Tissue-specific adhesives can also be used. The application of adhesive to the second surface  44  of the flexible member contributes to the placement stabilization of the medical device  10 . Adhesives of low or moderate tacking strength can also be used on either surface, to facilitate repositioning or removal of the flexible member. Preferably, the adhesive selected for this purpose will not leave a residue or exhibit any adhesive transfer to the tissue surface  154  upon removal or relocation of the medical device  10 . Materials left behind after removal of the medical device can adversely affect healing of the body. 
         [0068]    The flexible member  30  can be manufactured from many different materials. Preferably, the flexible member is formed from at least one of thermoplastics, elastomers, polyurethanes, and fiber reinforced elastomers. Suitable fibers for this purpose include polyester or Kevlar® fiber. Kevlar® is a registered trademark of E.I. duPont de Nemours and Company. The flexible member can also be manufactured from materials such as a latex/plastic polymer blend, silicone, vinyl, foam, rubbers, varying percentages of rubbery block co-polymers and midblocks comprising ethylene/propylene and ethylene/butylene, and mixtures thereof, S-EP block co-polymers (styrene-ethylene/propylene), dycyclopentadiene, fully hydrogenated aliphatic C5 and C9 resins, and alpha-methylstyrene based resins. 
         [0069]    Various packaging and usage options are within the scope of the invention. For example, a package can be sold that includes a set of pre-cut flexible members or “frames.” The physician can then select the desired style from the set, attach it to the medical device, and perform the implantation. The package can include flexible members with, for example, a one, two, or three-hole option. The physician merely selects the flexible member that meets his needs and preferences. Optionally, if desired, the medical device can be trimmed and/or suture holes can be added, before attaching a flexible member. 
         [0070]      FIG. 22  is a flow chart illustrating steps that can be used by a physician to select and prepare the flexible member for use. A physician opens a package containing a number of flexible members (step  221 ). One of the flexible members from the package is selected. The flexible member selected should have tabs  72  and perimeter regions  35  in at least each of the locations desired (step  222 ). Extra, unwanted tabs can be removed by cutting (step  223 ). Any additional suture holes  14  can be added (step  224 ), for example, by puncturing. Optionally, a filling material such as silicone can be added to any suture holes that have not been prefilled, to prevent or minimize tissue ingrowth. These unfilled suture holes can be filled by the physician or his staff before surgery, or after implantation into the body of a patient (described below). The unfilled suture holes could have been formed, for example, in either step  224  or step  217 . 
         [0071]      FIG. 23  is a flow chart illustrating steps that can be used to implant and secure a medical device  10  comprising a flexible member  30  into a body. Various methods can be used for this purpose. The physician first determines the location and number of suture locations desired and prepares the flexible member as described in  FIG. 22  (step  231 ). If the flexible member has tabs  72 , any undesired tabs are removed. If insufficient suture holes  14  are present, more can be added by puncturing the appropriate suture location(s) of the flexible member. More than one suture hole can be added to each suture location, depending upon the physician&#39;s preference. 
         [0072]    A linear incision is made in the patient (step  232 ). The incision is of reduced size, due to the planned usage of the flexible member. The flexible member can be adhesively attached to the housing surface  32  at this time (step  233 ), or it can be attached later. Attaching it later allows the smallest incision size to be used. 
         [0073]    The housing  11  and the flexible member  30  are inserted through the incision, into the body of the patient, near an area in which the catheter  22  is to be placed. The physician positions the catheter, and then positions the flexible member adjacent the tissue layer  154  (step  236 ). The flexible member is then sutured into place (step  237 ). This can be done by sewing subcutaneous sutures through the suture locations  38 , thereby securing the flexible member  30  to adjacent tissue. The flexible member is now attached to the housing surface  32 , if it has not already been attached (step  238 ). The incision is then closed and bandaged (step  239 ). 
         [0074]    The sutures can thus be used to anchor the tissue layer  154  and/or the cutaneous layer  151  to the medical device  10 . In other embodiments tissue can be anchored the medical device using subcutaneous hooks and other devices and methods known to the skilled artisan. 
         [0075]    In some embodiments the flexible member  30  or the housing  11  can be coated with materials that promote tissue growth to provide better sealing of the incision, such as collagen or other tissue growth catalysts and substances. Materials that promote ingrowth of cells, such as a permeable fabric, a textured polymer, or appropriate mesh materials can also be bonded to or embedded into the surface of medical device  10 . The added ingrowth materials cause the skin surrounding the medical device  10  to bond securely with the medical device  10 . Alternatively, growth inhibition materials can be placed on or around the medical device. For example, suture holes  14  that will not be used can be filled with silicone to prevent tissue ingrowth. Thus, fibrin will not grow into these suture locations, and the medical device can later be more easily removed. 
         [0076]    The flexible member of the invention is suitable for use with various medical devices including implantable venous ports, PEG ports, and other epidermal and indwelling medical devices that, for example, provide access to the body or to vasculature. These include devices used for gastrointestinal feeding and metering, intervascular pumps, insulin pumps, drainage products (such as for draining an abscess), pacing products (such as pacemakers), and various catheters. 
         [0077]    While the invention has been particularly shown and described with reference to specific preferred embodiments, it should be understood by those skilled in the art that various changes in form and detail may be made therein without departing from the spirit and scope of the invention as defined by the appended claims.