Patent Publication Number: US-2013238020-A1

Title: Modular structure

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application is a continuation application of U.S. patent application Ser. No. 12/914,214, filed on Oct. 28, 2010, the content of which is incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure describes sutures having connection structures which enable various lengths and configurations of sutures to be created. 
     2. Background of Related Art 
     Medical sutures may be formed from a variety of materials and may be configured for use in limitless applications. Sutures are provided in various lengths and typically have a needle attached to at least one end thereof. Barbed sutures are also known, the barbs may comprise a single direction, e.g., monodirectional barbed suture or two directions, e.g., bidirectional barbed suture. In certain situations, it may be preferable for the user to choose a different suture configuration. 
     SUMMARY 
     The present disclosure is direct to a suture comprising a first elongate body having a first connection structure and a separate second elongate body selectively connectable to the first connection structure. In certain embodiments, the second elongate body comprises an extension projecting therefrom, the extension being selectively connectable to the first connection structure. The extension may comprise tabs or projections and the first connection structure comprises slots shaped to receive the tabs or projections. The tabs or projections may lock into the slots upon insertion of the extension into the first elongate body and in alternate embodiments, removal of the second elongate body is prevented. 
     The second elongate body may comprise a second connection structure. The first connection structure may be shaped to receive the second connection structure. In particular embodiments, the first connection structure is releasably connected to the second connection structure. The first or second connection structure may be selected from the group consisting of a ball connection, a socket connection, a threaded connection, and a flared connection. More specifically, the first and second connection structures may form a snap fit connection. In some embodiments, the first connection structure comprises a cavity. 
     The first or second elongate body may further comprise barbs disposed on a length thereof. 
     The first or second elongate body may comprise an end effector selected from the group consisting of a loop and a knot. 
     Further, the first or second elongate body may comprise a needle disposed at one end thereof. 
     According to another embodiment of the present disclosure, a suture comprising at least two separately connectable elongate bodies, wherein a first elongate body comprises an end portion including a first connection structure that is connectable to a second connection structure of a second elongate body is disclosed. The first elongate body may comprise a first plurality of barbs wherein the first plurality of barbs may prevent suture reversal in a first direction. The second elongate body may comprise a second plurality of barbs and the second plurality of barbs may prevent suture reversal in a second direction. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
       These and other characteristics of the present invention will be more fully understood by reference to the following detailed description in conjunction with the attached drawings, in which: 
         FIGS. 1A-1M  are various end effectors in accordance with certain embodiments of the present disclosure; 
         FIGS. 2A-2D  are perspective views of one embodiment of a suture in accordance with the present disclosure; 
         FIG. 3  is a perspective view of another embodiment of a suture in accordance with the present disclosure; 
         FIG. 4A-4H  are various embodiments of extensions in accordance with the present disclosure; 
         FIGS. 5A-5B  are perspective views on another embodiment of a suture in accordance with the present disclosure; 
         FIG. 5C  illustrates a cross-sectional view of  FIG. 5B  taken along line X-X; 
         FIGS. 6A-6B  are perspective views of another embodiment of a suture in accordance with the present disclosure; 
         FIG. 6C  is a side view of the suture of  FIG. 6A  in accordance with the present disclosure; 
         FIG. 7  is another embodiment of a second connection member in accordance with the present disclosure; 
         FIG. 8  is a cross-sectional view of an alternate embodiment of a suture in accordance with the present disclosure; and, 
         FIGS. 9A-9B  illustrate perspective views of another embodiment of a suture in accordance with the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure describes sutures including a first elongate body having first connection structure, and a second elongate body which is selectively connectable to the first connection structure. In some embodiments, the second elongate body may include a second connection structure. 
     The term “suture” as used herein is broadly defined as a medical device which may be used to approximate tissues during wound healing. Sutures described herein may include at least one needle disposed at an end portion of the first or second elongate body. 
     Sutures of the present disclosure may be provided with materials comprising both absorbable and non-absorbable materials. As used herein, the term “absorbable” includes both biodegradable and bioresorbable materials. By biodegradable, it is meant that the materials decompose, or lose structural integrity under body conditions (e.g., enzymatic degradation, hydrolysis) or are broken down (physically or chemically) under physiologic conditions in the body (e.g., dissolution) such that the degradation products are excretable or absorbable by the body. 
     Suitable absorbable materials include those selected from the group consisting of polymers selected from the group consisting of aliphatic polyesters; polyamides; polyamines; polyalkylene oxalates; poly(anhydrides); polyamidoesters; copoly(ether-esters); poly(carbonates) including tyrosine derived carbonates; poly(hydroxyalkanoates) such as poly(hydroxybutyric acid), poly(hydroxyvaleric acid), and poly(hydroxybutyrate); polyimide carbonates; poly(imino carbonates) such as poly (bisphenol A-iminocarbonate and the like); polyorthoesters; polyoxaesters including those containing amine groups; polyphosphazenes; poly (propylene fumarates); polyurethanes; polymer drugs such as polydiflunisol, polyaspirin, and protein therapeutics; biologically modified (e.g., protein, peptide)bioabsorbable polymers; and copolymers, block copolymers, homopolymers, blends, and combinations thereof. 
     More specifically, for the purpose of this invention, aliphatic polyesters include, but are not limited to, homopolymers and copolymers of lactide (including lactic acid, D-,L- and meso lactide); glycolide (including glycolic acid); epsilon-caprolactone, p-dioxanone (1,4-dioxan-2-one); trimethylene carbonate (1,3-dioxan-2-one); alkyl derivatives of trimethylene carbonate; Δ-valerolactone; β-butyrolactone; γ-butyrolactone; ε-decalactone; hydroxybutyrate; hydroxyvalerate; 1,4-dioxepan-2-one (including its dimer 1,5,8,12-tetraoxacyclotetradecane-7,14-dione); 1,5-dioxepan-2-one; 6,6-dimethyl-1,4-dioxan-2-one; 2,5-diketomorpholine; pivalolactone; α,α diethylpropiolactone; ethylene carbonate; ethylene oxalate; 3-methyl-1,4-dioxane-2,5-dione; 3,3-diethyl-1,4-dioxan-2,5-dione; 6,8-dioxabicycloctane-7-one; and polymer blends and copolymers thereof. In certain embodiments, the mesh may comprise an aliphatic polyester. 
     Other suitable biodegradable polymers include, but are not limited to, poly(amino acids) including proteins such as collagen (I, II and III), elastin, fibrin, fibrinogen, silk, and albumin; peptides including sequences for laminin and fibronectin (RGD); polysaccharides such as hyaluronic acid (HA), dextran, alginate, chitin, chitosan, and cellulose; glycosaminoglycan; gut; and combinations thereof. Collagen as used herein includes natural collagen such as animal derived collagen, gelatinized collagen, or synthetic collagen such as human or bacterial recombinant collagen. 
     Suitable non-absorbable materials which may be employed in the present disclosure include those such as polyolefins such as polyethylene (including ultra high molecular weight polyethylene) and polypropylene including atactic, isotactic, syndiotactic, and blends thereof; polyethylene glycols; polyethylene oxides; ultra high molecular weight polyethylene; copolymers of polyethylene and polypropylene; polyisobutylene and ethylene-alpha olefin copolymers; fluorinated polyolefins such as fluoroethylenes, fluoropropylenes, fluoroPEGSs, and polytetrafluoroethylene; polyamides such as nylon, Nylon 6, Nylon 6,6, Nylon 6,10, Nylon 11, Nylon 12, and polycaprolactam; polyamines; polyimines; polyesters such as polyethylene terephthalate, polyethylene naphthalate, polytrimethylene terephthalate, and polybutylene terephthalate; polyethers; polybutester; polytetramethylene ether glycol; 1,4-butanediol; polyurethanes; acrylic polymers; methacrylics; vinyl halide polymers and copolymers, such as polyvinyl chloride; polyvinyl alcohols; polyvinyl ethers such as polyvinyl methyl ether; polyvinylidene halides such as polyvinylidene fluoride and polyvinylidene chloride; polychlorofluoroethylene; polyacrylonitrile; polyaryletherketones; polyvinyl ketones; polyvinyl aromatics such as polystyrene; polyvinyl esters such as polyvinyl acetate; copolymers of vinyl monomers with each other and olefins, such as ethylene-methyl methacrylate copolymers; acrylonitrile-styrene copolymers; ABS resins; ethylene-vinyl acetate copolymers; alkyd resins; polycarbonates; polyoxymethylenes; polyphosphazine; polyimides; epoxy resins; aramids; rayon; rayon-triacetate; spandex; silicones; and copolymers and combinations thereof. 
     In certain embodiments, both absorbable and non-absorbable materials may be employed in the suture. For example, a non-absorbable first elongate body may be provided with an absorbable second elongate body. 
     It should be noted that sutures of the present disclosure include both monofilament and multifilament sutures. In certain embodiments sutures may have a first elongate body which comprises a multifilament braid while a second elongate body may comprise a monofilament. Various combinations of multifilaments, monofilaments and absorbable and non-absorbable materials may be employed in the present disclosure. Further, sutures of the present disclosure may include at least one needle attached to at least one end thereof. Suitable needles include those within the purview of those skilled in the art. 
     Methods for forming sutures in accordance with the present disclosure include techniques within the purview of those skilled in the art, such as, for example, extrusion, molding and/or solvent casting. In some embodiments, the suture may include a yarn made of more than one filament, which may contain multiple filaments of the same or different materials. Where the suture is made of multiple filaments, the suture may be made using any known technique such as, for example, braiding, weaving or knitting. The suture may also be combined to produce a non-woven suture. The suture may be drawn, oriented, crinkled, twisted, commingled or air entangled to form yarns as part of the suture forming process. In one embodiment, a multifilament suture may be produced by braiding. The braiding may be done by any method within the purview of those skilled in the art. 
     Further, sutures described herein may be of any suitable cross-sectional shape, for example, elliptical, square, star shaped, octagonal, rectangular, polygonal and flat. 
     In certain embodiments, sutures described herein may comprise barbed sutures. The first or second elongate bodies may comprise a plurality of barbs disposed on a portion of a length thereof. In certain embodiments, both the first and second elongate bodies may comprise a plurality of barbs. Sutures of the present disclose may comprise both monodirectional and bidirectional barbed sutures. 
     Bidirectional barbed sutures include barbs which may be arranged on a first portion of a length of the first elongate body to allow movement of a first end of the elongate body through tissue in one direction, while barbs on a second portion of a length of the second elongate body may be arranged to allow movement of the second end of the elongate body in an second (e.g., opposite) direction. 
     Suitable barbed sutures include those described in U.S. Pat. No. 8,273,105 and U.S. Patent Publication No. 2009/0248070 both assigned to Tyco Healthcare Group LP (North Haven, Conn.) the entire contents of which are incorporated by reference herein. In general, barbed sutures include barbs which extend outward, from a surface of the suture. The barbs may be disposed on a length of the medical device body (suture) to allow movement of a first end of the medical device through tissue in one direction, while resisting movement in the opposite direction. 
     The barbs can be arranged in any suitable pattern, for example, helical, spiral, linear, or randomly spaced. The pattern may be symmetrical or asymmetrical. The number, configuration, spacing and surface area of the barbs can vary depending upon the tissue in which the suture is used, as well as the composition and geometry of the material utilized to form the suture. Additionally, the proportions of the barbs may remain relatively constant while the overall length of the barbs and the spacing of the barbs may be determined by the tissue being connected. For example, if the suture is to be used to connect the edges of a wound in skin or tendon, the barbs may be made relatively short and more rigid to facilitate entry into this rather firm tissue. Alternatively, if the suture is intended for use in fatty tissue, which is relatively soft, the barbs may be made longer and spaced further apart to increase the ability of the suture to grip the soft tissue. 
     The surface area of the barbs can also vary. For example, fuller-tipped barbs can be made of varying sizes designed for specific surgical applications. For joining fat and relatively soil tissues, larger barbs may be desired, whereas smaller barbs may be more suitable for collagen-dense tissues. In some embodiments, a combination of large and small barbs within the same structure may be beneficial, for example when a suture is used in tissue repair with differing layer structures. In particular embodiments, a barbed suture may have both large and small barbs. 
     Sutures of the present disclosure may additionally include an end effector. End effectors provide resistance to help prevent the suture from being pulled through tissue. Often the end effector may be used in place of a surgeon tying a knot at one end of the suture line. End effectors may be larger in cross-sectional diameter (compared to the elongate body) so that suture pull through is prevented. In other embodiments, end effectors are sized and shaped so as to mitigate suture pull through. Examples of&#39;suitable end effectors include a knotted end effector such as one described in U.S. Pat. No. 8,333,788, filed on Oct. 1, 2009, the entire content of which is incorporated by reference. Another suitable end effector comprises a loop at a distal portion of the suture, the loop is described in U.S. Publication No. 2010/0063540, filed on Aug. 29, 2009, the entire content of which is incorporated by reference herein. 
     Other suitable end effectors which may be utilized in accordance with the present disclosure are illustrated in  FIGS. 1A-1M . It should be understood that end effectors in accordance with the present disclosure are not limited to those described herein and other end effectors may be employed. 
     One example of a suture in accordance with the present disclosure is illustrated in  FIGS. 2A and 2B . The suture  200  includes a first elongate body  210  and a second elongate body  220 . As illustrated, both the first and second elongate bodies,  210 ,  220  include a plurality of barbs  230  disposed on a length thereof. The plurality of barbs  230  extend in the same direction, outward and away from a surface of the elongate body. As illustrated, the barbs  230  extend away from a proximal portion of the suture. A first portion of the first elongate body includes a needle  240  and a second portion of the first elongate body  210  includes a first connection structure  250 . As shown herein, the first connection structure  250  includes a cavity  254  comprising at least two pockets  252 . The first connection structure  250  matingly cooperates with the second elongate body  220 . 
     The second elongate body  220  includes a proximal portion  242  having an extension  225  and at least two tabs  227 . The extension  225  is shaped to be received within the distal portion of the elongate body  210 . More specifically, the tabs  227  are shaped to be received within the pockets  252  ( FIG. 2A ). An outer diameter d 1  of the extension  225  is less than an inner diameter d 2  of the cavity  254  such that the extension  225  can be inserted within cavity  254 . The first elongate body  210  comprises an outer diameter d 4  which is greater than d 2 . The second elongate body also comprises a second outer diameter d 3 , which may be greater than d 1 . In other embodiments, d 1  and d 3  may be of similar size and both less than d 2 . 
     In some embodiments, the pockets  252  and the tabs  227  form an irreversible connection. Once connected, the configuration of the pockets  252  and tabs  227  prevent the second elongate body  220  from being removed or disconnected from the elongate body  210 . 
     Once connected, the first and second elongate bodies create a monodirectional barbed suture. The barbs  230  on the first and second elongate bodies  210 ,  220  are arranged to enable the suture to move in one direction. The barbs  230  extend away from elongate bodies  210 ,  220  and away from the needled end of suture  200 . 
     It will be understood that  FIG. 2C  is a similar embodiment to  FIG. 2A  and therefore all numerals and descriptions which are the same are designated with the prime mark and the differences will be described below.  FIGS. 2C  illustrates a suture  200 ′ having first and second elongate bodies  210 ′,  221 , respectively. The first elongate body  210 ′ comprises a first needle  240 ′ disposed at one end thereof. Additionally, the second elongate body  221  comprises a second needle,  241 , disposed at one end thereof. The first elongate body  210 ′ includes a first plurality of barbs  230 ′ which extend outward from the first elongate body  210 ′ in a first direction and away from the needle  240 ′. The second elongate body  221  includes a second plurality of barbs  231 , which extend outward from the second elongate body  221  in a second direction, away from the second needle  241 . The combination of the first and second plurality of barbs  230 ′,  231 , respectively, creates a bidirectional barbed suture. 
       FIG. 2D  is a similar embodiments to  FIG. 2A  and therefore all numerals and descriptions which are the same are designated with the prime mark and the differences will be described below.  FIG. 2D  illustrates a suture  200  having first and second elongate bodies  210 ′,  222 , respectively. The first elongate body  210 ′ comprises a first needle  240 ′ disposed at one end thereof. The first elongate body  210 ′ includes a plurality of barbs  230 ′ which extend in a first direction, outward from the elongate body  210 ′and away from the needle  240 ′. The second elongate body  222  comprises a monofilament thread. The two elongate bodies are connected together by the extension  225 ′ and the first connection structure  250 ′. Although not shown, the second elongate body  222  may include a second needle disposed at one end thereof. 
       FIG. 3  illustrates another example of a suture  300  having a first elongate body  310  and a second, separately connectable elongate body  320 , in accordance with the present disclosure. An end of one or both of elongate bodies  310 ,  320  may be configured for needle attachment. Various needles for use are within the purview of those skilled in the art. The distal portion of the first elongate body  310  includes a first connection structure  340 . Similar to  FIG. 2A , the first connection structure  340  includes a cavity  344  which enables insertion of an extension  325 . Additionally, the first connection structure  340  also includes slot  346 , extending from the outer surface  310   a  of the first elongate body  310  to the cavity  344  of the first elongate body. The slot  346  is sized and shaped for reception of a projection  327  from the surface of the second elongate  320 . 
     More specifically, the second elongate body  320  includes a distal portion and a proximal portion. The proximal portion includes an extension  325  and at least one projection  327  formed on a surface thereof. The extension  325  is shaped to be received within the cavity  344  of the first connection structure  340 . More specifically, the projection  327  is shaped to be received within the slots  346  (on distal portion of the first elongate body). In some embodiments, the slots  346  and the projections  327  form a snap fit or a friction fit. Once connected, the snap fit feature of the slots  346  and the projections  327  prevent the second elongate body  320  from being removed or disconnected from the elongate body  310 . 
     The projections (found on extension  325 ) may be a variety of shapes, including but not limited to those illustrated in  FIGS. 4A-4H . The projections may extend from at least one surface of the extension such as those illustrated in  FIGS. 4A-4D . For example,  FIG. 4A  is illustrated as extending outward from a first surface of the extension  325   a,  while  FIGS. 4E-4H  illustrate projections extending outward from a first and second surface  325   a,    325   b , respectively of the extension  325 . 
     For exemplary purposes,  FIGS. 5A-C  illustrate in more detail, how an extension similar to that illustrated in  FIG. 4G  connects with a first elongate body. The suture  400  is illustrated having a first elongate body  410  and a second, separately connectable elongate body  420 . A proximal end of one or both of the elongate bodies may be configured for needle attachment. The distal portion of the first elongate body  410  includes a first connection structure  440 , having a cavity  444  which enables insertion of an extension  425 . Additionally, the first connection structure  440  also includes two slots  446   a,    446   b,  each extending from an outer surface  410   a  of the first elongate body  410  to the cavity  444  of the first elongate body  410  (see  FIG. 5C ). Each slot  446   a ,  446   b  is sized and shaped for reception of a projection  427  from the surface of the second elongate  320 . 
     More specifically, the second elongate body  420  includes a distal portion and a proximal portion. The proximal portion includes an extension  425  and at least one projection  427  formed on a surface of the extension  425 . Upon insertion of the extension  425  into the cavity  444 , the projections  427  may bend or fold ( FIG. 5A ) towards the second elongate body  420  to enable insertion of the projections  427  in the direction indicated by arrow “A.” Once the projections  427  reach the slots  426   a - b , the projections  427  extend outward to a second, unfolded position (see  FIG. 5B ), preventing removal of the extension  425  from the cavity  444 . 
     In certain embodiments, both the first and second elongate bodies include first and second connection structures. Connection structures in accordance with the present disclosure are discussed herein below and may include a ball connection, a socket connection, a snap-fit connection, a threaded connection, and a flared connection. 
       FIGS. 6A-6C  illustrate an alternate embodiment of a suture in accordance with the present disclosure, including both first and second connection structures. More particularly, the suture  500  includes a first elongate body  510  and a second elongate body  520 . A proximal end of the elongate body may include a needle (not shown) and a distal portion of the first elongate body  510  includes a first connection structure  540 . The first connection structure  540  includes a hole or perforation  542 , which is shaped and sized to receive a second connection structure. 
     More specifically, the second elongate body  520  comprises a second connection structure  524  at a proximal portion of the second elongate body  520 . The second connection structure  524  comprises two flexible arms  526  which slightly separate as the arms  526  are moved into communication with the hole  542  ( FIG. 6B ). The arms  526  each comprise a bulbous portion  526   a  which slides across the first connection structure  540  until the hole  542  is reached. Once the bulbous portions  526   a  reach the hole  542 , the bulbous portions  526   a  slide into the hole  542  and the arms  526  return to their original, unflexed position ( FIG. 6C ). 
     The first connection structure  540  can also be used with a different second connection structure, such as, for example, one illustrated in  FIG. 7 . The second connection structure  600  shown in  FIG. 7  includes two arms  626 ,  628 , respectively. The first arm  626  terminates in a bulbous portion  626   a.  The second arm  628  terminates in a recess configuration  628   a  which is shaped and sized to receive the bulbous portion  626   a.  The second connection structure  600  functions in a similar manner as the second connection structure  524  ( FIGS. 6A-6C ). In some embodiments, the arms are flexible and slightly separate as they are moved into communication with the hole on a first connection structure  540 . Once the two arms  626 ,  628  reach the hole, the first arm  626  is received within the hole and connects to the second arm  628 . 
     More specifically, the bulbous portion  626   a  is received within the recess configuration  628   a . The two arms  626 ,  628  may require a small manual force to be connected together. As shown, the first and second arms,  626 ,  628 , create a snap fit connection. In some embodiments, the snap fit connection may be reversible. 
     An alternative embodiment of first and second connection structures are illustrated in  FIG. 8 . The suture  700  includes a first elongate body  710  and a second elongate body  720 . A proximal end of the first elongate body includes a needle  730  and a distal portion of the first elongate body  710  includes a first connection structure  740 . As shown herein, the first connection structure  740  has an interior concentric threaded portion  742 . The concentric threaded portion  742  surrounds a cavity  744  in the distal portion of the elongate body  710 . The cavity  744  enables insertion of a second connection structure  722  into the elongate body  710 . 
     The second elongate body  720  may include a distal portion (not shown) which is shaped to mitigate suture pull through. A proximal portion of the second elongate body  720  includes a second connection structure  722  which comprises a threaded extension  722 . The threaded extension  722  is shaped to be received within first connection structure  740  and more particularly, within the cavity  744 . The threaded extension  722  may comprise a right-handed or left-handed thread, corresponding to the threaded portion  742  of the first connection structure  740 . The extension  722  is threaded within the first connection structure  740 , creating a reversible connection. In other embodiments, however, the threaded connection may be configured to be irreversible. 
       FIGS. 9A and 9B  illustrate a suture in accordance with an alternate embodiment of the present disclosure. The suture  800  includes a first elongate body  810 , having a first connection structure  830 , and a second elongate body  820 , having a second connection structure  840 . The first connection structure  830  comprises a flange-shaped socket, the socket located at a first end of the first elongate body  810 . The second connection structure  840  comprises a ball located at a first end of the second elongate body  820 . The ball  840  is shaped to be received within the socket  830 . Once the ball  840  is inserted into the socket  830 , the socket  830  may be crimped or otherwise compressed to fully encompass and contain the ball therein ( FIG. 9B ). The ball  840  is free to rotate within the socket  840 . 
     Further, the first elongate body  810  includes a plurality of barbs  815  located on a surface of the suture, the plurality of barbs extending in a first direction. The second elongate body  820  includes a second plurality of barbs  825  located on a surface of the suture, the second plurality of barbs  825  extending in a second direction. Once the connection is made between the first elongate body and the second elongate body, a bidirectional barbed suture is created. 
     The elongate bodies described herein may be connected to one another during manufacturing or even in the operating room. For example, by connecting the elongate bodies during manufacturing, several combinations of sutures can be created and packaged. For example, a barbed elongate body can be connected to an unbarbed elongate body. In another non-limiting example, a monofilament elongate body can be connected to a multifilament elongate body. Several combinations and different suture lengths can be created using multifilament and monofilament barbed and unbarbed elongate bodies. It is also envisioned that more than two elongate bodies can be connected together. For example, one elongate body may include a connection structure disposed at each end. In one example an unbarbed elongate body can be connected at each end to a barbed elongate body. The two barbed elongate bodies may comprise barbs which are angled in different directions, therefore creating a bidirectional barbed suture with an unbarbed elongate body disposed between the barbed elongate bodies. 
     Another alternative is to have the surgeon choose and connect the various elongate bodies, specific to the patient or procedure, in the operating room. For example, a suture kit may be provided having several elongate bodies. The surgeon may create a suture by connecting the separate elongate bodies together, utilizing the connection structures and extension provided. 
     Further, sutures may additionally include coatings for improved performance/handling characteristics, suitable coatings arc within the purview of those skilled in the art. 
     In certain embodiments, sutures described herein may include at least one therapeutic agent. The term “therapeutic agent,” as used herein, is used in its broadest sense and includes any substance or mixture of substances that provides a beneficial, therapeutic, pharmacological, and/or prophylactic effect. The agent may be a drug which provides a pharmacological effect. 
     The term “drug” is meant to include any agent capable of rendering a therapeutic effect, such as, anti-adhesives, antimicrobials, analgesics, antipyretics, anesthetics (e.g. local and systemic), antiepileptics, antihistamines, anti-inflammatories, cardiovascular drugs, diagnostic agents, sympathomimetics, cholinomimetics, antimuscarinics, antispasmodics, hormones, growth factors, muscle relaxants, adrenergic neuron blockers, antineoplastics, immunogenic agents, immunosuppressants, gastrointestinal drugs, diuretics, steroids, lipids, lipopolysaccharides, polysaccharides, platelet activating drugs, clotting factors, and enzymes. It is also intended that combinations of agents may be used. 
     Other therapeutic agents, which may be included as a drug include: anti-fertility agents; parasympathomimetic agents; psychotherapeutic agents; tranquilizers; decongestants; sedative hypnotics; sulfonamides; sympathomimetic agents; vaccines; vitamins; antimalarials; anti-migraine agents; anti-parkinson agents such as L-dopa; anti-spasmodics; anticholinergic agents (e.g., oxybutynin); antitussives; bronchodilators; cardiovascular agents, such as coronary vasodilators and nitroglycerin; alkaloids; analgesics; narcotics such as codeine, dihydrocodeinone, meperidine, morphine and the like; non-narcotics, such as salicylates, aspirin, acetaminophen, d-propoxyphene and the like; opioid receptor antagonists, such as naltrexone and naloxone; anti-cancer agents; anti-convulsants; anti-emetics; antihistamines; anti-inflammatory agents, such as hormonal agents, hydrocortisone, prednisolone, prednisone, non-hormonal agents, allopurinol, indomethacin, phenylbutazone and the like; prostaglandins and cytotoxic drugs; chemotherapeutics; estrogens; antibacterials; antibiotics; anti-fungals; anti-virals; anticoagulants; anticonvulsants; antidepressants; and immunological agents. 
     Other examples of suitable agents, which may be included in the sutures described herein include, for example, viruses and cells; peptides, polypeptides and proteins, as well as analogs, muteins, and active fragments thereof; immunoglobulins; antibodies; cytokines (e.g., lymphokines, monokines, chemokines); blood clotting factors; hemopoietic factors; interleukins (e.g., IL-2, IL-3, IL-4, IL-6); interferons (e.g., β-IFN, α-IFN and γ-IFN); erythropoietin; nucleases; tumor necrosis factor; colony stimulating factors (e.g., GCSF, GMCSF, MCSF); insulin; anti-tumor agents and tumor suppressors; blood proteins such as fibrin, thrombin, fibrinogen, synthetic thrombin, synthetic fibrin, synthetic fibrinogen; gonadotropins (e.g., FSH, LH, CG, etc.); hormones and hormone analogs (e.g., growth hormone); vaccines (e.g., tumoral, bacterial and viral antigens); somatostatin; antigens; blood coagulation factors; growth factors (e.g., nerve growth factor, insulin-like growth factor); bone morphogenic proteins; TGF-B; protein inhibitors; protein antagonists; protein agonists; nucleic acids such as antisense molecules, DNA, RNA, and RNAi; oligonucleotides; polynucleotides; and ribozymes. 
     Some specific non-limiting examples of water-soluble drugs that may be used in the present disclosure include, lidocaine, bupivicaine, tetracaine, procaine, dibucaine, sirolimus, taxol, chlorhexidine, polyhexamethylene, thiamylal sodium, thiopental sodium, ketamine. flurazepam, amobarbital sodium, phenobarbital, bromovalerylurea, chloral hydrate, phenytoin, ethotoin, trimethadione, primidone, ethosuximide, carbamazepine, valproate, acetaminophen, phenacetin, aspirin, sodium salicylate, aminopyrine, antipyrine, sulpyrine, mepirizole, tiaramide, perixazole, diclofenac, anfenac, buprenorphine, butorphanol, eptazocine, dimenhydrinate, difenidol, dl-isoprenaline, chlorpromazine, levomepromazine, thioridazine, fluphenazine, thiothixene, flupenthixol, floropipamide, moperone, carpipramine, clocapramine, imipramine, desipramine, maprotiline, chlordiazepoxide, clorazepate, meprobamate, hydroxyzine, saflazine, ethyl aminobenzoate, chlorphenesin carbamate, methocarbamol, acetylcholine, neostigmine, atropine, scopolamine, papaverine, biperiden, trihexyphenidyl, amantadine, piroheptine, profenamine, levodopa, mazaticol, diphenhydramine, carbinoxamine, chlorpheniramine, clemastine, aminophylline, choline, theophylline, caffeine, sodium benzoate, isoproterenol, dopamine, dobutamine, propranolol, alprenolol, bupranolol, timolol, metoprolol, procainamide, quinidine, ajmaline, verapamil, aprindine, hydrochlorothiazide, acetazolamide, isosorbide, ethacrynic acid, captopril, enalapril, delapril, alacepril, hydralazine, hexamethonium, clonidine, bunitrolol, guanethidine, bethanidine, phenylephrine, methoxamine, diltiazem, nicorandil, nicametate, nicotinic-alcohol tartrate, tolazoline, nicardipine, ifenprodil, piperidinocarbamate, cinepazide, thiapride, dimorpholamine, levallorphan, naloxone, hydrocortisone, dexamethasone, prednisolone, norethistcrone, clomiphene, tetracycline, methyl salicylate, isothipendyl, crotamiton, salicylic acid, nystatin, econazole, cloconazole, vitamin B 1 , cycothiamine, vitamin B 2 , vitamin B 3 , vitamin B 5 , vitamin B 6 , vitamin B 7 , vitamin B 9 , vitamin B 12 , vitamin C, nicotinic acid, folic acid, nicotinamide, calcium pantothenate, pantothenol, panthetin, biotin, ascorbic acid, tranexamic acid, ethamsylate, protamine, colchicine, allopurinol, tolazamide, glymidine, glybuzole, metoformin, buformin, orotic acid, azathioprine, lactulose, nitrogen mustard, cyclophophamide, thio-TEPA, nimustine, thioinosine, fluorouracil, tegafur, vinblastine, vincristine, vindesine, mitomycin C, daunorubicin, aclarubicin, procarbazine, cisplatin, methotrexate, benzylpenicillin, amoxicillin, penicillin, oxycillin, methicillin, carbenicillin, ampicillin, cefalexin, cefazolin, erythromycin, kitasamycin, chloramphenicol, thiamphenicol, minocycline, lincomycin, clindamycin, streptomycin, kanamycin, fradiomycin, gentamycin, spectinomycin, neomycin, vanomycin, tetracycline, ciprofloxacin, sulfanilic acid, cycloserine, sulfisomidine, isoniazid, ethambutol, acyclovir, gancyclovir, vidabarine, azidothymidine, dideoxyinosine, dideoxycytosine, morphine, codeine, oxycodone, hydrocodone, cocaine, pethidine, fentanyl, polymeric forms of any of the above drugs and any combinations thereof. 
     Therapeutic agents may be combined with sutures in various forms. For example, therapeutic agents may be combined with the sutures in the form of a coating. Suitable methods for coating sutures are within the purview of those skilled in the art and include, but are not limited to, spray coating, dip coating, extrusion, coextrusion, overmolding, and the like. Additionally, the therapeutic agent may be combined with polar and non-polar solvents creating a suture coating. 
     Therapeutic agent may also be polymerized off the surface of the suture or compounded within the polymer resin used to create the suture. In other embodiments, polymer drugs (e.g., polydiflunisol, polyaspirin, and protein therapeutics) may be utilized to create sutures of the present disclosure. 
     Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure. For example, the disclosure is not limited to those embodiments described herein and various combinations of elongate bodies, with and without barbs may be combined, including monofilament and multifilament configurations. Additionally needles may be disposed at one or both ends of the suture.