Patent Description:
Many wound and surgical incisions are closed using surgical sutures or some other surgical closure device. Barbed sutures are well known and have recently been gaining attention for various medical applications. Typically, barbed sutures are constructed with a series of "barbs" or "protrusions" (used interchangeably herein) that extend outwardly from the suture, and function to increase the holding strength of the suture and/or eliminate the need for knot tying. The size and shape of the barbs have practical limitations in a surgical setting, and cannot simply be increased wherever increased holding strength is desired.

Some sutures and barbed sutures have been known to include anchors, tabs or the like on the distal end of the suture to provide a "stop" at the end that increases the holding strength of the suture and eliminates the need to tie knots to secure the suture. Conventional thinking dictates that the larger the surface area of the stop in a direction perpendicular to the direction of insertion of the suture, the more holding strength that will be achieved. Again, there are practical limitations on size however, as large masses may be intolerable in surgical procedures and/or palpable and therefore undesirable. Further, with T-shaped stops, the perpendicular portion is structurally weak when a bending moment is applied as it would be when pulling on the suture to approximate a wound.

Therefore, there remains a need to enhance the holding strength of a surgical suture without significantly increasing the insertion force, stiffness of the suture, or palpability of the device.

Document <CIT> describes a holding device where multiple tissue holding elements extend outwardly from the suture shaft, with each element further including a web-like portion extending between the inner side of the tissue holding element and the suture shaft.

Document <CIT> describes a stabilizer for an urethral support stabilization system. The stabilizer is a planar, elongate, substantially rectangular or oval tab including a radius at the distal end and is flat at the proximal end opposite to the distal end.

Document <CIT> describes a surgical suture including an elongated core having a first leg and a second leg, a first set of barbs projecting from the first leg of the core, and a second set of barbs projecting from the second leg of the core. The suture has a stop projecting from the core that is located between the first and second sets of barbs, and a braid surrounding the elongated core and the stop for strengthening the suture.

Document <CIT> describes a non-resorbable device with small holes for tissue ingrowth connected to a suture and used as an anchoring tool.

Document <CIT>describes a pre-installed pledget or stop device on one end of a flexible ligament of expanded polytetrafluoroethylene to allow it to be rapidly anchored at one end merely by pulling it into place. The stop device comprises an essentially flat pledget.

Document <CIT> describes a suture for use in MIS surgery and tying internally in a body cavity using graspers extending through trocars in the body wall, the suture comprising a length of suture material suitable for fastening body tissue within the body cavity, the length having opposite end portions, and gripping means attached to at least one of the end portions. The gripping means, which may be formed and shaped to facilitate engagement and movement by graspers, may be a soft, sponge-like body attached to the length end or an elongated body in the shape of a paddle attached to the length end for use by a grasper in the movement of a body organ.

Document <CIT> describes an anchoring device including an elongate body having a proximal portion and a distal portion. The proximal portion of the elongate body terminates in a free end and the distal portion forms a loop. The loop includes a proximal portion and a distal portion. and further includes a plurality of anchors disposed along a surface thereof. The plurality of anchors are oriented toward the proximal portion of the elongate body to limit movement of the loop through tissue. A pledget is disposed adjacent the proximal portion of the loop.

Specific embodiments are set forth in the dependent claims.

In this disclosure, the width of the stop element may be greater than <NUM> mils, the length of the stop element may be greater than <NUM> mils, and/or the maximum thickness of said stop element may be between <NUM> and <NUM> mils.

In this disclosure, the thickness of the stop element varies, and/or a minimum thickness of the stop element may be between <NUM> and <NUM> mils. Also in this disclosure, the leading edge thickness includes a maximum thickness at a center and/or at first and/or second outer edges, and a minimum thickness at a location between the center and the first outer edge and between the center and the second outer edge.

The wound closure device of claim <NUM> includes a plurality of projections extending outwardly from the filamentary element along at least a portion of its length. The plurality of projections may extend outwardly from said filamentary element by approximately <NUM>-<NUM> mils.

The device may be made of a polymeric, metallic or ceramic material that are absorbable or non-absorbable. In this disclosure, the device is made of a polymer material selected from the group consisting of absorbable and non-absorbable homopolymers, random copolymers, block copolymers or blends made from polydioxanone, polyglactin, polyglycolic acid, copolymers of glycolide, lactide, and/or caprolactone, polyoxaesters, poliglecaprone, polypropylene, polyethylene, polyvinylidene fluoride (PVDF), hexafluoropropylene, copolymers of vinylidene fluoride and hexafluoropropylene, polyesters, polyethylene terephthalate, polybutylene terephthalate, glycol-modified polyethylene terephthalate, polytetrafluoroethylene, fluoropolymers, thermoplastic elastomers, ionomers, copolymers of ethylene and methacrylic acid, polyamides, polytetramethylene oxide, polystyrene, polybutadiene, polybutylene, etc. including combinations and/or copolymers of absorbable and non-absorbable materials.

According to claim <NUM>, a ratio of the length to maximum thickness of the stop element is greater than <NUM>.

Also in this disclosure, the maximum thickness of the stop is approximately <NUM>-<NUM> mils, the width of the stop is approximately <NUM>-<NUM> mils, and the length of the stop is approximately <NUM>-<NUM> mils.

The present invention, as defined in claim <NUM>, provides a wound closure device including a filamentary element extending along a longitudinal axis between a proximal end and a distal end, and a stop element coupled to the distal end of the filamentary element and that has a length extending substantially parallel to the longitudinal axis of the filamentary element, a width extending substantially perpendicular to said longitudinal axis, and a maximum thickness. The ratio of the length to the maximum thickness of the stop element is at least <NUM>.

In this disclosure, the maximum thickness of the stop element is between <NUM> and <NUM> mils, the length of the stop element is greater than <NUM> mils, and/or the width of the stop element is between <NUM> and <NUM> mils.

The wound closure device as defined in claim <NUM> further includes a plurality of projections extending outwardly from the filamentary element along at least a portion of its length.

Also in this disclosure, the thickness of the stop element varies, and in another disclosure, the leading edge thickness includes a maximum thickness at a center and/or at first and/or second outer edges, and a minimum thickness at a location between the center and the first outer edge and between the center and the second outer edge.

In this specification the following non-SI units are used, which may be converted to the respective SI or metric unit according to the following conversion factors:.

<FIG> illustrates an exemplary embodiment of a wound closure device <NUM> according to the present invention. The wound closure device <NUM> includes a filamentary element <NUM> comprised of any suitable surgical suture material (i.e., absorbable and non-absorbable polymeric materials, metallic, or ceramic materials) that includes a plurality of barbs <NUM> that extend outwardly therefrom. The suture may be formed by any suitable method, but preferably is compound profile punched from preformed material in a manner described in more detail in <CIT>, which is herein referenced. The proximal end <NUM> of the wound closure device may include a needle or other insertion device <NUM>. At the distal end <NUM> of the wound closure device is a fixation tab or stop element or the like <NUM>. The stop <NUM> has a leading edge <NUM> defined by a leading edge thickness t and a leading edge width w, and also has a length <NUM> as shown in <FIG>. As indicated previously, known T-shaped configurations have relatively weak stiffness when a bending moment is applied, such as when tension is applied to the suture to approximate a wound. The graph depicted in <FIG> more clearly illustrates the advantage of the present invention over a T-shaped end configuration. Fixation tabs of equal leading edge maximum thickness (t) and width (w) (leading edge area), but varying length (<NUM>) were made and the holding strength tested. The holding strength was tested by passing the barbed suture through a porcine abdominal wall fascia sample and pulling against the fixation tab until failure occurred either by the stop breaking in some fashion, the stop pulling through the tissue, or a combination of both. The maximum load prior to failure was recorded and illustrated in <FIG>.

As shown therein, the holding strength decreases as the geometry becomes more like a T-shaped member, or in other words, as the ratio of length to leading edge area or length to maximum thickness decreases. The holding strength can be increased by increasing the thickness or width of the stop, but as indicated previously, there are practical and clinical limitations on the size and mass that can be implanted.

In addition to the length to maximum thickness or leading edge area ratio, the length <NUM> to width w ratio is also a significant consideration for any given maximum thickness. Surprisingly and counter-intuitively, a ratio of at least <NUM>:<NUM> provides much increased holding strength. <FIG> illustrates the elongation of the fixation stop or tab as a function of the length to width ratio for a given maximum thickness. As shown, the percentage of elongation (or more simply the amount of deformation) required to reach catastrophic failure increases with increasing length to width ratio.

In addition to raw elongation percentages, the actual amount of energy required for the failure of the device increases with increasing length to width ratios. This is illustrated by <FIG>, in which the area under the load-extension curve is a measure of the strain energy until catastrophic failure. As the length to width ratio increases, the amount of strain energy required to reach catastrophic failure significantly increases. <FIG> illustrates a load-extension curve for a fixation tab having a length to width ratio of <NUM>:<NUM>. As illustrated, the device reaches a peak load then decreases dramatically with sudden failure. <FIG> illustrates a load-extension curve for a fixation tab having a length to width ratio of <NUM>:<NUM>.

As illustrated, the curve has a second peak, and much greater extension before catastrophic failure occurs. In other words, the strain energy significantly increases as the length to width ratio increases from <NUM> to <NUM>.

Referring once again to <FIG>, the leading edge area of the stop element has relatively little surface area in contact with tissue when the suture is under tension, but its ratio of length <NUM> to maximum thickness t is very large. Thus, the actual area in contact with tissue (leading edge area <NUM>) in the direction ofload is very small relative to the overall dimensions of the fixation stop or tab. This relatively long length, but minimal thickness allows the stop to be placed in the wound in a relatively flat position, which minimizes palpability and allows the opposing sides of the tissue to neatly cover the stop. Since the stop lies nicely in the tissue, it can be placed at the apex of the wound, lateral to one side of the wound etc, without impeding the surgeon's individual closure technique.

In a preferred embodiment, the leading edge relative to the total surface area of the stop (sum of surface area of all sides) is small, preferably less than <NUM>% and more preferably less than <NUM>%. This is counterintuitive, as conventional thinking dictates that in order to increase holding strength and/or minimize failure, one must increase or maximize the surface area under load in order to spread out the load and decrease the load per unit area. The relatively long length l, but minimal thickness t results in clinical advantages, including flat positioning that minimizes palpability, and versatile positioning as mentioned above.

Claim 1:
A wound closure device (<NUM>) comprising:
a filamentary element (<NUM>) extending along a longitudinal axis between a proximal end (<NUM>) and a distal end (<NUM>), the filamentary element having a plurality of projections extending outwardly therefrom along at least a portion of its length;
a stop element (<NUM>) coupled to the distal end of the filamentary element, the stop element having a length extending substantially parallel to the longitudinal axis of the filamentary element, a width extending substantially perpendicular to the longitudinal axis and a maximum thickness;
characterised in that the ratio of the length to the maximum thickness of the stop element is at least <NUM>.