Patent Description:
Many surgical procedures require accurate cuts of bone. For example, in mandibular reconstruction surgery, deficient or infectious portions of the mandible may be removed from the patient and replaced with bone graft. In some instances, a surgeon performing orthognathic surgery typically makes several cuts on the mandible to properly fit a bone graft. To make an accurate cut, the surgeon may use a patient specific resection guide to guide the motion of the resection tool toward the bone. The resection guide can also be used while cutting a bone portion from other parts of the patient to harvest bone grafts.

The resection guide may wear over time due to the friction exerted by the resection tool on the resection guide during use. This wear may reduce the accuracy of the resection guide and produce wear debris. Wear debris stemming from the resection guide could be detrimental to the long-term efficacy of the bone graft.

<CIT> discloses a bone graft forming guide for obtaining a bone graft from a cadaver bone. The guide includes a plurality of elongate openings to guide a saw along a desired cutting axis.

Described herein but not forming part of the present invention is a surgical system for reconstructing at least a portion of a tissue body with a graft. The surgical system can include a resection guide that is configured to guide a one or more tools toward a graft source. The resection guide can generally include a resection guide body and a guide member. The resection guide body can be at least partially made from a first material, and defines an upper body surface and a lower body surface that is opposite the upper body surface and positioned to be placed against the graft source. Further, the resection guide body can define a first resection guide opening and a second resection guide opening that is spaced from the first resection guide opening. The first and second resection guide openings can extend through upper and lower body surfaces. The guide member can be configured to be at least partially inserted in at least one of the first resection guide opening or the second resection guide opening. In particular, the guide member can include a guide member body. The guide member can define a guide member opening that extends through the guide member body and is elongate along a graft resection axis. The guide member opening can be configured to receive at least a portion of the resection tool such that the guide member guides a movement of the resection tool along the graft resection axis when the resection tool is received in the guide member opening. The guide member can be at least partially made of a second material that is harder than the first material.

The first material of the resection guide body has a first hardness, and the second material of the guide member has a second hardness. The second hardness can be greater than the first hardness. Specifically, the first material can have a Brinell hardness ranging between about <NUM> HBS <NUM>/<NUM> and about <NUM> HBS <NUM>/<NUM>. The second material can have a Brinell hardness ranging between about <NUM> and about <NUM> HB. The second material can be a metallic material, such as stainless steel or aluminum. The first material can be a polymeric material.

At least a portion of the guide member can be removably disposed in the first resection guide opening or the second resection guide opening. The guide member can include at least one tab that protrudes from the guide member body, and the tab is configured to abut at least a portion of the upper body surface when the guide member body is fully seated into the first resection guide opening or the second resection guide opening. The tab can be cantilevered from the guide member body. The guide member can include a first tab and a second tab that is cantilevered from the guide member body. The second tab can be configured to abut at least a portion of the upper body surface when the guide member body is fully seated in the first resection guide opening or the second resection guide opening. The guide member body can define a front wall, a rear wall opposite to the front wall, and a pair of side walls that extend between the front and rear walls. The front wall, the rear wall, and the side walls can define the guide member opening. The first tab can protrude from the front wall, and the second tab protrudes from the rear wall. The side walls can be elongate along the graft resection axis.

The resection guide can further define a third resection guide opening and a fourth resection guide opening that is spaced from the third resection guide opening. The third and fourth resection guide openings can be configured to receive at least a portion of the resection tool so as to resect a second graft portion from the graft source. The guide member can be configured to be selectively inserted into each of the first, second, third, and fourth resection guide openings so as to guide the resection tool along the graft resection axis. The resection guide body can include first and second inner surfaces that at least partially define the first and second resection guide openings, respectively. The guide member can be segmented so as to define a plurality of discrete guiding components configured to be mounted to at least one of the first or second inner surfaces. The discrete guiding components can be made from the second material. The discrete guiding components and the respective first or second inner surface can define complementary engagement members that are configured to mate so as to attach the discrete guiding components to the respective inner surface. The engagement member of each of the guiding components can include a tongue, and the engagement member of the respective inner surface can define a groove configured to receive the tongue. The tongue can be tapered so as to so as to be press-fit within the respective groove. The guide member can be a first guide member configured to be attached to the first inner surface. The resection guide can further include a second guide member that is segmented so as to define a plurality of discrete guiding components that configured to be attached to the second inner surface. The second material can be at least partially made from a laser-sintered metallic material. The second material can be made using a direct metal laser sintering process. The first material can be stereolithographic.

The resection guide can include a metallic resection guide body that defines an upper body surface and a lower body surface opposite the upper body surface and configured to face the graft source. The resection guide body can define a first and second resection guide openings that are spaced from each other and extend from the lower body surface through the upper body surface. The first and second resection guide openings can define respective first and second graft resection axes that are configured to receive a portion of the resection tool and guide the resection tool along the respective first and second resection guide openings so as to resect a graft portion from the graft source. The resection guide body can define first and second inner surfaces that at least partially define the first and second resection guide openings and are configured to contact the resection tool as the resection tool is guided along the respective first and second graft resection axes. The first and second resection guide openings are devoid of inserts that are discrete with the resection guide body. The metallic resection guide body is laser-sintered. The first and second axes are angularly offset with respect to each other. The resection guide body can be made from a metallic material that has a Brinell hardness ranging between about <NUM> HB and about <NUM> HB. For example, the resection guide body can be made from a metallic material that has a Brinell hardness of about <NUM> HB.

The foregoing summary, as well as the following detailed description of a preferred embodiment, are better understood when read in conjunction with the appended diagrammatic drawings. For the purpose of illustrating the invention, the drawings show an embodiment that is presently preferred. The invention is not limited, however, to the specific instrumentalities disclosed in the drawings. In the drawings:.

Certain terminology is used in the following description for convenience only and is not limiting. The words "right", "left", "lower" and "upper" designate directions in the drawings to which reference is made. The words "proximally" and "distally" refer to directions toward and away from, respectively, the surgeon using the surgical device. The words, "anterior", "posterior", "superior", "inferior" and related words and/or phrases designate preferred positions and orientations in the human body to which reference is made and are not meant to be limiting. The terminology includes the above-listed words, derivatives thereof and words of similar import.

With reference to <FIG>, a surgical system <NUM> be used to reconstruct at least a portion of a tissue body <NUM> with a graft <NUM> (<FIG>). The tissue body <NUM> can include at least one of anatomical tissue or a tissue substitute. The term anatomical tissue can include hard tissue such as bone. For instance, the tissue body <NUM> can include a mandible <NUM>. The surgical system <NUM> can be configured to remove a diseased tissue portion <NUM> (<FIG>), such as a damaged tissue portion, from the tissue body <NUM>, harvest the graft <NUM> from a graft source <NUM>, and replace the diseased tissue portion <NUM> with the graft <NUM>.

The surgical system <NUM> can include a resection guide <NUM> that is configured to harvest the graft <NUM> (<FIG>) from the graft source <NUM> and prepare the graft <NUM> for positioning and securement to the tissue body <NUM>. In particular, the resection guide <NUM> can be configured to guide a resection tool <NUM> (<FIG>) toward the graft source <NUM> along one or more predetermined graft resection axes. For instance, the resection guide <NUM> can be configured to a guide the resection tool <NUM> along graft resection axes <NUM>, <NUM>, <NUM>, and <NUM>. The graft resection axes <NUM>, <NUM>, <NUM>, and <NUM> can be predetermined with the aid of virtual models of the graft source <NUM> and diseased tissue portion <NUM> (<FIG>) as discussed detail below. In other embodiments, the resection guide can also be configured to guide a drilling tool <NUM> (<FIG> and <FIG>) into the tissue body <NUM> or graft source <NUM>. For instance, the resection guide can be configured to guide a tool, such as drill bit along an anchor location axis <NUM> to form a bore in the graft source <NUM> or tissue body <NUM> that is sized to receive an anchor therein, for instance for coupling a bone plate to the graft <NUM> and tissue body <NUM>. The location and orientation of the anchor location axis <NUM> can also be predetermined with the aid of virtual models of the graft source <NUM>, the tissue body <NUM>, including the diseased tissue portion <NUM> (<FIG>), and a bone fixation element, as discussed detail below. Thus, the resection guide <NUM> can be patient specific. That is, the resection guide <NUM> can guide the resection tool <NUM> toward the graft source <NUM> to create one or more graft portions that are sized and shaped to properly replace the diseased tissue portion <NUM> (<FIG>) of the tissue body <NUM>.

With reference to <FIG>, the resection guide <NUM> can be configured to guide a resection tool <NUM> (<FIG>) toward the graft source <NUM> to resect a portion of the graft source <NUM> in order to create the graft <NUM> (<FIG>). The graft <NUM> can be shaped and sized to replace the diseased tissue portion <NUM> (<FIG>) that is removed from the tissue body <NUM>. The graft source <NUM> can be a long bone, such as the fibula <NUM>. Alternatively, the graft source <NUM> can be other bones such as the scapula, hip, forearm, among others. The resection guide <NUM> can include a resection guide body <NUM> that in turn can include one or more resection guide supporting members. As further detailed below, the resection guide can include one or more drill guide member <NUM> (<FIG>).

Each resection guide supporting member is configured to support a guide member as discussed in detail below. In the depicted embodiment, the resection guide body <NUM> can include a first resection guide supporting member <NUM>, a second resection guide supporting member <NUM>, a third resection guide supporting member <NUM>, and a fourth resection guide supporting member <NUM>.

The first resection guide supporting member <NUM> can define a first resection guide opening <NUM>. Thus, the resection guide body <NUM> can define the first resection guide opening <NUM>. The first resection guide opening <NUM> can be shaped and oriented relative to the resection guide body <NUM> such that the resection guide opening <NUM> can guide the resection tool <NUM> (<FIG>) along a first resection axis <NUM> defined along the graft source <NUM> when the resection guide <NUM> is coupled to the graft source <NUM>.

The second resection guide supporting member <NUM> can define a second resection guide opening <NUM>. Thus, the resection guide body <NUM> defines the second resection guide opening <NUM>. The second resection guide opening <NUM> can be spaced from the first resection guide opening <NUM>. The first resection guide opening <NUM> and the first resection guide opening <NUM> can extend through the upper body surface <NUM> and the lower body surface <NUM>. The second resection guide opening <NUM> can be shaped and oriented relative to the resection guide body <NUM> such that the second resection guide opening <NUM> can guide the resection tool <NUM> (<FIG>) along a second graft resection axis <NUM> defined along the graft source <NUM> when the resection guide <NUM> is coupled to the graft source <NUM>.

The third resection guide supporting member <NUM> defines a third resection guide opening <NUM>. The third resection guide opening <NUM> can be shaped and oriented relative to the resection guide body <NUM> such that the third resection guide opening <NUM> can guide the resection tool <NUM> (<FIG>) along a third graft resection axis <NUM> when the resection guide <NUM> is coupled to the graft source <NUM>.

The fourth resection guide supporting member <NUM> can define a fourth resection guide opening <NUM>. The fourth resection guide opening <NUM> can be shaped and oriented relative to the resection guide body <NUM> such that the fourth resection guide opening <NUM> can guide the resection tool <NUM> (<FIG>) along a fourth resection graft axis <NUM> when the resection guide <NUM> is coupled to the graft source <NUM>. The resection guide <NUM> can further defines the third resection guide opening <NUM> and the fourth resection guide opening <NUM> that is spaced from the third resection guide opening <NUM>. The third and fourth resection guide openings <NUM> and <NUM> can be configured to receive at least a portion of the resection tool <NUM> so as to resect a second graft portion <NUM> from the graft source <NUM>. The resection guide body <NUM> can define more than four resection guide openings. Also, the resection guide body <NUM> can define fewer than four resection guide openings.

With continuing reference to <FIG>, the resection guide body <NUM> can further include a first connection member <NUM> that couples the first resection guide supporting member <NUM> to the second resection guide supporting member <NUM>, a second connecting member <NUM> that couples the second resection guide supporting member <NUM> to the third resection guide supporting member <NUM>, and a third connecting member <NUM> that couples the third resection guide supporting member <NUM> to the fourth resection guide supporting member <NUM>. The resection guide body <NUM> can further define one or more holes <NUM> that are configured to receive a fastener, such as a bone screw. The fasteners can be inserted through the holes <NUM> to fix the resection guide body <NUM> to the graft source <NUM>. The holes <NUM> can be located, for example, along the first connecting member <NUM> and the third connecting member <NUM>.

With continuing reference to <FIG>, the resection guide <NUM> can be shaped and contoured to fit only over a portion of the graft source <NUM> such that the resection guide openings <NUM>, <NUM>, <NUM>, and <NUM> are substantially aligned with the graft resection axes <NUM>, <NUM>, <NUM>, and <NUM>, respectively. Thus, in operation, the resection guide <NUM> can be placed on the graft source <NUM> such that the resection guide openings <NUM>, <NUM>, <NUM>, and <NUM> are substantially aligned with the graft resection axes <NUM>, <NUM>, <NUM>, and <NUM>, respectively. Then, the resection guide <NUM> can be coupled to the graft source <NUM> by, for example, inserting fasteners through the holes <NUM> and into the graft source <NUM>. The resection tool <NUM> (<FIG>) can be inserted through the first resection guide opening <NUM> to make a resection, such as a cut, into the graft source <NUM> along the first graft resection axis <NUM>. The resection tool <NUM> (<FIG>) can be inserted through the second resection guide opening <NUM> and into the graft source <NUM> to make a resection, such as a cut, into the graft source <NUM> along the second graft resection axis <NUM>. Resections can be made to the graft source <NUM> along the first graft resection axis <NUM> and the second graft resection axis <NUM> to obtain the first graft portion <NUM> (<FIG>). The resection tool <NUM> (<FIG>) can be inserted through the third resection guide opening <NUM> and into the graft source <NUM> to make a resection, such as a cut, into the graft source <NUM> along the third graft resection axis <NUM>. Further, the resection tool <NUM> (<FIG>) can be inserted through the fourth resection guide opening <NUM> and into the graft source <NUM> to make a resection, such as a cut, into the graft source <NUM> along the fourth resection axis <NUM>. Resections can be made to the graft source <NUM> along the third graft resection axis <NUM> and the fourth graft resection axis <NUM> to obtain a second graft portion <NUM> (<FIG>). The resection guide <NUM> can then be detached from the graft source <NUM>.

With reference to <FIG>, after making resection into the graft source <NUM> along the graft resection axes <NUM>, <NUM>, <NUM>, and <NUM>, the first graft portion <NUM> and the second graft portion <NUM> can be removed from the graft source <NUM> (<FIG>). At this point, the first graft portion <NUM> and the second graft portion <NUM> can be two separate elements. However, the first graft portion <NUM> and the second graft portion <NUM> can be coupled to each other to form the graft <NUM> (<FIG>). In other words, the first graft portion <NUM> and the second graft portion <NUM> can cooperate to define the graft <NUM>.

With reference to <FIG>, a tissue portion of the tissue body <NUM>, such as the diseased tissue portion <NUM> (<FIG>), can be resected from the tissue body <NUM>, thereby forming a cavity <NUM>. In the depicted embodiment, the cavity <NUM> is defined by the resected or cut portion of the ramus at one end, and resected or cut portion the mental protuberance at the other end of the cavity. The first graft portion <NUM> and the second graft portion <NUM> can be interconnected to form the graft <NUM>, which is shaped and sized to fit in the cavity <NUM> so as to replace the tissue portion removed from the tissue body <NUM>.

With reference to <FIG>, the first graft portion <NUM> and the second graft portion <NUM> can cooperate to define the graft <NUM>. For example, the first graft portion <NUM> and the second graft portion <NUM> can be coupled to the tissue body <NUM> and to each other, such that the first graft portion <NUM> and the second graft portion <NUM> can together fit in the cavity <NUM>, thereby replacing the tissue portion previously removed from the tissue body <NUM>. As discussed above, the first graft portion <NUM> and the second graft portion <NUM> can be coupled to each other so as to define the graft <NUM>. Thus, the graft <NUM> can replace the tissue portion removed from the tissue body <NUM>, such as the diseased tissue portion <NUM> (<FIG>).

With reference to <FIG>, the surgical system <NUM> can further include the resection tool <NUM> that is configured to resect, such as cut, the tissue body <NUM>, and a resection guide <NUM>, that is configured to be coupled to the tissue body <NUM> to guide the movement of the resection tool <NUM> toward the tissue body <NUM>. The surgical system <NUM> can also include drilling tool <NUM> configured to form anchor locations in the tissue body <NUM> or graft source <NUM> as detailed below. The resection guides can also be configured to guide movement of the drilling tool <NUM> toward the tissue body <NUM> (<FIG>) or graft source <NUM> (<FIG>).

The resection tool <NUM> is configured to resect, such as cut, the tissue body <NUM>, and can be a chisel, a saw, a blade, or any tool capable of resecting, such as cutting, the tissue body <NUM>. The resection guide <NUM> can be configured to guide advancement of the resection tool <NUM> toward the tissue body <NUM> and can include a resection guide body <NUM> and a connecting member <NUM> connected to the resection guide body <NUM>. The resection guide body <NUM> can define a resection guide opening <NUM> that is configured and sized to receive at least a portion of the resection tool <NUM>. The resection guide opening <NUM> can also be configured and sized to receive a guide member as described below. The connecting member <NUM> can be configured to be coupled to the tissue body <NUM> at the desired resection site. For example, the connecting member <NUM> can be configured to be coupled to the tissue body <NUM> at a first resection site defined along the first resection axis <NUM>. Thus, the connecting member <NUM> can be contoured to mirror the shape of a portion of the tissue body <NUM> along the first resection axis <NUM> so that the connecting member <NUM> substantially fits only over the portion of the tissue body <NUM> located along the first resection axis <NUM>. Since the tissue body <NUM> of different patients have different shapes and sizes, the connecting member <NUM> can be created to fit over the desired resection site of a specific patient. That is, the connecting member <NUM>, and thus the resection guide <NUM>, can be patient specific.

To create a patient specific resection guide <NUM>, a virtual three-dimensional model of a patient's tissue body <NUM>, such as a skull <NUM>, can be created using any suitable technology, such as x-ray computed tomography (CT) or any technology capable of mapping the tissue portion <NUM>. For example, a virtual three-dimensional model of the patient's skull <NUM> can be created using a suitable CT machine. The skull <NUM> includes the mandible <NUM>. Thus, a virtual model of the mandible <NUM> can also be created using the CT machine. Then, a clinician, such as a physician, asses the virtual model of the tissue body <NUM> to determine what portion of the tissue body <NUM> should be removed and replaced with a graft. The clinician can then determine the appropriate resection sites. For example, in the depicted tissue body <NUM>, the clinician has determined that the tissue body <NUM> should be resected along the resection axes <NUM> and <NUM> in order to remove a diseased tissue portion <NUM> of the mandible <NUM>. As used herein, the diseased tissue portion <NUM> can include damaged tissue portion. However, it is envisioned that the other portions of the tissue body <NUM> can be removed, and thus, the resection axes can be located at other positions as desired. After determining the appropriate resection sites as defined by the resection axes <NUM> and <NUM>, the resection guide <NUM> can be created to fit over a specific resection site (as defined by, for example, the first resection axis <NUM>) of the patient. That is, the connection member <NUM> can be shaped and sized to fit only over the resection site identified in the virtual model of the patient's tissue body <NUM>.

With continuing reference to <FIG>, after determining the resection sites (as defined by resection axes <NUM> and <NUM>), the appropriate graft size and shape can be determined. For example, a virtual model of an appropriate graft <NUM> can be superimposed over tissue body portion to be replaced, such as the diseased tissue portion <NUM>, to determine the virtual model of the graft <NUM> has the proper size and shape. In the depicted embodiment, the virtual model of the graft <NUM> can include two portions, namely: a first graft portion <NUM> and a second graft portion <NUM>. The first graft portion <NUM> and the second graft portion <NUM> can cooperate to define the graft <NUM>. However, it is envisioned that the graft <NUM> can be a monolithic structure or can include more two portions. The graft <NUM> can be virtually designed so that it can be acquired from the same patient. That is, the graft <NUM> can be an autologous graft. Preferably, the first and second graft portions <NUM> and <NUM> can be designed such that the bone graft <NUM> can be harvested from a vascularized bone graft source, such as the fibula. Vascularized bone graft is preferred because these grafts provide better blood supply than non-vascularized bone grafts and thereby can lead to faster healing. However, it is contemplated that the graft <NUM> can be harvested from a non-vascularized bone graft source.

As seen in <FIG>, the first graft portion <NUM> and the second graft portion <NUM> can be oriented at an oblique angle relative to each other when these portions are virtually superimposed over the diseased portion <NUM>. However, in their natural state, the first graft portion <NUM> and the second graft portion <NUM> can stem from the same graft source, and can therefore be aligned with each other. For example, the virtual models of the first graft portion <NUM> and the second graft portion <NUM> can be virtually removed from the virtual model of the patient's mandible <NUM>, unfolded, and then aligned with a virtual model of a graft source <NUM>, such as a fibula <NUM>, to determine the appropriate location of the resection sites in the graft source <NUM>. In the depicted embodiment, it can be appreciated that resections should be made in the graft source <NUM>, such as the fibula, along a first graft resection axis <NUM>, a second graft resection axis <NUM>, a third graft resection axis <NUM>, and a fourth graft resection axis <NUM> to obtain a graft that has the proper size and shape to replace the resected portion, such as the diseased tissue portion <NUM>, of the tissue body <NUM>. In particular, according to the virtual model of that particular patient, the graft source <NUM> can be resected along the graft resection axes <NUM> and <NUM> to harvest the first graft portion <NUM>. Similarly, the graft source <NUM> can be resected along resection axes <NUM> and <NUM> to harvest the second graft portion <NUM>. The location and orientation of the graft resection axes <NUM>, <NUM>, <NUM>, and <NUM> in the virtual model of the graft source <NUM> can serve as guidelines to create a resection guide <NUM> (<FIG>) capable of facilitating resection along those same resection axes in the physical graft source <NUM>. The resection guide <NUM> (<FIG>) can be shaped and contoured to fit only over a portion of the graft source <NUM> such that its resection guide opening (as discussed below) are aligned with the graft resection axes <NUM>, <NUM>, <NUM>, and <NUM>.

Referring again to <FIG>, once the resections have been virtually planned as discussed above, the resection guide <NUM> can be placed over the tissue body <NUM> such that the resection guide opening <NUM> is substantially aligned with the first resection axis <NUM>. As discussed above, the connection member <NUM> can be shaped and contoured to fit only over the desired resection site such that the resection guide opening <NUM> is substantially aligned with the resection axis <NUM>. The connection member <NUM> can be coupled to the tissue body <NUM> at the desired resection site. For instance, the connecting member <NUM> can define one or more holes <NUM> configured to receive a fastener, such as a bone screw. One or more fasteners can be inserted through the holes <NUM> to couple the resection guide <NUM> to the tissue body <NUM>. The resection tool <NUM> can then be inserted through the resection guide opening <NUM>, and advanced toward the tissue body <NUM> to resect the tissue body <NUM> along the first resection axis <NUM>.

With reference to <FIG>, the graft <NUM> can replace the tissue portion removed from the tissue body <NUM>, such as the diseased tissue portion <NUM> (<FIG>). In the depicted embodiment, the first graft portion <NUM> and the second graft portion <NUM> can be positioned in the tissue body <NUM>, such that the first graft portion <NUM> and the second graft portion <NUM> can together fit in the cavity <NUM> (<FIG>). The first graft portion <NUM> and second graft portion <NUM> span the cavity <NUM> in posterior-anterior direction and lateral-medial direction interconnecting exposed ramus and mental protuberance of the tissue body <NUM>. Once positioned in the cavity <NUM>, the first graft portion <NUM> and the second graft portion <NUM> can be coupled to each other and the tissue body <NUM>.

Bone fixation plates <NUM> and anchors <NUM> can be used to couple the graft <NUM> to the tissue body <NUM>. Bone fixation plates <NUM> can be used to couple to graft portions to each other and to the tissue body <NUM>. One or more bone bone fixation plates <NUM> can be placed across the ramus of tissue body <NUM>, the first graft portion <NUM>, the second graft portion <NUM>, and mental protuberance of tissue body <NUM>, then then anchors <NUM> can be inserted through the bone fixation plates <NUM> and into the tissue body portions <NUM> and the graft <NUM> so as to couple the graft <NUM> to the tissue body <NUM>. Specifically, the anchors <NUM> can be inserted into the preformed tissue body bores <NUM> while other anchors can be inserted through bone plate openings and into corresponding numbers of graft bores <NUM> formed during resection of the graft <NUM>.

Bone fixation plates <NUM> can define a plate body extending along a plate longitudinal axis. The plate body defines a plurality of openings extending through the plate along an opening axis such that the opening axis is perpendicular to the plate axis. The openings can be oriented such that the opening axis is angled in any radial direction with respect to the plate axis. The bone plates can include a primary leg and an auxiliary leg obliquely offset relative to the primary leg. The bone fixation plate can define one or more openings in the primary leg and the auxiliary leg. Examples suitable bone fixation plates <NUM> are described and illustrated in <CIT>. Further, the bone fixation plates can be bendable to conform to the anatomy of patient and/or structure of the graft <NUM>. For instance, the bone fixation plate can be bendable, or bent, along one or more portions of the bone fixation plate so that the plate axis aligned with a parallel to the surface of the tissue body <NUM> and graft <NUM>.

The bone fixation plates <NUM> can be patient specific bone plates. For instance, the tissue body <NUM> prior to resection can be scanned, and the scanned data can be used to develop a virtual three-dimensional model of the tissue body <NUM> as described above. For instance, Computer Aid Design (CAD) software, running on a computer, can create a virtual three-dimensional model of a bone fixation plate, based on the virtual three-dimensional model of the tissue body. The virtual three-dimensional model of the bone plate can be manipulated or modified , for instance to include holes or openings for receiving anchors therein. The holes can smooth, threaded, or partially threaded and configured to receive an a wide variety of anchors, such as locking screws, compression screws and/or nail and any type of fixation member or device. The plate virtual three-dimensional model can be used to form a patient specific bone plate via rapid processing technologies described herein. For instance, via a computer, the virtual three-dimensional model of the bone plate can be used to develop manufacturing instructions for the bone plate. The manufacturing instructions can be transmitted to a computer in electrical communication with a rapid manufacturing machines. The computer receives the manufacturing instructions, then via a processor, the manufacturing instructions initiate in the rapid manufacturing machine, the formation of the patient specific bone plate. The patient specific bone plate can be formed to have a plurality of openings that are configured to align with the tissue body bores and graft bores. Or, as further detailed below, the resection guide can be manufactured to have drill guides positioned and oriented to align with the openings formed in the patient specific bone plate.

Referring to <FIG>, in accordance with an embodiment, the resection guide <NUM> includes the resection guide body <NUM> and one or more guide members <NUM>. The resection guide body <NUM> is configured to support one or more guide members <NUM>, and can be wholly or partly made of a first material, such as any suitable polymeric material. For example, the resection guide body <NUM> can be at least partially made from the first material. Suitable polymeric materials include, but are not limited to, thermoplastics, thermosets and the like. The material at least partly forming the resection guide body <NUM> (i.e., the first material) can be a polymeric material to allow the use of a rapid prototyping technology during the manufacturing process, thereby reducing manufacturing cost and streamlining the manufacturing process. For example, the polymeric resection guide body <NUM> can be manufactured for a specific patient using any suitable rapid prototyping technology. In rapid prototyping manufacturing process, a virtual design, such as a computer aided design model, is transformed into a physical model. Examples of rapid prototyping technologies include, but are not limited to, selective laser sintering (SLS), fused deposition modeling (FDM), stereolithography (SLA), and 3D printing. To take advantage of the rapid prototyping technologies, the first material can have a relatively low hardness. For example, the first material can have a Brinell hardness ranging between about <NUM> HBS <NUM>/<NUM> and about <NUM> HBS <NUM>/<NUM>. The guide members <NUM> can be entirely or partly made of a second material, such as any suitable metallic material. Suitable metallic materials include, but are not limited, to stainless steel and aluminum. The second material can have a Brinell hardness ranging between <NUM> HB and about <NUM> HB. For example, the second material can have a Brinell hardness of about <NUM> HB. The guide members <NUM> can also be referred to as inserts.

With continuing reference to <FIG>, the resection guide body <NUM> defines a first end <NUM>, a second end <NUM> opposite to the first end <NUM>, and a central portion <NUM> that is disposed between the first end <NUM> and the second end <NUM>. The first end <NUM> is spaced apart from the second end <NUM> along the longitudinal direction <NUM>. The resection guide body <NUM> can define an upper body surface <NUM> and a lower body surface <NUM> that is opposite the upper body surface. The upper body surface <NUM> can be spaced from the lower body surface <NUM> along a transverse direction <NUM>. The lower body surface <NUM> is configured and positioned to be placed against the graft source <NUM>. In the depicted embodiment, the resection guide body <NUM> includes a first resection guide supporting member <NUM>, a second resection guide supporting member <NUM>, a third resection guide supporting member <NUM>, and a fourth resection guide supporting member <NUM>. It is envisioned, however, that the resection guide body <NUM> can include more or fewer resection guide supporting members. The first resection guide supporting member <NUM> can be disposed at or near the first end <NUM> of the resection guide body <NUM>. The second and third resection guide supporting members <NUM> and <NUM> can be disposed at or near the central portion <NUM> of the resection guide body <NUM>. The fourth resection guide supporting member <NUM> can be disposed at or near the second end <NUM> of the resection guide body <NUM>.

With continuing reference to <FIG>, the resection guide body <NUM> can include a plurality of connecting members that are configured to couple the resection guide supporting members <NUM>, <NUM>, <NUM>, and <NUM> to one another. In the depicted embodiment, the resection guide body <NUM> includes a first connecting member <NUM>, a second connecting member <NUM>, and a third connecting member <NUM> that are separated from one another along the longitudinal direction <NUM>. The first connecting member <NUM> can couple the first resection guide supporting member <NUM> with the second resection guide supporting member <NUM> such that the first resection guide supporting member <NUM> and the second resection guide supporting member <NUM> are spaced apart from each other a predetermined distance along the longitudinal direction <NUM>. A second connecting member <NUM> can couple the second resection guide supporting member <NUM> with the third resection guide supporting member <NUM>. A third connecting member <NUM> can couple the third resection guide supporting member <NUM> with the fourth resection guide supporting member <NUM> such that the third resection guide supporting member <NUM> and the fourth resection guide supporting member <NUM> are spaced apart from each other a predetermined distance along the longitudinal direction <NUM>. The cross-section of the connecting members <NUM>, <NUM>, and <NUM> can have any suitable shape. For example, the cross-section of one or more connecting members <NUM>, <NUM>, or <NUM> can be substantially arc-shaped. It is envisioned, however, that the cross-section of one or more connecting members <NUM>, <NUM> or <NUM> can have other suitable shapes, such as circular, oval, rectangular, polygonal, etc. The resection guide supporting members <NUM>, <NUM>, <NUM>, <NUM> and the connecting members <NUM>, <NUM>, and <NUM> cooperate to define the resection guide body <NUM>.

With continuing reference to <FIG>, the first resection guide supporting member <NUM> can include a first left side wall <NUM>, a first right side wall <NUM> opposite to the first left side wall <NUM>, a first front wall <NUM>, and a first rear wall <NUM> opposite to the first front wall <NUM>. The first front wall <NUM> can interconnect the first left side wall <NUM> and the first right side wall <NUM>. The first rear wall <NUM> can interconnect the first left side wall <NUM> and the first right side wall <NUM>. The first left side wall <NUM> can interconnect the first front wall <NUM> and the first rear wall <NUM>. The first right side wall <NUM> can interconnect the first front wall <NUM> and the first rear wall <NUM>. Furthermore, at least a portion of the first right side wall <NUM> is directly or indirectly connected to the first connecting member <NUM>. The first left wall <NUM>, first right side wall <NUM>, first front wall <NUM>, and first rear wall <NUM> cooperate so as to define a first upper surface <NUM>. Moreover, the first left wall <NUM>, first right side wall <NUM>, first front wall <NUM>, and first rear wall <NUM> cooperate so as to define a first lower surface <NUM>.

With continuing reference to <FIG>, the first left wall <NUM>, first right side wall <NUM>, first front wall <NUM>, and first rear wall <NUM> can cooperate so as to define a substantially or completely enclosed first inner surface <NUM>. Alternatively, the first inner surface <NUM> is not a substantially or completely enclosed. The first inner surface <NUM> of the resection guide supporting member <NUM> defines a first resection guide opening <NUM> that is configured and sized to receive at least a portion of a guide member <NUM> as discussed in detail below. The first inner surface <NUM> is disposed between the first upper surface <NUM> and the first lower surface <NUM>. The first resection guide opening <NUM> can extend through the first upper surface <NUM> and the first lower surface <NUM> along the transverse direction <NUM> that is substantially perpendicular to the longitudinal direction <NUM>. In the depicted embodiment, the resection guide opening <NUM> can have a substantially rectangular cross-section, and can be elongate, for example, along a lateral direction <NUM> that is perpendicular to the longitudinal direction <NUM>. In other words, the resection guide opening <NUM> can be elongate, for example, along a direction from the first front wall <NUM> toward the first rear wall <NUM>.

Continuing with <FIG>, the second and third resection guide supporting members <NUM> and <NUM> can be disposed at the central portion <NUM> of the resection guide body <NUM>. Each of the second and third resection guide supporting members <NUM> and <NUM> defines a corresponding resection guide opening <NUM> and <NUM>. The second and third resection guide supporting members <NUM> and <NUM> are oriented relative to each other so that their respective resection guide openings <NUM> and <NUM> intersect each other. The second and third resection guide supporting members <NUM> and <NUM> can also intersect each other.

With continuing reference to <FIG>, the second resection guide supporting member <NUM> can include a second left side wall <NUM>, a second right side wall <NUM> opposite to the second left side wall <NUM>, a second front wall <NUM>, and a second rear wall <NUM> opposite to the second front wall <NUM>. The second front wall <NUM> can interconnect the second left side wall <NUM> and the second right side wall <NUM>. The second rear wall <NUM> can interconnect the second left side wall <NUM> and the second right side wall <NUM>. The second left side wall <NUM> can interconnect the second front wall <NUM> and the second rear wall <NUM>. The second right side wall <NUM> can interconnect the first front wall <NUM> and the second rear wall <NUM>. Furthermore, at least a portion of the second left side wall <NUM> can be directly or indirectly connected to the first connecting member <NUM>. At least a portion of the second right side wall <NUM> can be directly or indirectly connected to the second connecting member <NUM>. The second left wall <NUM>, second right side wall <NUM>, second front wall <NUM>, and second rear wall <NUM> can cooperate so as to define a second upper surface <NUM>. Moreover, the second left wall <NUM>, second right side wall <NUM>, second front wall <NUM>, and second rear wall <NUM> can cooperate so as to define a second lower surface <NUM>.

Continuing with <FIG>, the second left wall <NUM>, second right side wall <NUM>, second front wall <NUM>, and second rear wall <NUM> can cooperate so as to define a substantially enclosed second inner surface <NUM>. Alternatively, the second inner surface <NUM> is not a substantially or completely enclosed. The second inner surface <NUM> of the second resection guide supporting member <NUM> can define the second resection guide opening <NUM> that is configured and sized to receive at least a portion of the guide member <NUM> or any other suitable guide member as discussed in detail below. The second resection guide opening <NUM> can extend through the second upper surface <NUM> and the second lower surface <NUM> along the transverse direction <NUM>. In the depicted embodiment, the resection guide opening <NUM> can have a substantially rectangular cross-section, and can be elongate, for example, along a first angled direction <NUM> that defines an oblique angle relative to the longitudinal direction <NUM>. The first angled direction <NUM> can also define an oblique angle relative to the lateral direction <NUM>. The second resection guide opening <NUM> can be elongate, for example, along a direction from the second front wall <NUM> toward the first rear wall <NUM>.

Continuing with <FIG>, the third resection guide supporting member <NUM> can include a third left side wall <NUM>, a third right side wall <NUM> opposite to the third left side wall <NUM>, a third front wall <NUM>, and a third rear wall <NUM> opposite to the third front wall <NUM>. The third front wall <NUM> can interconnect the third left side wall <NUM> and the third right side wall <NUM>. The third rear wall <NUM> can interconnect the third left side wall <NUM> and the third right side wall <NUM>. The third left side wall <NUM> can interconnect the third front wall <NUM> and the third rear wall <NUM>. The third right side wall <NUM> can interconnect the third front wall <NUM> and the third rear wall <NUM>. Furthermore, at least a portion of the third left side wall <NUM> can be directly or indirectly connected to the second connecting member <NUM>. At least a portion of the third right side wall <NUM> can be directly or indirectly connected to the third connecting member <NUM>. The third left wall <NUM>, third right side wall <NUM>, third front wall <NUM>, and third rear wall <NUM> can cooperate so as to define a third upper surface <NUM>. Moreover, the third left wall <NUM>, third right side wall <NUM>, third front wall <NUM>, and third rear wall <NUM> can cooperate so as to define a third lower surface <NUM>.

Continuing with <FIG>, the third left wall <NUM>, third right side wall <NUM>, third front wall <NUM>, and third rear wall <NUM> can cooperate so as to define a substantially enclosed third inner surface <NUM>. Alternatively, the third inner surface <NUM> is not a substantially enclosed. The third inner surface <NUM> can define the third resection guide opening <NUM> that is configured and sized to receive at least a portion of the guide member <NUM> or any other suitable guide member as discussed in detail below. The third resection guide opening <NUM> can extend through the third upper surface <NUM> and the third lower surface <NUM> along the transverse direction <NUM>. In the depicted embodiment, the third resection guide opening <NUM> can have a substantially rectangular cross-section, and can be elongate, for example, along a second angled direction <NUM> that defines an oblique angle relative to the longitudinal direction <NUM>. The second angled direction <NUM> can also define an oblique angle relative to the longitudinal lateral direction <NUM>. The third resection guide opening <NUM> can be elongate, for example, along a direction from the third front wall <NUM> toward the first rear wall <NUM>.

Referring to <FIG>, the fourth resection guide supporting member <NUM> can be substantially similar to the first resection guide supporting member <NUM>. The fourth resection guide supporting member <NUM> can include a fourth left side wall <NUM>, a fourth right side wall <NUM> opposite to the fourth left side wall <NUM>, a fourth front wall <NUM>, and a fourth rear wall <NUM> opposite to the fourth front wall <NUM>. The fourth front wall <NUM> can interconnect the fourth left side wall <NUM> and the fourth right side wall <NUM>. The fourth rear wall <NUM> can interconnect the fourth left side wall <NUM> and the fourth right side wall <NUM>. The fourth left side wall <NUM> can interconnect the fourth front wall <NUM> and the fourth rear wall <NUM>. The fourth right side wall <NUM> can interconnect the fourth front wall <NUM> and the fourth rear wall <NUM>. Furthermore, at least a portion of the fourth left side wall <NUM> can be directly or indirectly connected to the third connecting member <NUM>. The fourth left wall <NUM>, fourth right side wall <NUM>, fourth front wall <NUM>, and fourth rear wall <NUM> can cooperate so as to define a fourth upper surface <NUM>. Moreover, the fourth left wall <NUM>, fourth right side wall <NUM>, fourth front wall <NUM>, and fourth rear wall <NUM> can cooperate so as to define a fourth lower surface <NUM>.

With continuing reference to <FIG>, the fourth left wall <NUM>, fourth right side wall <NUM>, fourth front wall <NUM>, and fourth rear wall <NUM> can cooperate so as to define a substantially or completely enclosed fourth inner surface <NUM>. Alternatively, the fourth inner surface <NUM> is not a substantially or completely enclosed. The fourth inner surface <NUM> can define a fourth resection guide opening <NUM> that is configured and sized to receive at least a portion of the guide member <NUM> or any other suitable guide member as discussed in detail below. The fourth resection guide opening <NUM> can extend through the first upper surface <NUM> and the first lower surface <NUM> along the transverse direction <NUM>. In the depicted embodiment, the resection guide opening <NUM> can have a substantially rectangular cross-section, and can be elongate, for example, along the lateral direction <NUM> that is perpendicular to the longitudinal direction <NUM>. The resection guide opening <NUM> can be elongate, for example, along a direction from the first front wall <NUM> toward the first rear wall <NUM>.

With reference to <FIG>, the first lower surface <NUM> can include a first connecting portion <NUM> contoured and configured to receive a portion of the tissue body <NUM> so as to allow the resection guide body <NUM> to be positioned on a portion of the tissue body <NUM>. The first connecting portion <NUM> can have a substantially concave shape. The second lower surface <NUM> can include a second connecting portion <NUM> contoured and configured to receive a portion of the tissue body <NUM> so as to allow the resection guide body <NUM> to be positioned on at least a portion of the tissue body <NUM>. The second connecting portion <NUM> can have a substantially concave shape. The third lower surface <NUM> can include a third connecting portion <NUM> contoured and configured to receive a portion of the tissue body <NUM> so as to allow the resection guide body <NUM> to be positioned on at least a portion of the tissue body <NUM>. The third connecting portion <NUM> can have a substantially concave shape. The fourth lower surface <NUM> can include a fourth connecting portion <NUM> contoured and configured to receive a portion of the tissue body so as to allow the resection guide body <NUM> to be positioned on a portion of the tissue body. The fourth connecting portion <NUM> can have a substantially concave shape.

Referring to <FIG> and <FIG>, the guide member <NUM> is configured to guide the resection tool <NUM> to a desired surgical site in order to make an accurate and precise cut on the tissue body <NUM>. At least a portion of the guide member <NUM> is configured and sized to be removably inserted in each of the resection guide openings <NUM>, <NUM>, <NUM>, and <NUM>. For example, the guide member <NUM> can be configured to be at least partially inserted in at least one of the first resection guide opening <NUM> or the second resection guide opening <NUM>. At least a portion of the guide member <NUM> can be removably disposed in the first resection guide opening <NUM> or the second resection guide opening <NUM>. The guide member <NUM> can be configured to be selectively inserted into each of the first, second, third, and fourth resection guide openings <NUM>, <NUM>, <NUM>, and <NUM> so as to guide the resection tool <NUM> along the graft resection axis <NUM>. Alternatively, the guide member <NUM> is configured and sized to be removably inserted in some but not all of the resection guide openings <NUM>, <NUM>, <NUM>, and <NUM>.

The guide member <NUM> can be wholly or partly made of a second material that is different than the first material discussed above. For example, the guide member <NUM> can be at least partially made of the second material. The second material can be harder than the first material. The second material can be a cut resistant material, such as a metallic material or a ceramic material. As used herein, the term cut resistant material refers to a material that minimizes the wear of the guide member <NUM> caused by the friction exerted by the resection tool (e.g., a resection tool capable of resecting tissue, such as bone) on the guide member <NUM> when the resection tool <NUM> contacts the guide member <NUM>. It is important to employ a cut resistant material because the wear of the guide member <NUM> may reduce the accuracy of the resection guide <NUM> and produce wear debris. Wear debris stemming from the resection guide <NUM> could be detrimental to the long-term efficacy of the bone graft. The second material can be different from the first material, which at least partly forms the resection guide supporting members <NUM>, <NUM>, <NUM>, <NUM>. The hardness of the second material can be greater than the hardness of the first material. For instance, the first material has a first hardness, the second material has a second hardness, and the second hardness is greater than the first hardness. The first material does not necessarily have to be a cut resistant material to minimize costs and streamline the manufacturing process as discussed above. In some embodiments, the second material can have a Brinell hardness that ranges between about <NUM> HB and about <NUM> HB. For example, the second material can have a Brinell hardness of about <NUM> HB. The hardness ranges and values described above are important because a guide member <NUM> wholly or partly made of a material with these hardness values minimizes the wear of the guide member <NUM> during use, thereby extending the life of the resection guide <NUM>. The second material can be at least partially made from a laser-sintered metallic material. The second material can be made using a direct metal laser sintering process. As discussed above, the resection guide body <NUM> can be wholly or partly made of a first material that has a Brinell hardness that ranges between about <NUM> HBS <NUM>/<NUM> and about <NUM> HBS <NUM>/<NUM>.

With reference to <FIG> and <FIG>, the guide member <NUM> includes a guide member body <NUM>. The guide member body <NUM> can be a monolithic (i.e., one-piece) structure or a structure composed of multiple connected parts. In the depicted embodiment, the guide member body <NUM> can include a guiding left wall <NUM>, a guiding right wall <NUM> opposite the guiding left wall <NUM>, a guiding front wall <NUM>, and a guiding rear wall <NUM> opposite to the guiding front wall <NUM>. In other words, the guide member body <NUM> can define the front wall <NUM>, the rear wall <NUM> opposite the front wall <NUM>, and a pair of side walls <NUM> and <NUM> that extend between the front and rear walls <NUM> and <NUM>. The front wall <NUM>, the rear wall <NUM>, and the side walls <NUM> and <NUM> define the guide member opening <NUM>. The guiding front wall <NUM> can be spaced apart from the guiding rear wall <NUM> along a transverse direction <NUM>. The guiding left wall <NUM> can be spaced apart from the guiding right wall <NUM> along a longitudinal direction <NUM>. The guiding left wall <NUM> can interconnect the guiding front wall <NUM> and the guiding rear wall <NUM>. The guiding right wall <NUM> can interconnect the guiding front wall <NUM> and the guiding rear wall <NUM>. The guiding front wall <NUM> can interconnect the guiding left wall <NUM> and the guiding right wall <NUM>. The guiding rear wall <NUM> can interconnect the guiding left wall <NUM> and the guiding right wall <NUM>.

With reference to <FIG> and <FIG>, the guiding left wall <NUM>, guiding right wall <NUM>, guiding front wall <NUM>, and guiding rear wall <NUM> can cooperate so as to define a guiding upper surface <NUM>. Furthermore, the guiding left wall <NUM>, guiding right wall <NUM>, guiding front wall <NUM>, and guiding rear wall <NUM> can cooperate so as to define a guiding lower surface <NUM>. Moreover, the guiding left wall <NUM>, guiding right wall <NUM>, guiding front wall <NUM>, and guiding rear wall <NUM> can cooperate so to define a guiding inner surface <NUM>. The guiding inner surface <NUM> can define a guide member opening <NUM> that can extend through the guiding upper surface <NUM> and the guiding lower surface <NUM> along the lateral direction <NUM>. Thus, the guide member <NUM> can define the guide member opening <NUM> that extends through the guide member body <NUM>. The guide member opening can be elongate along a graft resection axis <NUM>. The guide member opening <NUM> is configured and sized to receive at least a portion of the resection tool <NUM> such that the guide member <NUM> guides a movement of the resection tool <NUM> along the graft resection axis <NUM> when the resection tool <NUM> is received in the guide member opening <NUM>. The side walls <NUM> and <NUM> can be elongate along the graft resection axis <NUM>.

With reference to <FIG> and <FIG>, the guide member <NUM> further includes at least one tab <NUM> or <NUM> that protrudes from the guide member body <NUM>. Each of the tabs <NUM> and <NUM> is configured to help retain the guide member <NUM> in the corresponding resection guide supporting members <NUM>, <NUM>, <NUM>, and <NUM> as discussed in detail below. The guide member <NUM> includes a first tab <NUM> that can be directly or indirectly connected to the guiding front wall <NUM>, and a second tab <NUM> that can be directly or indirectly connected to the guiding rear wall <NUM>. The first tab <NUM> can be at least partially disposed on top of the guiding front wall <NUM>. The second tab <NUM> can be at least partially disposed on top of the guiding rear wall <NUM>. The first tab <NUM> is cantilevered from guiding front wall <NUM>, and the second tab <NUM> is cantilevered from the guiding rear wall <NUM>. Thus, at least one of the tab <NUM> or the tab <NUM> can be cantilevered from the guide member body <NUM>.

When the guide member body <NUM> is inserted in the resection guide opening <NUM>, <NUM>, <NUM>, or <NUM>, the first tab <NUM> and second tab <NUM> are each configured to abut a portion of the upper surface of the corresponding resection guide supporting member <NUM>, <NUM>, <NUM>, or <NUM> to thereby retain the guide member <NUM> in the resection guide body <NUM>. For example, the guide member body <NUM> can be removably inserted in the resection guide opening <NUM> of the resection guide supporting member <NUM>. When the guide member body <NUM> is disposed in the resection guide opening <NUM>, the first and second tabs <NUM> and <NUM> abut the upper surface <NUM> of the resection guide body <NUM> to thereby retain the guide member <NUM> in the resection guide supporting member <NUM>. At least one of the tab <NUM> or the tab <NUM> can be configured to abut at least a portion of the upper body surface <NUM> when the guide member body <NUM> is fully seated into the first resection guide opening <NUM> or the second resection guide opening <NUM>. The guide member <NUM> can include the second tab <NUM> that is cantilevered from the guide member body <NUM>. The second tab <NUM> can be configured to abut at least a portion of the upper body surface <NUM> when the guide member body <NUM> is fully seated in the first resection guide opening <NUM> or the second resection guide opening <NUM>. The first tab <NUM> can protrude from the front wall <NUM>, and the second tab <NUM> can protrude from the rear wall <NUM>.

With reference to <FIG>, a guide member <NUM> is configured to be simultaneously disposed in the resection guide supporting members <NUM> and <NUM>. The guide member <NUM> is substantially similar to the guide member <NUM>, except that the guide member <NUM> includes two guide member bodies instead of one guide member body. The guide member <NUM> includes a first guide member body <NUM> and a second guide member body <NUM> that intersect each other. The first and second guide member bodies <NUM> and <NUM> are oriented such that they are configured to be disposed simultaneously in the resection guide openings <NUM> and <NUM>. For example, the first guide member body <NUM> can be disposed to be removably inserted in the resection guide opening <NUM>, while the second guide member body <NUM> can be configured to be removably disposed in the resection guide opening <NUM>. Each of the guide member bodies <NUM> and <NUM> can define a respective guide member opening <NUM> and <NUM> that is configured and sized to receive at least a portion of the resection tool <NUM> to thereby guide the movement of the resection tool <NUM> toward the tissue body <NUM>. The guide member openings <NUM> and <NUM> can intersect each other. The guide member <NUM> can further include at least one tab <NUM> that protrudes from the respective guide member bodies <NUM> and <NUM>. The guide member body <NUM> can include a first tab <NUM> and a second tab <NUM>. Similarly, the guide member body <NUM> can include a first tab <NUM> and a second tab <NUM>. The guide member <NUM> can be wholly or partly made of the second material discussed above. The second material can be a cut resistant material, such as a metallic material or a ceramic material.

In operation, the user positions the resection guide supporting members <NUM>, <NUM>, <NUM>, and <NUM> in the desired location adjacent to the tissue body <NUM> (<FIG>). Then, the guide member <NUM> is inserted in a resection guide opening <NUM>, <NUM>, <NUM> or <NUM> to couple the guide member <NUM> to the corresponding the resection guide supporting member <NUM>, <NUM>, <NUM>, or <NUM>. Next, at least a portion of the resection tool <NUM> is inserted through the guide member opening <NUM>. The resection tool <NUM> is advance toward the tissue body <NUM> to make a precise cut of the tissue body <NUM>. The guide member <NUM> can then be removed from the resection guide body and inserted in another resection guide body. In addition, the user can place guide member <NUM> in the resection guide openings <NUM> and <NUM>. The resection tool <NUM> can then be inserted and advanced through the guide member opening <NUM> to make a first cut on the tissue body <NUM>. Moreover, the resection tool <NUM> can also be inserted in the guide member opening <NUM> to make another cut on the tissue body <NUM>.

With reference to <FIG>, the resection guide <NUM> can include guide members <NUM> formed by a plurality of discrete guiding components <NUM>, such as discrete guiding inserts. As used herein, the term "discrete components" refers, for example, to unconnected elements. Like in other embodiments, the discrete guiding components <NUM> can be entirely or partly made from a cut resistant material (e.g., the second material discussed above). The discrete guiding components <NUM> can be made from the second material. The discrete guiding components <NUM> can be attached to the first inner surface <NUM>, second inner surface <NUM>, third inner surface <NUM>, and fourth inner surface <NUM>. For instance, when the discrete guiding components <NUM> are attached to the first inner surface <NUM>, second inner surface <NUM>, third inner surface <NUM>, and fourth inner surface <NUM>, the discrete guiding components <NUM> can cooperate to define a guide member opening <NUM> that is configured and sized to receive at least a portion of the resection tool <NUM> to thereby guide the movement of the resection tool <NUM> toward the tissue body <NUM>. The resection guide body <NUM> can includes the first and second inner surfaces <NUM>, <NUM> that at least partially define the first and second resection guide openings <NUM>, <NUM>, respectively, and guide member <NUM> is segmented so as to define a plurality of discrete guiding components <NUM> that are configured to be mounted to at least one of the first or second inner surfaces <NUM>, <NUM>.

With continuing reference to <FIG>, the discrete guiding component <NUM> can be attached to the resection guide supporting members <NUM>, <NUM>, <NUM>, <NUM> along the respective first inner surface <NUM>, second inner surface <NUM>, third inner surface <NUM>, and fourth inner surface <NUM>. In the depicted embodiment, the discrete guiding components <NUM> can include at least one guiding wall <NUM>. The guiding wall <NUM> can have a substantially planar configuration.

With continuing reference to <FIG>, any of the discrete guiding components <NUM> described above can be attached to the first inner surface <NUM>, second inner surface <NUM>, third inner surface <NUM>, or fourth inner surface <NUM> by any suitable apparatus, connection, or mechanism. For example, a press-fit connection <NUM> can be used to attach a discrete component <NUM> to the first inner surface <NUM> (or any other inner surface) of the resection guide supporting member <NUM> (or any other resection guide body). In the interest of brevity, the present disclosure describes the connection between the discrete guide member <NUM> and the first resection guide supporting member <NUM>; however, the discrete guide member <NUM> can be connected to any of the resection guide supporting members as described below. The press-fit connection <NUM> includes a first engagement member <NUM> and a second engagement member <NUM>. The discrete guiding components <NUM> and the respective first or second inner surface <NUM> or <NUM> defines complementary engagement members <NUM> and <NUM> that are configured to mate so as to attach the discrete guiding components <NUM> to the respective inner surface <NUM> and <NUM>. The first engagement member <NUM> can be part of the discrete guiding component <NUM>, and the second engagement member <NUM> can be part of the resection guide supporting member <NUM> (or any other resection guide body of the resection guide body <NUM>). The first engagement member <NUM> is configured to engage the second engagement member <NUM> so as to connect the discrete guide member <NUM> to the resection guide supporting member <NUM>. The second engagement member <NUM> can include a groove <NUM> that extends into the inner surface <NUM> and is configured to receive at least a portion of the engagement member <NUM>. Thus, the inner surface <NUM> (or <NUM> or any other inner surface of the resection guide body <NUM>) can define the groove <NUM> that is configured to receive the tongue <NUM>. The tongue <NUM> can be tapered so as to so as to be press-fit within the respective groove <NUM>.

With continuing reference to <FIG>, as discussed above, each discrete guiding component <NUM> includes at least one guiding wall <NUM>. The guiding wall <NUM> can define an outer surface <NUM>, an inner surface <NUM> opposite to the outer surface <NUM>, an upper surface <NUM>, a bottom surface <NUM> opposite the upper surface <NUM>, a first sidewall <NUM>, and a second sidewall <NUM> opposite the first sidewall <NUM>. The outer surface <NUM> is spaced from the inner surface <NUM> along a lateral direction <NUM>. The upper surface <NUM> is spaced from the bottom surface <NUM> along a transverse direction <NUM> that is substantially perpendicular to the lateral direction <NUM>. The first side wall <NUM> is spaced from the second sidewall <NUM> along a longitudinal direction <NUM> that is substantially perpendicular to the lateral direction <NUM>. The longitudinal direction <NUM> can also be substantially perpendicular to the transverse direction <NUM>.

With continuing reference to <FIG>, the first engagement member <NUM> can be a protrusion <NUM> that protrudes from the guiding wall <NUM>. The first engagement member <NUM> can protrude from the guiding wall <NUM> in a direction away from the inner surface <NUM> along the lateral direction <NUM>. The first engagement member <NUM> is coupled to the inner surface <NUM>, and can be elongate in a direction from the upper surface <NUM> toward the bottom surface <NUM>. The first engagement member <NUM> can be elongate along the transverse direction <NUM>. The first engagement member <NUM> can be monolithically formed with the guiding wall <NUM>, and can be shaped as a column. Furthermore, the first engagement member <NUM> of each of the discrete guiding components <NUM> can include a tongue <NUM> that defines a first sidewall <NUM> and a second sidewall <NUM> opposite to the first sidewall <NUM>. The first sidewall <NUM> is spaced from the second sidewall <NUM> along the longitudinal direction <NUM>. The tongue <NUM> includes an upper portion <NUM> and a lower portion <NUM>. The upper portion <NUM> is located closer to the upper surface <NUM> than the lower portion <NUM>. The lower portion <NUM> is located closer to the bottom surface <NUM> than the upper portion <NUM>. The tongue <NUM> has a width defined from the first sidewall <NUM> to the second sidewall <NUM>. The lower portion <NUM> can have a tapered configuration such that the width of the tongue <NUM> decreases in a direction from upper surface <NUM> toward the bottom surface <NUM>. (i.e., downwardly). The tapered configuration of the lower portion <NUM> facilitates insertion of the first engagement member <NUM> into the groove <NUM>.

With continuing reference to <FIG>, the first engagement member <NUM> further includes one or more projections <NUM>, such as barbs, that protrude from the tongue <NUM>. A plurality of projections <NUM> are disposed along the first and second sidewalls <NUM> and <NUM> at the upper portion <NUM>. Alternatively, the surfaces defining the groove <NUM> can include protrusions that are configured to be received inside recesses defined by the first engagement member <NUM>.

As discussed above, the second engagement member <NUM> can be the groove <NUM> that is configured and sized to receive the guiding connection member <NUM>. The groove <NUM> can extends into the first inner surface <NUM> and is configured to receive at least a portion of the first engagement member <NUM>. The mounting channel <NUM> can be defined by a first sidewall <NUM>, a second sidewall <NUM> opposite to the first sidewall <NUM>, and an end wall <NUM>. The first sidewall <NUM> can be spaced from the second sidewall <NUM> along the longitudinal direction <NUM>. In addition, the mounting channel <NUM> can define an open end <NUM> to facilitate insertion of the first engagement member <NUM> in the mounting channel <NUM>. The open end <NUM> is located along the upper surface <NUM> of the resection guide supporting member <NUM> (or other upper surface of another resection guide body). The mounting channel <NUM> can define another open end along first lower surface <NUM> (or other lower surface of another resection guide body). Moreover, the mounting channel <NUM> can be elongate in a direction from the upper surface <NUM> toward the lower surface <NUM> (i.e., along the transverse direction <NUM>). The width of first engagement member <NUM> at the upper portion <NUM> is sufficiently large so that the projections <NUM> contact at least one of the first sidewall <NUM> or the second sidewall <NUM> when the upper portion <NUM> is at least partially disposed in the mounting channel <NUM> to thereby secure the first engagement member <NUM> to the second engagement member <NUM>. The secure connection between the first engagement member <NUM> and the second engagement member <NUM> in turn causes the discrete guiding component <NUM> to be connected to the resection guide supporting member <NUM>.

With continuing reference to <FIG>, the discrete guiding component <NUM> can be coupled to the resection guide supporting member <NUM> (or any other resection guide supporting member) by inserting the first engagement member <NUM> into the groove <NUM>. The lower portion <NUM> can be inserted first, and then the first engagement member <NUM> can be advanced further into the groove <NUM> until at least one projection <NUM> contacts the first sidewall <NUM> or second sidewall <NUM> that define the mounting channel <NUM>. The friction created between the projections <NUM> and at least one of the first sidewall <NUM> or second sidewall <NUM> when at least a section of the upper portion <NUM> is disposed in the mounting channel <NUM> causes the discrete guiding component <NUM> to be secured to the resection guide supporting member <NUM> (or any other resection guide supporting member).

With reference to <FIG>, a resection guide <NUM> is substantially similar to the resection guide <NUM> shown in <FIG>. However, in this embodiment, the resection guide support <NUM> is wholly or partly made of a laser sintered polymer material, and the guide members 60a and 70a are entirely or partly made of a laser sintered metallic material. The resection guide support <NUM> can be manufactured using a direct metal laser sintering (DMLS) process, whereas the guide members 60a and 70a can be manufactured using stereolithography (commonly referred to as SLA). The DMLS and SLA processes allow 3D CAD drawings to be turned into physical objects, thereby facilitating and streamlining the manufacturing process. The guide members 60a are substantially similar to the guide member <NUM> shown in Figure <NUM>. However, the guide member 60a does not necessarily include supporting members and are not necessarily configured to be removed from the resection guide supporting members <NUM> and <NUM>. For example, the guide members 60a can be press fitted into the resection guide supporting members <NUM> and <NUM>. The guide member 70a is substantially similar to the guide member <NUM> shown in <FIG>. However, the guide member 70a does not necessarily include supporting members and are not necessarily configured to be removed from the resection guide bodies <NUM> and <NUM>. For instance, the guide member 70a can be press fitted into the resection guide bodies <NUM> and <NUM>. As with the other guide members described above, the guide members 60a and 70a are wholly or partly made from a cut resistant material, such as a metallic material.

With reference to <FIG>, a resection guide <NUM> is substantially similar to the resection guide <NUM> shown in <FIG>, but does not necessarily include guide members. The resection guide <NUM> is entirely or partly made of a cut resistant material, such as a metallic material. For instance, the entire resection guide <NUM> can be manufactured from a metallic material using a direct metal laser sintering (DMLS) process. As discussed above, in the DMLS process, <NUM>-D CAD drawings can be turned into physical objects.

With continuing reference to <FIG>, the resection guide <NUM> can include metallic resection guide body <NUM>. The resection guide body <NUM> can define an upper body surface <NUM> and a lower body surface <NUM> opposite the upper body surface <NUM>. The lower body surface <NUM> can be configured to face the graft source <NUM>. The resection guide body <NUM> can define a first and second resection guide openings <NUM> and <NUM> that are spaced from each other and extend from the lower body surface <NUM> through the upper body surface <NUM>. The first and second resection guide openings <NUM> and <NUM> can define respective first and second graft resection axes <NUM> and <NUM> that are configured to receive a portion of the resection tool <NUM> and guide the resection tool <NUM> along the respective first and second resection guide openings <NUM> and <NUM> so as to resect a graft portion from the graft source <NUM>. The resection guide body <NUM> can define a third and fourth resection guide openings <NUM> and <NUM> that are spaced from each other and extend from the lower body surface <NUM> through the upper body surface <NUM>. The third and fourth resection guide openings <NUM> and <NUM> can define respective third and fourth graft resection axes <NUM> and <NUM> that are configured to receive a portion of the resection tool <NUM> and guide the resection tool <NUM> along the respective first and second resection guide openings <NUM> and <NUM> so as to resect a graft portion from the graft source <NUM>. The resection guide body <NUM> can define first and second inner surfaces <NUM> and <NUM> that at least partially define the first and second resection guide openings <NUM> and <NUM>. The first and second inner surfaces <NUM> and <NUM> are configured to contact the resection tool <NUM> as the resection tool <NUM> is guided along the respective first and second graft resection axes <NUM> and <NUM>. The resection guide body <NUM> can define third and fourth inner surfaces <NUM> and <NUM> that at least partially define the first and second resection guide openings <NUM> and <NUM>. The third and fourth inner surfaces <NUM> and <NUM> are configured to contact the resection tool <NUM> as the resection tool <NUM> is guided along the respective first and second graft resection axes <NUM> and <NUM>. The openings <NUM>, <NUM>, <NUM>, and <NUM> can be devoid of inserts that are discrete with the resection guide body <NUM>. The metallic resection guide body <NUM> can be laser-sintered. The first and second axis <NUM> and <NUM> can be angularly offset with respect to each other. The third and fourth exes <NUM> and <NUM> can be angularly offset with respect to each other. The resection guide body <NUM> can be made from a metallic material that has a Brinell hardness ranging between about <NUM> HBS and about <NUM> HBS. For example, the resection guide body <NUM> can be made from a metallic material that has a Brinell hardness of about <NUM> HB.

Referring to <FIG>, the resection guide <NUM> includes a resection guide body <NUM> that defines one or more resection guides and/or resection support members as described above. In accordance with the alternative embodiment, the resection guide <NUM> can include and one or more drilling guide members <NUM>. The resection guide <NUM> can be a patient specific resection guide, designed and manufactured as described above in other embodiments of the present disclosure. The resection guide <NUM> is configured to be placed on the graft source <NUM> such that the resection guide members are in alignment with resection axes (<FIG>), while the drilling guide members <NUM> align with desired anchor locations on the graft source <NUM>. Anchor locations are locations on the graft source <NUM> that are suitable for securing a bone fixation plate thereto when graft <NUM> is positioned on the tissue body <NUM>. As discussed above, the resection guide <NUM> is patient specific; the resection guide members guide a cutting tool <NUM> to the graft source <NUM> so as to cut patient specific graft portions <NUM> and <NUM>, and the drilling guide members <NUM> guide a drill bit <NUM> to the graft source <NUM> to form patient specific graft bores <NUM> at the desired anchor locations. The graft bores <NUM> are formed in the graft source <NUM> during resection so that when the graft <NUM> is positioned in the cavity <NUM>, and the fixation plate <NUM> is placed against the graft <NUM> and tissue body <NUM>, one or more of graft bores <NUM> are aligned with a corresponding number of holes in the fixation plate <NUM>. An anchor <NUM> can be interested through the hole in the bone fixation plate <NUM> into the aligned graft bore <NUM>. It should be appreciated that the graft bores <NUM> can be formed at any location the graft source <NUM> depending on the configuration of the resection guide and drill guide members <NUM>, as further described below.

Referring to <FIG> and <FIG>, in accordance with an alternative embodiment, the resection guide body <NUM> extends between a first end <NUM> and a second end <NUM> spaced from the first end <NUM> along the longitudinal direction <NUM>. The resection guide body <NUM> defines an upper body surface <NUM> and a lower body surface <NUM> that is opposite to and spaced from the upper body surface <NUM> along the transverse direction <NUM>. The lower body surface <NUM> is configured to be placed against the graft source <NUM>. The resection guide <NUM> defines a longitudinal central axis <NUM> that is aligned with and extends along the longitudinal direction <NUM>, a lateral axis <NUM> that is perpendicular to the central axis <NUM>, and a transverse axis <NUM> that is perpendicular to the lateral axis <NUM> and the central axis <NUM>. The lateral and transverse axes <NUM> and <NUM> may considered first and second radial axes <NUM> and <NUM>, for instance, when the resection guide body <NUM> has curved profile as illustrated in <FIG> and <FIG>. The central axis <NUM>, lateral axis <NUM>, and transverse axis <NUM> intersect at a point <NUM>.

It should be appreciated that the resection guide axes <NUM>, <NUM> and <NUM> correspond to and are aligned with graft source axes <NUM>, <NUM>, and <NUM>. For instance, the graft source <NUM> can define a central axis <NUM> extending along a length of the graft source <NUM>, a lateral axis <NUM> that is perpendicular to the central axis <NUM>, and a transverse axis <NUM> that is perpendicular to the lateral axis <NUM> and the central axis <NUM>. The graft source lateral axis <NUM> and graft source transverse axis <NUM> can be defined as perpendicular first and second radial axes <NUM> and <NUM>.

Further, the resection guide body <NUM> includes a first resection guide supporting member <NUM>, a second resection guide supporting member <NUM>, a third resection guide supporting member <NUM>, and a fourth resection guide supporting member <NUM> configured similar to the resection guide <NUM> described above. The resection guide body <NUM> also includes a plurality of connection members <NUM>, <NUM>, <NUM> each of which couple respective adjacent resection guide supporting members <NUM>, <NUM>, <NUM>, and <NUM> together. A resection guide member, such as resection guide members <NUM> and/or <NUM>, can be disposed in the opening of the resection guide support member <NUM>, <NUM>, <NUM>, and <NUM>. The resection guide body <NUM> can further define one or more holes <NUM> that are configured to receive therethrough a fastener, such as a bone screw, used to couple the guide body <NUM> to the graft source <NUM> during resection of graft portions <NUM> and <NUM> and formation of the graft bores <NUM>. Further, the resection guide body <NUM> can be a monolithic metallic material or polymeric material, similar to the embodiment shown in <FIG>, such that the resection guide support members are monolithic with the resection guide body <NUM> and define the resection guide members <NUM>.

In accordance with the alternative embodiment, the resection guide body <NUM> defines a flange <NUM> disposed at the second end <NUM> of the resection guide body <NUM>. The flange <NUM> is configured to guide a cutting tool toward the graft source <NUM>. The resection guide body <NUM> illustrated in <FIG> include a fourth connection member <NUM> the couples resection guide support member <NUM> to the flange <NUM> such that the flange <NUM> is spaced from the resection guide support member <NUM> along the longitudinal direction <NUM>. The flange <NUM> protrudes from the body surface <NUM> along the transverse direction <NUM> and the lateral direction <NUM>. The flange <NUM> includes a first surface <NUM> and a second surface <NUM> spaced from the first surface <NUM>. The first surface <NUM> defines a guide surface, which is configured to guide a cutting tool toward the graft source <NUM>. It should be appreciated that the flange <NUM> can be oriented relative resection guide body <NUM> such that guide surface <NUM> can guide a resection tool <NUM> along a desired resection axis, such as first resection <NUM> (<FIG>). For instance, the flange <NUM> can be oriented on the resection guide body <NUM> such that the guide surface <NUM> is angularly offset relative to the lateral axis <NUM> (<FIG>) so as to define a flange angle π between the surface <NUM> and central axis <NUM>. The flange angle π can be oblique, for instance acute or obtuse, depending on the desired graft <NUM> configuration. For instance, the flange <NUM> can be oriented on the resection guide body <NUM> such that the guide surface <NUM> is perpendicular to the central axis <NUM>.

The resection guide <NUM> can also include a support member <NUM> extending from the resection guide body <NUM> and configured to support the resection guide <NUM> on the patient. The support member <NUM> includes a support plate <NUM> and a beam <NUM> connecting the plate <NUM> to the resection guide body <NUM>. The plate <NUM> defines a tissue contact surface <NUM> and plate surface <NUM> opposite the tissue contact surface <NUM>. The beam <NUM> defines a first end 928a and a terminal end 925b spaced from the first end 928a. The beam first end 925a is coupled to or integral with the connection member <NUM> on the resection guide body <NUM>, while beam terminal end 925b is coupled to or integral with the plate <NUM>. The beam <NUM> can arch along the transverse direction <NUM> over flange <NUM>. The support member <NUM> can be a monolithic, for instance the beam <NUM> and plate <NUM> are monolithic. The support member <NUM> can be coupled to the support guide body <NUM> or monolithic with support guide body <NUM>. The resection guide <NUM> can include one or more support members <NUM>, for instance a first support member (not shown) and second support member (not shown) disposed at the first end <NUM> of the resection guide body <NUM>. In other embodiments, the support member <NUM> can one include or more multiple beams <NUM> each having a support plates disposed on the terminal ends of the beams. Further, the support member can define one or more beams with a bulb or an enlarged portion disposed a terminal end of the beam.

The drilling guide members <NUM> are configured to receive and guide a tool, such as a drill bit, toward to the graft source <NUM> to form the graft bores <NUM> (<FIG>) in the graft source <NUM>. Referring to <FIG>, the resection guide <NUM> includes at least one drill guide member <NUM> disposed along the resection guide body <NUM>. At least one (a plurality is illustrated) drilling guide member <NUM> is disposed on one or more of the connection members <NUM>, <NUM>, <NUM> and <NUM>. For instance, in the embodiment shown in <FIG>, the first connection member <NUM> includes drilling guide members 900a-900c, the third connection member can include guide members 900d-<NUM>, and fourth connection member <NUM> includes drilling guide members <NUM>-900j. The quantity of drilling guide members <NUM>, as well as the location and angular orientation of the drilling guide members <NUM> on the resection guide body <NUM> can vary depending on the patient anatomy, such as configuration of the desired graft <NUM>, graft source <NUM>, and type and/or size of the intended bone fixation plate.

Referring to <FIG>, the drilling guide member <NUM> protrudes from the upper surface <NUM> of the resection guide body <NUM> along a transverse direction <NUM>. The resection guide body <NUM> defines a drilling guide body <NUM> that extends or protrudes from the upper surface <NUM> of the resection guide body <NUM> to a drilling guide tip <NUM>. The drilling guide body <NUM> defines an outer surface <NUM> and an inner surface <NUM> spaced from the outer surface <NUM>. The inner surface <NUM> defines a throughbore <NUM> that extends through the body <NUM> between the lower surface <NUM> of the resection body <NUM> and the tip <NUM> of the drilling guide body <NUM>. The guide member <NUM> defines guide member axis <NUM> extending through and along the throughbore <NUM>.

The drilling guide member <NUM> also supports or carries a sleeve <NUM>. The sleeve <NUM> can define a sleeve body <NUM> extending between a distal end 904e and proximal end 904p spaced from the distal end 904e along the guide member axis <NUM>. When the sleeve <NUM> is disposed in the guide body <NUM>, the sleeve distal end 904e is positioned proximate or aligned with the resection guide lower surface <NUM> and the proximal end 904p is proximate to or aligned with the guide member tip <NUM>. The sleeve body <NUM> further defines a throughbore <NUM> extending through the sleeve body <NUM> between the distal end 904e and the proximal end 904p. The sleeve body <NUM> has an outer surface <NUM> and inner surface <NUM> spaced from the outer surface <NUM>. The sleeve <NUM> is positioned at least partially in the throughbore <NUM> of guide body <NUM> such that the sleeve outer surface <NUM> is adjacent to the guide body inner surface <NUM>. The sleeve body inner surface <NUM> defines a througbore <NUM>. The throughbore <NUM> is sized to receive a tool therethrough, such as a portion of the drill bit. The guide member body <NUM> and the sleeve <NUM> can be formed of the same or dissimilar materials. The sleeve <NUM> can be formed of materials similar to the resection guide members <NUM> and <NUM> discussed above. When the sleeve <NUM> is formed of a cut-resistant material, for instance a metallic material, drilling accuracy is improved, and tissue contamination during resection/reconstruction procedure from debris can be minimized.

Referring to <FIG>, the drilling guide members <NUM> can be configured, for instance oriented, on the resection guide <NUM> depending on the patient anatomy contemplated bone fixation plates that will used to couple the graft <NUM> to the tissue body <NUM>. For instance, the drilling guide member <NUM> can oriented and /or positioned on the resection guide <NUM> such that the drill bit can form a graft bore <NUM> that is the appropriate size, shape and orientation of the graft source <NUM> so as to receive the bone anchors therein as discussed above. Each graft bore <NUM> can define a graft bore axis <NUM> that extends along the length of the bore <NUM>. Referring to <FIG>, the drilling guide member <NUM> can be configured so that the drilling guide axis <NUM> defines an angle α with respect to the lateral axis <NUM>. The angle α can be about <NUM> degrees as shown in <FIG> or oblique. For instance angle α can be acute as shown in <FIG> or obtuse (not shown).

As shown in <FIG>, the drill guide member <NUM> is configured such that the drilling guide axis <NUM> intersects and is perpendicular to the lateral axis <NUM> and the central axis at a point <NUM>, and is parallel or aligned with transverse axis <NUM>. The drilling guide member <NUM> shown in <FIG> can be used to form a graft bore 420a in the graft source <NUM> that is oriented with drilling guide axis <NUM> as illustrated, for instance parallel or aligned with transverse axis <NUM> of the resection guide body <NUM>. The dimensions of the graft bore, such as the width and depth can be control with the drill bit. In <FIG>, the drilling guide axis <NUM> intersects the lateral axis <NUM>, the transverse axis <NUM>, and the central axis at a point <NUM>, similar to <FIG>. The drilling guide member <NUM> shown in <FIG> can be used to form a graft bore 420c in the graft source <NUM> that is oriented with drilling guide axis <NUM> as illustrated. For instance, the bore 420c is oriented such that the bore axis <NUM> is acute with respect to graft source transverse axis <NUM>.

The drilling guide member <NUM> can be positioned at any location along the upper surface <NUM> of the resection guide body <NUM> such that the guide member body <NUM> is perpendicular to the upper surface <NUM>. Referring to <FIG>, the drilling guide member <NUM> is oriented such the that guide member body <NUM> is inclined with respect to the upper surface <NUM> such that the drilling guide axis <NUM> is acute with the respect the lateral axis <NUM>, and intersects the lateral axis <NUM> at a point <NUM> that is offset from the central axis <NUM> and the transverse axis <NUM>. In <FIG>, drilling guide member <NUM> is configured such that the drilling guide axis <NUM> is acute relative to the lateral axis <NUM> and intersects the lateral axis <NUM> at a point <NUM> that is offset from the central axis <NUM> and lateral axis <NUM>. The drilling guide member <NUM> shown in <FIG> can be used to form a graft bore 420b in the graft source <NUM> that is oriented with drilling guide axis <NUM>. For instance the graft bore 420b is oriented such that bore axis <NUM> is at an acute angle with respect to the graft source lateral axis <NUM>, and is aligned with the surface of the graft source <NUM>.

Turning to <FIG>, the drilling guide member <NUM> can be oriented toward either opposing end <NUM> or <NUM> of the resection guide body <NUM> such that the drilling guide body <NUM> defines an angle θ2 with respect to the upper surface <NUM>. Angle θ2 can be equal to <NUM> degrees as shown in <FIG> or oblique, for instance angle θ2 can be obtuse as shown in <FIG>, or acute (not shown). The drilling guide axis <NUM> can define an angle β with respect to the central axis <NUM>. Angle β can be equal to about <NUM> degrees as shown in <FIG>, acute as shown in <FIG>, or obtuse (not shown). The drilling guide members 900e and 900f shown in <FIG> guides a tool into a graft source <NUM> to form graft bores 420e and 420f that are aligned with the lateral axis <NUM> of the resection guide body <NUM>, and thus the graft source lateral axis <NUM>. The drilling guide member <NUM> shown in <FIG> guides a tool into a graft source <NUM> to form graft bores <NUM> that are oriented toward either opposing end <NUM> or <NUM> of the resection guide body. Such a configuration forms a graft bore <NUM> that is oriented such that bore axis <NUM> is at an acute angle with respect to the central axis of the graft source <NUM>.

It should be appreciated that the drilling guide member <NUM> can be oriented in any direction relative to the resection guide body <NUM> by varying one or more of the angle α, angle β, angle θ1, and angle θ2 angles. For instance, the drilling guide member <NUM> can disposed on the resection guide body <NUM> such that at least one of the of angle α and angle β is acute, a right angle, or obtuse. For instance, angle α and angle β can both be acute, right angles, or obtuse angles. Alternatively, angle α can be acute and angle β can be a right angle or obtuse. The drilling guide member <NUM> can disposed on the resection guide body <NUM> such that one or both angle θ1 and angle θ2 is acute, a right angle, or obtuse. The drilling guide members <NUM> can configured during the design and development of the resection guide <NUM> using the scanning and three-dimensional modeling technologies discussed above.

Referring to <FIG>, resection guide <NUM> is configured to resect tissue from the tissue body <NUM>, the resection guide <NUM> can be configured to be coupled to the tissue body <NUM> at the desired resection site. For example, the resection guide <NUM> can be configured to be coupled to the tissue body <NUM> so as to define a resection axis 102a. The resection guide <NUM> The resection guide <NUM> can be a patient specific resection guide, designed and manufactured as described above, for example similar to the resection guide <NUM> described above. The resection guide <NUM> can include one or more resection guide members, and one or more drilling guide members <NUM> that are configured, or can be configured, similar to the drilling guide members <NUM> shown in <FIG>. The drilling guide members <NUM> guide a tool toward the tissue body <NUM> such the tool, such as drill bit can form tissue body bores <NUM> in the tissue body <NUM> at specific locations that can align the holes in a bone fixation plate used to couple the graft <NUM> to the tissue body <NUM>.

The resection guide <NUM> can define a resection guide body <NUM> extending between a first end <NUM> and a second end <NUM> spaced from the first end along a longitudinal direction <NUM>. The resection guide <NUM> defines a longitudinal central axis <NUM> that is aligned with and extends along the longitudinal direction <NUM>, a lateral axis <NUM> that is perpendicular to the central axis <NUM>, and a transverse axis <NUM> that is perpendicular to the lateral axis <NUM> and the central axis <NUM>. The lateral and transverse axes <NUM> and <NUM> may considered first and second radial axes <NUM> and <NUM>, for instance, when the resection guide body <NUM> has a curved profile.

The resection guide body <NUM> defines a flange <NUM> disposed at the second end <NUM> of the resection guide body <NUM>. The flange <NUM> is configured to guide a cutting tool toward the tissue body <NUM>. The flange <NUM> protrudes from the resection guide body <NUM> along the transverse direction <NUM> and the lateral direction <NUM>. The flange <NUM> includes a first surface <NUM> and a second or guide surface <NUM> spaced from the first surface <NUM> along the longitudinal direction <NUM>. The guide surface <NUM> is configured to guide a cutting tool toward the graft tissue body <NUM>. It should be appreciated that the flange <NUM> can be oriented relative resection guide body <NUM> such that guide surface <NUM> can guide a resection tool <NUM> along a desired resection axis, such as first resection 102a. The flange <NUM> can include coating and/or a plate positioned adjacent the guide surface <NUM>. The plate (not shown) can size an dimensioned to conform to the surface area of the guide surface <NUM>. The plate can be formed of a hardened polymeric material as described above, or a metallic material or alloy. The plate is configured to guide the resection tool, improve cutting accuracy, and minimize debris from being removed from the resection guide body <NUM>. The coating can be any material, such as a composition, polymer or polymeric blend applied to the guide surface <NUM> so as to create a cut-resistant surface. The resection guide <NUM> can be formed with any of the materials and processes described above.

Claim 1:
A resection guide (<NUM>; <NUM>) configured to guide a resection tool (<NUM>) toward a graft source (<NUM>) of a patient, the resection guide comprising:
a resection guide body (<NUM>; <NUM>) that is elongate along a longitudinal direction (<NUM>), the resection guide body (<NUM>; <NUM>) defining:
an upper body surface (<NUM>; <NUM>);
lower body surface (<NUM>; <NUM>) opposite the upper body surface (<NUM>; <NUM>) and configured to face the graft source (<NUM>), the lower body surface (<NUM>; <NUM>) being concave;
a first resection guide opening (<NUM>; <NUM>) and a fourth resection guide opening (<NUM>; <NUM>) that is spaced from the first resection guide opening (<NUM>; <NUM>), the first and fourth resection guide openings (<NUM>, <NUM>; <NUM>, <NUM>) extending through the upper and lower body surfaces (<NUM>, <NUM>; <NUM>, <NUM>); and
a pair of resection guide openings (<NUM>, <NUM>; <NUM>, <NUM>) that are disposed between and spaced from the first and fourth resection guide opening (<NUM>, <NUM>; <NUM>, <NUM>) along the longitudinal direction (<NUM>), that extend from the lower body surface (<NUM>; <NUM>) through the upper body surface (<NUM>; <NUM>), and that intersect one another, wherein each of the resection guide openings (<NUM>, <NUM>, <NUM>; <NUM>, <NUM>, <NUM>, <NUM>) defines a respective graft resection axis (<NUM>, <NUM>, <NUM>, <NUM>; <NUM>, <NUM>, <NUM>, <NUM>) that is configured to receive a portion of the resection tool (<NUM>) and guide the resection tool (<NUM>) along the resection guide opening (<NUM>, <NUM>, <NUM>, <NUM>; <NUM>, <NUM>, <NUM>, <NUM>) so as to resect a graft portion from the graft source (<NUM>) of the patient.