US20090182375A1 - Suture for wound closure, tissue approximation, tissue support, suspension and/or fixation - Google Patents

Abstract

A suture assembly includes an elongated flexible body which may be either a single filament for a multiple strand braided or woven body, supporting a plurality of shaped tissue-engaging elements in a generally spaced arrangement thereon. A curved body having a sharp point is joined to one end of the flexible body while a straight pointed body is joined to the remaining end of the flexible body. In alternate embodiments, the tissue-engaging elements define a variety of cross-section shapes. In a further alternate embodiment, the tissue-engaging elements are divided into first and second oppositely facing sets to provide a bidirectional suture. In a still further alternate embodiment, the elongated flexible body supports an elongated tissue-bonding sleeve.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of co-pending application Ser. No. 11/500,733, filed 7 Aug. 2006, which is herein incorporated by reference; and claims benefit of co-pending application Ser. No. 11/168,173, filed 28 Jun. 2005 and now abandoned U.S. Provisional Application No. 60/584,927, filed 30 Jun. 2004, which are respectively incorporated herein by reference.
FIELD OF THE INVENTION
• This invention relates generally to apparatus for tissue suturing and particularly to apparatus for surgical incision or wound closure as well as tissue approximation in surgical procedures such as cosmetic surgery.
BACKGROUND OF THE INVENTION
• A substantial number of devices have been provided throughout the years which may be used for closure of a wound or surgical incision. Such devices have included staples, sewing and stitching as well as tissue connecting sutures.
• One recently developed type of suture maybe generally described as a “barbed suture”. Such sutures generally comprise elongated thin filaments having pluralities of tissue-engaging barbs and are designed for closure of wounds or surgical incisions. In such use, the main filament applies drawing tension while the pluralities of tissue-engaging barbs increase the “grip” of the suture to the drawn tissue.
• Not surprisingly, the need for ever-improved sutures has prompted practitioners in the art to provide a variety of suture structures which can be generally described as barbed sutures. For example, U.S. Pat. No. 3,123,077 issued to Alcamo sets forth a SURGICAL SUTURE having an elongated flexible filament defining a plurality of outwardly extending barbs or projections formed on its surface.
• U.S. Pat. No. 6,241,747 issued to Ruff sets forth a BARBED BODILY TISSUE CONNECTOR having an elongated filament or body which supports a plurality of closely spaced barbs disposed along the body. The barbs are pointed in a first direction on one portion of the body and in an opposite direction on the remaining portion of the body.
• U.S. Pat. No. 5,425,747 issued to Brotz sets forth a SUTURE formed of a bioabsorbable material having a central body defining a plurality of lateral members extending perpendicularly therefrom in the same general plane with the central body. Each lateral member further defines a plurality of barb members extending at acute angles therefrom. The lateral members are constructed to be inserted laterally into two sides of a tissue cut and to provide a securely retained structure.
• U.S. Pat. No. 5,584,859 issued to Brotz sets forth a SUTURE ASSEMBLY formed of a bioabsorbable material having a central body member and a plurality of elongated members in a plane extending perpendicularly on each side therefrom. The extending lateral members are interconnected to the central body member by connectors and each support a plurality of acutely angled barb members extending from their respective outer surfaces.
• While the foregoing described prior art devices have to some extent improved the art and in some instances enjoyed commercial success, there remains nonetheless a continuing need in the art for evermore improved tissue sutures.
SUMMARY OF THE INVENTION
• Accordingly, the present invention provides an improved apparatus for tissue suturing. More particularly, the present invention provides an improved apparatus for wound closure, tissue approximation, tissue support, suspension and/or fixation. Still more particularly, the present invention provides an improved suture apparatus that is advantageous in cosmetic surgery procedures directed toward recently emerging nonsurgical minimally invasive cosmetic surgery procedures directed toward facial lifting and contouring.
• Thus, the inventive suture structure of the present invention provides an implantable directional camming device that may be fabricated in either a directional or bidirectional structure. The suture apparatus of the present invention may be formed of elements that are injection molded or cold-headed. This apparatus may be used for wound closure, tissue approximation, tissue support, suspension and/or fixation. The molded or cold-headed elements may be formed having any of a number of cross-sections as desired. The suture of the present invention is constructed to be implanted into the human body with or without the use of an introducer. It is also designed to work in conjunction with the post surgical healing process, such as scar tissue formation and fibrosis. The inventive suture apparatus holds wounds closed or fixates tissue without the need for suture knot tying to maintain tissue approximation. The inventive structure being formed of injection molded or cold-headed elements may be formed without the need for conventional machine cutting to provide tissue-gripping structure.
• In certain embodiments of the present invention, the suture may be formed of a braided polyester, nylon or the like. In further embodiments, the suture may further include an elongated porous sleeve to aid in tissue-bonding.
• Thus, in accordance with the present invention, there is provided a suture comprising: an elongated flexible body having first and second ends; a plurality of tissue-engaging elements each defining a bore therethrough, the tissue-engaging elements received upon the elongated flexible body; and a plurality of knots tied in the elongated flexible body each larger than the bore, the knots maintaining the tissue-engaging elements in a serial arrangement on the elongated flexible body; and an elongated porous tissue bonding sleeve supported upon said elongated flexible body.
• In further accordance with the present invention, there is provided a suture assembly comprising: an elongated needle body having a first pointed end and a first connector end; a curved needle body having a second pointed end and a second connector end; an elongated filament having a first end joined to the first connector end, a second end joined to the second connector end, and a plurality of knots formed in the filament; a plurality of tissue-engaging elements each defining a bore therethrough, the tissue-engaging elements being received upon the filament by passing the filament through the bores with each tissue-engaging element being proximate one of the knots; and an elongated porous tissue bonding sleeve supported upon the elongated flexible body.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention, together with further objects and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying drawings, wherein like reference numerals identify like elements, and in which:
• FIG. 1 sets forth a side view of a complete suture assembly constructed in accordance with the present invention;
• FIG. 2 sets forth a side view of the suture portion of the present invention suture assembly;
• FIG. 3 sets forth a section view of an illustrative segment of the tissue-gripping portion of the present invention suture;
• FIG. 4 sets forth a section view of a tissue-gripping element prior to installation in the suture assembly;
• FIG. 5 sets forth a front view of the tissue-gripping element ofFIG. 4;
• FIG. 6 sets forth a side view of the straight needle portion of the present invention suture assembly;
• FIG. 7 sets forth a side view of the curved needle portion of the present invention suture assembly;
• FIG. 8 sets forth a section view of an alternate embodiment tissue-gripping element;
• FIG. 9 sets forth a front view of the tissue-gripping element ofFIG. 8;
• FIG. 10 sets forth a still further alternate embodiment of the present invention which provides a bidirectional suture;
• FIG. 11 sets forth a perspective view of a still further alternate embodiment of the present invention;
• FIGS. 12A and 12B set forth respective front and section views of a tissue-gripping element constructed in accordance with the present invention having a generally conical shape and slot configuration;
• FIGS. 13A and 13B set forth respective front and section views of a tissue-gripping element defining a generally five-sided tapered shape;
• FIGS. 14A and 14B set forth respective front and section views of a tissue-gripping element defining a generally square cross-section;
• FIGS. 15A and 15B set forth respective front and section views of a tissue-gripping element defining a four lobed cross-section;
• FIGS. 16A and 16B set forth respective front and section views of a tissue-gripping element defining a three lobed cross-section;
• FIGS. 17A and 17B set forth respective front and section views of a flat disc-like tissue-gripping element;
• FIG. 18 sets forth a side view of a suture portion constructed in accordance with the present invention and utilizing a plurality of tied knots for tissue-gripping elements;
• FIG. 19 sets forth a side view of a complete suture assembly constructed in accordance with the present invention supporting a porous tissue bonding sleeve;
• FIG. 20 sets forth a side view of a suture portion having tissue-gripping elements which are nonuniformly spaced;
• FIG. 21 sets forth a partial section side view of a suture portion constructed in accordance with the present invention having a tissue-gripping element secured to the elongated filament of the suture assembly by attachment utilizing laser welding, ultrasonic welding, or adhesive attachment;
• FIG. 22 sets forth a partial section side view of a suture portion constructed in accordance with the present invention having a plurality of tissue-gripping elements formed by molding or heading process;
• FIG. 23 sets forth a partial section side view of a suture portion constructed in accordance with the present invention having a plurality of tissue engaging elements positioned by a plurality of integrally formed enlargements on the filament body; and
• FIG. 24 sets forth a side view of a suture portion constructed in accordance with the present invention utilizing a braided or woven multi strand filament.
DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION
• TheFIG. 1 sets forth a side view of a suture assembly constructed in accordance with the present invention and generally referenced bynumeral10. By way of overview,suture assembly10 comprises four basic elements which are a generallystraight body11, a flexibleelongated body20, a plurality of tissue-engagingelements30 through47 and acurved body14. More specifically,suture assembly10 includes an elongatedstraight body11 formed of a plastic material such as polypropylene or the like and includes a generally pointedend12 and aconnector end13.Suture assembly10 further includes a flexibleelongated filament body20 having anend22 secured toconnector13 in the manner described below.Flexible body20 further supports a plurality of tissue-engagingelements30 through47 set forth below in greater detail illFIGS. 4 and 5. Suffice it to note here that tissue-engagingelements30 through47 are substantially identical in structure and are received uponflexible body20. In addition, tissue-engagingelements30 through47 comprise generally conical structures which impart a directional character to the suture assembly in its engagement of tissue. As is better seen inFIG. 3,flexible body20 further defines a plurality of tiedknots50 through67 which are tied withinflexible body20 to provide limitation of the movement of tissue-engagingelements30 through47 uponflexible body20.Flexible body20 further defines anend21 which is received within aconnector16 ofcurved body14.Curved body14 further defines a sharppointed end15.Connectors13 and16 secure ends22 and21 offlexible body20 by use of a conventional crimping attachment. The present invention suture may be fabricated of either absorbative or non-absorbative materials to suit the patient and the procedure.
• As mentioned above, the present invention suture assembly is suitable for use in a variety of wound closure, tissue approximation, tissue support, suspension and/or fixation procedures. However, as is also mentioned above, the present invention suture assembly is particularly well suited to use in procedures which involve face-lifting or contouring during cosmetic surgery procedures. During such use, the directional grip or directional character provided by tissue-engagingelements30 through47 further enhance the lifting and contouring capability of the suture. In its preferred fabrication, the entire suture is formed of a monofilament material such as polypropylene or the like. Alternatively, an absorbable material such as PDF may be used. Once inserted under the skin, the directional character of tissue-engagingelements30 through47 form a permanent support structure for the tissue and actually lift and contour the tissue. While not limited to use in any particular procedure, the present invention suture is well suited to use for lifting and contouring nasolabral lines (smile lines) as well as retracting of the patient's jowls or other parts of the body which need lifting or contouring. The procedure utilizing the present invention suture is extremely safe and requires relatively little time compared to conventional cosmetic surgery. The procedure utilizing the present invention suture may be performed under local anesthesia with the patient remaining comfortably awake. During the procedure, the suture is inserted deep into the subcutaneous tissue along the lines where the new contour is desired. Typically, as few as three suture insertions significantly raise the cheek contour while as few as two sutures correctly placed may be utilized to draw back the patient's jowls. The suture may also be used to raise the patient's brow and pull back neck tissue. Also, the present invention suture may be used elsewhere such as pulling in waist lines. Once inserted, the gripping power and lifting effect of the tissue is maximized after several months when the collagen of the patient's tissue has formed around the tissue-engaging elements.
• It will be apparent to those skilled in the art that the number of tissue-engaging elements utilized in the present invention suture assembly is to some extent a matter of choice and may readily be varied for suitability to specific applications or uses. Thus, the number of tissue-engaging elements shown inFIG. 1 should be regarded as illustrative of the principles of operation of the present invention suture assembly and not as limitation as to the inventive structure.
• FIG. 2 sets forth a side view of the suture portion ofsuture assembly10. As described above, the present invention suture includes an elongated flexible preferablymonofilament body20 formed of a material such as polypropylene or the like.Flexible body20 defines anend21 and anend22. A plurality of tissue-engagingelements30 through47 are threaded uponflexible body20. As is better seen below inFIG. 3,flexible body10 is tied to define a plurality of knots (knots50 through67 shown inFIG. 1).Knots50 through67 are positioned uponflexible body20 at generally evenly spaced intervals and are utilized in limiting the movement of tissue-engagingelements30 through47 uponflexible body20. Thus, it will be apparent thattissue engaging elements30 through67 are serially placed uponflexible body20 and that a corresponding plurality ofknots50 through67 are tied in front of each tissue-engaging-element as it is threaded uponend22 offlexible body20. For example, assembly of tissue-engagingelements30 through47 uponflexible body20 is initiated by threaded tissue-engagingelement47 passedend22 to the desired position onbody20. Thereafter,knot67 is tied inflexible body20. Next,tissue engaging element67 is threaded uponend22 offlexible body20 and positioned in proximity totissue engaging element47. Thereafter,flexible body22 is tied to formknot66. This procedure continues as each tissue-engaging element is threaded uponend22 offlexible body20 and thereafter moved into proximity of the preceding tissue-engaging element after which the corresponding positioning knot is tied inflexible body20—Once all of the desired tissue-engaging elements have been assembled toflexible body20 and the corresponding travel limiting knots have been tied withinflexible body20,flexible body20 is ready for assembly tostraight body portion11 and curved body portion14 (seen inFIG. 1) to complete the suture.
• FIG. 3 sets forth an enlarged view of a portion offlexible body20 having section views of tissue-engagingelements44 and45 secured thereon in the manner described above. Thus, in the example ofFIG. 3,flexible body20 is shown supportingtissue engaging elements44 and45. Correspondingly,flexible body20 has been tied to form a pair ofknots65 and64 each of which limit the positions of corresponding of tissue-engagingelements44 and45. In this manner, tissue-engagingelements44 and45 are able to transfer drawing force fromflexible body20 to surrounding tissue which is engaged byelements44 and45. Once again, it will be noted that this engagement is directional in thatelements44 and45 provide substantial greater engagement of tissue in the direction indicated byarrow48.
• FIG. 4 sets forth a section view of tissue-engagingelement30. It will be apparent to those skilled in the art that tissue-engagingelements30 through47 (seen inFIG. 1) are substantially identical in construction. Thus,FIG. 4 and the descriptions which are provided in conjunction therewith will be understood to apply equally well to tissue-engagingelements31 through47. More specifically, tissue-engagingelement30 is generally frusto-conical in shape and thus defines anarrow end75 and a flaredend77.End75 defines abore76 which is sized to fit snugly upon flexible body20 (seen inFIG. 2). Flaredend77 provides increased volume forinterior portion78 thereof. The conical shape of tissue-engagingelement30 together with the open character of flaredend77 and interior78 cooperate to provide a substantial tissue-engaging property forelement30. As mentioned above, the tissue-engaging elements of the present invention maybe fabricated using injection molding or cold-heading techniques as desired. While a number of suitable materials may be utilized in fabricating the tissue engaging elements of the present invention suture assembly, materials such as polypropylene or the like have been found to be suitable and advantageous. Alternatively, absorbable materials may also be used.
• FIG. 5 sets forth a rear view of tissue-engagingelement30 showing flaredend77 andinterior78. Also seen inFIG. 5 is the extension ofbore76 throughend75 of the tissue-engaging element.
• FIG. 6 sets forth a partially sectioned side view ofstraight body11 in the absence of attachment toflexible body20. As is described above,straight body11 is fabricated of a suitable material such as polypropylene or the like and defines atapered end12 forming a somewhat pointed end structure together with aconnector end13.Connector end13 is shown in partial section and defines aninternal bore17.Bore17 is sized to receive the end portion of flexible body20 (seen illFIG. 1).Connector13 securesstraight body11 toflexible body20 through the application of a conventional crimping process once the end portion offlexible body20 has been received withinbore17.
• FIG. 7 sets forth a partially sectioned view ofcurved body14. As described above,curved body14 defines a sharppointed end15 and aconnector end16.Connector end16 defines aninternal bore18 which is sized to receive the end portion of flexible body20 (seen inFIG. 1) in a snug-fit.Curved body14 is preferably formed of a plastic material such as polypropylene or the like. The attachment ofconnector end16 toflexible body20 to form the structure shown above inFIG. 1 is carried forward by insertingend21 of flexible body20 (seen inFIG. 1) intobore18 after which a conventional crimping operation is applied toconnector end16. The very sharp point formed inend15 facilitates the insertion ofcurved body14 into skin or other tissue.
• FIGS. 8 and 9 set forth respective section and rear views of an illustrative alternate embodiment tissue-engaging element. The difference between the tissue-engaging element illustrated inFIGS. 8 and 9 and the tissue-engaging element set forth inFIGS. 4 and 5 is found in the generally elliptical cross-sectional shape rather than the circular cross-section shape found in the above-described embodiments.
• More specifically,FIG. 8 sets forth a section view of an elliptically shaped tissue-engaging element generally referenced bynumeral70.Tissue engaging element70 defines anarrow end71 having abore72 formed therein.Element70 further defines a flaredend73 and an interior74.Element70 is preferably fabricated utilizing injection molding or cold-heading manufacturing processes. It will be apparent to those skilled in the art that tissue-engagingelement70 provides a direct alternative replacement to tissue-engagingelements30 through47 shown inFIG. 1. It will be further apparent to those skilled in the art that a plurality of tissue-engaging elements such aselement70 may be utilized in the same manner aselements30 through47 described above. In certain applications it has been found that the elliptical cross-section of tissue-engagingelement70 provides some advantage; however, in general, the operation of tissue-engagingelement70 is substantially identical to the operation of tissue-engagingelement30 seen inFIG. 4.
• FIG. 9 sets forth a rear view of tissue-engagingelement70 showing bore72 and interior74 formed therein. Tissue-engagingelement70 further defines a flaredend73.
• FIG. 10 sets forth a side view of a still further alternate embodiment of the present invention suture generally referenced bynumeral80. It will be apparent to those skilled in the art from a comparison of the embodiment of the present invention shown inFIG. 2 and that which is shown inFIG. 10 that suture80 provides a bidirectional suture.Suture80 includes an elongatedflexible body81 having ends82 and83. A first plurality of tissue-engagingelements90 through99 are supported uponbody81 and are positioned by a plurality ofknots110 through119.Knots110 through119 are tied as simple knots infilamentary body81 in the manner described above.Suture80 further includes a second plurality of oppositely facing tissue-engagingelements100 through109. Tissue-engagingelements100 through109 are positioned uponbody81 in an opposite orientation to that ofelements90 through99. In a similar fashion to the above-described suture, a plurality ofknots120 through129 are tied withinbody81 to secure the positions of tissue-engagingelements100 through109. It will be apparent to those skilled in the art that the opposite orientation of tissue-engagingelements90 through99 from tissue-engagingelements100 through109 providessuture80 with a bidirectional gripping characteristic suitable for insertion in surgical procedures where a bidirectional grip is required. It will be equally apparent to those skilled in the art from examiningFIGS. 2 and 10 that alternative arrangements to the arrangements of tissue-engaging elements shown inFIGS. 2 and 10 may be utilized without departing from the spirit and scope of the present invention. In accordance with an important advantage of the present invention suture, the position of tissue-engaging elements upon the filamentary body as well as the orientation of the tissue-engaging elements may be varied or combined as desired to meet specific and particular needs in a given procedure.
• FIG. 11 sets forth a perspective view of a tissue-engaging element constructed in accordance with a still further alternate embodiment of the present invention. It will be recalled thatFIGS. 4 and 5 above set forth a frusto-conical embodiment of the present invention tissue-engaging elements whileFIGS. 8 and 9 set forth an elliptically cross-sectioned conical body forming an alternate construction for the tissue-engaging elements.FIG. 11 shows a faceted embodiment of the present invention in which the outer shape of the tapered tissue-engaging element defines a plurality of facets. Thus inFIG. 11, a tissue-engagingelement85 defines abore87 therethrough. Tissue-engagingelement85 is generally tapered to define a narrow end and a broader end and is covered on its outer surface by a plurality offacets86.Tissue engaging element85 is suitable for substitution in any of the above-described suture assemblies and is representative of a still further alternate shape for the tissue-engaging elements of the present invention suture. Thus, it will be apparent to those skilled in the art that a variety of tissue-engaging element structures or shapes may be envisioned and utilized without departing from the spirit and scope of the present invention.
• With concurrent reference toFIGS. 12A and 12B which set forth respective front and section views, a tissue-grippingelement140 defines a frusto-conical body141 having afront aperture145 formed therein.Body141 further defines a plurality ofelongated slots142,143 and144.Slots142,143 and144 further aide in the tissue bonding or tissue engagement oftissue engaging element140.
• With concurrent reference toFIGS. 13A and 13B which set forth respective front and section views, atissue engaging element150 defines atapered body151 having anaperture157 formed therein.Body151 further defines a plurality ofend lobes152,153,154,155 and156.Lobes152 through156 cooperate to enhance the tissue bonding and tissue engaging capability oftissue engaging element150.
• With concurrent reference toFIGS. 14A and 14B which set forth respective front and section views, atissue engaging element160 includes atapered body161 defining anaperture162 therein.Body161 defines a generally square-shaped end portion which provides corner sections to enhance the tissue-gripping and tissue engaging capability oftissue engaging element160.
• With concurrent reference toFIGS. 15A and 15B which set forth respective front and section views, atissue engaging element170 defines atapered body171 having anaperture172 formed therein.Body171 further defines a plurality oflobes173,174,175 and176 at the larger end thereof.Lobes173 through176 enhance the tissue engaging and tissue-gripping capability oftissue engaging element170.
• With concurrent reference toFIGS. 16A and 16B which set forth respective front and section views, atissue engaging element180 includes atapered body181 defining anaperture182 therein. The enlarged end ofbody181 defines a trio oflobes183,184 and185.Lobes183 through185 enhance the tissue engaging and tissue-gripping capabilities oftissue engaging element180.
• With concurrent reference toFIGS. 17A and 17B which set forth respective front and section views, atissue engaging element190 defines a generally circular disc-shapedbody191 having acenter aperture192 formed therein.
• With respect to the variously shaped tissue engaging elements set forth above, it will be apparent to those skilled in the art that a variety of tissue engaging element shapes may be utilized without departing from the spirit and scope of the present invention. It will be equally apparent from the discussions and Figures that follow that a corresponding variety of positioning elements may be utilized to cooperate with the various tissue engaging elements described therein. The essential function of the tissue engaging element is to provide a grip or engaging characteristic for the suture while the function of the positioning elements such as the tied knots set forth above is to provide a restricted movement of the tissue engaging elements and thereby transfer the gripping force between the tissue and the tissue engaging element to the suture body.
• FIG. 18 sets forth a suture portion which includes tissue gripping elements formed by knots tied in the elongated flexible body of the suture. It will be apparent to those skilled in the art thatFIG. 18 shows a portion of a suture constructed in accordance with the present invention. With reference toFIG. 1, it will be recalled that the complete suture structure includes a flexible elongated body together with elongated straight or curved needle portions. Thus, it will be understood that the embodiment shown inFIG. 18 forms a portion of the inventive suture utilizing the remainder of the structure set forth above. More specifically,FIG. 18 shows a portion of asuture195 having an elongatedflexible body196 which supports a plurality oftissue engaging elements197,198 and199 which are fabricated as knots tied in elongatedflexible body196. It will be apparent to those skilled in the art that the purpose of tying knots such asknots197,198 and199 inbody196 is to provide an enlarged segment which functions as a tissue engaging element. Thus, a variety of different knots may be tied inflexible body196 to provide this function without departing from the spirit an scope of the present invention.
• FIG. 19 sets forth a side view of a complete suture structure constructed in accordance with an alternate embodiment of the present invention and generally referenced bynumeral200. By way of overview,suture assembly200 is constructed generally in accordance with the fabrication ofsuture10 set forth above inFIG. 1, in that it provides a pair of generally rigid needle-like structures joined by an elongated flexible body. In further similarity, it will be noted thatsuture assembly200 includes a plurality of tissue engaging elements which are positioned upon the elongated flexible body by corresponding positioning elements such as knots or enlarged beads.Suture assembly200 differs from the suture assembly set forth above in that it further includes an elongated portion of the flexible body which is free of the tissue engaging elements and which supports an elongated tissue bonding sleeve positioned upon the flexible body. As described below, the function of the tissue bonding sleeve is to provide a mechanism for further enhancing the gripping and tissue engaging characteristics ofsuture200. In essence, the porous structure of the tissue bonding sleeve allows the growth of tissue into that porosity and strongly bonds the sleeve and as a result the suture to the patients tissue. The inventive suture may be fabricated using a variety of implantable materials including absorbative or non-absorbative materials.
• More specifically,suture200 includes a pair of elongated generallyresilient needles201 and204 having respectivesharp ends202 and205.Needles201 and204 further define respective attachment ends203 and206. An elongatedflexible body210 is secured betweenend attachments203 and206 ofneedles201 and204. It will be noted that in the example shown forsuture200 inFIG. 19, bothneedles204 define straight needles. However, it will be apparent to those skilled in the art that either or both ofneedles201 and204 may define curved or hooked segments as shown above inFIG. 1.
• In accordance with the fabrication set forth above, elongatedflexible body210 supports a plurality of spacedtissue engaging elements201 through220 which are positioned uponbody210 by a corresponding plurality ofknots221 through230. Further, elongatedflexible body210 supports a second plurality oftissue engaging elements231 through240 which are positioned upon elongatedflexible body210 by a corresponding plurality of knots orother positioning elements241 through250. It will be apparent to those skilled in the art from the descriptions which follow thatpositioning elements221 through230 as well aspositioning elements241 through250 may alternatively be knots tied in elongatedflexible body210 or may comprise headed or beaded segments in the manner set forth below and illustrated inFIG. 20.
• In accordance with the alternate embodiment of the present invention, elongatedflexible body210 defines a portion which is free oftissue engaging elements211 through220 and231 through240. It is upon this portion of elongatedflexible body210 that elongated flexibletissue bonding sleeve251 is supported. For purposes of illustration,sleeve251 is shown supported uponbody210 generally equidistant from the two sets of tissue engaging elements thereon. It will be apparent however that the position ofsleeve251 may be varied in accordance with specific needs ofsuture200.Sleeve251 is positioned by positioningelements254 and255 at ends252 and253 respectively ofsleeve251.
• In its preferred fabrication,sleeve251 is elongated and some what flexible and defines a center passage allowing it to be supported upon elongatedflexible body210. In further accordance with the preferred fabrication of the present invention,sleeve251 is preferably formed of a material such as Gortex or other suitable implantable material. The preferred function of thesleeve251 is realized as the generally porous structure ofsleeve251 allows the tissue within the patient to “grow into” or bond with the body ofsleeve251. This process provides an enhanced tissue gripping capability as the patients tissue extends into and bonds with the body ofsleeve251.
• As mentioned above, the present invention suture may be fabricated utilizing a variety of differently shaped tissue engaging elements. Additionally, and as is also mentioned above, the attachment or positioning of these tissue engaging elements may be similarly varied upon the elongated flexible body portion of the suture. Thus,FIGS. 20 through 24 set forth below provide side views of portion of these alternate embodiment sutures which may be fabricated in accordance with the various embodiments of the present invention. Thus, inFIGS. 20 through 24 it will be understood that the Figures show a portion of the suture assembly which, in its entirety, is fabricated in the manner indicated inFIGS. 1 and 19 and in accordance with the construction shown therein forsutures10 and200.
• More specifically, and with reference toFIG. 20, asuture portion260 is shown having an elongatedflexible body261 within which a plurality ofpositioning elements262,263 and264 are formed. Positioningelements262,263 and264 may alternatively comprise knots tied inflexible body261 or may be molded or headed onto the flexible body in the manner illustrated inFIG. 3. In a simple embodiment, the tissue engaging elements may be formed by simply “flattening” the flexible body to form enlargement thereof in one dimension.Body261 supports a corresponding plurality oftissue engaging elements265,266 and267. Of importance to note inFIG. 20 is the non uniform spacing oftissue engaging elements265,266 and267. Thus, it will be apparent to those skilled in the art while in many instances uniform spacing of tissue engaging elements is contemplated and may be utilized, there remain other applications in which the spacing of tissue engaging elements may be varied and may be non uniform as desired.
• FIG. 21 sets forth asuture portion270 having an elongatedflexible body271 upon which atissue engaging element272 is supported. Of importance to note inFIG. 21 is the utilization of anattachment273 betweentissue engaging element272 andbody271 which provides a direct attachment and which may avoid the need for positioning elements. This attachment may, for example, comprise ultrasonic welding, laser welding, adhesive attachment or other direct attachment mechanisms.
• FIG. 22 sets forth a partially sectioned side view of asuture portion275. The importance ofsuture portion275 is its utilization of a one piece structure for the flexible body and tissue engaging elements. Thus,flexible body276 is molded or headed to provide a plurality oftissue engaging elements277,278 and279. Such molding or heading processes are known in the art and may be utilized in some embodiments of the present invention.
• FIG. 23 sets forth a partial section side view of asuture portion280 having an elongatedflexible body281 within which a plurality ofpositioning elements282,283 and284 are formed as an integral portion ofbody281. This integral formation may be provided by heading or molding processes or staking or impacting processes. With positingelements282,283 and284 as shown, a corresponding plurality oftissue engaging elements285,286 and287 are positioned uponbody281.
• FIG. 24 sets forth a side view of a suture portion generally referenced by numeral290 which utilizes a multi strand braided or woven elongatedflexible body291.Body291 may be fabricated of a variety of implantable materials such as braided polyester, nylon or other materials. A plurality ofpositioning elements292 and293 are formed inbody291 as tied knots therein. A corresponding plurality oftissue engaging elements294 and295 are also shown uponbody291. Of importance with respect to the embodiment of the present invention shown inFIG. 24, the braided or woven character ofbody291 further enhances the tissue bonding characteristic of the entire suture structure. The braided or woven characteristic ofbody291 allows tissue growth to adhere to and grow into the spacing between the various braided or woven strands ofbody291. In this manner, the tissue adherence is greatly enhanced as the entire flexible body of the suture assembly provides direct tissue bonding superior to that realized with the single filament flexible bodies used in sutures. The braided or woven character ofbody291 provides better attachment or tissue bonding initially. But perhaps of more importance is the eventual growth into the spaces within the braided or woven strands which provides tissue engagement along the entire length of the flexible body portion of the suture.
• What has been shown is a novel suture assembly which provides an implantable directional camming device which maybe either directional or bi-directional in fabrication. The suture assembly shown may be fabricated using injection molded or cold-headed manufacturing techniques and is suitable for use in wound closure, tissue approximation, tissue support, suspension and/or fixation. Tissue engaging elements are shown which provide either circular cross-section or elliptical cross-section. The present invention suture assembly may be inserted into the human body either with or without the use of an introducer. The present invention suture is designed to work in conjunction with the healing process post surgical. The inventive suture assembly shown holds wounds closed without the need for suture knot tying to maintain tissue approximation.
• While particular embodiments of the invention have been shown and described, it will be obvious to those skilled in the art that changes and modifications may be made without departing from the invention in its broader aspects. Therefore, the aim in the appended claims is to cover all such changes and modifications as fall within the true spirit and scope of the invention.

Claims (26)

1. A suture comprising: an elongated flexible body having first and second ends; a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements received upon said elongated flexible body; and a plurality of knots tied in said elongated flexible body each larger than said bore, said knots maintaining said tissue-engaging elements in a serial arrangement on said elongated flexible body.

2. The suture set forth inclaim 1 wherein said tissue-engaging elements each define a narrow end and a broad end.

3. The suture set forth inclaim 2 wherein said tissue-engaging elements are each generally frusto-conical in shape.

4. The suture set forth inclaim 3 wherein said tissue-engaging elements each define an open end.

5. The suture set forth inclaim 4 further including: a curved end having a sharp pointed end and a connector end joined to said first end of said elongated flexible body; and an elongated body having a pointed end and a connector end joined to said second end of said elongated flexible body.

6. A suture assembly comprising: an elongated needle body having a first pointed end and a first connector end; a curved needle body having a second pointed end and a second connector end; an elongated filament having a first end joined to said first connector end, a second end joined to said second connector end, and a plurality of knots formed in said filament; and a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements being received upon said filament by passing said filament through said bores with each tissue-engaging element being proximate one of said knots.

7. The suture assembly set forth inclaim 6 wherein said tissue-engaging elements are generally frusto-conical.

8. The suture assembly set forth inclaim 7 wherein said tissue-engaging elements define generally circular cross-sections.

9. The suture assembly set forth inclaim 7 wherein said tissue-engaging elements define generally elliptical cross-sections.

10. A suture comprising: an elongated flexible body formed of a braided or woven multiple stranded member having first and second ends; a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements received upon said elongated flexible body; and a plurality of knots tied in said elongated flexible body each larger than said bore said knots maintaining said tissue-engaging elements in a serial arrangement on said elongated flexible body.

11. The suture set forth inclaim 10 wherein said tissue-engaging elements each define a narrow end and a broad end.

12. The suture set forth inclaim 11 wherein said tissue-engaging elements are each generally frusto-conical in shape.

13. The suture set forth inclaim 12 wherein said tissue-engaging elements each define an open end.

14. The suture set forth inclaim 13 further including: a curved end having a sharp pointed end and a connector end joined to said first end of said elongated flexible body; and an elongated body having a pointed end and a connector end joined to said second end of said elongated flexible body.

15. A suture assembly comprising: an elongated needle body having a first pointed end and a first connector end; a curved needle body having a second pointed end and a second connector end; an elongated flexible body formed of a multiple strand braided or woven member having a first end joined to said first connector end, a second end joined to said second connector end, and a plurality of knots formed in said filament; and a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements being received upon said elongated flexible body by passing said elongated flexible body through said bores with each tissue-engaging element being proximate one of said knots.

16. The suture assembly set forth inclaim 15 wherein said tissue-engaging elements are generally frusto-conical.

17. The suture assembly set forth inclaim 16 wherein said tissue-engaging elements define generally circular cross-sections.

18. The suture assembly set forth inclaim 16 wherein said tissue-engaging elements define generally elliptical cross-sections.

19. A suture comprising: an elongated flexible body formed of a braided or woven multiple stranded member having first and second ends; a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements received upon said elongated flexible body to form two spaced-apart groups having a space therebetween; a plurality of knots tied in said elongated flexible body each larger than said bore, said knots maintaining said tissue-engaging elements in grouped serial arrangements on said elongated flexible body; and an elongated flexible sleeve formed of a porous material and supported upon said elongated flexible body between said groups of tissue-engaging elements.

20. The suture set forth inclaim 19 wherein said tissue-engaging elements each define a narrow end and a broad end and wherein said elongated flexible sleeve is positioned by a knot on each side of said elongated flexible sleeve.

21. The suture set forth inclaim 20 wherein said tissue-engaging elements are each generally frusto-conical in shape.

22. The suture set forth inclaim 21 wherein said tissue-engaging elements each define an open end.

23. A suture comprising: an elongated flexible body formed of a braided or woven multiple stranded member having first and second ends; a plurality of tissue-engaging elements each defining a bore therethrough, said tissue-engaging elements received upon said elongated flexible body forming at least two spaced-apart groups; a plurality of positioning elements in said elongated flexible body each larger than said bore, said positioning elements maintaining said tissue-engaging elements in a serial arrangement on said elongated flexible body; and an elongated flexible porous sleeve supported upon said elongated flexible body between said groups positioned by a pair of said positioning elements.

24. The suture set forth inclaim 23 wherein said tissue-engaging elements each define a narrow end and a broad end.

25. The suture set forth inclaim 24 wherein said tissue-engaging elements are each generally frusto-conical in shape.

26. The suture set forth inclaim 25 wherein said tissue-engaging elements each define an open end.

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