Surgical methods using one-way suture

- Ethicon, Inc.

Methods are disclosed for binding together human or animal tissue using one-way sutures having barbs on their exterior surfaces, allowing passage of a needle-drawn suture in one direction through tissue, but not in the opposite direction. In closing a wound, the sutures are passed through tissue at each of the opposed sides of the wound, forming suture pairs in which trailing ends of the sutures are juxtaposed in the wound. The number of suture pairs is selected in accordance with the size of the wound. The wound is closed and ends of the sutures of each suture pair are secured together, which may be by heat bonding or surgical knots. In a variation of this procedure double-armed sutures are used. In another variation detachable needles are used to leave the barbed sutures below the skin. The invention avoids loop stitching, minimizing scarring. In addition to wounds at the skin surface, the method is useful in binding together severed tendons or other internal tissue of a patient, providing considerable tensile strength with a minimum of suturing and locating the tensile support precisely where needed. In facelifts and other cosmetic operations, the sutures are used to provide lines of tissue support beneath the skin.

Skip to: Description  ·  Claims  ·  References Cited  · Patent History  ·  Patent History
Description
BACKGROUND OF THE INVENTION

The invention concerns surgical procedures, and in particular relates to surgical methods using a one-way suture which has barb elements enabling the suture to be pulled through tissue in one direction, but resisting movement in the opposite direction. The methods include closing wounds, tissue support and repair of internal tissues such as tendons and ligaments.

Sutures have been used in surgical procedures to close surgical and traumatic wounds, to close the skin in plastic surgery, to secure damaged or severed tendons, muscles or other internal tissues, and in microsurgery on nerves and blood vessels, all for holding tissues together to support healing and regrowth. Such sutures are attached to the shank end or trailing end of a needle. The sutures can be a monofilament or a braided material and many are available as a one-piece unit pre-attached to a needle. Sutures can be of non-absorbable material such as silk, nylon, polyester, polypropylene or cotton, or of bioabsorbable material such as polymers and copolymers of glycolic and lactic acid. Loop stitching has been the primary procedure, particularly to close a surface wound, whether an accidental or surgical wound. Such looped sutures, which are similar to the simplest method of seaming two pieces of fabric together, can leave ugly scars and a “Frankenstein” look to the fully healed wound. Although this can be alleviated in some cases and to some extent by using very fine suture material (e.g. 100 microns in diameter), the loop stitching still can cause very visible scars, and for adequate closure of some wounds the suture material must be of a high tensile strength and thus a larger diameter, increasing scarring.

Surface adhesive tapes are often used on the skin to hold small wounds closed to permit healing, but-these have relatively low tensile strength and are not useful in many situations. Another approach, sometimes practical, has been the use of staples for holding closed a wound for healing. The staples have relatively high strength and save time, but are not as accurate as sutures, are bulky and painful to remove.

Surgical sutures having barbs, for providing a non-slip attribute in one direction, are shown in U.S. Pat. No. 3,123,077. In addition, in about the 1960s a metal tendon suture was produced and tried, the suture having a single, large barb for gripping of the tendon tissue. The metal suture was not successful and may no longer be available, and the technique is outdated.

U.S. Pat. Nos. 5,425,747 and 5,584,859 disclose a type of “suture” having external barbs for holding together the two sides of an open wound. Although the theory of operation of the suture devices of these two patents is similar to that of the present invention, these prior suture devices were in essence a single relatively rigid frame. the disclosed devices had “lateral members” with barbs, the lateral members being shaped somewhat like small spears which were to be inserted into the tissue on opposite sides of a wound, to bind the wound together. The arrays of barbed, parallel-extending spears on both sides of the wound were held together by a “central body member” which lay within the wound and parallel to the length of the wound and which was secured to the barbed spears on each of the two sides. All of these components were described as being of bioabsorbable material. In the '859 patent, stretchable elastic connectors secured the spear-like lateral members to the central body member, so as to impose a tension force to pull the two sides of the wound together.

The spear-like barbed lateral members of the two described patents were required to be pushed into the patient's tissue, and therefore had to be of sufficient stiffness and large enough diameter such as to be capable of being pushed into the tissue. The resulting tissue securement would appear to be bulky and painful. The larger foreign body would tend to cause excessive scarring and would tend to increase the possibility for wound infections.

It is an object of the present invention to improve on suturing techniques for closing wounds and severed tissues, and for performing cosmetic surgery such as face lifts, while minimizing scarring and providing a strong retaining force between the two side of tissue.

SUMMARY OF THE INVENTION

The invention described herein includes several surgical procedures for binding together living tissue using one-way sutures having barbs on their exterior surfaces and a needle on one or both ends. The one-way sutures allow passage of a needle-drawn suture in one direction through tissue but not in the opposite direction, thus having the capability to put tension in the tissue when tension is placed on the trailing end of the suture.

In a procedure for closing a wound or surgical incision, the one-way sutures are passed through tissue at each of the opposed sides of the wound, forming suture pairs in which trailing ends of the sutures are positioned generally in alignment at opposite sides of the wound. On insertion of each suture, the needle is pushed to extend out of the flesh at a point laterally remote from the wound, then the needle is pulled out to draw the suture to the desired position, and the suture is severed from the needle. The number of suture pairs is chosen in accordance with the size of the wound and the strength required to hold the wound closed.

Once all sutures are in place, the wound is closed (as by holding or clamping), and ends of the sutures of each suture pair are secured together, and this may be by heat bonding or surgical knots.

By the described method of using one-way sutures to hold closed a wound, loop stitching is avoided and scarring is minimized.

In addition to closing wounds at the skin surface, the method of the invention is useful in binding together partially or completely severed tendons or other internal tissue of a patient or animal, providing considerable tensile strength with a minimum of suturing. The procedure locates the tensile support precisely where it is needed.

In facelifts and other cosmetic operations, the surgeon uses the one-way sutures to provide lines of tissue support beneath the skin.

In the procedures of the invention, the sutures are hidden and may be left in place. If desired, however, they may be formed of bioabsorbable material.

In a variation of the above procedure, double-armed sutures are used, with first and second surgical needles oriented in opposite directions and a single suture extending between the shank ends of the two needles. The suture has exterior barbs oriented in one direction for about half the length of the suture and in the opposite direction for the other half of the suture, each portion having the barbs oriented so as to allow movement along with the adjacent needle secured to the suture. In the double-armed suture procedure, the surgeon may fully insert one side of the suture at one side of the wound or severed tissue, then manually close the wound as he draws the opposite needle through the tissue to draw into place the other side of the suture, thus closing the wound as the double-armed suture is fully secured in position. Both needles are severed from the sutures at the points of exit from the tissue.

In another variation of the procedure, the surgeon can use a pull-away needle which is detachable from the one-way suture when the needle is pulled with sufficient tension. This enables the surgeon to leave the barbed suture well below the skin, avoiding “puckering” of the skin from the pull of the barbed suture just below the skin surface. This can be done with double-armed sutures as well.

In a facelift operation, the surgeon selects one or more paths through the patient's tissue where lines of tissue support are needed. The surgeon selects a surgical needle of sufficient length to be inserted through one of the selected paths in the tissue, the needle having a shank end secured to a one-way suture with exterior barbs providing for gripping of the tissue in one direction only, the direction opposite that in which the needle is pushed through the tissue. The surgeon inserts the needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the needle extends out through the skin at a distal end of the selected path. Then the surgeon grips the needle from the point end and pulls it out of the tissue, leaving the one-way suture lying within the tissue along the selected path. The suture is then severed from the surgical needle, at a point below the skin, leaving the leading end of the one-way suture hidden beneath the skin at that distal end.

The surgeon repeats the above procedure for additional lines of tissue support, as needed for the particular facelift operation. Once all one-way sutures are in place along the desired lines of tissue support, the surgeon applies tension to the trailing end of each suture, such tension being in a direction opposite the direction in which the needle was drawn, to engage the barbs against the internal tissue along the desired lines of tissue support. The trailing end of each suture is secured in such a way that the desired line of support is placed in tension. The trailing end of each suture may be secured to the patient's adjacent tissue, or to another one-way suture which extends in essentially an opposite direction, or a double armed opposing barbed suture can be used.

Accordingly, it is among the objects of the described invention to provide an efficient procedure for closing wounds, incisions and severed tissue such as tendons, joint capsules and ligaments, as well as to establish a highly efficient and invisible tissue support procedure, especially for facelift operations. These and other objects, advantages and features of the invention will be apparent from the following description of preferred embodiments, considered along with the accompanying drawings.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view showing a surgical needle with a one-way suture secured to the shank end of the needle, the suture including barbs on its exterior surface.

FIG. 1A is a cross sectional view showing the suture of FIG. 1.

FIG. 2 is a cross sectional view showing a portion of a patient's skin and subcutaneous tissue, with a surgical wound or incision from the skin surface down into the tissue, and showing the use of the needle and one-way suture of FIG. 1.

FIG. 3 is a cross sectional view of patient tissue similar to FIG. 2, but showing use of a needle and suture at both sides of the wound or incision and showing an alternate method for removing the needle from the suture below the skin.

FIG. 4 is another cross sectional view similar to FIG. 2, but with the surgical needles removed and sutures severed from the needles below the skin surface and with trailing ends of the sutures extending into the open wound.

FIG. 5 is a schematic perspective view indicating a series of one-way sutures inserted at one side of a wound, at different levels.

FIG. 5A is a plan view showing the patient's skin with the wound still open, and showing a series of opposed suture pairs which have been put in place by the procedure shown in FIGS. 2-4.

FIG. 6 is a cross sectional view similar to FIG. 4, but with the wound closed and showing a knot being tied to join trailing ends of a sutured pair.

FIG. 7 is a cross sectional view similar to FIG. 6, with the wound closed but with the suture ends being joined by a heat bonding technique.

FIG. 8 is an enlarged detail view showing the use of a device for performing the heat bonding of FIG. 7.

FIG. 9 is a view showing a double-armed suture, with two needles and a barbed suture extending between the needles, the suture having two sections with oppositely-directed barbs.

FIG. 10 is a cross sectional view similar to FIGS. 6 and 7 showing a surface wound joined together with a double-armed suture such as shown in FIG. 9, the needles having been removed.

FIG. 11 is a view schematically showing a severed tendon joined together by one-way sutures, which in this case are shown as double-armed barbed sutures.

FIG. 12 is a schematic view indicating a facelift procedure using the one-way sutures of the invention.

FIGS. 13-18 are views showing schematically several different techniques for production of the one-way sutures.

DESCRIPTION OF PREFERRED EMBODIMENTS

FIG. 1 shows schematically a suture 10 secured to the trailing end 12 of a surgical needle 14 in accordance with the invention. As described above, the suture 10 is a one-way suture, allowing its travel through tissue in one direction only, toward the left as viewed in FIG. 1, due to the presence of a multiplicity of barbs 16 on the exterior surface of the suture. The barbs 16 are configured to engage against a patient's tissue, much in the manner of a bee's stinger or a porcupine's quill. The surgical needle 14 is long enough to serve the type of tissue repair to be addressed, so that the needle can be completely removed, leaving the suture in the desired position within the tissue.

FIG. 1A shows in cross section an example of one type of barb configuration which can be used on the sutures of the invention. The suture 10, which may be about 100 to 500 microns in diameter, has the barbs 16 formed in a helical pattern; however, the barbs can also be formed in other patterns and by various means, as explained below.

FIG. 2 indicates schematically a cross section of a patient's tissue 20, showing an open wound or surgical incision 22 with sides 24 and 26. The figure shows surgical needles 14a and 14b which have drawn one-way sutures 10 through the tissue, to points 28, 30 of exit from the skin. The barbed, one-way sutures 10 remain in the tissue, at desired locations (at two different levels in the wound, in this example), with trailing ends 10b of the sutures left extending into the wound 22. Again, the needles 14a and 14b are selected to be sufficiently long to extend through the entire path where the sutures 10 are to be placed.

In all cases the leading ends 10a of the sutures will be cut off so as to lie below the surface of the skin, which is easily accomplished by depressing the skin immediately around the suture and severing the suture closely against the skin, with the trailing end of the suture tensioned, then allowing the skin to cover the end of the suture. However, in many cases it is important that the skin surface not “pucker” inwardly due to tension in the suture just below the skin. This potential problem can be addressed in several ways. One procedure is to provide, and to select, the proper needle and suture combination for the particular situation to be addressed, such that the leading end 10a of the suture will be free of barbs in an initial region, for a selected distance. In FIG. 2 one of the sutures 10 is shown with a dotted line 10c indicating a location where the barbs 16 commence, continuing toward the trailing end 10b of the suture. Thus, the region between the leading end 10a and the dashed line 10c is free of barbs, so that no tension is exerted in the tissue to pull downwardly on the skin. Another method for avoiding this potential problem, and under many circumstances the best method, is to use a pull-away needle/suture combination, in which the needle is detachable from the leading end of the suture when sufficient force is applied. One such system is marketed as De-tach by Davis and Geck. The De-tach needle requires a pulling force equal to about one-third the tensile strength of the suture itself, to pull the needle free of the suture. Such a detachable arrangement can easily be made with the barbed sutures of the invention, such as by swaging a metal end of the needle over the leading end of the suture with just sufficient force to allow the suture to be pulled through tissue but still allowing the needle to be pulled free when deliberate force is applied. To use such a detachable needle system, the surgeon simply holds the trailing end 10b of the suture after the suture has been emplaced and pulls the needle with the force required to detach it.

One aspect of the invention is that the detachable needle preferably has at its base end length markings, e.g., at one centimeter intervals from the trailing end of the needle, to show the surgeon how far the suture end lies beneath the skin. With reference to such markings the surgeon can gauge the depth of the suture, predetermining the depth of needle-suture separation.

FIG. 3 gives a schematic indication of this procedure. A suture 10d which has been inserted at a lower level in the patient's tissue 20, from near the bottom of a wound 22, has been detached from a needle 14c by pulling the leading end of the needle 14c firmly while holding the trailing end 10b of the implanted suture. As a result of this procedure, the surgeon can select a shorter suture than otherwise needed, can place the suture 10d in a more horizontal or skin-parallel position, correctly aligned with the desired tension to close the wound 22, and the leading end of the suture need not be brought through or even close to the skin surface. In addition, there is no need for a selection of needles/suture combinations with different lengths of barb-free “blank” regions behind the needle, as discussed relative to FIG. 2.

The sutures in FIG. 3 other than the suture 10d are not shown as having been placed with detachable needles, since the figure is meant to illustrate different techniques. Normally, but not necessarily, the same procedure would be used for all procedures around a particular wound.

FIG. 3A shows a detachable needle 14c, with distance markings 14e at the base end of the needle. The needle 14c is detachably secured to the leading end 10a of a one-way suture 10.

FIGS. 3 and 4 show two different stages in the procedure using the one-way sutures of the invention. FIG. 3 shows that the sutures are emplaced in pairs, so that corresponding juxtaposed sutures can be attached when the wound is to be closed, and FIG. 4 shows the sutures, in place under the skin, after removal of the needles. Once all suture pairs have been put in place, the trailing ends of the sutures will be ready for attachment together with the wound 22 held closed.

FIG. 5 shows schematically, in plan view, series of suture pairs, each pair having sutures implanted in opposite sides of the wound 22. FIG. 5 shows suture pairs 32a, 32b; 34a, 34b; 36a, 36b; 38a, 38b; 40a, 40b, etc. As indicated, any number of suture pairs can be arranged for tying or otherwise securing them together upon closure of the wound, so that the wound is closed successively from one end to the other and held closed by the connected one-way suture pairs, providing for healing without loop suturing at the surface.

FIG. 5A schematically shows in cross section one side of the wound or surgical incision 22, showing trailing ends 10b of sutures extending into the wound, from sutures which have been pulled into position using surgical needles.

FIG. 6 is a schematic view showing in cross section the tying of a pair of trailing ends 10b of sutures 10 which have been placed in the patient's tissue 20. In this case the sutures 10d are shown extending in positions generally parallel to the surface of the skin, drawn into position by detachable needles such as shown and described with reference to FIG. 3. As mentioned above, the advantages of using this type of detachable needle are (1) the suture can be kept more parallel to the skin surface, so that the tension is pulling in the most efficient direction to close the wound; (2) the suture need not come out through the skin, and can be left deep beneath the skin, preventing any “puckering” of the skin; and (3) the suture can be shorter.

In FIG. 6 the suture ends 10b are tied in a knot, as the wound 22 is held closed, and the tying and drawing of the knot tightly can actually help draw the wound closed.

However, FIGS. 7 and 8 show an alternative procedure for tying the suture ends together, in which a heat sealing device 42 is used to secure the suture ends together. The device 42 may be shaped generally in the form of a pair of tweezers, with an electrical cord 44 supplying power to an isolated tungsten filament 46 on a first leg 47 of the tool. As can be seen in FIGS. 7 and 8, a metal tip 48 of an opposite leg 49 has a recess or notch 50 which engages the two suture ends 10d. With the two suture ends securely engaged in this notch 50, the two legs of the tweezer-like tool are brought together and the filament 46 contacts the suture ends and simultaneously severs the excess ends of the sutures and bonds the sutures together by fusion. The filament is heated instantaneously by closure of a remote switch. The blade tips 47 and 49 of the instrument act as a heat sink to protect the surrounding tissue.

The surgeon will need to hold or temporarily clamp the wound 22 together while using the heat bonding tool 42. By using the tool 42 the surgeon can quickly bond a series of suture pairs, both shallow and deep pairs, eliminating the surgical knot 41 which is left in the wound by the procedure of FIG. 6.

FIG. 9 shows a double-armed suture 55, similar to the barbed suture 10 described above but having barbs 16 oriented in one direction to one side of a division line 56 and in the opposite direction on the other side. As reviewed earlier, this enables the use of such one-way sutures to close and bind a wound without the need to secure suture ends together in the wound. The double-armed suture 55 of FIG. 9 has a left side 55a and a right side 55b.

FIG. 10 shows a wound 22 held closed by double-armed sutures 55 according to procedures of the invention. The double-armed sutures 55 have barb reversal points, such as shown at 56 in FIG. 9. located at or close to the closed wound 22, such that the two sides of the double-armed suture each exert tension on tissue at the respective side of the wound. The upper suture 55 in FIG. 10 is shown with cut-off leading ends 55c, which are just below the surface of the skin in accordance with the first form of the invention described above, wherein the sutures are severed at the skin and the skin springs back over the severed ends 55c to cover them. However, the lower double-armed suture 55 shown in FIG. 10 is shown with terminal leading ends 55c which are well down into the tissue, far below the skin surface 58. This is merely for the purpose of illustration and not to suggest that the suturing procedure should be different for the lower suture 55 than for the upper suture 55, although this can be done. The lower suture in FIG. 10 is emplaced by the procedure shown on the lower left in FIG. 3, by a pull-away needle, similar to the De-tach needle/suture combination described above, such that the suture can be drawn more horizontally through the tissue and can be left far below the skin. The patient's tissue is flexible and pliable, and in most cases the surgeon can insert the needle horizontally, then make what is in effect a rather pronounced turn with the needle up toward the surface, by manipulating the skin to angle the needle toward the surface.

The procedure for use of the double-armed sutures 55 is described above, preferably involving first inserting one end of the suture through the tissue to the position desired, with the transition point or barb reversal point 56 located in the wound; then inserting the opposed needle of the double-armed suture into the tissue at the other side of the wound, and drawing this second arm of the suture tight while closing the wound 22, to the closed position shown in FIG. 10. The needles are removed after the suture ends are properly in place.

FIG. 11 shows double-armed sutures 60 used to repair a severed tendon 62. FIG. 11 shows the use of double armed sutures, but the simpler barbed sutures shown in FIGS. 1 through 8 could also be used. In this case there is no concern with “puckering” of the surface, so that the leading ends 60a of the sutures can be simply cut off at the surface of the tendon 62, as generally indicated in the figure. Again, if a double-armed suture 60 is used, the point of barb direction reversal will be located at or very close to the tendon wound 64.

FIG. 12 is a schematic illustration indicating procedures of the invention in facelift surgery. A facelift patient 70 has a long surgical incision 72, in which skin has been elevated in order to tighten the facial skin, providing tissue support to remove some of the effects of aging. The drawing indicates a series of suture pairs 73a, 73b, . . . 73g, 73h and 73i, which may also be double-armed sutures as described above. As in the surface wound closure situations described and illustrated above, the suture pairs (or double-armed sutures) have barbs for engaging the tissue and gripping the tissue in one direction, so as to pull the tissue toward the surgical wound 72. When each of the suture pairs or double-armed sutures 73a, 73b, etc. has been inserted and the wound has been closed at each suture, the sutures will hold and bind the wound tightly closed, without loop stitching, staples or other means, resulting in reduced scarring. The one-way sutures may be on elongated paths, and the sutures themselves can provide tissue support in the facelift operation, rather than relying solely on the removal of skin at the wound 72 for tightening of the facial tissue. FIG. 12 shows only one example; the one-way sutures of the invention, whether in pairs or alone, can be used in a number of different ways for tissue support. The one-way sutures, inserted along lines beneath the skin, can support the subcutaneous layers better than current procedures.

FIG. 13 shows schematically one method for producing one-way sutures for use in the invention. A pair of parallel and movable bars 80, 81 have cutting blades 83 on one surface, the two sets of cutting blades being in facing relationship and being of a size and spacing to form the suture barbs in the size and spacing desired. The cutting blades are precision-formed, since the raw suture 84, which may be nylon or other suitable material, has a small diameter which may be in the range of about 100 to 500 microns. As an example, the barb spacings can be from about 100 microns to about 1 millimeter or even greater. The depth of the barbs formed in the suture material can be about 30 microns to 100 microns, depending, to a large extent, on the diameter of the suture material.

As indicated in FIG. 13, the two bars 80 and 81, with the cutting blades 83, are in a machine which converges them inwardly and downwardly, with reference to the figure, to engage the cutting blades into the exterior walls of the suture filament material 84. The suture material is held stable during this operation, or the suture is advanced upwardly while the bars 80, 81 are moved only inwardly. The distance of relative longitudinal movement between the bars and the suture will determine the depth of the barbs formed, limited by the length of the cutting blades 83 themselves.

FIG. 14 shows a resulting barbed suture 84a as produced by the device shown in FIG. 13. Barbs 86 are closely spaced in the suture 84a, and can be farther apart or in different configurations if desired. As the figure indicates, the barbs 86 are on opposite sides of the suture due to the method of their formation, and they extend outwardly somewhat on the suture due to the manufacturing process, wherein the cutting blades 83 may be removed from the cuts by simply spreading the two bars 80 and 81 (FIG. 13) outwardly, without longitudinal movement of the suture material 84.

FIG. 15 schematically indicates another method for forming a barbed suture 88a from suture filament material 88 such as nylon (or other suitable materials, including resorbable materials as discussed above). This method is somewhat similar to that of FIG. 13, but with rotating cutting wheels 90. These cutting wheels 90 may have cutting blades 92 somewhat similar to the cutting blades 83 shown in FIG. 13. In this production method, the nylon suture material 88 is held with sufficient tension to cause the blades 92 of the wheels 90 to cut into the nylon, forming the barbs 94. The suture being formed nonetheless advances with the motion of the opposed cutting wheels 90, against the imposed resistance. Again, when the cutting blades 92 are pulled free from the formed barbs 94, this pulls outwardly on each barb and causes the barb to protrude slightly from the body of the suture, setting the barbs up for better engagement with the tissue during use.

FIG. 16 indicates a barbed suture 96 having barbs 98 in staggered positions. Such a suture may be formed by a method generally similar to what is shown in FIGS. 13 and 15, but with cutting blades staggered as to height and in different positions around the periphery of the suture material.

FIGS. 17 and 18 indicate another system for producing barbed sutures in accordance with the invention. FIG. 17 shows a raw suture filament 100, which may be about 100 to 500 microns in diameter, being cut into a barbed suture 102 by laser machining. As schematically indicated, a laser beam is directed at the cross hatched areas 104 in FIG. 17, removing these sections to produce barbs 106 as shown in FIG. 18. The barbs can be on opposed sides of the suture, as shown, and staggered if desired. Further, they can be positioned in a spiral pattern if desired, as by rotating the suture filament 100 or moving the laser around the filament, during the material removal operation. Industrial lasers are capable of being focused very sharply, easily down to the range required for this laser machining operation.

Procedures described herein are useful in animal suturing as well as human, and the term “patient” as used in the claims should be taken as including application to animals.

The above described preferred embodiments are intended to illustrate the principles of the invention, but not to limit its scope. Other embodiments and variations to this preferred embodiment will be apparent to those skilled in the art and may be made without departing from the spirit and scope of the invention as defined in the following claims.

Claims

1. A method for bringing together and holding closed an open wound in human or animal flesh to allow healing and regrowth together of the two sides of the wound, comprising:

(a) in the open wound, inserting a surgical needle into flesh at one side of the wound, penetrating into the flesh wall at the one side, the needle having a base or trailing end secured to a one-way suture which has a series of exterior barbs providing for gripping of the flesh in one direction only, the barbs permitting movement of the suture through the flesh in the direction the needle is inserted,
(b) pushing the needle to extend out of the flesh at a point laterally spaced from the wound, then gripping the needle from the point end and pulling the needle out of the flesh, leaving a trailing end of the suture in the open wound,
(c) severing the suture from the needle,
(d) repeating the procedure of step (a) at the opposite side of the open wound, at a position to form a suture pair of two sutures located across the wound from one another,
(e) repeating steps (b) and (c) at said opposite side of the open wound,
(f) repeating steps (a) through (e) to form additional suture pairs as necessary at further locations along the wound depending on the size of the wound,
(g) bringing the two sides of the wound together, and
(h) connecting together trailing ends of the two sutures of each suture pair to bind the wound in a closed position.

2. The method of claim 1, wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion.

3. The method of claim 2, wherein the suture is formed of nylon.

4. The method of claim 1, wherein the suture is formed of nylon.

5. The method of claim 1, wherein the suture has a periphery and has said barbs oriented at progressively staggered positions around the periphery of the suture.

6. The method of claim 1, wherein the surgical needle is a detachable needle and wherein the step of severing the suture from the needle comprises, while conducting the step of pulling the needle out of the flesh, restraining the trailing end of the suture and pulling the needle with sufficient force to detach it from the suture at a position wherein the leading end of the suture is well below the surface of the flesh, thereby leaving the leading end of the suture within the flesh.

7. The method of claim 6, wherein the base end of the detachable needle has metric markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching the needle at a desired depth by reference to the metric markings.

8. The method of claim 1, wherein the suture has a leading end region free of barbs, and wherein the step of pulling the needle out of the flesh comprises pulling the barb free leading end of the suture to the flesh, leaving the barbs well below the flesh so as to avoid downward tension at or near the surface of the skin.

9. A surgical method for bringing and holding together two tissue portions in a living patient or animal, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:

(a) at the tissue separation, inserting a surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted, the surgical needle being a part of a double-armed suture which includes first and second such surgical needles oriented in opposite directions and a single suture extending between the trailing ends of the two surgical needles, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a remaining, second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted,
(b) pushing the first surgical needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the needle from its point end and pulling the needle out of the tissue, leaving said second portion of the suture extending in the tissue separation,
(c) repeating the procedure of step (a) at the opposite side of the open wound, using the second surgical needle, at a position located across the tissue separation from the position in which the first needle was inserted,
(d) repeating step (b) at said opposite side of the tissue separation, to the extent that said second portion of the suture is drawn through tissue at said opposite side of the separation, with the second surgical needle,
(e) bringing the two tissue portions together, while drawing one or both of the surgical needles outwardly from the wound until the two portions of the suture are located substantially in respective tissue portions at opposed sides of the separation and the suture is drawn substantially tight so as to bind the two tissue portions together in a substantially closed position, and
(f) severing the suture from the two surgical needles.

10. The surgical method of claim 9, wherein the surgical needles are detachable needles, detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from the two surgical needles comprises, while conducting the step of pulling the needle out of the tissue, pulling each needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue.

11. The surgical method of claim 10, wherein the two tissue portions comprise two sides of an open wound at the skin of a patient.

12. The surgical method of claim 9, wherein the suture is formed of nylon.

13. The surgical method of claim 9, wherein the suture is formed of a resorbable material.

14. The surgical method of claim 9, wherein the two tissue portions are portions of a tendon which is at least partially severed.

15. The surgical method of claim 9, wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, wherein the suture includes leading end regions free of barbs, adjacent to the trailing end of each surgical needle, and including leaving the barb free regions of the suture just below the skin to avoid pulling in of the skin.

16. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:

selecting one or more paths through the patient's facial tissue on which lines of facial tissue support are desired,
selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the facial tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the facial tissue in one direction only, the barbs permitting movement of the suture through the facial tissue in the direction the needle is inserted,
pushing the needle into the facial tissue, below the skin and along the selected path for the desired line of facial tissue support, until the needle extends out through the skin at a distal end of the selected path,
gripping the needle from its point end and pulling the needle out of the patient's facial tissue, leaving the one-way suture lying within the facial tissue along the selected path,
severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of facial tissue support, to place additional one-way sutures below the skin at said additional desired lines of facial tissue support,
applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of facial tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired facial tissue support.

17. The surgical method of claim 16, wherein the trailing end of each suture is secured to facial tissue of the patient.

18. The surgical method of claim 16, A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:

selecting one or more paths through the patient's tissue on which lines of tissue support are desired,
selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted,
pushing the needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the needle extends out through the skin at a distal end of the selected path,
gripping the needle from its point end and pulling the needle out of the patient's tissue, leaving the one-way suture lying within the tissue along the selected path,
severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of tissue support, to place additional one-way sutures below the skin at said additional desired lines of tissue support,
applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired tissue support, wherein the trailing end of each suture is secured to a trailing end of another one-way suture which extends in essentially an opposite another direction.

19. The surgical method of claim 16, wherein the surgical needle is a detachable needle which detaches from the suture under a prescribed degree of pulling force, and wherein the step of severing the sutures from the surgical needle comprises, while conducting the step of pulling the needle out of the facial tissue, restraining the trailing end of the suture and pulling the needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is at a selected depth below the surface of the skin, thereby leaving the suture at said selected depth.

20. The surgical method of claim 19, wherein the surgical needle has near its trailing end metric markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching the needle at a desired depth by reference to the metric markings.

21. A surgical method for bringing and holding together two tissue portions in a living patient, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:

(a) at the tissue separation, inserting a surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted,
(b) pushing the needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the needle from its point end and pulling the needle out of the tissue, leaving a trailing end of the suture in the tissue separation,
(c) severing the suture from the needle,
(d) repeating the procedure of step (a) at the opposite side of the tissue separation, in the other tissue portion, at a position to form a suture pair of two sutures located across the tissue separation from one another,
(e) repeating steps (b) and (c) at said opposite side of the tissue separation, in said other tissue portion,
(f) repeating steps (a) through (e) to form additional suture pairs as necessary at further locations in the tissue separation depending on the size of the tissue separation,
(g) bringing the two tissue portions together, and
(h) connecting together trailing ends of the two sutures of each suture pair to bind the tissue separation in a closed position to facilitate regrowth together of the two tissue portions.

22. The surgical method of claim 21, wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion.

23. The surgical method of claim 21, wherein the two tissue portions comprise sections of a tendon of the patient.

24. The surgical method of claim 23, wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion.

25. The surgical method of claim 21, wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, and wherein the step of severing the sutures comprises severing the sutures below the skin surface.

26. The surgical method of claim 21, wherein the surgical needle is a detachable needle, detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from the surgical needle comprises, while conducting the step of pulling the needle out of the tissue, pulling the needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue.

27. A surgical needle and suture combination, comprising:

a surgical needle,
a one-way suture having a series of exterior barbs providing for gripping of tissue in one direction only, the barbs permitting movement of the suture through tissue in the direction the needle is inserted,
a detachable connection means securing the trailing end of the needle to a leading end of the suture, for releasing the needle from the suture when the needle pulls the suture with a prescribed amount of tension, and
the needle having near its trailing end metric markings as a visual reference indicating distance from the trailing end of the needle, whereby a surgeon can predetermine a depth at which the needle is released from the suture by reference to the markings.

28. The surgical method according to claim 16 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture.

29. The surgical method according to claim 17 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture.

30. The surgical method according to claim 19 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture.

31. The surgical method according to claim 20 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture.

32. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:

selecting one or more paths through the patient's tissue on which lines of tissue support are desired,
selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted,
pushing the needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the needle extends out through the skin at a distal end of the selected path,
gripping the needle from its point end and pulling the needle out of the patient's tissue, leaving the one-way suture lying within the tissue along the selected path,
severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of tissue support, to place additional one-way sutures below the skin at said additional desired lines of tissue support,
applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired tissue support for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, said method further including providing tissue support in the facelift operation from the sutures themselves.

33. The surgical method according to claim 32 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, said method comprising: the one-way suture being a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture.

34. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:

selecting one or more paths through the patient's skin and adjacent subcutaneous tissue on which lines of tissue support are desired;
selecting a first surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the first surgical needle having a trailing end wherein a double armed suture extends between and has its ends secured to the trailing ends of the first surgical needle and a second such surgical needle, the two needles oriented in opposite directions, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted;
pushing the first needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the first needle extends out through the skin at a distal end of the selected path;
pulling the first needle out of the patient's tissue, leaving the first portion of the suture lying within the tissue along the selected path;
as needed for the particular facelift operation, inserting the second needle in an additional selected path through the patient's skin and adjacent subcutaneous tissue for an additional desired line of tissue support, to place the second portion of the suture below the skin at said additional desired line of tissue support, until the second needle extends out through the skin at a distal end of the additional selected path;
pulling the second needle out of the patient's tissue, leaving the second portion of the suture lying within the tissue along the additional selected path;
applying tension to the suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, in the tensioned condition, such that the desired lines of support are placed in tension to provide the desired tissue support, and
severing the suture from each needle.

35. The surgical method of claim 34, wherein the surgical needles are detachable needles which detach from the suture under a prescribed degree of pulling force, and wherein the step of severing the sutures from the needles comprises, while conducting the step of pulling each needle out of the tissue, restraining the suture and pulling each needle with sufficient force to detach each needle from the suture at a position wherein the trailing end of each needle is at a selected depth below the surface of the skin, thereby leaving the suture at said selected depth.

36. The surgical method of claim 34, wherein each surgical needle has near its trailing end markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching each needle at a desired depth by reference to the markings.

37. The method of claim 34, wherein the barbs extend outwardly somewhat on the suture.

38. The method of claim 34, wherein the suture has said barbs at staggered positions along the suture.

39. The method of claim 34, wherein the suture has barbs at helical positions along the suture.

40. The method of claim 34, wherein the suture has barbs at opposing positions on either side along the suture.

41. The method of claim 34, wherein the suture is about 100 to about 500 microns in diameter.

42. The method of claim 34, wherein the suture is formed of non-absorbable material.

43. The method of claim 34, wherein the suture is formed of bioabsorbable material.

44. A surgical method for bringing and holding together two tissue portions in a living patient, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:

(a) at the tissue separation, inserting a first surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the first surgical needle having a trailing end wherein a double-armed suture extends between and has its ends secured to the trailing ends of the first surgical needle and a second such surgical needle, the two needles oriented in opposite directions, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted,
(b) pushing the first needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the first needle from its point end and pulling the first needle out of the tissue, leaving the first portion of the suture in the tissue separation,
(c) repeating the procedure of steps (a) and (b) at the opposite side of the tissue separation, in the other tissue portion, with the second needle at a position located across the tissue separation,
(d) repeating steps (a), (b) and (c) using additional double-armed sutures as necessary at further locations in the tissue separation depending on the size of the tissue separation,
(e) bringing the two tissue portions together to bind the tissue separation in a closed position to facilitate regrowth together of the two tissue portions, and
(f) severing the suture from each needle.

45. The surgical method of claim 44, wherein the two tissue portions comprise sections of a tendon of the patient.

46. The surgical method of claim 44, wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, and wherein the step of severing the sutures comprises severing the sutures below the skin surface.

47. The surgical method of claim 44, wherein each surgical needle is a detachable needle detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from each needle comprises, while conducting the step of pulling each needle out of the tissue, pulling each needle with sufficient force to detach it from the suture at a position wherein the trailing end of each needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue.

48. The method of claim 44, wherein the barbs extend outwardly somewhat on the suture.

49. The method of claim 44, wherein the suture has said barbs at staggered positions along the suture.

50. The method of claim 44, wherein the suture has barbs at helical positions along the suture.

51. The method of claim 44, wherein the suture has barbs at opposing positions on either side along the suture.

52. The method of claim 44, wherein the suture is about 100 to about 500 microns in diameter.

53. The method of claim 44, wherein the suture is formed of non-absorbable material.

54. The method of claim 44, wherein the suture is formed of bioabsorbable material.

Referenced Cited
U.S. Patent Documents
709392 September 1902 Brown
733723 July 1903 Lukens
816026 March 1906 Meier
879758 February 1908 Foster
1142510 June 1915 Engle
1248825 December 1917 Dederer
1321011 November 1919 Cottes
1558037 October 1925 Morton
1728316 September 1929 Von Wachenfeldt
1886721 November 1932 O'Brien
2094578 October 1937 Blumenthal et al.
2201610 May 1940 Dawson, Jr.
2232142 February 1941 Schumann
2254620 September 1941 Miller
2347956 May 1944 Lansing
2355907 August 1944 Cox
2421193 May 1947 Gardner
2452734 November 1948 Costelow
2472009 May 1949 Gardner
2480271 August 1949 Sumner
2572938 October 1951 Kulp at al.
2684070 July 1954 Kelsey
2736964 March 1956 Lieberman
2779083 January 1957 Enton
2814296 November 1957 Everett
2817339 December 1957 Sullivan
2866256 December 1958 Matlin
2910067 October 1959 White
2928395 March 1960 Forbes et al.
2988028 June 1961 Alcamo
3003155 October 1961 Mielzynski et al.
3066452 December 1962 Bott et al.
3066673 December 1962 Bott et al.
3068869 December 1962 Shelden et al.
3068870 December 1962 Levin
3082523 March 1963 Modes et al.
3123077 March 1964 Alcamo
3166072 January 1965 Sullivan, Jr.
3187752 June 1965 Glick
3206018 September 1965 Lewis et al.
3209652 October 1965 Burgsmueller
3209754 October 1965 Brown
3212187 October 1965 Benedict
3214810 November 1965 Mathison
3221746 December 1965 Noble
3234636 February 1966 Brown
3273562 September 1966 Brown
3352191 November 1967 Crawford
3378010 April 1968 Codling
3385299 May 1968 Le Roy
3394704 July 1968 Dery
3494006 February 1970 Brumlik
3522637 August 1970 Brumlik
3525340 August 1970 Gilbert
3527223 September 1970 Shein
3545608 December 1970 Berger et al.
3557795 January 1971 Hirsch
3570497 March 1971 Lemole
3586002 June 1971 Wood
3608095 September 1971 Barry
3608539 September 1971 Miller
3618447 November 1971 Goins
3646615 March 1972 Ness
3683926 August 1972 Suzuki
3700433 October 1972 Duhl
3716058 February 1973 Tanner, Jr.
3720055 March 1973 de Mestral et al.
3748701 July 1973 De Mestral
3762418 October 1973 Wasson
3825010 July 1974 McDonald
3833972 September 1974 Brumlik
3845641 November 1974 Waller
3847156 November 1974 Trumble
3889322 June 1975 Brumlik
3918455 November 1975 Coplan
3922455 November 1975 Brumlik
3941164 March 2, 1976 Musgrave
3963031 June 15, 1976 Hunter
3977937 August 31, 1976 Candor
3980177 September 14, 1976 McGregor
3981051 September 21, 1976 Brumlik
3981307 September 21, 1976 Borysko
3985138 October 12, 1976 Jarvik
3990144 November 9, 1976 Schwartz
4006747 February 8, 1977 Kronenthal
4008303 February 15, 1977 Glick et al.
4027608 June 7, 1977 Arbuckle
4043344 August 23, 1977 Landi
4052988 October 11, 1977 Doddi et al.
D246911 January 10, 1978 Bess, Jr. et al.
4069825 January 24, 1978 Akiyama
4073298 February 14, 1978 Le Roy
4137921 February 6, 1979 Okuzumi et al.
4182340 January 8, 1980 Spencer
4186239 January 29, 1980 Mize et al.
4198734 April 22, 1980 Brumlik
4204541 May 27, 1980 Kapitanov
4204542 May 27, 1980 Bokros et al.
4259959 April 7, 1981 Walker
4278374 July 14, 1981 Wolosianski
4300424 November 17, 1981 Flinn
4311002 January 1982 Hoffmann et al.
4313448 February 2, 1982 Stokes
4316469 February 23, 1982 Kapitanov
4317451 March 2, 1982 Cerwin et al.
4372293 February 8, 1983 Vijil-Rosales
4428376 January 31, 1984 Mericle
4430998 February 14, 1984 Harvey
4434796 March 6, 1984 Karapetian
4449298 May 22, 1984 Patz
4454875 June 19, 1984 Pratt et al.
4467805 August 28, 1984 Fukuda
4490326 December 25, 1984 Beroff et al.
4492075 January 8, 1985 Faure
4493323 January 15, 1985 Albright et al.
4505274 March 19, 1985 Speelman
4510934 April 16, 1985 Batra
4531522 July 30, 1985 Bedi et al.
4532926 August 6, 1985 O'Holla
4535772 August 20, 1985 Sheehan
4548202 October 22, 1985 Duncan
4553544 November 19, 1985 Nomoto et al.
4610250 September 9, 1986 Green
4610251 September 9, 1986 Kumar
4635637 January 13, 1987 Schreiber
4637380 January 20, 1987 Orejola
4653486 March 31, 1987 Coker
4669473 June 2, 1987 Richards et al.
4676245 June 30, 1987 Fukuda
4689882 September 1, 1987 Lorenz
4702250 October 27, 1987 Ovil et al.
4712553 December 15, 1987 MacGregor
4719917 January 19, 1988 Barrows
4741330 May 3, 1988 Hayhurst
4750910 June 14, 1988 Takayanagi et al.
4776337 October 11, 1988 Palmaz
4832025 May 23, 1989 Coates
4841960 June 27, 1989 Garner
4865026 September 12, 1989 Barrett
4873976 October 17, 1989 Schreiber
4887601 December 19, 1989 Richards
4895148 January 23, 1990 Bays et al.
4898156 February 6, 1990 Gatturna et al.
4899743 February 13, 1990 Nicholson et al.
4900605 February 13, 1990 Thorgersen et al.
4905367 March 6, 1990 Pinchuk et al.
4930945 June 5, 1990 Arai et al.
4932962 June 12, 1990 Yoon et al.
4946468 August 7, 1990 Li
4948444 August 14, 1990 Schultz et al.
4950258 August 21, 1990 Kawai et al.
4950285 August 21, 1990 Wilk
4968315 November 6, 1990 Gatturna
4976715 December 11, 1990 Bays et al.
4979956 December 25, 1990 Silvestrini et al.
4981149 January 1, 1991 Yoon
4994073 February 19, 1991 Green
4994084 February 19, 1991 Brennan
4997439 March 5, 1991 Chen
5002550 March 26, 1991 Li
5002562 March 26, 1991 Oberlander
5007921 April 16, 1991 Brown
5007922 April 16, 1991 Chen et al.
5026390 June 25, 1991 Brown
5037422 August 6, 1991 Hayhurst et al.
5037433 August 6, 1991 Wilk et al.
5041129 August 20, 1991 Hayhurst et al.
5046513 September 10, 1991 Gatturna et al.
5047047 September 10, 1991 Yoon
5053047 October 1, 1991 Yoon
5084063 January 28, 1992 Korthoff
5089010 February 18, 1992 Korthoff
5102418 April 7, 1992 Granger et al.
5102421 April 7, 1992 Anpach, Jr.
5103073 April 7, 1992 Danilov et al.
5112344 May 12, 1992 Petros
5123911 June 23, 1992 Granger et al.
5123913 June 23, 1992 Wilk et al.
5123919 June 23, 1992 Sauter et al.
5127413 July 7, 1992 Ebert
5133738 July 28, 1992 Korthoff et al.
5141520 August 25, 1992 Goble et al.
5147382 September 15, 1992 Gertzman et al.
5156615 October 20, 1992 Korthoff et al.
5156788 October 20, 1992 Chesterfield et al.
5176692 January 5, 1993 Wilk et al.
5179964 January 19, 1993 Cook
5192274 March 9, 1993 Bierman
5192302 March 9, 1993 Kensey et al.
5192303 March 9, 1993 Gatturna et al.
5197597 March 30, 1993 Leary et al.
5201326 April 13, 1993 Kubicki et al.
5207679 May 4, 1993 Li
5207694 May 4, 1993 Broome
5217486 June 8, 1993 Rice et al.
5217494 June 8, 1993 Coggins et al.
5222508 June 29, 1993 Contarini
5222976 June 29, 1993 Yoon
5224946 July 6, 1993 Hayhurst et al.
5234006 August 10, 1993 Eaton et al.
5242457 September 7, 1993 Akopov et al.
5246441 September 21, 1993 Ross et al.
5258013 November 2, 1993 Granger et al.
5259846 November 9, 1993 Granger et al.
5263973 November 23, 1993 Cook
5269783 December 14, 1993 Sander
5282832 February 1, 1994 Toso et al.
5292326 March 8, 1994 Green et al.
5306288 April 26, 1994 Granger et al.
5306290 April 26, 1994 Martins et al.
5312422 May 17, 1994 Trott
5320629 June 14, 1994 Noda et al.
5330488 July 19, 1994 Goldrath
5330503 July 19, 1994 Yoon
5336239 August 9, 1994 Gimpelson
5342376 August 30, 1994 Ruff
5342395 August 30, 1994 Jarrett et al.
5350385 September 27, 1994 Christy
5352515 October 4, 1994 Jarrett et al.
5354271 October 11, 1994 Voda
5354298 October 11, 1994 Lee et al.
5358511 October 25, 1994 Gatturna et al.
5363556 November 15, 1994 Banholzer et al.
5372146 December 13, 1994 Branch
5374268 December 20, 1994 Sander
5374278 December 20, 1994 Chesterfield et al.
5380334 January 10, 1995 Torrie et al.
5391173 February 21, 1995 Wilk
5403346 April 4, 1995 Loeser
5411523 May 2, 1995 Goble
5414988 May 16, 1995 DiPalma et al.
5417691 May 23, 1995 Hayhurst
5425746 June 20, 1995 Proto et al.
5425747 June 20, 1995 Brotz
5437680 August 1, 1995 Yoon et al.
5450860 September 19, 1995 O'Connor
5451461 September 19, 1995 Broyer
5462561 October 31, 1995 Voda
5464422 November 7, 1995 Silverman
5464426 November 7, 1995 Bonutti
5464427 November 7, 1995 Curtis et al.
5472452 December 5, 1995 Trott
5478353 December 26, 1995 Yoon
5480403 January 2, 1996 Lee et al.
5480411 January 2, 1996 Liu et al.
5484451 January 16, 1996 Akopov et al.
5486197 January 23, 1996 Le et al.
5500000 March 19, 1996 Feagin et al.
5500991 March 26, 1996 Demarest et al.
5520084 May 28, 1996 Chesterfield et al.
5520691 May 28, 1996 Branch
5522845 June 4, 1996 Wenstrom, Jr.
5527342 June 18, 1996 Pietrzak et al.
5531760 July 2, 1996 Alwafaie
5531761 July 2, 1996 Yoon
5531790 July 2, 1996 Frechet et al.
5533982 July 9, 1996 Rizk et al.
5536582 July 16, 1996 Prasad et al.
5540705 July 30, 1996 Meade et al.
5540718 July 30, 1996 Bartlett
5545148 August 13, 1996 Wurster
5546957 August 20, 1996 Heske
5549631 August 27, 1996 Bonutti
5554171 September 10, 1996 Gatturna et al.
5569272 October 29, 1996 Reed et al.
5571139 November 5, 1996 Jenkins, Jr.
5571175 November 5, 1996 Vanney et al.
5571216 November 5, 1996 Anderson
5573543 November 12, 1996 Akopov et al.
5584859 December 17, 1996 Brotz
5593424 January 14, 1997 Northrup, III et al.
5601557 February 11, 1997 Hayhurst
5626590 May 6, 1997 Wilk
5626611 May 6, 1997 Liu et al.
5632753 May 27, 1997 Loeser
5643288 July 1, 1997 Thompson
5643295 July 1, 1997 Yoon
5643319 July 1, 1997 Green et al.
5645568 July 8, 1997 Chervitz et al.
5647874 July 15, 1997 Hayhurst
5649939 July 22, 1997 Reddick
5653716 August 5, 1997 Malo et al.
5662714 September 2, 1997 Charvin et al.
5669935 September 23, 1997 Rosenman et al.
5676675 October 14, 1997 Grice
D386583 November 18, 1997 Ferragamo et al.
5683417 November 4, 1997 Cooper
D387161 December 2, 1997 Ferragamo et al.
5693072 December 2, 1997 McIntosh
5695879 December 9, 1997 Goldmann et al.
5697976 December 16, 1997 Chesterfield et al.
5702397 December 30, 1997 Goble et al.
5702462 December 30, 1997 Oberlander
5709692 January 20, 1998 Mollenauer et al.
5716358 February 10, 1998 Ochoa et al.
5716376 February 10, 1998 Roby et al.
5722991 March 3, 1998 Colligan
5723008 March 3, 1998 Gordon
5725557 March 10, 1998 Gatturna et al.
5728114 March 17, 1998 Evans et al.
5731855 March 24, 1998 Koyama et al.
5741277 April 21, 1998 Gordon et al.
5744151 April 28, 1998 Capelli
5763411 June 9, 1998 Edwardson et al.
5765560 June 16, 1998 Verkerke et al.
5766246 June 16, 1998 Mulhauser et al.
5779719 July 14, 1998 Klein et al.
5782864 July 21, 1998 Lizardi
5807403 September 15, 1998 Beyar et al.
5807406 September 15, 1998 Brauker et al.
5810853 September 22, 1998 Yoon
5814051 September 29, 1998 Wenstrom, Jr.
5843087 December 1, 1998 Jensen et al.
5843178 December 1, 1998 Vanney et al.
5855619 January 5, 1999 Caplan et al.
5863360 January 26, 1999 Wood et al.
5887594 March 30, 1999 LoCicero, III
5891166 April 6, 1999 Schervinsky
5893856 April 13, 1999 Jacob et al.
5895395 April 20, 1999 Yeung
5895413 April 20, 1999 Nordstrom
5897572 April 27, 1999 Schulsinger et al.
5899911 May 4, 1999 Carter
5919234 July 6, 1999 Lemperle et al.
5921982 July 13, 1999 Lesh et al.
5925078 July 20, 1999 Anderson
5938668 August 17, 1999 Scirica et al.
5941899 August 24, 1999 Granger et al.
5950633 September 14, 1999 Lynch et al.
5964783 October 12, 1999 Grafton et al.
5968097 October 19, 1999 Frechet et al.
5972024 October 26, 1999 Northrup, III et al.
5984933 November 16, 1999 Yoon
5993459 November 30, 1999 Larsen et al.
6012216 January 11, 2000 Esteves et al.
6015410 January 18, 2000 Tormala et al.
6027523 February 22, 2000 Schmieding
6039741 March 21, 2000 Meislin
6045571 April 4, 2000 Hill et al.
6056778 May 2, 2000 Grafton et al.
6063105 May 16, 2000 Totakura
6071292 June 6, 2000 Makower et al.
6074419 June 13, 2000 Healy et al.
6076255 June 20, 2000 Shikakubo et al.
6083244 July 4, 2000 Lubbers et al.
6102947 August 15, 2000 Gordon
6106544 August 22, 2000 Brazeau
6110484 August 29, 2000 Sierra
6129741 October 10, 2000 Wurster et al.
D433753 November 14, 2000 Weiss
6149660 November 21, 2000 Laufer et al.
6159234 December 12, 2000 Bonutti et al.
6163948 December 26, 2000 Esteves et al.
6187095 February 13, 2001 Labrecque et al.
6203565 March 20, 2001 Bonutti et al.
6206908 March 27, 2001 Roby
6231911 May 15, 2001 Steinback et al.
6235869 May 22, 2001 Roby et al.
6241747 June 5, 2001 Ruff
6251143 June 26, 2001 Schwartz et al.
6264675 July 24, 2001 Brotz
6267772 July 31, 2001 Mulhauser et al.
6270517 August 7, 2001 Brotz
6315788 November 13, 2001 Roby
6319231 November 20, 2001 Andrulitis
6322581 November 27, 2001 Fukuda et al.
6334865 January 1, 2002 Redmond et al.
6383201 May 7, 2002 Dong
6387363 May 14, 2002 Gruskin
6388043 May 14, 2002 Langer et al.
6395029 May 28, 2002 Levy
D462766 September 10, 2002 Jacobs et al.
6443962 September 3, 2002 Gaber
6471715 October 29, 2002 Weiss
6478809 November 12, 2002 Brotz
6485503 November 26, 2002 Jacobs et al.
6491701 December 10, 2002 Tierney et al.
6491714 December 10, 2002 Bennett
6494898 December 17, 2002 Roby et al.
6495127 December 17, 2002 Wallace et al.
RE37963 January 7, 2003 Thal
6506190 January 14, 2003 Walshe
6506197 January 14, 2003 Rollero et al.
6511488 January 28, 2003 Marshall et al.
6514265 February 4, 2003 Ho et al.
6527795 March 4, 2003 Lizardi
6548002 April 15, 2003 Gresser et al.
6548569 April 15, 2003 Williams et al.
6551343 April 22, 2003 Tormala et al.
6554802 April 29, 2003 Pearson et al.
6565597 May 20, 2003 Fearnot et al.
6592609 July 15, 2003 Bonutti
6596296 July 22, 2003 Nelson et al.
6599310 July 29, 2003 Leung et al.
6607541 August 19, 2003 Gardiner et al.
6610078 August 26, 2003 Bru-Magniez et al.
6613059 September 2, 2003 Schaller et al.
6613254 September 2, 2003 Shiffer
6616982 September 9, 2003 Merrill et al.
6623492 September 23, 2003 Berube et al.
6626930 September 30, 2003 Allen et al.
6632245 October 14, 2003 Kim
6641592 November 4, 2003 Sauer et al.
6641593 November 4, 2003 Schaller et al.
6645226 November 11, 2003 Jacobs et al.
6645227 November 11, 2003 Fallin et al.
6648921 November 18, 2003 Anderson et al.
6656182 December 2, 2003 Hayhurst
6689153 February 10, 2004 Skiba
6689166 February 10, 2004 Laurencin et al.
6692761 February 17, 2004 Mahmood et al.
6702844 March 9, 2004 Lazarus
6712830 March 30, 2004 Esplin
6712859 March 30, 2004 Rousseau et al.
6716234 April 6, 2004 Grafton et al.
6720402 April 13, 2004 Langer et al.
6726705 April 27, 2004 Peterson et al.
6746443 June 8, 2004 Morley et al.
6746458 June 8, 2004 Cloud
6749616 June 15, 2004 Nath
6773450 August 10, 2004 Leung et al.
6783554 August 31, 2004 Amara et al.
6814748 November 9, 2004 Baker et al.
6818010 November 16, 2004 Eichhorn et al.
6838493 January 4, 2005 Williams et al.
6848152 February 1, 2005 Genova et al.
6852825 February 8, 2005 Ledlein et al.
6860891 March 1, 2005 Schulze
6860901 March 1, 2005 Baker et al.
6867248 March 15, 2005 Martin et al.
6877934 April 12, 2005 Gainer
6881766 April 19, 2005 Hain
6893452 May 17, 2005 Jacobs
6905484 June 14, 2005 Buckman et al.
6911035 June 28, 2005 Blomme
6911037 June 28, 2005 Gainor et al.
6913607 July 5, 2005 Ainsworth et al.
6921811 July 26, 2005 Zamora et al.
6923819 August 2, 2005 Meade et al.
6945021 September 20, 2005 Michel
6945980 September 20, 2005 Nguyen et al.
6960221 November 1, 2005 Ho et al.
6960233 November 1, 2005 Berg et al.
6974450 December 13, 2005 Weber et al.
6981983 January 3, 2006 Rosenblatt et al.
6984241 January 10, 2006 Lubbers et al.
6986780 January 17, 2006 Rudnick et al.
6991643 January 31, 2006 Saadat
6996880 February 14, 2006 Kurtz, Jr.
7021316 April 4, 2006 Leiboff
7033379 April 25, 2006 Peterson
7037984 May 2, 2006 Ledlein et al.
7048748 May 23, 2006 Ustuner
7056331 June 6, 2006 Kaplan et al.
7056333 June 6, 2006 Walshe
7057135 June 6, 2006 Li
7063716 June 20, 2006 Cunningham
7070610 July 4, 2006 Im et al.
7081135 July 25, 2006 Smith et al.
7083637 August 1, 2006 Tannhauser
7083648 August 1, 2006 Yu et al.
7107090 September 12, 2006 Salisbury, Jr. et al.
7112214 September 26, 2006 Peterson et al.
7125403 October 24, 2006 Julian et al.
7125413 October 24, 2006 Grigoryants et al.
D532107 November 14, 2006 Peterson et al.
7138441 November 21, 2006 Zhang
7141302 November 28, 2006 Mueller et al.
7144401 December 5, 2006 Yamamoto et al.
7144412 December 5, 2006 Wolf et al.
7144415 December 5, 2006 DelRio et al.
7150757 December 19, 2006 Fallin et al.
7156858 January 2, 2007 Shuldt-Hempe et al.
7156862 January 2, 2007 Jacobs et al.
7160312 January 9, 2007 Saadat
7172595 February 6, 2007 Goble
7172615 February 6, 2007 Morriss et al.
7186262 March 6, 2007 Saadat
7195634 March 27, 2007 Schmieding et al.
7211088 May 1, 2007 Grafton et al.
7214230 May 8, 2007 Brock et al.
7217744 May 15, 2007 Lendlein et al.
7225512 June 5, 2007 Genova et al.
7226468 June 5, 2007 Ruff
7232447 June 19, 2007 Gellman et al.
7244270 July 17, 2007 Lesh et al.
7279612 October 9, 2007 Heaton et al.
7297142 November 20, 2007 Brock
7322105 January 29, 2008 Lewis
7371253 May 13, 2008 Leung et al.
7513904 April 7, 2009 Sulamanidze et al.
7582105 September 1, 2009 Kolster
7601164 October 13, 2009 Wu
7624487 December 1, 2009 Trull et al.
7645293 January 12, 2010 Martinek et al.
7806908 October 5, 2010 Ruff
7857829 December 28, 2010 Kaplan et al.
7879072 February 1, 2011 Bonutti et al.
7919112 April 5, 2011 Pathak et al.
8118834 February 21, 2012 Goraltchouk et al.
8216273 July 10, 2012 Goraltchouk et al.
8226684 July 24, 2012 Nawrocki et al.
8308761 November 13, 2012 Brailovski et al.
8615856 December 31, 2013 Gelbart
20010011187 August 2, 2001 Pavcnik et al.
20010018592 August 30, 2001 Schaller et al.
20010018599 August 30, 2001 D'Aversa et al.
20010039450 November 8, 2001 Pavcnik et al.
20010051807 December 13, 2001 Grafton
20020007218 January 17, 2002 Cauthen
20020022861 February 21, 2002 Jacobs et al.
20020029011 March 7, 2002 Dyer
20020029066 March 7, 2002 Foerster
20020077448 June 20, 2002 Antal et al.
20020095164 July 18, 2002 Andreas et al.
20020099394 July 25, 2002 Houser et al.
20020111641 August 15, 2002 Peterson et al.
20020111688 August 15, 2002 Cauthen
20020138009 September 26, 2002 Brockway et al.
20020151932 October 17, 2002 Bryant et al.
20020151980 October 17, 2002 Cauthen
20020161168 October 31, 2002 Shalaby et al.
20020165555 November 7, 2002 Stein et al.
20020173822 November 21, 2002 Justin et al.
20020179718 December 5, 2002 Murokh et al.
20030040795 February 27, 2003 Elson et al.
20030069602 April 10, 2003 Jacobs et al.
20030088270 May 8, 2003 Lubbers et al.
20030149447 August 7, 2003 Morency
20030158604 August 21, 2003 Cauthen, III et al.
20030167072 September 4, 2003 Oberlander
20030199923 October 23, 2003 Khairkhahan et al.
20030203003 October 30, 2003 Nelson et al.
20030204193 October 30, 2003 Gabriel et al.
20030204195 October 30, 2003 Keane et al.
20030225424 December 4, 2003 Benderev
20030229361 December 11, 2003 Jackson
20030236551 December 25, 2003 Peterson
20040006353 January 8, 2004 Bosley, Jr. et al.
20040010275 January 15, 2004 Jacobs et al.
20040010276 January 15, 2004 Jacobs et al.
20040015187 January 22, 2004 Lendlein et al.
20040024169 February 5, 2004 Shalaby et al.
20040024420 February 5, 2004 Lubbers et al.
20040030354 February 12, 2004 Leung et al.
20040039415 February 26, 2004 Zamierowski
20040049224 March 11, 2004 Buehlmann et al.
20040059370 March 25, 2004 Greene, Jr. et al.
20040059377 March 25, 2004 Peterson et al.
20040060409 April 1, 2004 Leung et al.
20040060410 April 1, 2004 Leung et al.
20040068293 April 8, 2004 Scalzo et al.
20040068294 April 8, 2004 Scalzo et al.
20040088003 May 6, 2004 Leung et al.
20040093023 May 13, 2004 Allen et al.
20040098051 May 20, 2004 Fallin et al.
20040106949 June 3, 2004 Cohn et al.
20040116620 June 17, 2004 Shalaby et al.
20040138683 July 15, 2004 Shelton et al.
20040153153 August 5, 2004 Elson et al.
20040167572 August 26, 2004 Roth et al.
20040167575 August 26, 2004 Roby
20040186487 September 23, 2004 Klein et al.
20040193191 September 30, 2004 Starksen et al.
20040193217 September 30, 2004 Lubbers et al.
20040193257 September 30, 2004 Wu et al.
20040230223 November 18, 2004 Bonutti et al.
20040260340 December 23, 2004 Jacobs et al.
20040265282 December 30, 2004 Wright et al.
20040267309 December 30, 2004 Garvin
20050004601 January 6, 2005 Kong et al.
20050004602 January 6, 2005 Hart et al.
20050033324 February 10, 2005 Phan
20050034431 February 17, 2005 Dey et al.
20050038472 February 17, 2005 Furst
20050049636 March 3, 2005 Leiboff
20050055051 March 10, 2005 Grafton
20050059984 March 17, 2005 Chanduszko et al.
20050065533 March 24, 2005 Magen et al.
20050070959 March 31, 2005 Cichocki, Jr.
20050080455 April 14, 2005 Schmieding et al.
20050085857 April 21, 2005 Peterson et al.
20050096698 May 5, 2005 Lederman
20050113936 May 26, 2005 Brustad et al.
20050119694 June 2, 2005 Jacobs et al.
20050125020 June 9, 2005 Meade et al.
20050125034 June 9, 2005 Cichocki, Jr.
20050125035 June 9, 2005 Cichocki, Jr.
20050149064 July 7, 2005 Peterson et al.
20050149118 July 7, 2005 Koyfman et al.
20050154255 July 14, 2005 Jacobs
20050171561 August 4, 2005 Songer et al.
20050177190 August 11, 2005 Zamierowski
20050181009 August 18, 2005 Hunter et al.
20050182444 August 18, 2005 Peterson et al.
20050182445 August 18, 2005 Zamierowski
20050186247 August 25, 2005 Hunter et al.
20050197699 September 8, 2005 Jacobs et al.
20050199249 September 15, 2005 Karram
20050203576 September 15, 2005 Sulamanidze et al.
20050209542 September 22, 2005 Jacobs et al.
20050209612 September 22, 2005 Nakao
20050234510 October 20, 2005 Zamierowski
20050240220 October 27, 2005 Zamierowski
20050267531 December 1, 2005 Ruff et al.
20050267532 December 1, 2005 Wu
20050277984 December 15, 2005 Long
20050283246 December 22, 2005 Cauthen, III et al.
20060020272 January 26, 2006 Gildenberg
20060030884 February 9, 2006 Young et al.
20060036266 February 16, 2006 Sulamanidze et al.
20060058470 March 16, 2006 Rizk
20060058574 March 16, 2006 Priewe et al.
20060058799 March 16, 2006 Elson et al.
20060058844 March 16, 2006 White et al.
20060063476 March 23, 2006 Dore
20060064115 March 23, 2006 Allen et al.
20060064116 March 23, 2006 Allen et al.
20060064127 March 23, 2006 Fallin et al.
20060079469 April 13, 2006 Anderson et al.
20060079935 April 13, 2006 Kolster
20060085016 April 20, 2006 Eremia
20060089525 April 27, 2006 Mamo et al.
20060089672 April 27, 2006 Martinek
20060111734 May 25, 2006 Kaplan et al.
20060111742 May 25, 2006 Kaplan et al.
20060116503 June 1, 2006 Lendlein et al.
20060122608 June 8, 2006 Fallin et al.
20060135994 June 22, 2006 Ruff
20060135995 June 22, 2006 Ruff
20060140999 June 29, 2006 Lendlein et al.
20060142784 June 29, 2006 Kontos
20060193769 August 31, 2006 Nelson et al.
20060194721 August 31, 2006 Allen
20060200062 September 7, 2006 Saadat
20060207612 September 21, 2006 Jackson et al.
20060229671 October 12, 2006 Steiner et al.
20060235445 October 19, 2006 Birk et al.
20060235447 October 19, 2006 Walshe
20060235516 October 19, 2006 Cavazzoni
20060241658 October 26, 2006 Cerundolo
20060249405 November 9, 2006 Cerwin et al.
20060253126 November 9, 2006 Bjerken et al.
20060257629 November 16, 2006 Lendlein et al.
20060258938 November 16, 2006 Hoffman et al.
20060272979 December 7, 2006 Lubbers et al.
20060276808 December 7, 2006 Arnal et al.
20060282099 December 14, 2006 Stokes et al.
20060286289 December 21, 2006 Prajapati et al.
20060287675 December 21, 2006 Prajapati et al.
20060287676 December 21, 2006 Prajapati et al.
20060293710 December 28, 2006 Foerster et al.
20070005109 January 4, 2007 Popadiuk et al.
20070005110 January 4, 2007 Collier et al.
20070016251 January 18, 2007 Roby
20070021779 January 25, 2007 Garvin et al.
20070027475 February 1, 2007 Pagedas
20070038249 February 15, 2007 Kolster
20070065663 March 22, 2007 Trull et al.
20070088135 April 19, 2007 Lendlein et al.
20070088391 April 19, 2007 McAlexander et al.
20070134292 June 14, 2007 Suokas et al.
20070135840 June 14, 2007 Schmieding
20070135843 June 14, 2007 Burkhart
20070151961 July 5, 2007 Kleine et al.
20070156175 July 5, 2007 Weadock et al.
20070167958 July 19, 2007 Sulamanidze et al.
20070187861 August 16, 2007 Geneva et al.
20070208355 September 6, 2007 Ruff
20070208377 September 6, 2007 Kaplan et al.
20070213770 September 13, 2007 Dreyfyss
20070219587 September 20, 2007 Accardo
20070224237 September 27, 2007 Hwang et al.
20070225642 September 27, 2007 Houser et al.
20070225761 September 27, 2007 Shetty
20070225763 September 27, 2007 Zwolinski et al.
20070233188 October 4, 2007 Hunt et al.
20070239206 October 11, 2007 Shelton, IV et al.
20070239207 October 11, 2007 Beramendi
20070257395 November 8, 2007 Lindh et al.
20070282247 December 6, 2007 Desai et al.
20070293892 December 20, 2007 Takasu
20080004490 January 3, 2008 Bosley, Jr. et al.
20080004603 January 3, 2008 Larkin et al.
20080009838 January 10, 2008 Schena et al.
20080009888 January 10, 2008 Ewers et al.
20080009902 January 10, 2008 Hunter et al.
20080027273 January 31, 2008 Gutterman
20080027486 January 31, 2008 Jones et al.
20080046094 February 21, 2008 Han et al.
20080058869 March 6, 2008 Stopek et al.
20080064839 March 13, 2008 Hadba et al.
20080066764 March 20, 2008 Paraschac et al.
20080066765 March 20, 2008 Paraschac et al.
20080066766 March 20, 2008 Paraschac et al.
20080066767 March 20, 2008 Paraschac et al.
20080077181 March 27, 2008 Jones et al.
20080082113 April 3, 2008 Bishop et al.
20080082129 April 3, 2008 Jones et al.
20080086169 April 10, 2008 Jones et al.
20080086170 April 10, 2008 Jones et al.
20080109036 May 8, 2008 Stopek et al.
20080131692 June 5, 2008 Rolland et al.
20080132943 June 5, 2008 Maiorino et al.
20080169059 July 17, 2008 Messersmith et al.
20080195147 August 14, 2008 Stopek
20080208358 August 28, 2008 Bellamkonda et al.
20080215072 September 4, 2008 Kelly
20080221618 September 11, 2008 Chen et al.
20080234731 September 25, 2008 Leung et al.
20080248216 October 9, 2008 Yeung et al.
20080255611 October 16, 2008 Hunter
20080262542 October 23, 2008 Sulamanidze et al.
20080281338 November 13, 2008 Wohlert et al.
20080281357 November 13, 2008 Sung et al.
20080312688 December 18, 2008 Naworocki et al.
20090012560 January 8, 2009 Hunter et al.
20090018577 January 15, 2009 Leung et al.
20090043336 February 12, 2009 Yuan et al.
20090076543 March 19, 2009 Maiorino et al.
20090082856 March 26, 2009 Flanagan
20090088835 April 2, 2009 Wang
20090099597 April 16, 2009 Isse
20090105753 April 23, 2009 Greenhalgh et al.
20090107965 April 30, 2009 D'Agostino
20090112236 April 30, 2009 Stopek
20090112259 April 30, 2009 D'Agostino
20090143819 June 4, 2009 D'Agostino
20090200487 August 13, 2009 Maiorino et al.
20090210006 August 20, 2009 Cohen et al.
20090216253 August 27, 2009 Bell et al.
20090226500 September 10, 2009 Avelar et al.
20090248066 October 1, 2009 Wilkie
20090248067 October 1, 2009 Maiorino
20090248070 October 1, 2009 Kosa et al.
20090250588 October 8, 2009 Robeson et al.
20090259233 October 15, 2009 Bogart et al.
20090259251 October 15, 2009 Cohen
20090287245 November 19, 2009 Ostrovsky et al.
20090299407 December 3, 2009 Yuan et al.
20090299408 December 3, 2009 Schuldt-Hempe et al.
20090306710 December 10, 2009 Lindh et al.
20090318958 December 24, 2009 Ochial
20100021516 January 28, 2010 McKay
20100023055 January 28, 2010 Rousseau
20100057123 March 4, 2010 D'Agostino et al.
20100063540 March 11, 2010 Maiorino
20100071833 March 25, 2010 Maiorino
20100087855 April 8, 2010 Leung et al.
20100101707 April 29, 2010 Maiorino et al.
20100160961 June 24, 2010 Nawrocki et al.
20100211097 August 19, 2010 Hadba et al.
20100211098 August 19, 2010 Hadba et al.
20100230300 September 16, 2010 Hunter et al.
20100292718 November 18, 2010 Sholev et al.
20100294103 November 25, 2010 Genova et al.
20100294104 November 25, 2010 Genova et al.
20100294105 November 25, 2010 Genova et al.
20100294106 November 25, 2010 Genova et al.
20100294107 November 25, 2010 Genova et al.
20100298637 November 25, 2010 Ruff
20100298639 November 25, 2010 Leung et al.
20100298848 November 25, 2010 Leung et al.
20100298867 November 25, 2010 Ruff
20100298868 November 25, 2010 Ruff
20100298871 November 25, 2010 Ruff et al.
20100298878 November 25, 2010 Leung et al.
20100298879 November 25, 2010 Leung et al.
20100298880 November 25, 2010 Leung et al.
20100313723 December 16, 2010 Genova et al.
20100313729 December 16, 2010 Genova et al.
20100313730 December 16, 2010 Genova et al.
20100318122 December 16, 2010 Leung et al.
20100318123 December 16, 2010 Leung et al.
20100318124 December 16, 2010 Leung et al.
20110009902 January 13, 2011 Leung et al.
20110046669 February 24, 2011 Goraltchouk et al.
20110106152 May 5, 2011 Kozlowski
20110130774 June 2, 2011 Criscuolo et al.
20110166597 July 7, 2011 Herrmann et al.
20120109188 May 3, 2012 Viola
Foreign Patent Documents
2309844 December 1996 CA
1810800 June 1970 DE
03227984 February 1984 DE
4302895 August 1994 DE
19618891 April 1997 DE
0121362 September 1987 EP
0329787 August 1989 EP
0513713 May 1992 EP
0 428 253 July 1994 EP
0632999 January 1995 EP
0513736 February 1995 EP
0464479 March 1995 EP
0464480 March 1995 EP
0 576 337 March 1997 EP
0574707 August 1997 EP
0612504 November 1997 EP
0558993 April 1998 EP
0913123 May 1999 EP
0916310 May 1999 EP
0664198 June 1999 EP
0960600 December 1999 EP
1075843 February 2001 EP
0705567 March 2002 EP
0673624 August 2002 EP
0839499 September 2003 EP
0755656 December 2003 EP
0826337 December 2005 EP
0991359 November 2007 EP
2338421 November 2012 EP
2619129 February 1989 FR
2693108 January 1994 FR
0267007 March 1927 GB
1091282 November 1967 GB
1428560 July 1973 GB
1508627 April 1978 GB
1506362 April 1978 JP
54-116419 September 1979 JP
63-288146 November 1988 JP
001113091 May 1989 JP
3-165751 July 1991 JP
4-096758 March 1992 JP
4-266749 September 1992 JP
9-103477 April 1997 JP
410085225 April 1998 JP
11-313826 November 1999 JP
011332828 December 1999 JP
2002-059235 February 2002 JP
2003-275217 September 2003 JP
2009-118967 June 2009 JP
10-2005-0072908 July 2005 KR
6013299 February 2006 KR
501224 March 2002 NZ
531262 December 2005 NZ
2139690 October 1999 RU
2175855 November 2001 RU
2241389 December 2004 RU
1745214 July 1992 SU
1752358 August 1992 SU
WO 96/06565 March 1966 WO
WO 86/00020 January 1986 WO
WO 87/01270 March 1987 WO
WO 88/09157 December 1988 WO
WO 89/05618 June 1989 WO
WO 90/09149 August 1990 WO
WO 90/14795 December 1990 WO
WO 92/22336 December 1992 WO
WO 95/16399 June 1995 WO
WO 95/29637 November 1995 WO
WO 98/52473 November 1998 WO
WO 98/55031 December 1998 WO
WO 00/51658 September 2000 WO
Other references
  • “Drilled End Surgical Needles”, B.G. Sulzle, Inc., Syracuse, New York, Jul. 2002.
  • “Up Lifting (Aptos Threads)”, http://www.ccpr.com.br/upl-l.htm, Aug. 19, 2002, pp. 1-2.
  • Sulamanidze et al., “Facial Lifting with “Aptos” Threads”, http://www.fonendo.com Jul. 18, 2001, pp. 1-4.
  • McKenzie, “An Experimental Multiple Barbed Suture for the Long Flexor Tendons of the Palm and Fingers”, The Journal of Bone and Joint Surgery, vol. 49B, No. 3, Aug. 1967, pp. 440-447.
  • Datillo et al., “Medical Textiles: Application of an Absorbable Barbed Bi-directional Surgical Suture”, vol. 2, Issue, 2, The Journal of Textile and Apparel Technology and Management (Spring 2002).
  • McKenzie, An Experimental Multiple Barbed Suture For The Long Flexor Tendons Of The Palm and Fingers, The Journal of Bone and-Joint-Surgery, vol. 49B, No. 3, Aug. 1967, p. 440-447.
  • Sulamanidze, Paikidze, Sulamanidze, Facial Lifting With “Aptos” Threads, Jul. 18, 2001, www.fonendo.com, p. 1-6.
  • Declaration of Dr. Gregory L. Ruff, Dated Aug. 19, 2005, 8 pages, with Exhibits A-E.
  • Bunnell, S. ‘Gig pull-out suture for tendons’ J Bone Joint Surg. Am (1954) vol. 36A, No. 4 pp. 850-851.
  • Jennings et al ‘A New Technique in primary tendon repair’ Surg. Gynecol. Obstet. (1952) vol. 95, No. 5 pp. 597-600.
  • Mansberger et al ‘A New Type Pull-Out Wire for Tendon Surgery: A Preliminary Report’ Department of Surgery, University Hospital and University of Maryland School of Medicine, Baltimore, Maryland, Received for Publication May 10, 1951 pp. 119-121.
  • Mason, M.L. ‘Primary and Secondary Tendon Suture. A discussion of the significance of technique in tendon surgery’ (1940) Surg Gynecol Obstet 70.
  • McKee, GK ‘Metal anastomosis tubes in tendon suture’ The Lancet (1945) pp. 659-660.
  • Potenza, A. ‘Tendon Healing Within the Flexor Digital Sheath in the Dog: An Experimental Study’ Journal of Bone & Joint Surgery (1962) vol. 44A No. 1 pp. 49-64.
  • Pulvertaft ‘Suture Materials and Tendon Junctures’ American Journal of Surgery (1965) vol. 109 pp. 346-352.
  • Schmid A. et al ‘The outspreading anchor cord. A material for arthroscopic suturing of a fresh anterior cruciate ligament rupture’ Surgical Clinic of the University of Gottingen' (1987) pp. 417-426.
  • Serafetinides, AA ‘Short pulse laser beam interactions with polymers biocompatible materials and tissue’ Proce SPIE vol. 3052 (1996) pp. 111-123.
  • Verdan, C. ‘Primary Repair of Flexor Tendons’ Journal of Bone and Joint Surgery (1960) vol. 42, No. 4 pp. 647-657.
  • Zoltan, J. ‘Cicatrix Optima: Techniques for Ideal Wound Healing’ English language edition University Park Press Baltimore (1977) Chapter 3 pp. 54-55.
  • Communication from EPO re: 10000486 dated Apr. 4, 2011, 4 pages.
  • European Search Report re: EP05025816 dated Jun. 23, 2006.
  • European Search Report for EP07006258.3 dated May 4, 2007, 4 pages.
  • European Search Report for EP07015906 dated Oct. 2, 2007.
  • European Search Report for EP07015905.8 dated Oct. 2, 2007, 2 pages.
  • European Search Report for EP07016222 dated Jan. 7, 2008.
  • European Search Report for EP09014651 dated Jan. 12, 2010.
  • European Search Report for EP10000629.5 dated Mar. 10, 2010, 4 pages.
  • European Search Report re: EP10000486 dated Apr. 23, 2010.
  • European Search Report re: 10004453 dated Jun. 15, 2010.
  • European Search Report for EP10011871.0 dated Dec. 3, 2010, 2 pages.
  • European Search Report for EP10011868.6 dated Dec. 6, 2010, 2 pages.
  • European Search Report for EP10011869 dated Jan. 20, 2011.
  • European Search Report for EP10011872 dated Apr. 20, 2011.
  • European Search Report for EP10012437 dated Apr. 28, 2011.
  • European Search Report for EP10186592.1 dated Jan. 19, 2011, 2 pages.
  • European Search Report for EP10184766 dated Apr. 20, 2011.
  • Extended European Search Report re: 07015905.8 dated Oct. 23, 2007.
  • Extended European Search Report re: 07016222.7 dated Jan. 30, 2008.
  • International Preliminary Examination Report re: PCT/US1998/10478 dated Dec. 11, 1999.
  • International Preliminary Report re: PCT/US2007/002688 dated Aug. 14, 2008.
  • International Preliminary Report re: PCT/US2008/060127 dated Oct. 13, 2009.
  • International Preliminary Report re: PCT/US2008/087788 dated Jun. 22, 2010.
  • International Preliminary Report re: PCT/US2009/032693 dated Aug. 3, 2010.
  • International Preliminary Report re: PCT/US2009/040545 dated Oct. 19, 2010.
  • International Preliminary Report re: PCT/US2009/041685 dated Oct. 26, 2010.
  • International Preliminary Report re: PCT/US2009/044274 dated Nov. 17, 2010.
  • International Preliminary Report re: PCT/US2011/035431 dated Nov. 6, 2012.
  • International Preliminary Report re: PCT/US2011/059238 dated May 7, 2013.
  • International Search Report for PCT/US1994/09631 dated Dec. 9, 1994.
  • International Search Report for PCT/US1998/10478 dated Sep. 23, 1998.
  • International Search Report for PCT/US2002/20449 dated May 20, 2003.
  • International Search Report for PCT/US2002/027525 dated Dec. 9, 2002, 3 pages.
  • International Search Report for PCT/US2003/030424 dated Nov. 1, 2004.
  • International Search Report for PCT/US2003/030664 dated May 25, 2004.
  • International Search Report for PCT/2003/030666 dated Dec. 15, 2004.
  • International Search Report for PCT/US2003/025088 dated Dec. 29, 2003.
  • International Search Report re: PCT/US2003/030674 dated Sep. 2, 2004.
  • International Search Report re: PCT/US2004/014962 dated Feb. 24, 2005.
  • International Search Report for PCT/US2005/017028 dated Mar. 26, 2008.
  • International Search Report for PCT/US2007/002688 dated Oct. 22, 2007.
  • International Search Report for PCT/US2007/074658 dated Jun. 12, 2007, 3 pages.
  • International Search Report for PCT/US2008/060127 dated Sep. 23, 2008, 5 pages.
  • International Search Report for PCT/US2008/077813 dated Mar. 31, 2009.
  • International Search Report for PCT/US2008/082009 dated Feb. 16, 2010.
  • International Search Report for PCT/US2009/032693 dated Aug. 26, 2009.
  • International Search Report for PCT/US2009/034703 dated Sep. 28, 2009.
  • International Search Report for PCT/US2009/040545 dated Oct. 29, 2009.
  • International Search Report for PCT/US2009/063081 dated Aug. 2, 2010.
  • International Search Report for PCT/US2009/041685 dated Dec. 22, 2009.
  • International Search Report for PCT/US2009/044274 dated Jan. 15, 2010.
  • International Search Report for PCT/US2010/056898 dated Aug. 2, 2011.
  • International Search Report for PCT/US2010/060889 dated Oct. 11, 2011.
  • International Search Report for PCT/US2011/034660 dated Feb. 8, 2012.
  • International Search Report for PCT/US2011/035270 dated Jan. 12, 2012.
  • International Search Report for PCT/US2011/035271 dated Jan. 12, 2012.
  • International Search Report re: PCT/US2011/035431 dated Jan. 12, 2012.
  • International Search Report for PCT/US2011/059238 dated May 21, 2012.
  • International Search Report for PCT/US2012/030441 dated Sep. 27, 2012.
  • Partial European Search Report re: EP05025816 dated Mar. 20, 2006.
  • Singapore Search Report for Singapore Patent Application No. 200702625-5 dated Nov. 26, 2008, 7 pages.
  • Singapore Search Report for Singapore Patent Application No. 200702350-0 dated Nov. 26, 2008, 6 pages.
  • Singapore Search Report for Singapore Patent Application No. 200703688-2 dated Nov. 26, 2008, 7 pages.
  • Singapore Search Report for Singapore Patent Application No. 201103117-6 dated Mar. 8, 2013.
  • Supplementary European Search Report re: EP98923664 dated Jun. 12, 2001.
  • Supplementary European Search Report re: EP03752630 dated Nov. 17, 2005.
  • Supplementary European Search Report re: 03770556 dated Nov. 17, 2005.
  • Supplementary European Search Report re: 03754965 dated Nov. 18, 2005.
  • Supplementary European Search Report re: EP03785177 dated May 19, 2009.
  • Supplementary European Search Report re: 05750101 dated Apr. 7, 2010.
  • Supplementary European Search Report re: 07017663 dated Nov. 7, 2007.
  • H. Han, et al. “Mating and Piercing Micromechanical Structures for Surface Bonding Applications”. Micro ElectroMechanical Systems (MEMS-91), Jan. 31-Feb. 2, 1991, CH2957-Sep. 1991, pp. 253-258, 1991.
  • H. Buncke, et al. “The Suture Repair of One-Millimeter Vessels”. Micro-Vascular Surgery, pp. 24-35 (esp. p. 34), 1966.
Patent History
Patent number: RE45426
Type: Grant
Filed: Jul 31, 2001
Date of Patent: Mar 17, 2015
Assignee: Ethicon, Inc. (Somerville, NJ)
Inventor: Gregory Millette Buncke (Hillsborough, CA)
Primary Examiner: Todd E Manahan
Assistant Examiner: Michael G Mendoza
Application Number: 09/919,750
Classifications
Current U.S. Class: Suture Or Ligature (606/228); Material Placed On Opposed Sides Of Incision Or Wound (606/215); Means To Draw Opposed Sides Of Incision Into Apposition (606/216); Filament Attachment (606/224)
International Classification: A61B 17/04 (20060101); A61B 17/08 (20060101); A61D 1/00 (20060101);