BR112020017001A2 - KNITTED FRAMES FOR FABRIC - Google Patents

Abstract

the present invention relates to staple cartridge assemblies for use with surgical staplers and methods for making them. scaffolds for use with a surgical staple cartridge and methods for making them are also provided.

Description

Invention Patent Descriptive Report for "KNITTED TISSUE ARCHWORKS".

FIELD

[001] Knitted frameworks for fabric and methods for fabricating them are provided.

BACKGROUND

[002] Surgical staplers are used in surgical procedures to close openings in tissues, blood vessels, ducts, shunts (anastomoses) or other objects or parts of the body involved in the specific procedure. The openings may be naturally occurring, such as passages in blood vessels or an internal organ such as the stomach, or they may be formed by the surgeon during a surgical procedure, for example by puncturing tissue or blood vessels to form a bypass or an anastomosis, or by cutting tissue during a stapling procedure.

[003] Some surgical staplers require a surgeon to select the appropriate staples that have the appropriate staple height for the tissue that is stapled. For example, a surgeon could select long staples for use with thick tissue and short staples for use with thin tissue. In some cases, however, the fabric that is stapled does not have a consistent thickness, so the staples are unable to achieve the desired triggering setting at each staple location. As a result, it is not possible to form a desirable seal at or near all stapled locations, thereby allowing blood, air, gastrointestinal fluids, and other fluids to infiltrate the unsealed locations.

[004] Additionally, staples, as well as other objects and materials that can be implanted in conjunction with procedures such as stapling, generally do not have some characteristics of the tissue in which they are implanted. For example, staples and other objects and materials may not have the natural flexibility of the tissue in which they are implanted and, therefore, are unable to withstand the different pressures intracted at the implantation site. This can lead to undesirable tears in the tissue and, consequently, to leaks at or near the staple site, and / or to leaks between the juxtaposed implant and the tissue.

[005] Consequently, there is a need for improved instruments and methods that address the current problems encountered in surgical staplers.

SUMMARY

[006] Staple cartridge sets are provided for use with a surgical stapling instrument.

[007] In an exemplary embodiment, the staple cartridge assembly may include a staple cartridge that has a plurality of staples and a cartridge platform, and an elastically deformable, bioabsorbable knitted frame attached to the cartridge platform and formed by at least three distinct zones, each having a different functionality, and the clips are implantable through the framework in the tissue captured against the framework. The framework can include a first knitted area that can be configured to promote the internal growth of the fabric, a second knitted area that can be configured to be conformable to be attached to the cartridge platform, and a spacer area that is arranged between the first and second knitted zones and that can be configured to support the first and second knitted zones, the openings are present in the first and second knitted zones and empty spaces are present in the spacer zone, the empty spaces being larger than the openings. The first knitted zone can include first fibers made from a first bioabsorbable polymer and second fibers made from a second bioabsorbable polymer, with each first fiber having a fiber diameter that is less than a fiber diameter of each second fiber. The second knitted zone can include the first and second fibers of the first knitted zone. The spacer zone can be formed from the second fibers and the second fibers are interconnected in a non-fixed and sliding manner to the first fibers of the first and second knitted zones. In one aspect, the framework can be configured to apply a tension of at least about 3 g / mm2 to the captured tissue, for at least 3 days when the framework is in a state implanted in the tissue.

[008] In some respects, the fiber diameters of the first fibers can be about 1/5 to 1/20 of the fiber diameters of the second fibers. In other respects, the fiber diameters of the first fibers can be about 1/10 of the fiber diameters of the second fibers.

[009] In one aspect, the second fibers can extend from the first knitted zone to the second knitted zone so that the second fibers extend along the spacer zone, with at least a portion of the second fibers within the zone The spacer can be oriented substantially perpendicular to the first fibers of the first and second knitted areas.

[0010] The first and second types of fibers can be formed from a variety of materials. In one aspect, the first type of fibers can be formed by at least one of poly-L-lactic acid, a copolymer of glycolide and L-lactide, a copolymer of glycolic acid and lactic acid, poly (lactic-co-glycolic acid) , poly (lactic acid), polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. In another aspect, the second type of fibers can be formed by at least one among polydioxanone, a copolymer of polydioxanone and polyglycolide, a copolymer of lactide and polycaprolactone), a copolymer of glycolide, dioxanone and trimethylene carbonate, poly (trimethylene carbonate ), polyhydroxyalkanoate and polyglycolate.

[0011] In another embodiment, a staple cartridge assembly is provided which may include a staple cartridge that has a plurality of staples and a cartridge platform, and an elasticly deformable knitted bioabsorbable frame attached to the cartridge platform and formed by at least three distinct zones, each having a different functionality, the clips being implantable through the framework into the tissue captured against the framework. The framework can include a first zone which can have a knitted configuration and which can be configured to promote the internal growth of the fabric, the first zone including first fibers made of a first bioabsorbable polymer. The framework can also include a second zone that can be formed by second fibers made of a second bioabsorbable polymer and that can be configured to support the first zone vertically, the second fibers being non-fixed and sliding interconnected to the first fibers of the first zone so that the second fibers are oriented substantially vertically in the second zone. Each first fiber can have a fiber diameter that is less than a fiber diameter of each second fiber, and where openings are present in the first zone and voids are present in the second zone, with the voids being larger than those openings.

[0012] In some respects, the framework can also include a third zone that can have a knitted configuration and that can be configured to be conformable in order to be attached to the cartridge platform, where the third zone can include the first fibers and the The second zone can be located between the first and the third zones. In such cases, the second fibers can be interconnected in a non-fixed and sliding way to the first fibers of the third zone, and the second fibers can extend from the first zone to the third zone so that at least a portion of the second fibers are vertically oriented in the second zone. The framework can be configured to apply a tension of at least about 3 g / mm2 to the captured tissue, for at least 3 days when the framework is in a state implanted in the tissue.

[0013] In some respects, the fiber diameters of the first fibers can be about 1/5 to 1/20 of the fiber diameters of the second fibers. In other respects, the fiber diameters of the first fibers can be about 1/10 of the fiber diameters of the second fibers.

[0014] The first and second types of fibers can be formed from a variety of materials. In one aspect, the first type of fibers can be formed by at least one of poly-L-lactic acid, a copolymer of glycolide and L-lactide, a copolymer of glycolic acid and lactic acid, poly (lactic-co-glycolic acid) , poly (lactic acid), polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. In another aspect, the second type of fibers can be formed by at least one among polydioxanone, a copolymer of polydioxanone and polyglycolide, a copolymer of lactide and polycaprolactone), a copolymer of glycolide, dioxanone and trimethylene carbonate, poly (trimethylene carbonate) ), polyhydroxyalkanoate and polyglycolate.

[0015] Frameworks are also provided for use with a surgical staple cartridge that may include a first knitted area that is configured to promote internal tissue growth, a second knitted area that is configured to be conformable in order to attach to a cartridge platform, and a spacer zone that is arranged between the first and second knitted zones and which is configured to support the first and second knitted zones, with the openings being present in the first and second knitted zones and the empty spaces they are present in the spacer zone, the empty spaces being larger than the openings. The first knitted zone can include first fibers made from a first bioabsorbable polymer and second fibers made from a second bioabsorbable polymer, with each first fiber having a fiber diameter that is less than a fiber diameter of each second fiber. The second knitted zone can include the first and second fibers of the first knitted zone. The spacer zone can be formed from the second fibers and the second fibers can be interconnected in a non-fixed and sliding way to the first fibers of the first and second knitted zones.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016] The patent or patent application document contains at least one color drawing. Copies of that patent or of the patent application publication with colored drawings will be provided by the Office upon request and payment of the necessary fee.

[0017] This invention will be understood more fully from the detailed description below in conjunction with the accompanying drawings, in which:

[0018] Figure 1 is a perspective view of an exemplary modality of a conventional surgical cutting and stapling instrument;

[0019] Figure 2 is a perspective view of a wedge slide of a staple cartridge of the stapling and surgical cutting instrument of Figure 1;

[0020] Figure 3 is a perspective view of a knife and a firing bar ("rod with E-profile") of the stapling and surgical cutting instrument of Figure 1;

[0021] Figure 4 is a longitudinal cross-sectional view of a surgical cartridge that can be disposed within the stapling and cutting instrument of Figure 1;

[0022] Figure 5 is a top view of a staple in a non-triggered (pre-implanted) configuration that can be disposed within the staple cartridge of the surgical cartridge assembly of Figure 4;

[0023] Figure 6 is a longitudinal cross-sectional view of an exemplary embodiment of a surgical cartridge set provided with a frame attached to a cartridge platform;

[0024] Figure 7 is a schematic drawing that illustrates the framework of Figure 6 when stapled to the fabric;

[0025] Figure 8A is an enlarged top view of an exemplary embodiment of a framework that can be attached to the cartridge platform of the surgical cartridge assembly of Figure 6;

[0026] Figure 8B is an enlarged cross-sectional view of the framework of Figure 8A taken in B-B;

[0027] Figure 8C is another view in enlarged cross section of the framework of Figure 8A taken in C-C;

[0028] Figure 9 is a scanning electron micrograph (SEM) image of the framework in Figures 8A to 8C on a 500 µm scale;

[0029] Figure 10A is a histopathology image of a framework removed in 60 days, as discussed in Example 2.

[0030] Figure 10B is an enlarged view of section 10B of Figure 10A;

[0031] Figure 11A is a histopathology image of an implanted framework removed in 90 days, as discussed in Example 2;

[0032] Figure 11B is an enlarged view of section 11B in Figure 11A;

[0033] Figure 12A is a perspective view of another exemplary embodiment of a framework;

[0034] Figure 12B is another exemplary embodiment of a staple cartridge assembly that has the frame shown in Figure 12A attached to a cartridge platform; and

[0035] Figure 13 is a bottom view of another example of a framework.

DETAILED DESCRIPTION

[0036] Certain exemplifying modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the instruments and methods disclosed here. One or more examples of these modalities are illustrated in the attached drawings. Those skilled in the art will understand that the instruments, systems and methods specifically described in the present invention and illustrated in the accompanying drawings are non-limiting exemplary modalities, and that the scope of the present invention is defined solely by the claims. The resources illustrated or described in relation to an exemplary modality can be combined with the resources of other modalities. Such modifications and variations are intended to be included in the scope of the present invention.

[0037] Additionally, in the present disclosure, components with the same names in the modalities have, in general, similar resources and, therefore, in a particular modality, not all the resources of each component with the same names are necessarily described in detail. In addition, when linear or circular dimensions are used in describing the disclosed systems, instruments and methods, these dimensions are not intended to limit the types of format that can be used in conjunction with such systems, instruments and methods. One skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. The sizes and formats of the systems and instruments, and the components thereof, may depend at least on the anatomy of the individual in which the systems and instruments will be used, the size and shape of components with which the systems and instruments will be used, and the methods and procedures in which the systems and instruments will be used.

[0038] It will be recognized that the terms "proximal" and "distal" are used here with reference to a user, for example a doctor, who holds the handle of an instrument. Other spatial terms such as "front" and "rear" correspond similarly to distal and proximal, respectively. It will also be understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments are used in many orientations and positions, and such spatial terms are not intended to be limiting and absolute.

[0039] Values or ranges can be expressed here as "about" and / or from / from "about" a specific value to another specific value. When such values or ranges are expressed, other modalities disclosed include the specific value mentioned and / or from / the specific value up to another specific value. Similarly, when the values are expressed as approximations, by using the antecedent "about", it must be understood that several values are presented here and that the specific value constitutes another modality. It will be further understood that various values are presented within, and that each value is also disclosed in the present invention as "about" that specific value in addition to the value itself. In modalities, "about" can be used to mean, for example, within 10% of the mentioned value, within 5% of the mentioned value or within 2% of the mentioned value.

[0040] For the purposes of describing and defining the present teachings, it is noted that, unless otherwise indicated, the term "substantially" is used in the present invention to represent the inherent degree of uncertainty that can be attributed to any quantitative comparison , value, measure or other representation. The term "substantially" is also used in the present invention to represent the degree to which a quantitative representation can vary from an established reference without resulting in a change in the basic function of the matter in question.

[0041] Surgical staple cartridge sets and methods for their manufacture are provided. In general, a staple cartridge assembly is provided that has a staple cartridge that includes a cartridge platform with a plurality of staples disposed thereon. The staple cartridge set also includes an elastic, deformable, knitted bioabsorbable frame that is configured to attach to the cartridge platform and to enable staples to be implanted through it into the fabric. The framework can be releasably coupled to the cartridge platform so that when a clamp is implanted from the cartridge platform and into the fabric, at least a portion of the framework can attach to the fabric captured by the clamp. As discussed in this document, the framework can be configured to compensate for variations in tissue properties, such as variations in tissue thickness, and / or to promote internal tissue growth when the framework is stapled to the tissue. For example, the framework can be configured to apply a tension of at least about 3 g / mm2 to the tissue for at least 3 days when in an implanted tissue state (for example, when the framework is stapled to the tissue in vivo). An exemplary staple cartridge set can include a variety of features to facilitate the application of a surgical staple, as described here and illustrated in the drawings. However, one skilled in the art will recognize that the staple cartridge assembly may include only some of these features and / or may include a variety of other features known in the art. The staple cartridge sets described herein are intended merely to represent certain exemplary embodiments. In addition, although scaffolds are described in connection with surgical staple cartridge sets, scaffolds can be used in connection with any type of surgical instrument.

[0042] Figure 1 illustrates an exemplary surgical stapling and cutting instrument 100 suitable for use with an implantable adjunct such as, for example, a framework. The surgical stapling and cutting instrument 100 can comprise an anvil 102 that can be repeatedly opened and closed around its pivoting fixation to an elongated staple channel 104. A staple application set 106 can comprise anvil 102 and channel 104 , the assembly 106 being fixed proximally to an elongated drive shaft 108 forming an implementation portion 110. When the clamp application assembly 106 is closed, or at least substantially closed, the implementation portion 110 may have a section sufficiently small cross section suitable for inserting the staple application set 106 through a trocar. Although instrument 100 is configured to staple and cut tissue, surgical instruments configured to staple, but not to cut, tissue are also contemplated in the present invention.

[0043] In several cases, the clamp application set 106 is manipulated by a handle 112 connected to the elongated drive shaft 108. The handle 112 can comprise user controls such as a rotary knob 114 that rotates the elongated drive shaft 108 and the clamp application set 106 around a longitudinal geometric axis of the elongated drive shaft 108 and a closing trigger 116, which can pivot in front of a pistol grip 118 to close the clamp application set 106. One button closing release 120 protrudes out over handle 112 when closing trigger 116 is secured so that closing release button 120 can be pressed to release closing trigger 116 and open clamp application set 106 , for example.

[0044] A trigger trigger 122, which can pivot in front of the closing trigger 116, causes the clamp application set 106 to simultaneously cut and staple the tissue fixed there. In several cases, multiple firing strokes can be employed using the trigger trigger 122 to reduce the amount of force required to be applied by the surgeon's hand per stroke. In certain embodiments, the handle 112 may comprise one or more rotating indicator wheels, such as, for example, rotating indicator wheel 124 which can indicate the progress of firing. A manual firing release lever 126 can enable the firing system to retract before the full firing path has been completed, if desired, and in addition, firing release lever 126 can allow a surgeon or other physician , retract the trigger system if the trigger system is fixed and / or fails.

[0045] Additional details on surgical stapling and cutting instrument 100 and other surgical stapling and cutting instruments suitable for use in the present disclosure are described, for example, in US patent application No. 9,332,984 and in the publication of application for US patent 2009/0090763, the disclosures of which are hereby incorporated by reference in their entirety. In addition, the surgical stapling and cutting instrument does not need to include a handle, but instead a compartment that is configured to attach to a surgical robot, for example, as described in US patent application No. 15 / 689,198, filed in August 29, 2017 to Frederico E. Shelton et al, whose disclosure is hereby incorporated by reference in its entirety.

[0046] With reference to Figures 2 and 3, a trigger set, such as trigger set 228, can be used with a stapling and surgical cutting instrument, such as instrument 100 in Figure 1, to advance a slide wedge 230 comprising a plurality of wedges 232 configured to implant staples from a staple application set, such as staple application set 106 in Figure 1 on the tissue captured between an anvil, such as anvil 102 in Figure 1 and an elongated clamp channel, such as channel 104 in Figure 1. In addition, an E-profile rod 233 in a distal portion of trigger assembly 228 can fire clamps from the clamp application assembly as well as position the anvil in relation to the elongated staple channel during firing. The E-profile rod 233 includes a pair of upper pins 234, a pair of intermediate pins 236 that can follow portion 238 of the wedge slide 230 and a lower pin or shoe 240, as well as a sharp cutting edge 242, which can be configured to cut the captured tissue as the firing set 228 is advanced distally. In addition, a fully formed and proximal protruding top guide 244 and an intermediate guide 246 grouping each vertical edge of the cutting edge 242 can additionally define a tissue positioning area 248 helping to guide the fabric to the sharp cutting edge 242 before that the fabric is cut. The intermediate guide 246 can also serve to engage and fire the clamp application set by confinement with a stepped central member 250 of the wedge slide 230 which forms the clamp through the clamp application set.

[0047] With reference to Figure 4, a staple cartridge 400 can be used with a surgical stapling and cutting instrument, such as the surgical stapling and cutting instrument 100 in Figure 1, and can include a cartridge platform 402 and a plurality of staple cavities 404. A staple 406, for example, can be removably positioned in each staple cavity 404. Staple 406 in an un triggered (pre-implanted) configuration is shown in more detail in Figure 5. The cartridge of staples 400 can also include a longitudinal channel that can be configured to receive a firing and / or cutting member, for example, an E-profile rod, such as the E-profile rod 233 in Figure 3.

[0048] Each clamp 406 may comprise a crown (base) 406C and one or more legs 406L extending from crown 406C. Before staples 406 are implanted, the crowns 406C of staples 406 can be supported by the staple drivers 408 positioned inside the staple cartridge 400 and, simultaneously, the legs 406L of staples 406 can be, at least partially, contained inside the staples. staple cavities 404. In addition, staple legs 406L of staples 406 may extend beyond the tissue contact surface 410 of staple cartridge 400 when staples 406 are in their non-triggered positions. In certain cases, as shown in Figure 5, the tips of the 406L clip legs may comprise sharp points that can cut and penetrate the fabric.

[0049] Staples 406 can be implanted between an un-fired position and a fired position so that legs 406L move through the staple cavities 404, penetrate the tissue positioned between an anvil, such as anvil 102 in Figure 1, and staple cartridge 400, and contact the anvil. As the legs 406 are deformed against the anvil, the legs 406L of each staple 406 can capture a portion of the fabric inside each staple 406 and apply a compressive force to the fabric. In addition, the legs 406L of each staple 406 can be deformed downwardly towards the crown 406C of staple 406 to form a staple trapping area in which the fabric can be captured inside. In several cases, the clamp trapping area can be defined between the internal surfaces of the deformed legs and the internal surface of the clamp crown. The size of a clip's trapping area can depend on several factors, such as the length of the legs, the diameter of the legs, the width of the crown and / or the extent to which the legs are deformed, for example.

[0050] In use, an anvil, such as anvil 102 in Figure 1, can be moved to a closed position by pressing a closing trigger, such as closing trigger 116 in Figure 1, to advance a rod with an E-profile , such as the E 233 profile rod in Figure 3. The anvil can position the tissue against a contact surface with the tissue 410 of the staple cartridge 400. When the anvil has been properly positioned, the staples 406 can be implanted.

[0051] To deploy staples 406, as discussed above, a staple trigger slide, such as slide 230 in Figure 2, can be moved from a proximal end 400p towards a distal end 400d of the staple cartridge 400. As the firing assembly, like firing assembly 228 in Figure 3, is advanced, the slider can contact the staple actuators 408 and lift the staple actuators 408 upward into the staple cavities 404. In at least one For example, the slider and clamp actuators 408 can each include one or more ramps, or inclined surfaces, which can cooperate to move the clamp actuators 408 upward from their non-triggered positions. As staple drivers 408 are lifted upward within their respective staple cavities 404, staple actuators 408 can raise staples 406 upward so that staples 406 can emerge from their staple cavities 404 and penetrate the fabric. In many cases, the slider can move several clips upwards at the same time as part of a firing sequence.

[0052] One skilled in the art will recognize that, although the scaffolds are shown and described below, the scaffolds disclosed herein can be used with other surgical instruments and do not need to be attached to a staple cartridge as described.

[0053] As discussed above, with some surgical staplers, it is often necessary for a surgeon to select the appropriate staples that have the appropriate staple height for the tissue to be stapled. For example, a surgeon could select long staples for use with thick tissue and short staples for use with thin tissue. In some cases, however, the fabric being stapled does not have a consistent thickness, so staples cannot reach the desired triggered setting for each section of the stapled fabric (for example, sections of thick and thin fabric). The inconsistent thickness of the fabric can also lead to unwanted leaks and / or tears of the fabric at the staple site when staples of the same or substantially the same height are used, particularly when the staple site is exposed to intractable pressure at the staple site and / or along the staple line.

[0054] Consequently, several modalities of frameworks are provided that can be configured to compensate for the variable thickness of the fabric that is captured within the fired (implanted) staples to avoid the need to take into account the height of the staple when stapling the fabric during the surgery. That is, the scaffolds described here may enable a set of staples with equal or similar heights to be used for stapling fabric of varying thickness (that is, thin to thick fabric) while also, in combination with the scaffold , provides adequate compression of the tissue inside and between the fired clips. In this way, the frameworks described here can maintain adequate compression against the thin or thick tissue stapled to them, thus minimizing leaks and / or tears in the tissue at the staple locations.

[0055] Alternatively or additionally, the framework can be configured to promote the internal growth of the tissue. In several cases, it is desirable to promote the internal growth of the tissue into an implantable framework, to promote the healing of the treated tissue (for example, stapled and / or cut tissue) and / or to accelerate the patient's recovery. More specifically, the internal growth of the tissue into an implantable framework can reduce the incidence, extent and / or duration of inflammation at the surgical site. The internal growth of the tissue into and / or around the implantable framework can control the spread of infections at the surgical site, for example. The internal growth of blood vessels, especially leukocytes, for example, into and / or around the implantable framework can fight infections within and / or around the implantable framework and in the surrounding tissue. Internal tissue growth can also stimulate the acceptance of foreign matter (for example, the implantable framework and staples) by the patient's body and can reduce the likelihood that the patient's body will reject foreign matter. Foreign material rejection can cause infection and / or inflammation at the surgical site.

[0056] In general, the scaffolds provided here are designed and positioned on a staple cartridge, such as staple cartridge 400 in Figure 4, so that when the staples are fired (implanted) from the cartridge platform of the staples, the staples penetrate through the frame and into the fabric. As the staple legs are deformed against the anvil that is positioned opposite the staple cartridge assembly, the deformed legs capture a portion of the frame and a portion of the fabric within each staple. That is, when the clamp is fired on the fabric, at least a portion of the frame is positioned between the fabric and the fired clamp. Although the scaffolds described herein are configured to be attached to a staple cartridge in a staple cartridge assembly, it is also provided in the present invention that the scaffolds can be configured to couple with other instrument components, for example a surgical stapler.

[0057] Figure 6 illustrates an exemplary embodiment of a staple cartridge assembly 600 that includes a staple cartridge 602 and a frame 604. Despite the differences described in detail below, the staple cartridge 602 may be similar to the staple cartridge 400 (Figure 4) and is therefore not described in detail in the present invention. As shown, frame 604 is positioned against staple cartridge 602. The staple cartridge can include a cartridge platform 606 and a plurality of staples 608, like staples 406 shown in Figures 4 and 5. Staples 608 can have any adequate unformed (pre-implanted) height. For example, clamps 608 can have an unformed height of between about 2 mm to 4.8 mm. Prior to implantation, the crowns of clamps 608 can be supported by clamp drivers 610.

[0058] In the illustrated embodiment, the frame 604 can be coupled to an outer surface 612, for example, a contact surface with the fabric, of the cartridge platform 606. The outer surface 612 of the cartridge platform 606 can include one or more fixing features. The one or more fastening features can be configured to engage frame 604 to prevent unwanted movement of frame 604 in relation to cartridge platform 606 and / or premature release of frame 604 from cartridge platform 606. Exemplary fastening features can be found in US patent publication No. 2016/0106427, which is incorporated herein by reference in its entirety.

[0059] The framework 604 is elastically deformable to allow the framework to compress to varying heights to thereby compensate for the different thicknesses of tissues that are captured inside an implanted clamp. The frame 604 has an uncompressed (not deformed), or pre-implanted height, and is configured to deform to one of a plurality of compressed (deformed), or implanted heights. For example, frame 604 may have an uncompressed height that is greater than the height of clips 608 (e.g., height (H) of the clip 608a in Figure 7). In one embodiment, the uncompressed height of frame 604 can be about 10% greater, about 20% greater, about 30% greater, about 40% greater, about 50% greater, about 60% greater,

about 70% bigger, about 80% bigger, about 90% bigger or about 100% bigger than the fired height of the clamps 608. In certain embodiments, the uncompressed height of the frame 604 can be 100% bigger than the height fired from clamps 608, for example.

[0060] The frame 604 can be releasably attached to the outer surface 612 of the cartridge platform 606. As shown in Figure 7, when a clamp is fired, the fabric (T) and a portion of the frame 604 are captured by the fired clamp (formed) 608a. The triggered clip 608a defines the trapping area therein, as discussed above, to accommodate the captured frame 604 and the fabric (T). The trapping area defined by the fired clip 608a is limited, at least in part, by a height (H) of the fired clip 608a. For example, the height of a fired clip 608a can be about 0.130 inches or less. In some embodiments, the height of a fired clip 608a can be from about 0.025 inches to 0.130 inches. In some embodiments, the height of a fired clamp 608a can be from about 0.030 inches to 0.100 inches.

[0061] As described above, frame 604 can be compressed within a plurality of fired clips whether the thickness of the tissue captured within the clips is the same or different within each clip. In at least one exemplary embodiment, staples within a row, or row, of staples can be deformed so that the height is about 2.75 mm, for example, where the fabric (T) and the frame 604 can be compressed within that height. In certain cases, the fabric (T) can have a compressed height of about 1.0 mm and the frame 604 can have a compressed height of about 1.75 mm. In certain cases, the fabric (T) can have a compressed height of about 1.50 mm and the frame 604 can have a compressed height of about 1.25 mm. In certain cases, the fabric (T) can have a compressed height of about 1.75 mm and the frame 604 can have a compressed height of about 1.00 mm. In certain cases, the fabric (T) can have a compressed height of about 2.00 mm and the frame 604 can have a compressed height of about 0.75 mm. In certain cases, the fabric (T) can have a compressed height of about 2.25 mm and the frame 604 can have a compressed height of about 0.50 mm. Consequently, the sum of the compressed heights of the captured tissue (T) and the frame 604 can be equal, or at least substantially equal, to the height (H) of the triggered clip 608a.

[0062] As discussed in more detail below, the structure of the framework can be configured so that when the framework and tissue are captured within the triggered clamp, the framework can apply a tension capable of withstanding the pressure of circulating blood through the tissue . A blood pressure of 210 mmHg is typically considered high and therefore it would be desirable for the framework to apply a tension to the tissue that is equal to or greater than 210 mmHg (for example, 3 g / mm2) for a predetermined period of time (for example, example, 3 days). Thus, in certain modalities the framework can be configured to apply a tension of at least about 3 g / mm2 to the captured tissue for at least 3 days. The framework is in an implanted state when the framework is stapled to the tissue in vivo. In one embodiment, the applied voltage can be about 3 g / mm2. In another embodiment, the applied voltage can be greater than 3 g / mm2. In yet another embodiment, the tension can be at least about 3 g / mm2 and applied to the captured tissue for more than 3 days. For example, in one embodiment, the tension can be at least about 3 g / mm2 and applied to the captured tissue for about 3 to 5 days.

[0063] To design a framework that is configured to apply a tension of at least about 3 g / mm 2 to the captured tissue for a predetermined time, one can use the principles of Hooke's law (F = kD). For example, when the force (tension) to be applied to the captured tissue is known, it is possible to design a framework that has a stiffness (k). The stiffness can be defined by adjusting the materials and / or the geometry of the framework (for example, the type and / or the diameter of the fibers and / or the interconnectivity of the fibers). Additionally, the framework can be designed so that it has a maximum amount of compression displacement for a minimum fabric thickness, for example, 1 mm, and therefore the displacement length D can be the combination of a minimum fabric thickness, for example, 1 mm, plus a thickness of the fabric when stapled to the fabric for a given maximum staple height, for example, 2.75 mm. As an example, in one modality, a framework can be structured to have a height that is greater than a maximum stapled height formed by 2.75 mm and for compression up to a height of 1.75 mm when stapled to fabric that has a minimum thickness of 1 mm. Therefore, the framework can have variable compressibility to maintain a constant displacement length D, so that the stiffness (k) and the total thickness (D) of the captured tissue and the framework can apply a tension of 3 g / mm 2 to the tissue captured. It should be noted that one skilled in the art will recognize that the aforementioned formula can be modified to take account of temperature variations, for example, when the adjunct is brought from room temperature to body temperature after implantation.

[0064] Additionally, the framework can be further developed to provide a substantially continuous tension to the captured tissue (for example, 3 g / mm2) for a predetermined time (for example, 3 days). To achieve this, it would be necessary to take into account the rate of degradation of the framework materials and the rate of internal tissue growth into the framework when designing the framework. In doing so, a framework can be designed so that the rigidity of the framework and / or the total thickness of the captured tissue and the framework do not vary in a way that can affect an applied stress that is less than 3 g / mm2.

[0065] A framework is stapled to the fabric under various stapling conditions (for example, thickness of the fabric, height of the formed staple, intratide pressure). Depending on the stapling condition, an effective amount of tension can be determined that the framework needs to be able to apply to the fabric to prevent tearing of the fabric and leaks. For example, in one embodiment, an effective amount of tension is at least about 3 g / mm 2. In order for the framework to provide an effective amount of tension to the fabric, the framework can be designed to effectively compensate for various conditions of stapling. In this way, the framework can be adapted to assume different compressed heights when stapled to the fabric. As there is a finite range of intracted pressures, fabric thicknesses, and heights formed by clamps, the appropriate material and / or geometric structures for the framework can be determined that can be effective in applying a substantially continuous desired tension to the fabric ( eg 3 g / mm 2) when stapled to it for a given amount of time (eg at least 3 days) in a range of stapling conditions. That is, as described in more detail below, the frameworks of the present invention are formed by compressible materials and geometrically configured so as to allow the framework to compress to various heights in predetermined planes when stapled to the fabric. In addition, this varying response across the framework can also allow the framework to maintain its application of a desired continuous tension to the tissue when exposed to fluctuations in the intracted pressure that can occur when the framework is stapled to the tissue (for example, a spike in blood pressure ).

[0066] The framework can have a variety of configurations. For example, in certain embodiments, the framework may include at least one knitted layer and at least one support layer. As used here, the term "knitted layer" is used as a synonym for "knitted zone", and "support layer" is used as a synonym for "spacer zone".

[0067] Figures 8A to 8C and 9 illustrate an exemplary embodiment of a framework 800 that has a first and a second knitted layer 802, 804 with a support layer 806 disposed between them. In this illustrated embodiment, the first knitted layer 802 can be configured to be positioned against the fabric and the second knitted layer 804 can be configured to be positioned against a cartridge platform, such as cartridge platform 606 in Figure 6.

[0068] As shown, the knitted layers 802, 804 include fibers 808 of a first type and fibers 810 of a second type, and the support layer 806 includes the second type of fibers 810. Thus, due to the fact that the framework 800 being formed by two different fibers 808, 810, the framework may have a variable stiffness profile over time after implantation. For example, the first type of fibers 808 can function as a structural component of the knitted layers 802, 804, and the stiffness profile can be a function of the degradation profile of the first type of fibers 808 and the interaction between the first type of fibers 808 and the second type of fibers 810 in the knitted layers 802, 804.

[0069] In addition, the knitted layers 802, 804 can be configured so that when the frame 800 is attached to a cartridge platform, at least a portion of the first type of fibers 808 is oriented in a direction that is substantially parallel to the cartridge platform. Although the first and second types of fibers 808, 810 can have a variety of sizes, in some implementations, the first type of fibers 808 has a fiber diameter that is less than a fiber diameter of the second type of fibers 810.

[0070] Although the fibers 808, 810 of the knitted layers 802, 804 and the support layer 806 may be monofilament or multiple filaments, in some implementations, the first type of fibers 808 are multiple filament fibers and the second type of fibers 810 are monofilament fibers, as shown in Figures 8A to 8C and 9. For use in the present invention, the term "monofilament fibers" has its own common and customary meaning and can include fibers formed by a single filament. As used here, the term "multiple filament fibers" has its own common and customary meaning and can include fibers formed by two or more filaments that are associated with each other to form a unitary structure. In one embodiment, multiple filament fibers are unbound multiple filament fibers. As used here, an "unbound multiple filament fiber" has its own normal and usual meaning and may include a set of two or more filaments that are in contact with each other at at least one point along their lengths but that are not physically connected to each other. Non-limiting examples of unbound multiple filament fibers include yarns (filaments twisted around each other along their lengths) and tow (filaments not twisted around each other along their lengths).

[0071] Multiple filament fibers can have a variety of configurations. For example, in some implementations, each multi-filament fiber includes about 6 to 40 filaments. In one aspect, each multi-filament fiber includes about 14 to 28 filaments. The increased surface area and the empty spaces that exist between the filaments of the multiple filament fibers can facilitate the enhanced internal growth of the tissue within the framework (see for example, Example 2).

[0072] Multiple filament fibers can come in a variety of sizes. For example, each multi-filament fiber can have an average diameter of about 0.02 mm to 0.2 mm, about 0.05 mm to 0.2 mm, or about 0.15 mm to 0, 2 mm. In some implementations, each filament of the multiple filament fibers has a diameter that is less than a fiber diameter of the monofilament fibers. For example, when knitted layers 802, 804 include the first type of fibers which are multi-filament fibers and the second type of fibers which are monofilament fibers, each filament of the multi-filament fibers can have a diameter of about 1 / 5 to 1/20 of the diameter of the monofilament fibers. In certain embodiments, each filament of the multiple filament fibers may have a diameter that is approximately 1/10 the diameter of the monofilament fibers.

[0073] Multiple filament fibers can be formed by filaments formed from the same material or filaments of different materials. For example, in some implementations, multiple filament fibers may include first filaments from a first material and second filaments from a second material. In one embodiment, the second material degrades at a faster rate than the rate of degradation of the first material. In this way, the degradation of the second material can activate, and thus stimulate the accelerated attraction of macrophages, as well as accelerate the healing phase of the inflammation, without substantially affecting the variable stiffness profile of the framework after implantation. The activation of macrophages can, in turn, cause increases in the myofibroblast population and neovascularization. In addition, the degradation of the second material can stimulate the internal growth of the tissue within the framework. The first material, for example, because it is at least one of poly-L-lactic acid, a copolymer of glycolide and L-lactide, a copolymer of glycolic acid and lactic acid, poly (lactic-co-glycolic acid), poly ( lactic acid), polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. Non-limiting examples of suitable first materials can be formed by polyglactin 910, Lactomer ™ 9-1, 75:25 or 50:50 lactic acid / glycolic acid, Polygytone ™ 6211, or Caprosyn ™. The second material, for example, can be a glycolide and L-lactide copolymer, such as Vicryl Rapide ™.

[0074] While multiple filament fibers can include second filaments in various percentage ranges, in some implementations, multiple filament fibers can each include second filaments in a range of about 15% to 85% or in a range of about 25% to 45%. The second filaments can have several fiber diameters. For example, in some implementations, the second filaments can have a fiber diameter of about 0.0005 mm to 0.02 mm. In one embodiment, the second filaments have a fiber diameter of about 0.015 mm.

[0075] Monofilament fibers can have a variety of sizes. For example, monofilaments can have a diameter of about 0.2 mm to 0.35 mm. In some implementations, monofilament fibers may each have a diameter that is less than an average diameter for multiple filament fibers. The average diameter (D) of a multiple filament fiber can be calculated using the following formula:

4𝑊 𝐷 = √ 𝑁𝜌𝜋 where: W = weight of the multiple filament fiber (bundle of fibers) per unit length N = number of filaments ρ = fiber density.

[0076] Although the first and second types of fibers 808, 810 may have various glass transition temperatures, in some implementations, the first type of fibers 808 has a first glass transition temperature and the second type of fibers 810 has a second glass transition temperature which is less than the first glass transition temperature. For example, the first glass transition temperature can be higher than the second glass transition temperature by at least about 30 degrees C. In other exemplary embodiments, the first glass transition temperature can be higher than the second glass transition temperature. glassy by at least about 45 degrees C. A difference in the glass transition of the first and second types of fibers 808, 810 can further facilitate a secure attachment of the framework to the cartridge platform without adversely affecting the structural integrity of the framework.

[0077] As discussed above, a portion of the framework is captured with the tissue within the triggered clip and, therefore, it is desirable that the framework be formed of suitable bioabsorbable materials. In this way, the first and second types of fibers 808, 810 can be formed from a variety of absorbable materials. Non-limiting examples of materials suitable for the first type of fibers include at least one of poly-L-lactic acid, a glycolide and L-lactide copolymer, a glycolic and lactic acid copolymer, poly (lactic-co-glycolic acid ), poly (lactic acid),

polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. For example, the first type of fibers can be formed by polyglactin 910, Lactomer ™ 9-1, 75:25 or 50:50 lactic acid / glycolic acid, Polygytone ™ 6211, or Caprosyn ™. Non-limiting examples of materials suitable for the second type of fibers include at least one among polydioxanone, a polydioxanone and polyglycolide copolymer, a lactide and polycaprolactone copolymer, a glycolide, dioxanone and trimethylene carbonate copolymer, poly (trimethylene carbonate) , polyhydroxyalkanoate and polyglycolate. For example, the second type of fibers can be formed by polydioxanone / polyglycolide at a ratio of 92: 8, lactide / polycaprolactone at a ratio of 25:75, Glycomer ™ 631, or Maxon ™. In one embodiment, the first type of fibers is formed by polyglactin 910 and the second type of fibers is formed by polydioxanone.

[0078] In some embodiments, the first type of 808 fibers can be coated with a bioabsorbable polymeric material. In this way, the glass transition temperature of the first type of fibers 808 can be modified, for example, by increasing or decreasing the glass transition temperature in comparison with the glass transition temperature of the base material of the first type of fibers which, in In certain cases, it may be desirable to attach the frame to the cartridge platform. For example, decreasing the glass transition temperature of the first fiber type 808 can provide a safer fixation of the frame 800 to a cartridge platform, such as the cartridge platform 606 in Figure 6, and / or improve the conformability of the frame 800 to the cartridge platform and, when cooled, maintain a suitable shape. Non-limiting examples of suitable coating materials include polydioxanone or polydioxanone / polycaprolactone at a ratio of 25:75.

[0079] Although knitted layers 802, 804 can each have several knitting patterns, in some implementations, as in Figures 8A to 8C and 9, knitted layers 802, 804 can each have a pattern of Raschel knitting (for example, as described in Example 1 below). One skilled in the art will recognize that the knitted layers of the frame can take the form of other patterns knitted in warp knit.

[0080] As shown in Figures 8A to 8C and 9, the second type of fibers 810 interconnect with the first type of fibers 808 of the first and second knitted layers 802, 804 in such a way that the first and second fibers are attached not fixedly and slidably interconnected. Thus, in this illustrated embodiment, the first and second types of fibers 808, 810 can move in relation to each other, thus enabling movement and expansion in the x direction (for example, extension) and in the y direction (for example , compression). In addition, the interconnection between the first and second types of fibers 808, 810 can affect, at least in part, the stiffness of the frame 800. For example, the tighter the interconnection, the more rigid the frame 800 will be.

[0081] Furthermore, as shown in Figures 8A to 8C and 9, the first and second knitted layers 802, 804 include a plurality of openings 812 formed therein. The openings 812 of the first and second knitted layers 802, 804 each have a perimeter formed by the first and second types of fibers 808, 810. The openings 812 of the second knitted layer 804 can have a size that is less than about ¼ of a width of a staple crown, like staple 406 in Figure 5. Thus, in some implementations, the triggered staple crown can span at least four openings 812 in the second knitted layer 804. In one embodiment, the openings 812 can be about 1/8 the width of the crown. While the crown of a clamp can have a variety of widths, in some implementations, the width of the crown can be about 0.080 inches to 0.140 inches. In one embodiment, the width of the crown is about 0.12 inches.

[0082] The plurality of openings 812 in the first and second knitted layers 802, 804 can be of a variety of sizes. For example, the plurality of openings 812 in the second knitted layer 804 can have a diameter of about 0.002 inches to 0.1 inch. For use in the present invention, "diameter" of an opening is the largest distance between any pair of vertices of the opening.

[0083] As discussed above and shown in Figures 8A to 8C and 9, the frame 800 includes a support layer 806 that is positioned between the first and second knitted layers 802, 804. Support layer 806 is secured attached to the first and second knitted layers 802, 804. Support layer 806 can be configured so that when frame 800 is attached to a cartridge platform, such as cartridge platform 606 in Figure 6, at least a portion of the second type of fibers 810 of the support layer 806 is oriented in a direction that is substantially non-parallel to the cartridge platform. Although support layer 806 is shown in Figures 8A to 8C and 9, to include only the second type of fibers 810 which, in this exemplary embodiment, are monofilaments, it is also contemplated in the present invention that support layer 806 can include types additional fibers, including, for example, the first type of 808 fibers.

[0084] As shown, the fibers 810 of the support layer 806 are arranged within the support layer 806 to form vertical fibers (spacers) 814 and a plurality of voids 816 between them. The vertical fibers 814 are not attached to each other. In addition, vertical fibers 814 are slidably interconnected and not attached to the first type of fibers 808 of the first and second knitted layers 802, 804. In some implementations, the plurality of voids 816 may be larger than the plurality of openings 812 in the first and second knitted layers 802, 804.

[0085] The vertical fibers 814 are configured for flexion under force applied to the framework 800 (for example, when stapled to the fabric). The resilience of the vertical fibers 814 makes it possible, at least in part, for the framework to be compressed to various heights so as to accommodate the fabric (T) with portions of fabric of different thicknesses. That is, regardless of the specific tissue thickness, the sum of the compressed heights of the captured tissue and the framework within the triggered clip can be maintained and, thus, it can remain equal, or at least substantially equal, to the height of the triggered clip. In this way, at least in part, the framework 800 can be configured to apply a tension of at least about 3 g / mm2 to the captured tissue for at least a predetermined period (for example, of at least about 3 days).

[0086] In general, the composition of the material, the height and / or the cross-sectional area of each vertical fiber 814 control, at least in part, its stiffness or ability to flex under compression, which, in turn, controls , at least in part, the compressibility of the framework 800. Consequently, the vertical fibers 814 can be configured to adjust the compressibility of the framework 800 to one or more desired values. For example, although the vertical fibers 814 in Figures 8B, 8C and 9 are of the same material, in some implementations, the support layer 806 may include vertical fibers of different materials with different degrees of stiffness. Alternatively or additionally, in some implementations, the support layer 806 may include vertical fibers of different heights and / or cross-sectional areas. In one embodiment, the vertical fibers 814 can have a high length to diameter ratio, for example, a ratio of about 25: 1 to 6: 1. In this way, vertical fibers 814 can further stimulate internal tissue growth and cell integration within the implanted framework.

[0087] The amount of vertical fibers 814 within a certain section of the backing layer 806 can also affect, among other things, the compressibility of that section and, thus, the compressibility of the framework 800. In certain cases, the vertical fibers 814 can be strategically concentrated in certain sections of the backing layer 806 to provide greater column strength in such sections, for example. In at least one case, the vertical fibers 814 can be concentrated in sections of the backing layer 806 that are configured to receive staples when the staples are fired. Alternatively, the vertical fibers 814 can be concentrated in sections of the backing layer 806 that do not receive staples when the staples are fired.

[0088] The ratio between the voids 816 and the vertical fibers 814 can vary. In an implementation this ratio can be in the range of at least about 3: 1. In other implementations, the ratio of voids 816 to vertical fibers 814 can be in the range of at least about 5: 1 or at least about 12: 1. In addition, at least a portion of the voids 816 in the backing layer 806 may each be of a different size. In this way, the variable void sizes across the cross-section of frame 800 can promote extracellular remodeling. That is, the variable void sizes can facilitate revascularization as well as the mobility of cells within the framework 800 when the framework is implanted, thus stimulating both internal cell and tissue growth. In addition, the variable void sizes can also facilitate the extraction of by-products and cellular waste from the implanted framework, and thus from the implantation site.

[0089] In some embodiments, frame 800 may also include a porous layer interconnected to the second knitted layer 804. Thus, when frame 800 is attached to a cartridge platform, such as cartridge platform 606 in Figure 6, the layer porous layer would be positioned between the cartridge platform and the second knitted layer 804. In one embodiment, the porous layer is fused or bonded to the second knitted layer 804. The porous layer can be formed of a material that has a lower glass transition temperature than the fibers 808, 810 of the framework 800. It is also contemplated in the present invention that the porous layer can be formed by a material that has a glass transition temperature equal to or greater than at least one of the fibers 808, 810 of the framework

800. The porous layer can be less than about 0.003 inches thick. In one embodiment, the porous layer has a thickness that is less than about 0.001 inch. The porous layer can also include pores whose diameter is greater than about 0.0005 inches. For example, in some implementations, pores can range in size from about 0.0005 inches to about 0.001 inches. In addition, in some implementations, pores can make up to 50% of the surface area of the layer.

[0090] The frameworks described here, such as framework 800 in Figures 8A to 8C and 9 can be manufactured using any suitable methods. For example, in one embodiment, the method may include forming a first knitted layer, forming a second knitted layer, and interlocking spacer fibers with the first and second knitted layers. The first and second knitted fibers can comprise fibers from a first polymer. The first knitted layer can be configured to couple with a cartridge platform. The interlacing of the spacer fibers with the first and second knitted layers can connect the first and second knitted layers to one another in a spaced parallel relationship. As used here, a "spaced parallel relationship" means that the first and second layers extend within planes that are spaced apart and substantially parallel to each other. Spacer fibers can be formed by only a second polymer which is different from the first polymer. The fibers of the first polymer can have a diameter that is different from a diameter of the fibers of the second polymer. The spacer fibers can be integrated with the first and second knitted layers and extend between them. The method may also include annealing the first and second knitted layers interlaced with the spacer fibers.

[0091] The interlacing of the spacer fibers with the first and second knitted layers can form a support layer between them. The formation of the first knitted layer can include knitting the fibers of the first polymer according to a predetermined pattern. The formation of the second knitted layer can include knitting the fibers of the first polymer according to a predetermined pattern. While the knitted layers may each have several knitting patterns, in some implementations, the knitted layers may each have a Raschel knitting pattern (for example, as described in Example 1 below). One skilled in the art will recognize that the knitted layers of the frame can take the form of other patterns knitted in warp knit.

[0092] Figure 12A illustrates another exemplary embodiment of a framework 1000. Despite the differences described in detail below, framework 1000 may have similar construction to framework 800 (Figures 8A to 8C and 9) and, therefore, is not described in detail in the present invention. In this embodiment, frame 1000 includes a first knitted layer 1002 that has a first portion 1004 and a second portion 1006, each having external and internal edges. The inner edges 1004a, 1006a define a channel 1008 that extends along the longitudinal geometric axis (L) of the framework 1000. Channel 1008 is configured to receive a cutting member, such as a knife. As shown in Figure 12B, channel 1008 does not fully extend through frame 1000. In particular, channel 1008 does not extend through second knitted layer 1010. In this way, frame 1000 is configured to have sufficient structural integrity to be manipulated. and attached to a cartridge platform, such as the cartridge platform 2014 in Figure 12B. In another embodiment, as shown in Figure 13, the framework 3000 can have a channel 3008 that is perforated. In use, when the cutting member is initially fired and traverses the frame 1000, the cutting member cuts through the second knitted layer 1010, thus dividing the frame 1000 into two pieces.

[0093] In addition, as shown in Figure 12A, the frame 1000 includes flanges 1012 that are configured to mate with the recessed channels, such as the recessed channels 2016 of the cartridge platform 2014 in Figure 12B, as further described below. Although Figure 12A illustrates frame 1000 with flanges 1012 on one side of frame 1000, there are additional flanges 1012 positioned on the opposite side of frame 1000. One skilled in the art will recognize that the number and placement of flanges 1012 are not limited to what is shown in Figure 12A. Although flanges 1012 can be made of a variety of materials, in some implementations, as shown in Figure 12A, flanges 1012 are an extension of the second knitted layer 1010. In another embodiment, flanges 1012 can be formed from different material and formed in line or offline with the other components of the framework 1000. One skilled in the art will recognize that the flanges can be formed from materials equal to or different from those of the first and / or the second knitted layers of the framework and can be attached to them by any means appropriate method.

[0094] Figure 12B illustrates another exemplary embodiment of a staple cartridge set 2000. Despite the differences described in detail below, the staple cartridge set 2000 can be similar to the staple cartridge set 600 (Figure 6) and, therefore, it is not described in detail in the present invention. In addition, for the sake of simplicity, certain components of the staple cartridge assembly 2000 are not illustrated in Figure 12B.

[0095] The staple cartridge set 2000 includes the frame 1000 in Figure 12A attached to a cartridge platform 2014 that has recessed channels 2016. The frame 1000 can be attached to the cartridge platform using any suitable methods, as described in more detail below. As shown, the recessed channels 2016 are configured to receive flanges 1012 so that flanges 1012 can be attached to the side (s) of the cartridge platform. In this way, the frame 1000 can be securely attached to the cartridge platform 2014, thus preventing the unwanted movement of the frame 1000 during use.

[0096] Frameworks can be applied to a cartridge platform to form a staple cartridge set using any suitable method. For example, in some embodiments, the method may include heating a cartridge platform and positioning a frame against a surface of the cartridge platform. The framework can include a first and a second fiber type in which the first type of fiber is predominantly present. For use in the present invention, "predominantly present", when used to describe the amount of specific fibers in a layer,

means an amount that is greater than 50% of the total amount of fibers within that layer. The first type of fibers can have a first glass transition temperature and the second type of fibers can have a second glass transition temperature which is less than the first glass transition temperature. The cartridge platform can be heated to a temperature at least equal to the second glass transition temperature. The method may also include cooling the cartridge platform and the framework applied to it to a temperature that is less than the second glass transition temperature.

[0097] The framework can include the first and second knitted layers each having the first and second types of fibers and a support layer disposed between the first and second knitted layers. In that case, positioning the frame against the surface of the cartridge platform may include placing the first knitted layer against the surface and applying force to the frame, so that the first knitted layer connects and adapts to a shape of the surface. The support layer can be formed from the second type of fibers.

[0098] The instruments disclosed here can be designed to be discarded after a single use, or can be designed to be used multiple times. In any case, however, the instrument can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the instrument, followed by cleaning or replacing specific parts and subsequent reassembly. In particular, the instrument can be disassembled and any number of specific parts or parts of the instrument can be selectively replaced or removed, in any combination. By cleaning and / or replacing specific parts, the instrument can be reassembled for subsequent use in the reconditioning facilities or by a surgical team, immediately before a surgical procedure. Those skilled in the art will recognize that the reconditioning of an instrument can use a variety of techniques to disassemble, clean / replace and reassemble. The use of these techniques, as well as the resulting reconditioned instrument, are all within the scope of this application.

[0099] The present teachings can be further understood with reference to the following non-limiting examples. Examples Example 1: Fabrication of a framework

[00100] A sample that has two layers knitted and a support layer positioned between them was prepared. The two knitted layers were each formed by Vicryl fibers (multiple Vicryl filament fibers) and the support layer was formed by polydioxanone fibers (PDS) (PDS monofilament fibers), details of which are provided in the Table 1 below. Table 1. Information on Vicryl fiber and polydioxanone Fiber Fiber diameter Tension Elongation (mils) (lbf) (%) 7-0 PDS, dyed 3.18 0.67 38.28 2 layers, Vicryl 28 denier, 1 , 17 0,58 20,34 natural

[00101] The sample was knitted in a warp knit using a 16 gauge double needle Raschel knitting machine with a construction of six guide bars (GB). Each guide bar was individually controlled using a standard chain, the patterns of which can be found in Table 2 below. PDS was used in the support layer and Vicryl was used in the knitted layers. Table 2. Standard chain

Movement bars of the guide bar Weft Guide fiber used 1 1-0; 0-0 / 1-2; 2-2 / 2-3; 3-3 / 2-1; 1-1 // Vicryl 2 2-3; 3-3 / 2-1; 1-1 / 1-0; 0-0 / 1-2; 2-2 // Vicryl Frame 3 (1-0; 2-3) X 4 // PDS fully 4 (2-3; 1-0) X 4 // PDS completed 5 2-2; 2-3 / 3-3; 2-1 / 1-1; 1-0 / 0-0; 1-2 // Vicryl 6 1-1; 1-0 / 0-0; 1-2 / 2-2; 2-3 / 3-3; 2-1 // Vicryl

[00102] Approximately 6.4 yards of sample 5 inches wide was produced. The sample was rubbed with isopropyl alcohol. The sample was placed in a cylinder, sealed in a foil pouch purged with nitrogen, and kept under nitrogen flow until further processing.

[00103] An approximate 5-inch × 5-inch segment of the sample was then annealed using the cycle conditions, as described in Table 3. Table 3. Cycle conditions Purging with N2 Gradual increase Annealing Cooling Hours / Minutes / Speed Hours / Minutes / Temperature Temperature (° C / min) Temperature Temperature (° C) (° C) (° C) (° C) 1/30 90/85 0.94 / 1 6/85 60/30

[00104] The annealed sample was then cut to produce frame samples of approximately 5 mm X 10 mm. One of the framework samples was examined using optical microscopy (OM) and EPM. Several OM images of the framework sample are shown in Figures 8A to 8C, and an EPM image in cross section of the framework sample is shown in Figure 9.

Example 2: Internal cell growth and limited inflammation

[00105] The framework samples, prepared as in Example 1, were implanted subcutaneously for up to 90 days in rabbits injected with a hematoxylin stain and eosin stain (H&E). Histopathology images of an implanted framework removed in 60 days are illustrated in Figures 10A and 10B and an implanted framework removed in 90 days is illustrated in Figures 11A and 11B. The blank circles / ovals shown in these images are the fibers of the framework cut perpendicularly or slightly. As shown, the black boxes illustrate some of the portions of the framework in which internal tissue growth occurred during implantation. In addition, the arrows in Figures 10B and 11B point to inflammatory areas around the fibers, which are indicative of the healing phase of the inflammation.

[00106] The person skilled in the art will understand other features and advantages of the invention based on the modalities described above. Consequently, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited are expressly incorporated herein in full, by way of reference. Any patent, publication or information, in whole or in part, that is taken as incorporated by reference to the present invention, is incorporated into the present invention only to the extent that the incorporated material does not conflict with definitions, statements or other existing disclosure materials presented in this document. Accordingly, the disclosure as explicitly presented herein replaces any conflicting material incorporated into the present invention by reference.

Claims (16)

1. Staple cartridge set for use with a surgical stapling instrument, characterized by comprising: a staple cartridge that has a plurality of staples and a cartridge platform; and a knitted, bioabsorbable, elastically deformable framework fixed to the cartridge platform and formed by at least three distinct zones, each of which has a different functionality, in which the clips are implantable, through the framework, into the tissue captured against the framework, and in that the framework comprises: a first knitted zone that is configured to promote tissue growth, in which the first knitted zone includes first fibers made from a first bioabsorbable polymer and second fibers made from a second bioabsorbable polymer, where each first fiber has a fiber diameter that is less than a fiber diameter of each second fiber; a second knitted zone which is configured to be conformable to be attached to the cartridge platform and includes the first and second fibers of the first knitted zone; and a spacer zone formed from the second fibers, in which the spacer zone is arranged between the first and second knitted zones and is configured to support the first and second knitted zones, in which the second fibers are interconnected in a non-fixed and slidable manner. to the first fibers of the first and second knitted zones, where openings are present in the first and second knitted zones and empty spaces are present in the spacer zone, with the empty spaces being larger than the openings. Staple cartridge assembly according to claim 1, characterized in that the fiber diameters of the first fibers are about 1/5 to 1/20 of the fiber diameters of the second fibers. Staple cartridge assembly according to claim 1, characterized in that the fiber diameters of the first fibers are about 1/10 of the fiber diameters of the second fibers. Staple cartridge assembly according to claim 1, characterized in that the second fibers extend from the first knitted zone to the second knitted zone so that the second fibers extend through the spacer zone, in which at least a portion of the second fibers of the spacer zone is oriented substantially perpendicular to the first fibers of the first and second knitted zones. Staple cartridge assembly according to claim 1, characterized in that the fibers of the first type are formed from at least one of poly-L-lactic acid, a glycolide copolymer and L-lactide, a glycolic acid copolymer and lactic acid, poly (lactic-co-glycolic acid), poly (lactic acid), polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. 6. Staple cartridge assembly according to claim 1, characterized in that the fibers of the second type are formed from at least one of the polydioxanone, a polydioxanone and polyglycolide copolymer, a lactide and polycaprolactone copolymer, a glycolide copolymer, dioxanone and trimethylene carbonate, poly (trimethylene carbonate), polyhydroxyalkanoate and polyglycolate. 7. Staple cartridge assembly according to claim 1, characterized in that the framework is configured to apply a tension of at least about 3 g / mm2 to the captured tissue, for at least 3 days when the framework is in a state implanted in the tissue. 8. Staple cartridge set for use with a surgical stapling instrument, characterized by comprising: a staple cartridge that has a plurality of staples and a cartridge platform; and a knitted, bioabsorbable, elastically deformable framework fixed to the cartridge platform and formed by at least three distinct zones, in which each has a different functionality, in which the clips are implantable, through the framework, in the tissue captured against the framework, and in that the framework comprises: a first zone that has a knitted configuration and that is configured to promote the internal growth of the fabric, in which the first zone includes first fibers made from a first bioabsorbable polymer; and a second zone that is formed of second fibers made of a second bioabsorbable polymer and is configured to support the first zone vertically, in which the second fibers are slidably interconnected and not fixed to the first fibers of the first zone so that the second ones fibers are oriented substantially vertically in the second zone, where each first fiber has a fiber diameter that is less than a fiber diameter of each second fiber, and where openings are present in the first zone and empty spaces are present in the second zone, with the empty spaces being larger than the openings. 9. Staple cartridge assembly according to claim 8, characterized in that the frame further comprises a third zone that has a knitted configuration and that is configured to be conformable in order to be attached to the cartridge platform, in which the third zone includes the first fibers, and the second zone is located between the first and the third zones. Staple cartridge assembly according to claim 8, characterized in that the second fibers are non-fixed and slidable interconnected to the first fibers of the third zone, and in which the second fibers extend from the first zone to the third zone so that at least a portion of the second fibers are vertically oriented in the second zone. 11. Staple cartridge assembly according to claim 10, characterized in that the framework is configured to apply a tension of at least about 3 g / mm 2 to the captured tissue, for at least 3 days when the framework is in a state implanted in the tissue. Staple cartridge assembly according to claim 8, characterized in that the fiber diameters of the first fibers are about 1/5 to 1/20 of the fiber diameters of the second fibers. 13. Staple cartridge assembly according to claim 8, characterized in that the fiber diameters of the first fibers are about 1/10 of the fiber diameters of the second fibers. Staple cartridge assembly according to claim 8, characterized in that the fibers of the first type are formed from at least one of poly-L-lactic acid, a glycolide copolymer and L-lactide, a glycolic acid copolymer and lactic acid, poly (lactic-co-glycolic acid), poly (lactic acid), polyglycolide and a copolymer of glycolide, caprolactone, trimethylene carbonate and lactide. A staple cartridge assembly according to claim 8, characterized in that the fibers of the second type are formed from at least one of the polydioxanone, a polydioxanone and polyglycolide copolymer, a lactide and polycaprolactone copolymer, a glycolide copolymer, dioxanone and trimethylene carbonate, poly (trimethylene carbonate), polyhydroxyalkanoate and polyglycolate. 16. Framework for use with a surgical staple cartridge, characterized by comprising: a first knitted area that is configured to promote tissue growth, in which the first knitted area includes first fibers made from a first bioabsorbable polymer and second fibers made from a second bioabsorbable polymer, wherein each first fiber has a fiber diameter that is less than a fiber diameter of each second fiber; a second knitted zone which is configured to be conformable to be attached to a cartridge platform and includes the first and second fibers of the first knitted zone; and a spacer zone formed from the second fibers, in which the spacer zone is arranged between the first and second knitted zones and is configured to support the first and second knitted zones, in which the second fibers are interconnected in a non-fixed and slidable manner. to the first fibers of the first and second knitted zones, where openings are present in the first and second knitted zones and empty spaces are present in the spacer zone, with the empty spaces being larger than the openings.