Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/15—Absorbent pads, e.g. sanitary towels, swabs or tampons for external or internal application to the body; Supporting or fastening means therefor; Tampon applicators
  • A61F13/36—Surgical swabs, e.g. for absorbency or packing body cavities during surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
  • A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
  • A61L15/22—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons containing macromolecular materials
  • A61L15/32—Proteins, polypeptides; Degradation products or derivatives thereof, e.g. albumin, collagen, fibrin, gelatin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/15—Absorbent pads, e.g. sanitary towels, swabs or tampons for external or internal application to the body; Supporting or fastening means therefor; Tampon applicators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
  • A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
  • A61L15/42—Use of materials characterised by their function or physical properties
  • A61L15/64—Use of materials characterised by their function or physical properties specially adapted to be resorbable inside the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/00987—Apparatus or processes for manufacturing non-adhesive dressings or bandages
  • A61F13/00991—Apparatus or processes for manufacturing non-adhesive dressings or bandages for treating webs, e.g. for moisturising, coating, impregnating or applying powder
  • A61F13/00995—Apparatus or processes for manufacturing non-adhesive dressings or bandages for treating webs, e.g. for moisturising, coating, impregnating or applying powder for mechanical treatments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/01—Non-adhesive bandages or dressings
  • A61F13/01008—Non-adhesive bandages or dressings characterised by the material
  • A61F13/01012—Non-adhesive bandages or dressings characterised by the material being made of natural material, e.g. cellulose-, protein-, collagen-based
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/01—Non-adhesive bandages or dressings
  • A61F13/01021—Non-adhesive bandages or dressings characterised by the structure of the dressing
  • A61F13/01029—Non-adhesive bandages or dressings characterised by the structure of the dressing made of multiple layers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/01—Non-adhesive bandages or dressings
  • A61F13/01034—Non-adhesive bandages or dressings characterised by a property
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00089—Wound bandages
  • A61F2013/00106—Wound bandages emergency bandages, e.g. for first aid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00089—Wound bandages
  • A61F2013/00217—Wound bandages not adhering to the wound
  • A61F2013/00221—Wound bandages not adhering to the wound biodegradable, non-irritating
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00089—Wound bandages
  • A61F2013/00357—Wound bandages implanted wound fillings or covers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00365—Plasters use
  • A61F2013/00463—Plasters use haemostatic
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00365—Plasters use
  • A61F2013/00463—Plasters use haemostatic
  • A61F2013/00472—Plasters use haemostatic with chemical means
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00365—Plasters use
  • A61F2013/0054—Plasters use for deep wounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00544—Plasters form or structure
  • A61F2013/00604—Multilayer
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00727—Plasters means for wound humidity control
  • A61F2013/00731—Plasters means for wound humidity control with absorbing pads
  • A61F2013/00744—Plasters means for wound humidity control with absorbing pads containing non-woven
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F2013/00361—Plasters
  • A61F2013/00902—Plasters containing means
  • A61F2013/00927—Plasters containing means with biological activity, e.g. enzymes for debriding wounds or others, collagen or growth factors

Definitions

• the present invention relates to a reinforced absorbable multilayered hemostatic wound dressing and method of making.
• therapeutic agents including, but not limited to, thrombin, fibrin and fibrinogen have been combined with dressing carriers or substrates, including gelatin-based carriers, polysaccharide-based carriers, glycolic acid or lactic acid-based carriers and a collagen matrix.
• dressing carriers or substrates including gelatin-based carriers, polysaccharide-based carriers, glycolic acid or lactic acid-based carriers and a collagen matrix. Examples of such dressings are disclosed in USP 6,762,336, USP 6,733,774 and PCT publication WO 2004/064878 Al .
• carboxylic- oxidized cellulose Due to its biodegradability and its bactericidal, tissue sealing, tissue repairing, drug delivering and hemostatic properties, it is desirable to utilize cellulose that has been oxidized to contain carboxylic acid moieties, hereinafter referred to as carboxylic- oxidized cellulose, as a topical dressing in a variety of surgical procedures, including neurosurgery, abdominal surgery, cardiovascular surgery, thoracic surgery, head and neck surgery, pelvic surgery and skin and subcutaneous tissue procedures.
• nonwoven fabric includes, but is not limited to, bonded fabrics, formed fabrics, or engineered fabrics, that are manufactured by processes other than , weaving or knitting. More specifically, the term “nonwoven fabric” refers to a porous, textile-like material, usually in flat sheet form, composed primarily or entirely of staple fibers assembled in a web, sheet or batt.
• the structure of the nonwoven fabric is based on the arrangement of, for example, staple fibers that are typically arranged more or less randomly.
• the tensile, stress-strain and tactile properties of the nonwoven fabric ordinarily stem from fiber to fiber friction created by entanglement and reinforcement of, for example, staple fibers, and/or from adhesive, chemical or physical bonding.
• the raw materials used to manufacture the nonwoven fabric may be yarns, scrims, netting, or filaments made by processes that include, weaving or knitting.
• the present invention is directed to a reinforced absorbable multilayered hemostatic wound dressing comprising a first absorbable nonwoven fabric reinforced by one or more second absorbable woven or knitted fabric, and thrombin and/or fibrinogen, and method of making.
• the first absorbable nonwoven fabric comprises fibers comprising aliphatic polyester polymers, copolymers, or blends thereof; while the second absorbable woven or knitted fabric comprises oxidized regenerated cellulose fibers.
• the multilayered dressings described herein provide and maintain effective hemostasis when applied to a wound requiring hemostasis.
• Effective hemostasis is the ability to control and/or abate capillary, venous, or arteriole bleeding within an effective time, as recognized by those skilled in the art of hemostasis. Further indications of effective hemostasis may be provided by governmental regulatory standards and the like.
• multilayered dressings of the present invention are effective in providing and maintaining hemostasis in cases of severe or brisk bleeding.
• severe bleeding is meant to include those cases of bleeding where a relatively high volume of blood is lost at a relatively high rate.
• severe bleeding include, without limitation, bleeding due to arterial puncture, liver resection, blunt liver trauma, blunt spleen trauma, aortic aneurysm, bleeding from patients with over-anticoagulation, or bleeding from patients with coagulopathies, such as hemophilia.
• the reinforced absorbable multilayered dressing generally comprises a nonwoven fabric and one or more reinforcement fabric.
• the reinforcement fabric provides a backing to which the nonwoven fabric may be attached, either directly or indirectly, wherein thrombin and/or fibrinogen are substantially homogeneously dispersed throughout the nonwoven fabric and/or are disposed on the surface of the nonwoven fabric.
• the reinforcement fabric provides strength to the dressing sufficient to permit the user of the dressing to place and manipulate the dressing on or within a wound or directly onto tissue of a patient requiring hemostasis, or tissue sealing and adhering.
• the nonwoven fabric In addition to serving as a carrier for the thrombin and/or fibrinogen, the nonwoven fabric also serves to shield the thrombin and/or fibrinogen from acidic moieties that may be present in the reinforcement fabric, such as is the case where carboxylic-oxidized cellulose is used as the reinforcement fabric.
• the nonwoven fabric functions as the first absorbable nonwoven fabric of the reinforced absorbable multilayered dressing described herein.
• the first absorbable nonwoven fabric is comprised of fibers comprising aliphatic polyester polymers, copolymers, or blends thereof.
• the aliphatic polyesters are typically synthesized in a ring opening polymerization of monomers including, but not limited to, lactic acid, lactide (including L-, D-, meso and D, L mixtures), glycolic acid, glycolide, ⁇ - caprolactone, /?-dioxanone (l,4-dioxan-2- one), and trimethylene carbonate (1,3-dioxan- 2-one).
• the first absorbable nonwoven fabric comprises a copolymer of glycolide and lactide, in an amount ranging from about 70 to 95% by molar basis of glycolide and the remainder lactide.
• the nonwoven fabric is made by processes other than, weaving or knitting.
• the nonwoven fabric may be prepared from yarn, scrims, netting or filaments that have been made by processes that include, weaving or knitting.
• the yarn, scrims, netting and/or filaments are crimped to enhance entanglement with each other and attachment to the second absorbable woven or knitted fabric.
• Such crimped yarn, scrims, netting and/or filaments may then be cut into staple that is long enough to entangle.
• the staple may be between about 0.1 and 2.5 inches long, preferably between about 0.5 and 1.75 inches, and most preferably between about 1.0 and 1.3 inches.
• the staple may be carded to create a nonwoven batt, which may be then needlepunched or calendared into the first absorbable nonwoven fabric. Additionally, the staple may be kinked or piled.
• nonwoven fabrics may be utilized and include such processes as air laying, wet forming and stitch bonding. Such procedures are generally discussed in the Encyclopedia of Polymer Science and Engineering, Vol. 10, pp. 204-253 (1987) and Introduction to Nonwovens by Albin Turbank (Tappi Press, Atlanta GA 1999), both incorporated herein in their entirety by reference.
• the thickness of the nonwoven fabric may range from about 0.25 to 2 mm.
• the basis weight of the nonwoven fabric ranges from about 0.01 to 0.2 g/in 2 ; preferably from about 0.03 to 0.1 g/in 2 ; and most preferably from about 0.04 to 0.08 g/in 2 .
• the weight percent of first absorbable nonwoven fabric may range from about 5 to 50 percent, based upon the total weight of the reinforced absorbable multilayered dressing having thrombin and/or fibrinogen.
• the second absorbable woven or knitted fabric functions as the reinforcement fabric and comprises oxidized polysaccharides, in particular oxidized cellulose and the neutralized derivatives thereof.
• the cellulose may be carboxylic-oxidized or aldehyde-oxidized cellulose. More preferably, oxidized regenerated polysaccharides including, but without limitation, oxidized regenerated cellulose may be used to prepare the second absorbable woven or knitted fabric. Regenerated cellulose is preferred due to its higher degree of uniformity versus cellulose that has not been regenerated.
• fabrics that may be utilized as the reinforcement fabric include, but are not limited to, Interceed ® absorbable adhesion barrier, Surgicel ® absorbable hemostat; Surgicel Nu ⁇ Knit ® absorbable hemostat; and Surgicel ® Fibrillar absorbable hemostat; each available from Johnson & Johnson Wound Management Worldwide or Gynecare Worldwide, each a division of Ethicon, Inc., Somerville, New Jersey.
• the reinforcement fabric utilized in the present invention may be woven or knitted, provided that the fabric possesses the physical properties necessary for use in contemplated applications. Such fabrics, for example, are described in USP 4,626,253, USP 5,002,551 and USP 5,007,916, the contents of which are hereby incorporated by reference herein as if set forth in its entirety.
• the reinforcement fabric is a warp knitted tricot fabric constructed of bright rayon yarn that is subsequently oxidized to include carboxyl or aldehyde moieties in amounts effective to provide the fabrics with biodegradability.
• the reinforcement fabric comprises fibers comprised of aliphatic polyester polymers, copolymers, or blends thereof alone or in combination with oxidized polysaccharide fibers.
• the second absorbable woven or knitted fabric preferably comprises oxidized regenerated cellulose and may have a basis weight ranging from about 0.001 to 0.2 g/in 2 , preferably in the range of about 0.01 to 0.1 g/in 2 , and most preferably in the range of about 0.04 to 0.07 g/in 2 .
• the first absorbable nonwoven fabric is attached to the second absorbable woven or knitted fabric, either directly or indirectly.
• the nonwoven fabric may be incorporated into the second absorbable woven or knitted fabric via needlepunching, calendaring, embossing or hydroentanglement, or chemical or thermal bonding.
• the staple of the first absorbable nonwoven fabric may be entangled with each other and imbedded in the second absorbable woven or knitted fabric. More particularly, for methods other than chemical or thermal bonding, the first absorbable nonwoven fabric may be attached to the second absorbable woven or knitted fabric such that at least about 1% of the staple of the first absorbable nonwoven fabric are exposed on the other side of the second absorbable woven or knitted fabric, preferably about 10- 20% and preferably no greater than about 50%.
• the reinforced absorbable multilayered fabric is uniform such that substantially none of the second absorbable woven or knitted fabric is visibly devoid of coverage by the first absorbable nonwoven fabric.
• One method of making the multilayered fabric described herein is by the following process.
• Absorbable polymer fibers having a denier per fiber of about 1 to 4 may be consolidated to about 80 to 120 denier multifilament yarn and then to about 800 to 1200 denier yarns, thermally crimped and then cut to a staple having a length between about 0.75 and 1.5 inch.
• the staple may be fed into a multiroller dry lay carding machine one or more times and carded into a uniform nonwoven batt, while humidity is controlled between about 20-60% at a room temperature of 15 to 24 0 C.
• the uniform nonwoven batt may be made using a single cylinder roller-top card, having a main cylinder covered by alternate rollers and stripper rolls, where the batt is doffed from the surface of the cylinder by a doffer roller and deposited on a collector roll.
• the batt may be further processed via needlepunching or any other means such as calendaring.
• the first absorbable nonwoven fabric may be attached to the second absorbable woven or knitted fabric by various techniques such as needlepunching.
• the reinforced absorbable multilayered fabric may then be scoured by washing in an appropriate solvent and dried under mild conditions for 10-30 minutes.
• the consolidated yarns may have from about 5 to 50 crimps per inch and preferably from about 10 to 30 crimps per inch. Efficient cutting of the crimped yarns is desirable, as any long and incompletely cut staple tends to stick on the carding machine and cause pilling.
• a preferred range of the staple length is from about 0.75 to 1.5 inches, and preferably from about 1.0 to 1.3 inches.
• the relative humidity may be controlled during batt processing, preferably during carding to form the uniform nonwoven batt.
• the nonwoven batt is processed using a dry lay carding process at a relative humidity of at least about 20% at a room temperature of about 15 to 24 0 C. More preferably, the nonwoven batt is processed at a relative humidity of from about 40% to 60%.
• the multilayered fabric is scoured using solvents suitable to dissolve any spin finish.
• Solvents include, but are not limited to, isopropyl alcohol, hexane, ethyl acetate, and methylene chloride.
• the multilayered fabric is then dried under conditions to provide sufficient drying while minimizing shrinkage.
• the reinforced absorbable multilayered fabric may have an average thickness of between about 0.5 and 3.0 mm, preferably between about 1.00 and 2.5 mm, and most preferably between about 1.2 and 2.0 mm.
• the reported thickness is dependent upon the method of thickness measurement. Preferred methods are the ASTM methods (ASTM D5729-97 and ASTM D 1777-64) conventionally used for the textile industry in general and non-woven in particular. Such methods can be slightly modified and appropriately adopted in the present case as described below.
• the basis weight of the reinforced absorbable multilayered fabric is between about 0.05 and 0.25 g/in 2 , preferably between about 0.08 and 0.2 g/in 2 , and most preferably between about 0.1 and 0.18 g/in 2 .
• the reinforced absorbable multilayered fabric is uniform such that there is no more than about 10% variation (relative standard deviation of the mean) in the basis weight or thickness across each square inch.
• the thrombin and/or fibrinogen may be animal derived, preferably human, or may be recombinant.
• the thrombin activity on the multilayered dressing may be in the range of about 20 to 500 I ⁇ /cm 2 , preferably about 20 to 200 IU/cm 2 , and most preferably about 50 to 200 IU/cm 2 .
• the fibrinogen activity on the multilayered dressing may be in the range of about 2 to 15 mg/cm 2 , preferably about 3 to 10 mg/cm 2 , and most preferably about 4 to 7 mg/cm .
• the basis weight of the multilayered dressing having the thrombin and/or fibrinogen powders is between 0.1 and 1.0 g/in 2 , preferably between 0.1 and 0.5 g/in 2 , and most preferably between 0.1 and 0.3 g/in 2 .
• the multilayered dressing having the thrombin and/or fibrinogen may be sterilized, for example, by radiation, preferably by electron beam radiation.
• the air porosity of the multilayered dressing having the thrombin and/or fibrinogen powders ranges from about 50-250 cmVsec/cm 2 , preferably between 50-150 cm 3 /sec/cm 2 , and most preferably 50-100 cm 3 /sec/cm 2 .
• the reinforced absorbable multilayered dressing When the reinforced absorbable multilayered dressing is used internally, about 50 to 75% of its mass is absorbed after about 2 weeks.
• the percent of mass loss may be measured by using a rat implantation model.
• the dressing is inserted into the rat by first making a midline incision (approximately 4 cm) in the skin over the lumbosacral vertebral column of a rat.
• the skin is then separated from the underlying connective tissue, bilaterally, to expose the superficial gluteal muscles.
• An incision is then made in the dorso-lateral fascia, which is located above the gluteal muscles and directly adjacent to the vertebral column. Using blunt dissection, a small pocket is created between the fascia and the gluteal muscle lateral to the incision.
• the multilayered dressing is placed in the gluteal pocket.
• the fascia is then sutured in place.
• the rat is euthenized and the multilayered dressing is explanted to determine the percent
• the first absorbable nonwoven fabric retains solid thrombin and/or solid fibrinogen powder without separation and with minimal loss of the powder from its surface.
• Thrombin and/or fibrinogen containing solutions are separately lyophilized.
• the lyophilized materials are then ground into powders using a superfine mill or a cooled blade mill.
• the powders are weighed and suspended together in a carrier fluid in which the proteins are not soluble.
• a preferred carrier fluid is a perfluorinated hydrocarbon, including but not limited to HFE-7000, HFE-7100, HFE-7300 and PF- 5060 (commercially available from 3M of Minnesota). Any other carrier fluid in which the proteins do not dissolve may be used, such as alcohols, ethers or other organic fluids.
• the suspension is thoroughly mixed and applied to the first absorbable nonwoven fabric via conventional means such as wet, dry or electrostatic spraying, dip coating, painting, or sprinkling, while maintaining a room temperature of about 60 to 75 degrees F and relative humidity of about 10 to 45%.
• the multilayered dressing is then dried at ambient room temperature and packaged in a suitable moisture barrier container.
• the multilayered dressing having the thrombin and/or fibrinogen contains no more than 25% moisture, preferably no more than 15% moisture, and most preferably no more than 5% moisture.
• the amount of thrombin and/or fibrinogen powder applied to the nonwoven fabric is sufficient to cover its surface such that no area is visibly devoid of coverage.
• the powder may sit mostly on top of the nonwoven fabric or may penetrate into the nonwoven fabric as far as the surface of the second absorbable woven or knitted fabric. However, the bulk of the powder does not contact the second absorbable woven or knitted fabric, and no more than trace amounts of the powders penetrate to the underside of the second absorbable woven or knitted fabric.
• the multilayered dressing described herein may be used as an adjunct to primary wound closure devices, such as arterial closure devices, staples, and sutures, to seal potential leaks of gasses, liquids, or solids as well as to provide hemostasis.
• the multilayered dressing may be utilized to seal air from tissue or fluids from organs and tissues, including but not limited to, bile, lymph, cerebrospinal fluids, gastrointestinal fluids, interstitial fluids and urine.
• the multilayered dressing described herein has additional medical applications and may be used for a variety of clinical functions, including but not limited to tissue reienforcement and buttressing, i.e., for gastrointestinal or vascular anastomoses, approximation, i.e., to connect anastomoses that are difficult to perform (i.e. under tension), and tension releasing.
• the dressing may additionally promote and possibly enhance the natural tissue healing process in all the above events.
• This dressing can be used internally in many types of surgery, including, but not limited to, cardiovascular, peripheral-vascular, cardio-thoracic, gynecological, neuro- and general surgery.
• the dressing may also be used to attach medical devices (e.g. meshes, clips and films) to tissues, tissue to tissue, or medical device to medical device.
• Example 1 Poly (glycolide-co-lactide) (PGL, 90/10 mol/mol) was melt-spun into fiber. A
• 80 denier multifilament yarn was consolidated into a 800 denier consolidated yarn.
• the consolidated yarn was crimped at approximately 110 0 C.
• the crimped yarn was cut into staple having a length of about 1.25" in length.
• 20 g of the crimped staple was accurately weighed and laid out uniformly on the feed conveyor belt of a multi-roller carding machine.
• the environmental conditions (temp: 21 0 C /55% RH) were controlled.
• the staple was then carded to create a nonwoven batt.
• the batt was removed from the pick-up roller and cut into 4 equal parts. These were re-fed into the carder perpendicular to the collection direction.
• the batt was weighed (19.8 g: 99% fabric yield) and then compacted into a felt.
• the compact felt was precisely laid onto an ORC fabric and firmly attached via 2 passes in the needlepunching equipment.
• the multilayered fabric was trimmed and scoured in 3 discrete isopropyl alcohol baths to remove spin finish and any machine oils.
• the scoured multilayered fabric was dried in an oven at 70 0 C for 30 minutes, cooled and weighed.
• BAC-2 (Omrix Biopharmaceuticals, Inc.) specific activity (by Clauss) 0.3g/g] and 1.89 g of thrombin-containing powder (also from Omrix
• the multilayered hemostatic wound dressing was cut into appropriate sizes and packed in a tray.
• the tray is specifically designed such that the clearance between the top and the bottom of the tray is slightly less than the overall thickness of the dressing to ensure minimized motion of the dressing during shipping and handling, to prevent the coated powder from dislodging during transit..
• the tray is further packaged in a foil pouch, which is thermally sealed with dessicants as needed.
• the dressing was stored at 2-8 0 C until needed.
• the "thickness" of the multilayered fabric/dressing was measured as described herein.
• the measurement tools were:
• the multilayered fabric/dressing was placed on a platen surface that is a smooth and machined surface.
• the two metal plates were placed on top of each other on the multilayered fabric/dressing and gently pressed at their corners to make sure the multilayered fabric/dressing is flat.
• the gauge foot was placed onto the top of the metal plates and was then re-lifted and re-placed, at which time a reading was made.
• anesthetized pigs were dissected to expose the abdominal aorta.
• a biopsy punch was used to remove a 4 mm section of the aorta.
• the blood was allowed to flow freely, and the dressing to be tested was quickly applied to the wound site while aspirating any excessive pooling blood.
• Manual pressure was applied to hold the dressing to the wound site for 3 minutes. At the end of the three-minute period, pressure was removed. The test was considered a "pass" if the dressing adhered well to the wound and achieved full hemostasis with no re-bleeding.
• Non- woven PGL fabric with ORC reinforcement fabric Non- woven PGL fabric with ORC reinforcement fabric.
• Poly (glycolide-co-lactide) (PGL, 90/10 mol/mol) was melt-spun into fiber.
• the fiber was cut into small staple and then carded to create a very fine nonwoven fabric of about 1.25 millimeters thick and had a density of about 98.1 mg/cc.
• the nonwoven fabric was then needle punched into a knitted carboxylic-oxidized regenerated cellulose fabric, available from Ethicon, Inc., under the tradename Interceed ® , to secure the nonwoven fabric to the ORC fabric.
• the final construct comprised about 60 weight percent of the nonwoven fibers.
• Example 3 The material described in Example 3 was coated with dry particles consisting mostly of fibrinogen (7 to 8 mg/cm 2 ) and thrombin (50IU/cm 2 ), and then tested using a Hydraulic Burst Leak Test (HBLT). Samples were cut into circular pieces of % inch diameter. The samples were placed onto a tissue substrate derived from bovine pericardium with a hole in the center of the tissue. The pierced tissue substrate was placed over an airtight chamber into which saline was pumped. The pressure required to disrupt/burst the seal formed between the tissue and the sample was measured (see Figure 1). Samples without protein coating do not adhere to the tissue.
• HBLT Hydraulic Burst Leak Test
• Example 5 Poly (glycolide-co-lactide) (PGL, 90/10 mol/mol) was melt-spun into fiber. A 80 denier multifilament yarn was consolidated into a 800 denier consolidated yarn. The consolidated yarn was crimped at approximately 110 0 C. The crimped yarn was cut into staple having a length of about 1.25" in length. 44 g of the crimped staple was accurately weighed after conditioning the yarn for about 30 minutes in a high humidity environment (>55% RH). The yarn was laid out uniformly on the feed conveyor belt of a multi-roller carding machine. The feed time (5minutes) was accurately controlled to within 30-45 seconds. The environmental conditions (temp: 21 0 C /25% RH) were recorded.
• PGL poly (glycolide-co-lactide)
• Static bars were employed near the 2 nd Randomiser roller as well as near the steel pick up roller and were turned on during the run to minimize the detrimental impact of static generation on the uniformity and yield of the resulting batt.
• the staple was then carded to create a nonwoven batt.
• Two vacuum inlets were strategically placed near the two edges of the 2 nd Randomizer roller to control the width of the ensuing batt.
• the batt was removed from the pick-up roller and weighed (41g: 91% yield).
• the uniform batt was precisely laid onto an ORC fabric and firmly attached via a single pass in the needlepunching equipment. The needle penetration depth was controlled at 12 mm.
• the multilayered fabric was trimmed and scoured on a rack (along with other similarly produced sheets) suspended in a tank containing isopropyl alcohol to remove spin finish and any machine oils.
• the scoured multilayered fabric (matrix sheet) was calendered to remove excess solvent and dried in an oven at 7O 0 C for app. 30 minutes, cooled and weighed.
• Example 6 The matrix sheet as described has an off-white/beige color on both sides.
• One side may be described as the non-woven side where as the other side as the knitted fabric side.
• it may be vital to identify the non-woven versus knitted surfaces of the matrix. Under difficult environmental conditions, the similarity in color and texture (to some extent) makes it difficult to identify one side from the other.
• Several means were employed to impart sidedness to the matrix sheet, which enables the observer to distinguish the 2 sides apart. These means include physical (stitching/knitting, braiding, pleating, etc), thermo-mechanical (heat, heat embossing; laser etching; etc) and chromic (use of a dye) means may be employed to achieve sidedness. The following examples describe some of the means:
• the matrix sheet was modified on the knitted fabric side by attaching a lmm wide 4 inch long braided tape of the polyglactin 910 fiber.
• the tapes although successful in imparting sidedness add to the amount of the longer resorbing Polyglactin 910.
• a web made of dyed nylon fiber was placed under the knitted fabric and the non- woven batt during the needle-punching step.
• the web is secured to the knitted fabric side due to the needling process.
• the web affords excellent sidedness and if available in an absorbable material, could be used to make completely resorbable, implantable matrix sheets.
• the web (mesh) can be secured similarly on the non-woven side.
• Other means of securing the web may be thermo-mechanical in nature. Inclusion of such a web can be for the reason of mechanical enforcement as well. In such cases the web could be secured on either side or even between the two layers.
• Such a reinforced structure may have multiple applications.
• the small amount of Polyglactin 910 that resides on the knitted fabric side (due to the needle-punching step) of the matrix sheet can be thermally modified to create sidedness. This can include heating under pressure such that a shiny film of Polyglactin 910 is formed. Other options include heat embossing a discernible pattern. Both approaches achieve sidedness but may result in thermal degradation of the polymer/construct
• the knitted ORC fabric prior to the needle-punching step is pleated (vertical or horizontal pleats). The pleats are stabilized by using heat and pressure. The pleated fabric is then used in place of the regular fabric for the rest of the process as described in Example 5. The resulting matrix sheet has distinct stripes that achieve the sidedness.
• Dyed Polyglactin 910 creates matrix sheet that is colored on the non- woven side and off-white/beige on the other. This construct achieves sidedness.
• a dye can be used similarly by employing a dyed suture thread etc. on the knitted side. The suture (braided into a tape or used as is) may be sewed in or thermally bonded.

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