WO2016148647A1 - Ancrage et suture pour un ensemble suture - Google Patents

Ancrage et suture pour un ensemble suture Download PDF

Info

Publication number
WO2016148647A1
WO2016148647A1 PCT/SG2016/050118 SG2016050118W WO2016148647A1 WO 2016148647 A1 WO2016148647 A1 WO 2016148647A1 SG 2016050118 W SG2016050118 W SG 2016050118W WO 2016148647 A1 WO2016148647 A1 WO 2016148647A1
Authority
WO
WIPO (PCT)
Prior art keywords
suture
anchor
assembly
knot
leading end
Prior art date
Application number
PCT/SG2016/050118
Other languages
English (en)
Inventor
Nir Ellenbogen
Hajime WATAHIKI
Original Assignee
I Support Pte. Ltd.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from PCT/SG2015/000081 external-priority patent/WO2015137882A1/fr
Application filed by I Support Pte. Ltd. filed Critical I Support Pte. Ltd.
Publication of WO2016148647A1 publication Critical patent/WO2016148647A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00792—Plastic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0403—Dowels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0412—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from suture anchor body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0427—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from the anchor body
    • A61B2017/0437—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from the anchor body the barbs being resilient or spring-like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0438—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors slotted, i.e. having a longitudinal slot for enhancing their elasticity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06166—Sutures
    • A61B2017/06176—Sutures with protrusions, e.g. barbs

Definitions

  • the present invention relates to an anchor and a suture for a suture assembly for cosmetic enhancement.
  • each suture is stitched through the tissue with a needle, with the barbs oriented away from the needle, in a direction opposite the thread tension.
  • the facial tissue may then be lifted manually and the barbs would hold the tissue in place in the new configuration.
  • the tension on the thread is then readjusted and the thread secured at a final position with knots. The thread is then cut flush to the knot and urged under the skin.
  • some or all of these prior art methods may result in at least two entry/exit wounds per suture, may be subject to single sutures breaking, multiple entry and exit points, each entry and exit point causing scarring and bleeding, significant anaesthetic may be required, and/or the recovery time may be significant.
  • the present invention proposes a minimally invasive device and technique for cosmetic suturing.
  • an anchor for a suture assembly comprising: a rigid portion having a leading end; a suture engager configured to engage a central portion of a length of suture at a distance from the leading end; and at least two resilient portions projecting laterally from the rigid portion, the at least two resilient portions configured to be displaceable towards a central longitudinal axis of the anchor to allow passage of the anchor through a cannula during implantation of the suture assembly in a patient, the at least two resilient portions further configured to return to their undisplaced positions once the anchor exits the cannula in order to engage facial tissue of the patient to resist movement of the anchor after the anchor is implanted in the patient.
  • the suture engager may comprise a narrowed neck provided within the rigid portion at a distance from the leading end, the narrowed neck configured to engage an enlarged portion of the central portion of the length of suture, the narrowed neck and the leading end defining a space within the rigid portion for containing at least a majority of volume of the enlarged portion within the rigid portion.
  • the narrowed neck may comprise an opening configured to allow passage of two portions of suture therethrough and to prevent passage of the enlarged portion therethrough.
  • the opening may be elongate in a plane perpendicular to the central longitudinal axis of the anchor.
  • the space may be configured to fully contain the volume of the enlarged portion therein.
  • the enlarged portion may comprise one of: a knot of the suture and a bead secured to the suture.
  • the suture engager may comprise a channel extending across the leading end into the rigid portion.
  • the channel may be configured to engage the central portion of the length of suture via a press fit.
  • the rigid portion may comprise a groove on each side of the rigid portion, each groove extending longitudinally down each side of the rigid portion
  • a suture for a suture assembly comprising: a single length of suture; a first barbed portion having a first plurality of barbs formed thereon; and a second barbed portion having a second plurality of barbs formed thereon, wherein the first plurality of barbs and the second plurality of barbs are inclined towards a central portion of the length of suture.
  • the suture may have a knot tied at the central portion of the length of suture.
  • the knot may comprise an overhand knot.
  • the first barbed portion Prior to assembly of the suture with an anchor of the suture assembly, the first barbed portion may be on a first side of the knot and the second barbed portion may be on a second side of the knot, and wherein at the time of assembly of the suture with the anchor, the first barbed portion and the second barbed portion may be generally alongside each other on a same side of the knot.
  • a suture assembly comprising the anchor of the first aspect and the suture of the second aspect.
  • FIG. 1 is a front view of a patient's facial tissue implanted with a plurality of suture assemblies of the present invention.
  • FIG. 2 is a schematic illustration of a first embodiment of a suture of a first embodiment of a suture assembly prior to assembly.
  • FIG. 3 is a schematic illustration of the first embodiment of the suture assembly prior to complete assembly.
  • FIG. 4 shows various views of the suture assembly of FIG. 3 completely assembled for implantation in a patient.
  • FIG. 5 shows various views of an anchor of the suture assembly of FIG. 4.
  • FIG. 6 shows various views of a second embodiment of the suture assembly.
  • FIG. 7 shows various views of an anchor of the suture assembly of FIG. 6.
  • FIGS. 1 to 7 Embodiments of an anchor 80, a suture 90 and a suture assembly 100 will be described with reference to FIGS. 1 to 7, wherein the same reference numerals have been used to indicate the same or similar parts.
  • the suture assembly 100 is designed to effect a distributed lifting force to desired portions of facial tissue of a patient whose face may be subject to rhytides (wrinkles) or ptosis (sagging).
  • the suture assembly 100 may be used to lift tissue in the cheeks 102, temples 104, neck or forehead 106 zones. In each zone, one or more barbed sutures are upwardly implanted within or under the tissue.
  • An entry site 108 of the suture assembly 100 is below a final implantation position 112 of an anchor 80 of the suture assembly 100 when the patient is in an upright position, there being no exit site of the suture assembly 100 during implantation.
  • the suture assembly 100 may reduce the number of wounds significantly compared to known methods, and the practitioner is able to provide lift in any location, as there is no need to provide an exit site at an unobtrusive location.
  • Each entry site 108 may include more than one implanted suture, for example three implanted suture assemblies 110 at different angles.
  • Each suture assembly 110 may include a single or multiple sutures, which are anchored at the top 112.
  • the anchor 80 is configured to anchor the suture 90 in place to provide a necessary reaction force to lifting forces provided by the barbs 911 , 922 to the facial tissue.
  • the anchor 80 is also configured to allow the suture assembly 100 to be pushed into a cannula (not shown) provided for implantation of the suture assembly 100 in the patient.
  • a suture 90 of a first embodiment of the suture assembly 100 comprises a single length of suture 90 having a knot 99 tied at a central portion 98 of the length of the suture 90.
  • the suture 90 has a first barbed portion 91 having a first plurality of barbs 911 formed thereon, and a second barbed portion 92 having a second plurality of barbs 922 formed thereon.
  • the first plurality of barbs 911 and the second plurality of barbs 922 are inclined towards the knot 99, and are preferably provided on the first and second barbed portions 91 , 92 in a staggered and opposite-sided distribution, as depicted.
  • the knot Preferably, the knot
  • the knot 99 comprises an overhand knot so as to be as small and simple a knot as possible.
  • the first barbed portion 91 and the second barbed portion 92 may be on different sides of the knot 99, as shown in FIG. 2A.
  • a suture 90 of a second embodiment of the suture assembly As shown in FIG. 2B (not to scale), a suture 90 of a second embodiment of the suture assembly
  • the 100 comprises a single length of suture 90.
  • the suture 90 has a first barbed portion 91 having a first plurality of barbs 911 formed thereon, and a second barbed portion 92 having a second plurality of barbs 922 formed thereon.
  • the first plurality of barbs 911 and the second plurality of barbs 922 are inclined towards a central portion 98 of the length of the suture 90 that is free of barbs, and are preferably provided on the first and second barbed portions 91 , 92 in a staggered and opposite-sided distribution, as depicted.
  • the suture may be 345mm long. Alternatively multiple lengths may be provided for different zones of the face, or different sized faces for example 375mm long.
  • the suture may be 0.3mm thick. Alternatively multiple thicknesses may be provided for obtaining different tensile strengths.
  • the suture 90 may be extruded from Polypropylene, Polycaprolactone, Poliactic Acid or Polydioxanone. Some of these materials, such as Polydioxanone are biocompatible and biodegradable. As such, the face lift effect is temporary and the suture assembly 100 does not stay implanted permanently. This also reduces risk of complications.
  • the suture 90 is manipulated to result in both the first barbed portion 91 and the second barbed portion 92 being generally alongside each other on a same side of the knot 99.
  • the first barbed portion 91 and the second barbed portion 92 extend from the trailing end 82 of the anchor 80 while the knot 99 is fully contained within the anchor 80. In this way, no part of the suture 90 projects beyond the leading end 81 of the anchor 80.
  • the leading end 81 of the anchor first enters and leads the movement of the suture assembly 100 into the entry site 108 and along the canula.
  • the first embodiment of the anchor 80 comprises a rigid portion 88 having the leading end 81 and the trailing end 82.
  • the rigid portion 88 preferably comprises a generally cylindrical tube as shown, although any other suitable shapes may also be used, so long as the rigid portion 88 has a longitudinal through hole.
  • the anchor 80 comprises a suture engager 89 in the form of a narrowed neck 89 provided within the central longitudinal through hole of the rigid portion 88, at a distance from the leading end 81.
  • the narrowed neck 89 is configured to engage the knot 99 of the suture 90 so that the knot 99 lies on one side of the narrowed neck 89 in the longitudinal through hole of the rigid portion 88 while allowing the first barbed portion 91 and second barbed portion 92 of the suture 90 to extend out of the rigid portion 88 on the other side of the narrowed neck 89.
  • the narrowed neck 89 and the leading end 81 thus define a space 83 within the rigid portion 88 for fully containing the knot 99 within the rigid portion 88 of the anchor 80, or at least to contain a majority of volume of the knot.
  • the narrowed neck 89 thus comprises an opening 87 configured to allow passage of the first and second barbed portions 91 , 92 of the suture 90 therethrough, and to prevent passage of the knot 99 therethrough.
  • the opening 87 is elongate in a plane perpendicular to a central longitudinal axis L of the anchor 80, in order to have a minimally sized opening that allows both the first barbed portion 91 and the second barbed portion 92 to be simultaneously passed through the narrowed neck 89.
  • the anchor 80 By configuring the anchor 80 to allow the knot 99 of the suture 90 to be contained within the rigid portion 88 of the anchor 80, and by providing the knot 99 at the central portion 98 of the suture 90 rather than at the ends 910, 920 of the suture 90, no part of the suture 90 projects beyond the leading end 81 of the anchor 80. Furthermore, as the overhand knot 99 is significantly smaller than other knots that are required to securely tie two free ends of a suture together, the overhand knot 99 can be fully accommodated within the rigid portion 88 without requiring the rigid portion 88 to be enlarged. Enlargement of the rigid portion 88 is not desirable as this would require a larger cannula and entry site for implantation.
  • a bead (not shown) of diameter greater than the diameter than the suture 90 may be provided at the central portion 98 of the suture 90.
  • the centrally provided bead on the suture 90 should be small enough to be contained within the rigid portion 88 of the anchor 80 while also being large enough not to pass through the narrowed neck 89 of the rigid portion 88.
  • the bead thus functions in the same way as the knot 99, and and may be secured to the suture 90 by any appropriate means, such as soldering or glueing.
  • the anchor 80 has a narrowed neck 89 configured to engage an enlarged portion 99 of the central portion 98 of the suture 90 at a distance from the leading end 81 of the anchor 80, the enlarged portion 99 being a knot 99 or a bead (not shown).
  • the anchor 80 comprises a rigid portion 88 having the leading end 81 and the trailing end 82.
  • the rigid portion 88 preferably comprises a generally cylindrical block as shown, although any other suitable shapes may also be used.
  • the anchor 80 comprises a suture engager 89 in the form of a channel 89 provided in the rigid portion 88 from the leading end 81.
  • the channel 89 extends across the leading end 81 into the rigid portion 88 so as to separate the leading end 81 of the anchor 80 into two parts 81-1 , 81-2.
  • the channel 89 is configured to engage the central portion 98 of the second embodiment of the suture 90 at a distance from the leading end 81 , as shown in FIG. 2B, via a press fit or friction fit. In this way, the central portion 98 of the suture 90 is held within the rigid portion 88 and no part of the of the suture 90 projects beyond the leading end 81 of the anchor 80.
  • a groove 87 may extend from the channel 89 longitudinally down each side of the rigid portion 88, such that each groove 87 is contiguous with the channel 89 to at least partially accommodate part of the suture 90 that is on each side of the central portion 98 in the channel 89. In this way, overall width of the suture assembly 100 at the anchor may be minimized.
  • the suture engager 89 of the anchor 80 is configured to engage a central portion 98 of the suture 90 (with or without a knot or a bead) within the rigid portion 88 such that no part of the of the suture 90 projects beyond the leading end 81 of the anchor 80.
  • the practitioner can achieve better precision in the implantation of all embodiments of the suture assembly 100 of the present invention as no spatial allowance needs to be estimated by the practitioner for provision to accommodate extraneous suture that, in prior art systems, project beyond the leading end 81 of the anchor 80.
  • the anchor 80 also comprises at least two resilient portions 84 projecting laterally from the rigid portion 88.
  • the two resilient portions 84 are configured to allow alteration of a greatest lateral diameter or width of the anchor 80 (as defined by including the at least two resilient portions 84), depending on whether the anchor 80 is in a free state or in a compressed state. In the free state, the greatest lateral diameter or width of the anchor 80 is larger than a diameter of the entry site of the suture assembly 100.
  • the at least two resilient portions 84 are configured to be displaceable towards the central longitudinal axis L of the anchor 80 to result in the anchor 80 being in the compressed state.
  • the greatest lateral diameter or width of the anchor 80 is within the diameter of the entry site of the suture assembly 100, so that the compressed state allows passage of the anchor 80 through a cannula (not shown) that provides the entry site during implantation of the anchor 80 in the patient.
  • the at least two resilient portions 84 spring back to their undisplaced positions so that the anchor 80 is again in the free state.
  • the at least two resilient portions 84 are configured to engage facial tissue of a patient to inhibit downward movement of the anchor 80 when the anchor 80 is implanted in the final implantation position in the patient.
  • the at least two resilient portions 84 are symmetrically provided about the central longitudinal axis L of the anchor 80.
  • the at least two resilient portions are provided at the trailing end 82 of the rigid portion 88.
  • the at least two resilient portions may alternatively be provided at the leading end 81 of the rigid portion 88.
  • the anchor 80 may be moulded from a biodegradable material. This will degrade so that the anchor 80 does not stay implanted permanently. This also reduces the risk of complications. In use, the anchor 80 will stay inside the tissue and dissolve at an equal or lower rate than the suture 90, ensuring the reliability of the lift over the lifetime of the suture assembly 100.
  • the narrowed neck may be provided at the trailing end instead of centrally within the rigid portion, as depicted in the figures.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Rheumatology (AREA)
  • Surgical Instruments (AREA)

Abstract

Cette invention porte sur un ancrage (80) pour un ensemble suture, l'ancrage comprenant : une partie rigide (88) pourvu d'une extrémité avant ; un dispositif de fixation de suture (89) conçu pour venir en prise avec une partie centrale d'un segment de suture à une certaine distance de l'extrémité avant ; et au moins deux parties élastiques (84) faisant saillie latéralement à partir de la partie rigide. Au moins deux parties élastiques sont configurées de façon à pouvoir être déplacées vers un axe longitudinal central (L) de l'ancrage. Cette invention porte également sur un ensemble suture, la suture comprenant : un seul segment de fil de suture ; une première partie barbelée ayant une première pluralité de barbes formées sur cette dernière ; une seconde partie barbelée ayant une deuxième pluralité de barbes formées sur cette dernière. La première pluralité de pointes et la seconde pluralité de pointes sont inclinées vers une partie centrale du segment de suture.
PCT/SG2016/050118 2015-03-13 2016-03-14 Ancrage et suture pour un ensemble suture WO2016148647A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SGPCT/SG2015/000081 2015-03-13
PCT/SG2015/000081 WO2015137882A1 (fr) 2014-03-14 2015-03-13 Système pour amélioration cosmétique

Publications (1)

Publication Number Publication Date
WO2016148647A1 true WO2016148647A1 (fr) 2016-09-22

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ID=56932204

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/SG2016/050118 WO2016148647A1 (fr) 2015-03-13 2016-03-14 Ancrage et suture pour un ensemble suture

Country Status (1)

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WO (1) WO2016148647A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022031220A1 (fr) * 2020-08-05 2022-02-10 I-Support Pte. Ltd. Suture et système d'amélioration cosmétique

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5176682A (en) * 1992-06-01 1993-01-05 Chow James C Y Surgical implement
US5486197A (en) * 1994-03-24 1996-01-23 Ethicon, Inc. Two-piece suture anchor with barbs
US5571139A (en) * 1995-05-19 1996-11-05 Jenkins, Jr.; Joseph R. Bidirectional suture anchor
US20140364904A1 (en) * 2011-12-27 2014-12-11 John Jacobs Medical Inc. Knotless suture, and kit containing same

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5176682A (en) * 1992-06-01 1993-01-05 Chow James C Y Surgical implement
US5486197A (en) * 1994-03-24 1996-01-23 Ethicon, Inc. Two-piece suture anchor with barbs
US5571139A (en) * 1995-05-19 1996-11-05 Jenkins, Jr.; Joseph R. Bidirectional suture anchor
US20140364904A1 (en) * 2011-12-27 2014-12-11 John Jacobs Medical Inc. Knotless suture, and kit containing same

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022031220A1 (fr) * 2020-08-05 2022-02-10 I-Support Pte. Ltd. Suture et système d'amélioration cosmétique

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