Implantable layers for a surgical instrument

Description

BACKGROUND

The present invention relates to surgical instruments and, in various embodiments, to surgical stapling and cutting instruments and staple cartridges for use therewith.

A stapling instrument can include a pair of cooperating elongate jaw members, wherein each jaw member can be adapted to be inserted into a patient and positioned relative to tissue that is to be stapled and/or incised. In various embodiments, one of the jaw members can support a staple cartridge with at least two laterally spaced rows of staples contained therein, and the other jaw member can support an anvil with staple-forming pockets aligned with the rows of staples in the staple cartridge. Generally, the stapling instrument can further include a pusher bar and a knife blade which are slidable relative to the jaw members to sequentially eject the staples from the staple cartridge via camming surfaces on the pusher bar and/or camming surfaces on a wedge sled that is pushed by the pusher bar. In at least one embodiment, the camming surfaces can be configured to activate a plurality of staple drivers carried by the cartridge and associated with the staples in order to push the staples against the anvil and form laterally spaced rows of deformed staples in the tissue gripped between the jaw members. In at least one embodiment, the knife blade can trail the camming surfaces and cut the tissue along a line between the staple rows.

The foregoing discussion is intended only to illustrate various aspects of the related art in the field of the invention at the time, and should not be taken as a disavowal of claim scope.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features of the embodiments described herein, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings.

FIG. 1 is a cross-sectional perspective view of a portion of an implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 2 is a cross-sectional elevation view of a portion of a staple cartridge including an implantable layer and a portion of a staple depicting the staple in an unfired position and an undeformed configuration, in accordance with at least one embodiment of the present disclosure.

FIG. 3 is a cross-sectional elevation view of the staple of FIG. 2 in a fired position and a deformed configuration, and further depicting tissue along with a portion of the implantable layer of FIG. 2 captured within the staple.

FIG. 4 is a perspective view of an implantable layer with a portion of the layer cutaway to reveal pores and tissue ingrowth passages within the implantable layer, and further depicting passage-forming punches extending into the implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 5 is a cross-sectional elevation view of a portion of an implantable layer depicting tissue ingrowth along passages in the implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 6 is a perspective view of an implantable layer including a porous layer and a fibrous layer and with a portion of the fibrous layer removed to reveal the underlying porous portion, in accordance with at least one embodiment of the present disclosure.

FIG. 7 is a cross-sectional elevation view of a portion of the implantable layer of FIG. 6.

FIG. 8 is a cross-sectional perspective view of the implantable layer of FIG. 6 depicting the implantable layer and tissue captured within a fired and deformed staple.

FIG. 9 is a perspective view of an implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 10 is a perspective view of a fibrous mesh pocket, in accordance with at least one embodiment of the present disclosure.

FIG. 11 is a perspective view of a portion of an implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 12 is a cross-sectional elevation view of a portion of a staple cartridge including an implantable layer and a staple depicting the staple in an unfired position and an undeformed configuration, in accordance with at least one embodiment of the present disclosure.

FIG. 13 is a cross-sectional elevation view of the staple of FIG. 12 in a fired position and a deformed configuration, and further depicting tissue along with a portion of the implantable layer of FIG. 12 captured within the staple.

FIG. 14 is a detail view of an implantable layer including a plurality of foam fragments, in accordance with at least one embodiment of the present disclosure.

FIGS. 15A-15F are detail views of implantable layers depicting various foam fragments thereof, in accordance with various embodiments of the present disclosure.

FIG. 16 is a close-up view of an implantable layer depicting a plurality of foam fragments, in accordance with at least one embodiment of the present disclosure.

FIG. 17 is a graph depicting the release of medicaments from different foam fragments, in accordance with at least one embodiment of the present disclosure.

FIG. 18 is a perspective view of a portion of an implantable layer depicting a plurality of arced foam segments thereof, in accordance with at least one embodiment of the present disclosure.

FIG. 19 is a perspective view of a portion of an implantable layer depicting a plurality of spherical foam segments thereof, in accordance with at least one embodiment of the present disclosure.

FIG. 20 is a perspective view of a portion of an implantable layer depicting a plurality of foam segments thereof, in accordance with at least one embodiment of the present disclosure.

FIG. 21 is a cross-sectional elevation view of a portion of a mold depicting a plurality of foam fragments positioned within a cavity of the mold, in accordance with at least one embodiment of the present disclosure.

FIG. 22 is a cross-sectional elevation view of the portion of the mold of FIG. 21 depicting the application of heat and pressure to the foam fragments positioned within the cavity of the mold.

FIG. 23 is a detail view of a group of foam fragments within the cavity of the mold of FIG. 21 before the application of heat and pressure thereto.

FIG. 24 is a detail view of the group of foam fragments of FIG. 23 after the application of heat and pressure thereto.

FIG. 25 is a schematic of a grinder and a sorter for obtaining foam fragments, in accordance with at least one embodiment of the present disclosure.

FIG. 26 is a schematic depicting a range in the size of foam fragments from the grinder of FIG. 25.

FIG. 27 is a graph depicting the variations in the size of foam fragments from the grinder of FIG. 25.

FIG. 28 is a cross-sectional perspective view of a portion of a mold depicting a lyophilization solution dispersed in a cavity of the mold, and further depicting a plurality of bubbles within the lyophilization solution at an initial stage in the lyophilization process, in accordance with at least one embodiment of the present disclosure.

FIG. 29 is a cross-sectional perspective view of the portion of the mold of FIG. 28, depicting the lyophilization solution dispersed in the cavity of the mold at a secondary stage in the lyophilization process.

FIG. 30 is a cross-sectional perspective view of a portion of a mold depicting a dissolvable insert positioned in a cavity of the mold, in accordance with at least one embodiment of the present disclosure.

FIG. 31 is a perspective view of a portion of an implantable layer formed in the mold and with the dissolvable insert of FIG. 30 with a portion of the layer removed to reveal tissue ingrowth passages within the implantable layer.

FIG. 32 is a cross-sectional perspective view of a portion of a mold depicting a dissolvable insert positioned in a cavity of the mold, in accordance with at least one embodiment of the present disclosure.

FIG. 33 is a perspective view of a portion of an implantable layer formed in the mold and with the dissolvable insert of FIG. 32 with a portion of the layer removed to reveal tissue ingrowth passages within the implantable layer.

FIG. 34 is a perspective view of an implantable layer including a plurality of corrugated layers and with a portion of the implantable layer removed to reveal portions of the underlying corrugated layers, in accordance with at least one embodiment of the present disclosure.

FIG. 35 is a perspective view of an implantable layer including a plurality of foam tiers and with a portion of the implantable layer removed to reveal portions of the underlying foam tiers, in accordance with at least one embodiment of the present disclosure.

FIG. 36 is a perspective view of an implantable layer including a plurality of fibrous tiers and with a portion of the implantable layer removed to reveal portions of the underlying fibrous tiers, in accordance with at least one embodiment of the present disclosure.

FIG. 37 is a cross-sectional perspective view of an implantable layer with a portion of the implantable layer removed to expose fibers embedded in the implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 38 is a cross-sectional elevation view of a portion of a staple cartridge including an implantable layer and a portion of a staple depicting the staple in an unfired position and an undeformed configuration, in accordance with at least one embodiment of the present disclosure.

FIG. 39 is a cross-sectional elevation view of the staple of FIG. 38 in a fired position and a deformed configuration, and further depicting tissue along with a portion of the implantable layer of FIG. 38 captured within the staple.

FIG. 40 is a cross-sectional perspective view of an implantable layer, in accordance with at least one embodiment of the present disclosure.

FIG. 41 is a cross-sectional elevation view of a portion of a mold, depicting a solution being dispersed into a cavity of the mold, in accordance with at least one embodiment of the present disclosure.

FIG. 42 is a cross-sectional elevation view of a portion of a mold depicting a plurality of loose fibers positioned in a cavity of the mold and a lyophilization solution being dispersed into the cavity, in accordance with at least one embodiment of the present disclosure.

FIG. 43 is a cross-sectional perspective view of the fibers and the lyophilization solution in the cavity of the mold of FIG. 42 before application of a lyophilization treatment.

FIG. 44 is a cross-sectional elevation view of an implantable layer formed from the loose fibers and the lyophilization solution in the cavity of the mold of FIG. 42 after application of the lyophilization treatment.

FIG. 45 is a cross-sectional elevation view of a portion of a mold depicting a plurality of fibers woven into a three-dimensional mesh and positioned in the cavity of the mold, and further depicting a lyophilization solution being dispersed into the cavity, in accordance with at least one embodiment of the present disclosure.

FIG. 46 is a cross-sectional elevation view of an implantable layer formed from the woven fibers and the lyophilization solution in the cavity of the mold of FIG. 45 after application of a lyophilization treatment.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

DETAILED DESCRIPTION

The Applicant of the present application owns the following U.S. Patent Applications that were filed on even date herewith and which are each herein incorporated by reference in their respective entireties:

- U.S. patent application Ser. No. 14/827,856, entitled IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT; now U.S. Patent Application Publication No. 2017/0049444; and
- U.S. patent application Ser. No. 14/827,907, entitled IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT; now U.S. Patent Application Publication No. 2017/0049447.

The Applicant of the present application also owns the U.S. patent applications identified below which are each herein incorporated by reference in their respective entireties:

U.S. patent application Ser. No. 12/894,311, entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; now U.S. Pat. No. 8,763,877;

U.S. patent application Ser. No. 12/894,340, entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; now U.S. Pat. No. 8,899,463;

U.S. patent application Ser. No. 12/894,327, entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; now U.S. Pat. No. 8,978,956;

U.S. patent application Ser. No. 12/894,351, entitled SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; now U.S. Patent Application Publication No. 2012/0080502;

U.S. patent application Ser. No. 12/894,338, entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; now U.S. Pat. No. 8,864,007;

U.S. patent application Ser. No. 12/894,369, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; now U.S. Patent Application Publication No. 2012/0080344;

U.S. patent application Ser. No. 12/894,312, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; now U.S. Pat. No. 8,925,782;

U.S. patent application Ser. No. 12/894,377, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; now U.S. Pat. No. 8,393,514;

U.S. patent application Ser. No. 12/894,339, entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; now U.S. Pat. No. 8,840,003;

U.S. patent application Ser. No. 12/894,360, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; now U.S. Patent Application Publication No. 2012/0080484;

U.S. patent application Ser. No. 12/894,322, entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; now U.S. Pat. No. 8,740,034;

U.S. patent application Ser. No. 12/894,350, entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; now U.S. Patent Application Publication No. 2012/0080478;

U.S. patent application Ser. No. 12/894,383, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; now U.S. Pat. No. 8,752,699;

U.S. patent application Ser. No. 12/894,389, entitled COMPRESSIBLE FASTENER CARTRIDGE; now U.S. Pat. No. 8,740,037;

U.S. patent application Ser. No. 12/894,345, entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; now U.S. Pat. No. 8,783,542;

U.S. patent application Ser. No. 12/894,306, entitled COLLAPSIBLE FASTENER CARTRIDGE; now U.S. Pat. No. 9,044,227;

U.S. patent application Ser. No. 12/894,318, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; now U.S. Pat. No. 8,814,024;

U.S. patent application Ser. No. 12/894,330, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; now U.S. Pat. No. 8,757,465;

U.S. patent application Ser. No. 12/894,361, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX; now U.S. Pat. No. 8,529,600;

U.S. patent application Ser. No. 12/894,367, entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; now U.S. Pat. No. 9,033,203;

U.S. patent application Ser. No. 12/894,388, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; now U.S. Pat. No. 8,474,677;

U.S. patent application Ser. No. 12/894,376, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; now U.S. Pat. No. 9,044,228;

U.S. patent application Ser. No. 13/097,865, entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; now U.S. Patent Application Publication No. 2012/0080488;

U.S. patent application Ser. No. 13/097,936, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; now U.S. Pat. No. 8,657,176;

U.S. patent application Ser. No. 13/097,954, entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; now U.S. Patent Application Publication No. 2012/0080340;

U.S. patent application Ser. No. 13/097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; now U.S. Patent Application Publication No. 2012/0080336;

U.S. patent application Ser. No. 13/097,928, entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; now U.S. Pat. No. 8,746,535;

U.S. patent application Ser. No. 13/097,891, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; now U.S. Pat. No. 8,864,009;

U.S. patent application Ser. No. 13/097,948, entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; now U.S. Pat. No. 8,978,954;

U.S. patent application Ser. No. 13/097,907, entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; now U.S. Patent Application Publication No. 2012/0080338;

U.S. patent application Ser. No. 13/097,861, entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; now U.S. Patent Application Publication No. 2012/0080337;

U.S. patent application Ser. No. 13/097,869, entitled STAPLE CARTRIDGE LOADING ASSEMBLY; now U.S. Pat. No. 8,857,694;

U.S. patent application Ser. No. 13/097,917, entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; now U.S. Pat. No. 8,777,004;

U.S. patent application Ser. No. 13/097,873, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; now U.S. Pat. No. 8,740,038;

U.S. patent application Ser. No. 13/097,938, entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; now U.S. Pat. No. 9,016,542;

U.S. patent application Ser. No. 13/097,924, entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2012/0083835;

U.S. patent application Ser. No. 13/242,029, entitled SURGICAL STAPLER WITH FLOATING ANVIL; now U.S. Pat. No. 8,893,949;

U.S. patent application Ser. No. 13/242,066, entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; now U.S. Patent Application Publication No. 2012/0080498;

U.S. patent application Ser. No. 13/242,086, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; now U.S. Pat. No. 9,055,941;

U.S. patent application Ser. No. 13/241,912, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; now U.S. Pat. No. 9,050,084;

U.S. patent application Ser. No. 13/241,922, entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; now U.S. Patent Application Publication No. 2013/0075449;

U.S. patent application Ser. No. 13/241,637, entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; now U.S. Pat. No. 8,789,741;

U.S. patent application Ser. No. 13/241,629, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; now U.S. Patent Application Publication No. 2012/0074200;

U.S. patent application Ser. No. 13/433,096, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; now U.S. Patent Application Publication No. 2012/0241496;

U.S. patent application Ser. No. 13/433,103, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; now U.S. Patent Application Publication No. 2012/0241498;

U.S. patent application Ser. No. 13/433,098, entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2012/0241491;

U.S. patent application Ser. No. 13/433,102, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; now U.S. Patent Application Publication No. 2012/0241497;

U.S. patent application Ser. No. 13/433,114, entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2012/0241499;

U.S. patent application Ser. No. 13/433,136, entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; now U.S. Patent Application Publication No. 2012/0241492;

U.S. patent application Ser. No. 13/433,141, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; now U.S. Patent Application Publication No. 2012/0241493;

U.S. patent application Ser. No. 13/433,144, entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; now U.S. Patent Application Publication No. 2012/0241500;

U.S. patent application Ser. No. 13/433,148, entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; now U.S. Patent Application Publication No. 2012/0241501;

U.S. patent application Ser. No. 13/433,155, entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; now U.S. Patent Application Publication No. 2012/0241502;

U.S. patent application Ser. No. 13/433,163, entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; now U.S. Patent Application Publication No. 2012/0248169;

U.S. patent application Ser. No. 13/433,167, entitled TISSUE THICKNESS COMPENSATORS; now U.S. Patent Application Publication No. 2012/0241503;

U.S. patent application Ser. No. 13/433,175, entitled LAYERED TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2012/0253298;

U.S. patent application Ser. No. 13/433,179, entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; now U.S. Patent Application Publication No. 2012/0241505;

U.S. patent application Ser. No. 13/763,028, entitled ADHESIVE FILM LAMINATE; now U.S. Patent Application Publication No. 2013/0146643;

U.S. patent application Ser. No. 13/433,115, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; now U.S. Patent Application Publication No. 2013/0256372;

U.S. patent application Ser. No. 13/433,118, entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; now U.S. Patent Application Publication No. 2013/0256365;

U.S. patent application Ser. No. 13/433,135, entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2013/0256382;

U.S. patent application Ser. No. 13/433,140, entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; now U.S. Patent Application Publication No. 2013/0256368;

U.S. patent application Ser. No. 13/433,129, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; now U.S. Patent Application Publication No. 2013/0256367;

U.S. patent application Ser. No. 11/216,562, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, now U.S. Pat. No. 7,669,746;

U.S. patent application Ser. No. 11/714,049, entitled SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, now U.S. Patent Application Publication No. 2007/0194082;

U.S. patent application Ser. No. 11/711,979, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S. Pat. No. 8,317,070;

U.S. patent application Ser. No. 11/711,975, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, now U.S. Patent Application Publication No. 2007/0194079;

U.S. patent application Ser. No. 11/711,977, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, now U.S. Pat. No. 7,673,781;

U.S. patent application Ser. No. 11/712,315, entitled SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, now U.S. Pat. No. 7,500,979;

U.S. patent application Ser. No. 12/038,939, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, now U.S. Pat. No. 7,934,630;

U.S. patent application Ser. No. 13/020,263, entitled SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S. Pat. No. 8,636,187;

U.S. patent application Ser. No. 13/118,278, entitled ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, now U.S. Patent Application Publication No. 2011/0290851;

U.S. patent application Ser. No. 13/369,629, entitled ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, now U.S. Pat. No. 8,800,838;

U.S. patent application Ser. No. 12/695,359, entitled SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, now U.S. Pat. No. 8,464,923;

U.S. patent application Ser. No. 13/072,923, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, now U.S. Pat. No. 8,567,656;

U.S. patent application Ser. No. 13/766,325, entitled LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; now U.S. Patent Application Publication No. 2013/0256380;

U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; now U.S. Patent Application Publication No. 2013/0256383;

U.S. patent application Ser. No. 13/763,094, entitled LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; now U.S. Patent Application Publication No. 2013/0256377;

U.S. patent application Ser. No. 13/763,106, entitled END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; now U.S. Patent Application Publication No. 2013/0256378;

U.S. patent application Ser. No. 13/433,147, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; now U.S. Patent Application Publication No. 2013/0256369;

U.S. patent application Ser. No. 13/763,112, entitled SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; now U.S. Patent Application Publication No. 2013/0256379;

U.S. patent application Ser. No. 13/763,035, entitled ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; now U.S. Patent Application Publication No. 2013/0214030;

U.S. patent application Ser. No. 13/763,042, entitled RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; now U.S. Patent Application Publication No. 2013/0221063;

U.S. patent application Ser. No. 13/763,048, entitled FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2013/0221064;

U.S. patent application Ser. No. 13/763,054, entitled FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2014/0097227;

U.S. patent application Ser. No. 13/763,065, entitled FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; now U.S. Patent Application Publication No. 2013/0221065;

U.S. patent application Ser. No. 13/763,021, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER; now U.S. Patent Application Publication No. 2014/0224686;

U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; now U.S. Patent Application Publication No. 2013/0256383;

U.S. patent application Ser. No. 13/763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; now U.S. Patent Application Publication No. 2013/0161374;

U.S. patent application Ser. No. 13/763,147, entitled IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; now U.S. Patent Application Publication No. 2013/0153636;

U.S. patent application Ser. No. 13/763,192, entitled MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; now U.S. Patent Application Publication No. 2013/0146642;

U.S. patent application Ser. No. 13/763,161, entitled RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; now U.S. Patent Application Publication No. 2013/0153641;

U.S. patent application Ser. No. 13/763,177, entitled ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; now U.S. Patent Application Publication No. 2013/0146641;

U.S. patent application Ser. No. 13/763,037, entitled STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION; now U.S. Patent Application Publication No. 2014/0224857;

U.S. patent application Ser. No. 13/433,126, entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; now U.S. Patent Application Publication No. 2013/0256366;

U.S. patent application Ser. No. 13/433,132, entitled DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; now U.S. Patent Application Publication No. 2013/0256373;

U.S. patent application Ser. No. 13/851,703, entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN; now U.S. Patent Application Publication No. 2014/0291382;

U.S. patent application Ser. No. 13/851,676, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH; now U.S. Patent Application Publication No. 2014/0291379;

U.S. patent application Ser. No. 13/851,693, entitled FASTENER CARTRIDGE ASSEMBLIES; now U.S. Patent Application Publication No. 2014/0291381;

U.S. patent application Ser. No. 13/851,684, entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT; now U.S. Patent Application Publication No. 2014/0291380;

U.S. patent application Ser. No. 14/187,387, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No. 2014/0166724;

U.S. patent application Ser. No. 14/187,395, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No. 2014/0166725;

U.S. patent application Ser. No. 14/187,400, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No. 2014/0166726;

U.S. patent application Ser. No. 14/187,383, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS;

U.S. patent application Ser. No. 14/187,386, entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS;

U.S. patent application Ser. No. 14/187,390, entitled IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT;

U.S. patent application Ser. No. 14/187,389, entitled IMPLANTABLE LAYER ASSEMBLIES;

U.S. patent application Ser. No. 14/187,385, entitled IMPLANTABLE LAYERS COMPRISING A PRESSED REGION; and

U.S. patent application Ser. No. 14/187,384, entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT.

Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. Well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. The reader will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and illustrative. Variations and changes thereto may be made without departing from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”) and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features.

The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures. As the present Detailed Description proceeds, the reader will further appreciate that the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc. The working portions or end effector portions of the instruments can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which an end effector and elongated shaft of a surgical instrument can be advanced.

A surgical stapling system can comprise a shaft and an end effector extending from the shaft. The end effector comprises a first jaw and a second jaw. The first jaw comprises a staple cartridge. The staple cartridge is insertable into and removable from the first jaw; however, other embodiments are envisioned in which a staple cartridge is not removable from, or at least readily replaceable from, the first jaw. The second jaw comprises an anvil configured to deform staples ejected from the staple cartridge. The second jaw is pivotable relative to the first jaw about a closure axis; however, other embodiments are envisioned in which the first jaw is pivotable relative to the second jaw. The surgical stapling system further comprises an articulation joint configured to permit the end effector to be rotated, or articulated, relative to the shaft. The end effector is rotatable about an articulation axis extending through the articulation joint. Other embodiments are envisioned which do not include an articulation joint.

The staple cartridge comprises a cartridge body. The cartridge body includes a proximal end, a distal end, and a deck extending between the proximal end and the distal end. In use, the staple cartridge is positioned on a first side of the tissue to be stapled and the anvil is positioned on a second side of the tissue. The anvil is moved toward the staple cartridge to compress and clamp the tissue against the deck. Thereafter, staples removably stored in the cartridge body can be deployed into the tissue. The cartridge body includes staple cavities defined therein wherein staples are removably stored in the staple cavities. The staple cavities are arranged in six longitudinal rows. Three rows of staple cavities are positioned on a first side of a longitudinal slot and three rows of staple cavities are positioned on a second side of the longitudinal slot. Other arrangements of staple cavities and staples may be possible.

The staples are supported by staple drivers in the cartridge body. The drivers are movable between a first, or unfired position, and a second, or fired, position to eject the staples from the staple cavities. The drivers are retained in the cartridge body by a retainer which extends around the bottom of the cartridge body and includes resilient members configured to grip the cartridge body and hold the retainer to the cartridge body. The drivers are movable between their unfired positions and their fired positions by a sled. The sled is movable between a proximal position adjacent the proximal end and a distal position adjacent the distal end. The sled comprises a plurality of ramped surfaces configured to slide under the drivers and lift the drivers, and the staples supported thereon, toward the anvil.

Further to the above, the sled is moved distally by a firing member. The firing member is configured to contact the sled and push the sled toward the distal end. The longitudinal slot defined in the cartridge body is configured to receive the firing member. The anvil also includes a slot configured to receive the firing member. The firing member further comprises a first cam which engages the first jaw and a second cam which engages the second jaw. As the firing member is advanced distally, the first cam and the second cam can control the distance, or tissue gap, between the deck of the staple cartridge and the anvil. The firing member also comprises a knife configured to incise the tissue captured intermediate the staple cartridge and the anvil. It is desirable for the knife to be positioned at least partially proximal to the ramped surfaces such that the staples are ejected ahead of the knife.

The staple cartridge can also include an implantable layer. The implantable layer is configured to be captured within a staple along with tissue when the staple is deployed by the corresponding driver. The implantable layer can comprise a buttress, a tissue thickness compensator, and/or other adjunct material. A tissue thickness compensator is configured to compensate for variations in tissue properties, such as variations in the thickness of tissue, for example, along a staple line. A tissue thickness compensator can be compressible and resilient. In use, a tissue thickness compensator prevents or limits the over-compression of stapled tissue while facilitating adequate tissue compression within and between staples.

The implantable layer of a staple cartridge can be releasably secured to the body of the staple cartridge. For example, the implantable layer can be releasably secured to the deck of the staple cartridge with a releasable adhesive, at least one attachment tab, and/or other attachment features. Additionally or alternatively, an implantable layer can be releasably secured to the first jaw or the second jaw. An implantable layer can be positioned on the cartridge-side of an end effector and/or the anvil-side of the end effector, for example.

An implantable layer can be configured to promote tissue ingrowth. In various instances, it is desirable to promote the ingrowth of tissue into an implantable layer to promote the healing of the treated tissue (e.g. stapled and/or incised tissue) and/or to accelerate the patient's recovery. More specifically, the ingrowth of tissue into an implantable layer may reduce the incidence, extent, and/or duration of inflammation at the surgical site. Tissue ingrowth into and/or around the implantable layer may manage the spread of infections at the surgical site, for example. The ingrowth of blood vessels, especially white blood cells, for example, into and/or around the implantable layer may fight infections in and/or around the implantable layer and the adjacent tissue. Tissue ingrowth may also encourage the acceptance of foreign matter (e.g. the implantable layer and the staples) by the patient's body and may reduce the likelihood of the patient's body rejecting the foreign matter. Rejection of foreign matter may cause infection and/or inflammation at the surgical site.

An implantable layer having insufficient inlets and/or passages from the outer surface(s) of the implantable layer toward an inner portion of the layer may impede the ingrowth of tissue into the inner portion. In such instances, the tissue may be unable to obtain a foothold or grip on the implantable layer and/or tissue growth into the implantable layer may be restricted. The tissue may be unable to gain traction along and/or around the outer surface of the implantable layer, and thus, into the inner portion thereof. Even when the inner portion of the implantable layer comprises an adequate porosity and/or density to permit tissue ingrowth, the ingrowth of tissue may be obstructed if the outer surface, shell, or skin of the implantable layer comprises insufficient inlets and/or footholds for tissue ingrowth. For example, various foam materials, such as foam comprising a closed cellular structure and/or lyophilized foam, for example, can include a denser, less porous outer portion. Additionally or alternatively, various foam materials can be hydrophobic and/or comprise an outer surface that is substantially smooth and/or flat and, thus, is unconducive to cell adhesion. In such instances, the ingrowth of tissue into the inner portion of the implantable layer may be thwarted by the properties of the outer portion of the implantable layer.

In various instances, an implantable layer can include at least one tissue ingrowth passage through which tissue can be encouraged to grow and propagate. Such a tissue ingrowth passage can extend from an outer surface of the implantable layer toward and/or into an inner portion of the implantable layer. For example, the tissue ingrowth passage can include an inlet along a surface or face of the implantable layer. Additionally or alternatively, an implantable layer can include a surface treatment which can promote cell adhesion and/or cell motility along the surface and/or into the implantable layer. In certain instances, the material comprising the implantable layer can be degraded and/or deteriorated prior to the implantation of the implantable layer. An implantable layer comprising at least one ingrowth passage, surface treatment, and/or expedited degradation profile can be configured to promote tissue ingrowth. Additionally, the addition of a tissue ingrowth passage reduces the volume of the implantable layer, which may further prevent or reduce the likelihood of the patient's body rejecting the foreign layer implanted therein.

Referring to FIG. 1, a portion of an implantable layer 100 is depicted. The implantable layer 100 comprises a tissue thickness compensator. In other embodiments, the implantable layer 100 comprises a piece of buttress material. The implantable layer 100 includes a body 102 having an inner portion 106 and an outer portion 108. The outer portion 108 surrounds the inner portion 106 such that the inner portion 106 is defined within the boundary of the outer portion 108. The outer portion 108 includes a plurality of faces or sides 104, which define the perimeter of the body 102. In various instances, the body 102 of the implantable layer 100 comprises a rectangular prism having six faces including a first face 104a. In other instances, the body 102 can comprise a triangular prism or another three-dimensional shape. In the depicted embodiment, the first face 104a corresponds to a tissue-contacting surface of the implantable layer 100. In other instances, the first face 104a can correspond to a deck-contacting surface or a sidewall of the body 102.

The body 102 of the implantable layer 100 is a porous body. For example, the body 102 comprises a piece of foam having a plurality of pores 110 defined therein. In various instances, the body 102 is a piece of lyophilized foam. The body 102 comprises an open cellular structure. For example, a pore 110a is adjacent to the first face 104a of the body 102 and the boundary of the pore 110a defines an outer surface of the body 102. Open cell pores, such as the pore 110a, for example, can provide a tissue ingrowth inlet and/or a foothold for tissue ingrowth. In other embodiments, the body 102 can comprise a closed-cell structure. In such instances, the pores 110 can be positioned entirely within the body 102. Closed-cell pores are not open to an outer surface or face 104 of the body 102.

The body 102 also includes a plurality of tissue ingrowth passages 120. The passages 120 extend from the outer portion 108 of the body 102 toward the inner portion 106 of the body 102. For example, at least one passage 120 extends from the first face 104a of the outer portion 108 toward the inner portion 106. At least one passage 120 extends through the body 102. For example, a first passage 120a extends from the first face 104a to the opposing face 104 of the body 102. At least one passage 120 terminates within the inner portion 106 of the body 102, and at least two passages 120 transect or cross within the body 102. Additionally, at least one passage 120 transects and/or passes through at least one pore 110 in the body 102.

The various passages 120 are oriented at different angles within the body 102 and propagate in different directions within the body 102. For example, the first passage 120a is angularly-oriented relative to a second passage 102b and the first passage 120a transects the second passage 120b in the inner portion 106 of the body 102. The various passages 120 into and/or through the body 102 are configured to provide a pathway for tissue to grow into the implantable layer 100. For example, at least one passage 120 can extend from the tissue-contacting surface 104a of the implantable layer 100. In at least one instance, the varied orientation of the passages 120 may promote the integration of the implantable layer 100 into the surrounding tissue.

Referring primarily now to FIG. 2, a portion of a staple cartridge 250 is shown. The staple cartridge 250 includes a cartridge body 252 having a deck 256. A plurality of staple cavities are defined in the cartridge body 252, and each staple cavity comprises an opening in the deck 256. For example, a staple cavity 254 is defined in the cartridge body 252. The staple cartridge 250 further includes a plurality of staples. For example, a staple 260 is positioned in the staple cavity 254. The staple cartridge 250 includes an implantable layer 200, which is positioned adjacent to the deck 256 of the cartridge body 252. The implantable layer 200 extends over the staple cavity openings in the deck 256. The implantable layer 200 can be releasably positioned relative to the deck 256.

Referring to FIGS. 2 and 3, the implantable layer 200 comprises a tissue thickness compensator. The implantable layer 200 includes a plurality of pores 210 and a plurality of tissue ingrowth passages 220. The implantable layer 200 also includes a first face 204a and a second face 204b. The first face 204a comprises a tissue-contacting surface. For example, during a stapling operation, tissue T is positioned against and compressed against the first face 204a of the implantable layer. The second face 204b is opposite to the first face 204a. More particularly, in the orientation depicted in FIG. 2, the first face 204a comprises a top surface of the implantable layer 200, and the second face 204b comprises a bottom surface of the implantable layer 200. The second face 204b comprises a deck-contacting surface. At least one of the passages 220 in the implantable layer 200 extends between the opposing first face 204a and second face 204b. Referring to the embodiment of FIGS. 2 and 3, a plurality of passages 220 extend between the first face 204a and the second face 204b. Such passages 220 provide pathways for tissue ingrowth between opposing sides of the implantable layer (e.g. between the top surface and the bottom surface).

During a stapling operation, tissue T is captured within the staple 260 along with a portion of the implantable layer 200. The tissue T and the implantable layer 200 are compressed within the fired and deformed staple 260 (FIG. 3). As depicted in FIG. 3, the height of the compressed implantable layer 200 varies within the formed staple 260 in response to various properties of the adjacent tissue T. For example, the implantable layer 200 is configured to assume a greater height where the captured tissue T is thinner and is configured to assume a lesser height where the captured tissue T is thicker. The reader will further appreciate that the height of the compressed implantable layer 200 can also vary from staple to staple in a staple line and/or in the unstapled regions between adjacent staples in the staple line in response to various properties of the tissue T.

When the implantable layer 200 is compressed during a stapling operation, the first face 204a of the implantable layer 200 is compressed toward the second face 204b of the implantable layer 200. For example, the implantable layer 200 is compressed along an axis of compression A (FIG. 3), which is perpendicular, or substantially perpendicular, to the first face 204a and the second face 204b. In such instances, various tissue ingrowth passages 220 in the implantable layer 200 are configured to remain open and/or substantially unobstructed when the implantable layer 200 is compressed. For example, the tissue ingrowth passages 220 parallel to and/or substantially parallel to the axis of compression A remain substantially unobstructed when the implantable layer 200 has been compressed along the axis of compression A. Moreover, angled passages 220 extending between the first face 204a and the second face 204b and having a sufficient vertical vector component (e.g. a significant vector component aligned with the axis of compression A) also remain substantially unobstructed. Depending on the amount of compression, tissue ingrowth passages 220 that are perpendicular, or substantially perpendicular, to the axis of compression A can be closed and/or obstructed when the implantable layer 200 is compressed within a staple 260.

In various instances, tissue ingrowth passages, such as the passages 120 in the implantable layer 100 and/or the passages 220 in the implantable layer 200, for example, comprise a diameter that is greater than 125 μm (approximately 0.005″) and/or less than the diameter of a staple leg. In certain instances, a staple leg can have a diameter between approximately 0.005″ and approximately 0.015″, for example. In at least one instance, a staple leg can have a diameter between approximately 0.007″ and approximately 0.010″, for example. In certain instances, tissue ingrowth passages can be less than or equal to 125 μm or greater than or equal to the diameter of a staple leg. In various instances, the diameter of the tissue ingrowth passages can be greater than the diameter of the pores defined in the implantable layer. For example, the diameter of a tissue ingrowth passage through an implantable layer can be at least an order of magnitude greater than the diameter of at least one pore in the implantable layer. The addition of the tissue ingrowth passages 120 and 220 are configured not to affect the compressive properties and/or resiliency of the implantable layer 100 and 200, respectively.

Tissue ingrowth passages, such as the passages 120 in the implantable layer 100 and the passages 220 in the implantable layer 200, for example, can be formed in a variety of ways. In various instances, tissue ingrowth passages can be integrally formed with the implantable layer. In other instances, tissue ingrowth passages can be added to a preformed implantable layer. For example, a preformed implantable layer can be altered to remove and/or destroy portions thereof to form tissue ingrowth passages therethrough.

Referring primarily to FIG. 4, an implantable layer 300 is depicted. The implantable layer 300 comprises a tissue thickness compensator. The implantable layer 300 includes a body 302 having a plurality of pores 310 and a plurality of tissue ingrowth passages 320 defined therein. The passages 320 can be formed in a variety of ways. For example, the passages 320 can be mechanically punched into the body 302 of the implantable layer 300. More particularly, at least one punch 325 can be pressed and/or poked through the implantable layer 300 to form the tissue ingrowth passages 320. Referring to the embodiment depicted in FIG. 4, a plurality of punches 325 are configured to form the tissue ingrowth passages 320 in the body 302. The punches 325 form tissue ingrowth passages 320 that extend in a plurality of different orientations and initiate from different faces 304 of the implantable body 302. In various instances, the punches 325 can comprise different diameters and/or different cross-sectional shapes such that tissue ingrowth passages 320 of different diameters and/or different cross-sectional shapes are formed in the body 302.

In certain instances, a punch 325 can comprise a blunt end for cutting and/or punching through the body 302. In other instances, the punch 325 can comprise a pin and/or needle having a tapered, pointed end. A punch for forming the passages 320 can comprise various cross-sectional geometries. In at least one instance, a punch can comprise a polygonal cross-sectional geometry, such as a triangle, square, rectangle, hexagon, or other polygon, for example. Passages comprising polygonal cross-sectional boundaries, such as those formed from a square punch, for example, may provide a less hospitable and/or inhospitable environment for infections to take hold and spread. For example, macrophages and/or multi-nucleated giant cells may prefer passages having a circular, contoured, and/or scalloped cross-sectional shape.

In other instances, tissue ingrowth passages in an implantable layer can be drilled, ultrasonically tooled, and/or formed by water jets and/or lasers. For laser drilled passages, the type and energy of the laser can be selected to limit and/or reduce melting and/or deformation of the body adjacent to the laser-drilled tissue ingrowth passage. In various instances, lasers can be used to drill staple leg openings into the body, and such lasers can be further utilized to form tissue ingrowth passages transverse to and/or offset from the staple leg openings. The tissue ingrowth passages formed by the lasers can be narrower than the staple leg openings formed by the lasers. Additionally or alternatively, lasers can also be employed to add texture and/or cutaways on the surface of an implantable layer. For example, lasers can create elongate cutaways in the body of an implantable layer. Such elongate cutaways can be positioned intermediate at least two adjacent rows of staple cavities, for example. In various instances, cutaways between rows of staple cavities may further promote the ingrowth of tissue intermediate adjacent rows of staple cavities. Lasers can also form an interlocking and/or crossing array of grooves on the surface of the implantable layer to improve cell adhesion and traction.

In still other instances, tissue ingrowth passages can be molded into the body of the implantable layer. For example, the body can be molded around a plurality of removable mold inserts that form channels and/or tunnels at least partially through the body of the implantable layer. Additionally or alternatively, dissolvable material can be molded into the body of the implantable layer during the molding process. Such material can be dissolved prior to the stapling operation leaving ingrowth passages in its place. Such material could also be dissolved after the stapling operation leaving ingrowth passages in its place. Various insert-molding processes for creating tissue ingrowth passages are further described herein.

Referring now to FIG. 5, a portion of an implantable layer 400 is depicted. The implantable layer 400 comprises a tissue thickness compensator. The implantable layer 400 includes a body 402 having a plurality of pores 410 and a plurality of tissue ingrowth passages 420 defined therein. The passages 420 can be formed in a variety of ways further described herein such as punching, drilling, tooling, and/or with water jets and/or lasers. The implantable layer 400 also includes a surface treatment region 422 on at least one face of the body 402. For example, a tissue-contacting face 404a of the body 402 includes the surface treatment region 422.

The surface treatment used to create the surface treatment region 422 is configured to roughen, abrade and/or grind the tissue-contacting face 404a of the implantable layer 400, for example. In instances where a closed cell or closed pore is adjacent to and out of contact with the tissue-contacting face 404a, the surface treatment can open the closed cell to the tissue-contacting face 404a, for example. The surface treatment region 422 is configured to provide inlets into the inner portion of the body 402. In instances where the outer portion or shell of the body 402 is denser, and/or less porous, than the inner portion, such as when the body 402 comprises a lyophilized foam body, for example, the surface treatment region 422 may provide inlets through the outer portion toward the inner portion. For example, the outer portion of the body 402 may comprise a closed or substantially closed cellular structure, and the surface treatment can open at least one closed pore and/or cell positioned adjacent to and/or near the tissue-contacting face 404a to provide an inlet into the inner portion of the body 402.

In various instances, the surface treatment can include needle tufting and/or felting of the tissue-contacting face 404a of the body 402. Additionally or alternatively, the surface treatment can include sand and/or grit blasting, gas blasting such as dry-ice or CO₂blasting, and/or machining such as grinding, mill cutting, and/or fly cutting, for example. In certain instances, a fibrous outer coating can be applied to the body 402. For example, the body 402 can be treated with a melt-blown non-woven process to create fibers on at least a portion of at least one face of the body 402, such as on the tissue-contacting face 404a. Various alternative fibrous coatings and applications are further described herein.

In various instances, it can be desirable to accelerate the degradation, absorption, and/or disintegration of at least a portion of the material comprising an implantable layer. Tissue ingrowth may increase as the implantable layer degrades. To facilitate and/or expedite the ingrowth of tissue, in certain instances, the degradation profile of the implantable layer can be accelerated. More specifically, the implantable layer can be subjected to treatments and/or processes that promote degradation of the implantable layer prior to implantation of the layer. In various instances, the implantable layer can be degraded before and/or after the implantable layer has been attached to a staple cartridge. For example, an implantable layer comprising a piece of foam, such as a piece of lyophilized foam, can be attached to a staple cartridge and purposefully degraded to a certain degree before the stapling operation. The degradation process can be terminated and/or substantially stalled when the desired degree of degradation has been achieved. Natural degradation of the implantable layer may resume when the layer is implanted in the patient's tissue, for example.

In at least one instance, an implantable layer can be degraded with radiation therapy. For example, in an irradiation treatment, the implantable layer can be degraded up to 45 kGy. In other instances, the implantable layer can be degraded below 45 kGy or above 45 kGy. Radiation may be applied to the implantable layer after the layer has been attached to a staple cartridge. For example, a piece of lyophilized foam can be manufactured and/or otherwise obtained and attached to the staple cartridge. In certain instances, the piece of foam can be cut to a predefined shape and/or otherwise processed. The piece of foam can then be subjected to radiation therapy. The radiation can be in the form of gamma waves and/or E-beam waves, for example.

After the piece of foam (i.e. the implantable layer) has been irradiated, the staple cartridge including the implantable layer attached thereto can be sterilized and/or packaged. For example, the staple cartridge can undergo an ethylene oxide (EtO) sterilization process. The EtO sterilization process can include vacuum drying and/or hot room treatments. Such processes can terminate and/or stall degradation of the implantable layer that was initiated by the irradiation treatment. For example, the free radical by-products from the radiation can be eliminated during EtO sterilization and prior to packaging of the staple cartridge.

Referring again to FIG. 5, a surface treatment can include etching at least a portion of the body 402 of the implantable layer 400. Etching can expedite degradation of at least portions of the implantable layer 400, alter the surface energy of the implantable layer, and/or create inlets and/or tissue ingrowth passages from an outer portion of the implantable layer toward an inner portion. In a solvent etching process, a solvent is applied to the body 402, and the portions of the body 402 in contact with the solvent become etched and/or degraded. For example, the solvent can be configured to degrade the contacted polymer chains in the body 402. In various instances, a nebulized solvent can be applied to the implantable layer 400. In other instances, a solvent-soaked pad can be positioned adjacent to the implantable layer 400 and/or contained within a package comprising the implantable layer 400. The solvent can soak into or other otherwise spread throughout the internal structure of the body 402. The solvent can comprise potassium hydroxide (KOH), 1,4-Dioxane, methyl ethyl ketone, methyl propyl ketone, acetone, toluene, and/or DIESTONE HFP manufactured by Socomore of Vannes, France, for example.

In certain instances, the pressure can be varied to facilitate dispersion of the solvent throughout the implantable layer. For example, the implantable layer 400 having a solvent applied thereto can be subjected to positive and/or negative pressures. In various instances, the temperature and exposure time can be controlled to ensure that the solvent is dispersed through the layer 400. The solvent etching process can occur during a processing step and/or during sterilization. For example, the solvent can be applied to the layer 400, along with the appropriate pressure, during an ethylene oxide (EtO) sterilization process.

The solvent is configured to etch the surface(s) of the implantable layer 400. For example, the solvent can etch the surface(s) contacted by the solvent and subjected to the appropriate etching conditions (e.g. time, temperature, pressure). The etching process is configured to roughen and/or crack portions of the body 402. For example, the outer portion of the body 402 can be etched, which can provide inlets and/or tissue ingrowth passages into the inner portion of the body 402. The etched surface(s) and/or portions of the body 402 can promote cell adhesion to the body 402 and the degradation of the body 402, which may promote tissue ingrowth.

In various instances, it can be desirable to alter the surface energy of an implantable layer. For example, in certain instances, the untreated surface of the implantable layer body can include a substantially smooth and/or flat portion and/or scalloped pore surfaces. Such surfaces may discourage cell adhesion. For example, the surface of a piece of lyophilized foam can be substantially smooth and flat, and the outer portion of the foam can be denser than the inner portion of the foam. Moreover, the surface of a piece of lyophilized foam can be hydrophobic, which can further hinder the adherence of cells thereto. Increased cell adherence and/or cell motility can improve tissue ingrowth. More specifically, when cells can adhere and move along the surface and/or into the body of the implantable layer, the ingrowth of tissue may be more likely to occur and/or more involved. As further described herein, in various instances, the surface energy of an implantable layer can be altered by the addition of a coating to the body of the layer and/or by applying energy to the body to modify the surface energy thereof.

For example, an implantable layer can be exposed to plasma to modify the surface energy of the layer and create surface functionalities that promote tissue ingrowth. For example, exposure to plasma can create surface functionalities on the body of the layer, which may promote cell adhesion and/or cell motility. Functionalities may include carboxyl groups and/or hydroxyl groups, for example. In such instances, a plasma treatment can modify the surface energy of the foam to promote cell adhesion and/or motility, which can promote the ingrowth of tissue.

In various instances, the layer 400 can be treated with a corona or air plasma treatment in which the layer 400 is passed through low temperature plasma to change the surface energy of the layer 400. The layer 400 can be exposed to the plasma for a predefined period of time. For example, the layer 400 can be exposed to the plasma for less than 10 minutes. In other instances, the exposure period can be more than 10 minutes or less than 5 minutes. The plasma can be generated at a low power level to prevent melting of the body 402. Such a plasma treatment can be configured to modify the surface energy of the layer 400 to promote cell adhesion and/or cell motility, which can improve the ingrowth of tissue, for example.

Additionally or alternatively, the surface energy of the layer 400 can be altered with the addition of a coating thereto. For example, a piece of lyophilized foam can be coated with a hydrophilic material, such as a hydrophilic polymer, for example, to attract water and thus increase cell adhesion. In various instances, the coating can be permanently grafted to the body 402 of the layer 400. The hydrophilic coating can comprise a biocompatible hydrophilic coating such as SLIPSKIN™ 90/10 by INterface BIOmaterials BV, butyl methacrylate (BMA), and/or HYDROLAST™ by AST Products, Inc., for example. Such a hydrophilic surface coating can be configured to modify the surface energy of the layer 400 to improve cell adhesion and/or cell motility, which can promote the ingrowth of tissue.

In certain instances, an implantable layer can include a fibrous outer layer. The fibrous outer layer can provide an anchor or foothold for tissue ingrowth. For example, in instances where the body of the implantable layer, or at least an outer portion of the body, is inhospitable to tissue ingrowth (e.g. dense and/or lacking a sufficient open cell structure), tissue ingrowth can initiate in the fibrous outer layer, gain traction, and propagate into the body of the implantable layer.

Referring primarily to FIGS. 6-8, an implantable layer 500 including a body 502 and a fibrous layer 508 is depicted. The implantable layer 500 comprises a tissue thickness compensator. For example, referring to FIG. 8, when the implantable layer 500 and tissue T are captured within a staple 560, the implantable layer 500 is configured to compensate for variations in tissue properties, such as variations in the thickness of tissue T, for example. The implantable layer 500 includes a plurality of pores 510 (FIGS. 7 and 8) and a plurality of tissue ingrowth passages 520 (FIGS. 7 and 8) defined in the body 502 thereof. For example, the body 502 can comprise a piece of lyophilized foam having a plurality of pores 510. The passages 520 can be formed via one or more processes further described herein utilizing punching, drilling, tooling, water jets and/or lasers, for example. The body 502 includes a plurality of faces 504 including a tissue-facing face 504a.

The fibrous layer 508 is positioned adjacent to the tissue-facing face 504a of the body 502. In certain instances, the fibrous layer 508 can extend around multiple faces 504 of the body 502. Additionally or alternatively, the implantable layer 500 can include a plurality of fibrous layers 508, which can be positioned on different faces 504 of the body 502 and/or can cover different portions of at least one face 504 of the body 502. For example, strips and/or pieces of a fibrous material can be attached to the body 502 of the implantable layer 500. In various instances, the fibrous layer 508 is comprised of non-woven fibers 509. For example, the fibrous layer 508 is comprised of melt-blown non-woven fibers 509. In other instances, the fibrous layer 508 can be comprised of woven fibers.

The body 502 of the implantable layer 500 is denser than the fibrous layer 508. For example, the body 502 comprises a first density and the fibrous layer 508 comprises a second density that is less than the first density. More specifically, the lyophilized foam that forms the body 502 is denser than the melt-blown non-woven fibers that form the fibrous layer 508. Referring primarily to FIG. 8, the fibrous layer 508 is configured to contact tissue T during a stapling operating. The tissue T is configured to initially grow into the more hospitable, less dense fibrous layer 508 before reaching the less hospitable, denser body 502 of the implantable layer 500. For example, in the exemplary stapling operation depicted in FIG. 8, portions of the tissue T₁and T₂have grown through the fibrous layer 508 and into the tissue ingrowth channels 520a and 520b, respectively, in the body 502. In other instances, the body 502 may not include tissue ingrowth channels 520, however, in such instances, the fibrous layer 508 can be configured to provide sufficient footholds and/or traction to facilitate tissue ingrowth into the implantable layer 500.

Referring now to FIG. 9, an implantable layer 600 comprising a body 602 and a fibrous layer 608 is depicted. The implantable layer 600 comprises a tissue thickness compensator. In various instances, the implantable layer 600 can be similar in many aspects to the implantable layer 500. For example, the body 602 can comprise a piece of lyophilized foam. Additionally or alternatively, the body 602 can include a plurality of pores and/or a plurality of tissue ingrowth passages defined therein. The body 602 of the implantable layer 600 is denser than the fibrous layer 608.

The fibrous layer 608 comprises a layer or sheet of fibrous material. For example, the fibrous layer 608 comprises a woven mesh. The mesh comprises a lattice or netting of fibers 609 that are interwoven and interlaced. The fibrous layer 608 overlies a tissue-facing face of the body 602. In the depicted embodiment, the fibrous layer 608 covers the tissue-facing face of the body 602. In other embodiments, the fibrous layer 608 may cover a portion or portions of the tissue-facing face and/or may extend around additional faces of the body 602. The fibrous layer 608 is secured to the body 602 at a plurality of engagement regions 618. For example, the fibrous layer 608 is heat-staked to the body 602 at each engagement region 618. Additionally or alternatively, the fibrous layer 608 can be solvent-bonded to the body 602, secured with at least one suture, and/or otherwise affixed to at least a portion of the body 602. In certain instances, the implantable layer 600 can include a plurality of fibrous layers 608, which can be affixed to the body 602 of the implantable layer 600 and/or to each other.

Referring now to FIG. 10, a fibrous layer 708 is depicted. The fibrous layer 708 can be used with various implantable layers and/or bodies thereof that are further described herein. The fibrous layer 708 comprises a plurality of fibers 709 that are woven into a mesh or lattice pocket 716. The lattice pocket 716 is configured to be positioned around the body of an implantable layer. In various instances, the lattice pocket 716 can be positioned around and/or otherwise attached to an implantable layer before the implantable layer is attached to a staple cartridge and/or end effector.

In various instances, multiple lattice pockets 716 can be positioned around at least a portion of the body of an implantable layer. For example, multiple lattice pockets 716 can be layered around at least a portion of the body of an implantable layer. Additionally or alternatively, in instances where the implantable layer comprises a plurality of body portions, at least one lattice pocket 716 can be positioned around different body portions of the implantable layer. For example, individually-wrapped or individually-covered body portions of an implantable layer can be positioned on either side of a longitudinal knife slot and/or firing path in a staple cartridge.

In various instances, an implantable layer can be comprised of multiple pieces of porous material, such as multiple foam fragments. As described in greater detail herein, the multiple pieces of porous material can be fused together under conditions of increased temperature and/or pressure to form the implantable layer. In certain instances, pores can be defined in the foam fragments that form the implantable layer and gaps can exist between adjacent foam fragments in the formed implantable layer. In such instances, the implantable layer includes intrastitial voids (e.g. the pores in the foam fragments) and interstitial voids (e.g. the gaps between the foam fragments). The intrastitial voids can be smaller than the interstitial voids, for example, and the variation in void size in the implantable layer may facilitate tissue ingrowth. For example, the tissue can initially grow into the larger voids between adjacent pieces of porous material before permeating the smaller voids within a piece of porous material. As further described herein, the properties of the foam fragments (e.g. size, material, density, etc.) can be selected to adjust the properties of the implantable layer. An exemplary implantable layer 800 comprising a conglomeration of foam fragments is depicted in FIG. 11. The implantable layer 800 includes a plurality of foam fragments that have been fused together to form an implantable body 802. Interstitial voids 806 are defined between adjacent foam pieces in the body 802.

Referring primarily to FIG. 12, a portion of a staple cartridge 950 is shown. The staple cartridge 950 includes a cartridge body 952 having a deck 956. A plurality of staple cavities are defined in the cartridge body 952, and each staple cavity comprises an opening in the deck 956. For example, a staple cavity 954 is defined in the cartridge body 952. The staple cartridge 950 further includes a plurality of staples. For example, a staple 960 is positioned in the staple cavity 954. The staple cartridge 950 includes an implantable layer 900, which is positioned adjacent to the deck 956 of the cartridge body 952. The implantable layer 900 extends over the openings in the deck 956. The implantable layer 900 can be releasably attached to the cartridge body 952. The implantable layer 900 comprises a tissue thickness compensator. For example, referring now to FIG. 13, when the implantable layer 900 and tissue T are captured within the staple 960, the implantable layer 900 is configured to compensate for variations in tissue properties, such as variations in the thickness of tissue T, for example.

The implantable layer 900 includes a plurality of foam fragments 908. As further described herein, the foam fragments 908 are fused together under conditions of increased temperature and/or pressure to form a body 902 of the implantable layer 900. The body 902 includes a plurality of interstitial voids 906. For example, interstitial voids 906 are defined between adjacent foam fragments 908 in the body 902. Referring primarily to FIG. 12, the foam fragments 908 are angularly-oriented throughout the body 902. For example, a first foam fragment 908a is angularly-oriented relative to a second foam fragment 908b. In the depicted instance, the angular orientation of the foam fragments 908 is random. In other instances, the foam fragments 908 can be systematically oriented and/or purposefully arranged throughout the body 902.

A portion of an implantable layer 1000 is depicted in FIG. 14. Similar to the implantable layers 800 and 900, the implantable layer 1000 includes a plurality of foam fragments 1008. As further described herein, the foam fragments 1008 are fused together under conditions of increased temperature and/or pressure to form a body 1002 of the implantable layer 1000. The body 1002 also includes a plurality of interstitial voids 1006. For example, interstitial voids 1006 are defined between adjacent foam fragments 1008 in the body 1002. The foam fragments 1008 include a plurality of pores 1010 defined therein. The pores 1010 comprise intrastitial voids of the body 1002. The interstitial voids 1006 are larger than the intrastitial voids 1010 in the body 1002.

The interstitial voids 1006 can vary in size depending on the orientation and size of the foam fragments 1008, among other factors. In instances where the foam fragments 1008 are randomly-oriented in the body 1002, the interstitial voids 1006 can be randomly-sized, for example. The interstitial voids 1006 can vary in size between pore-sized, compressed pore-sized, open-cell sized, and/or orders of magnitude greater than the size of the pores 1010. In the depicted embodiment, the interstitial voids 1006 are approximately ten times to one hundred times larger than the intrastitial voids 1010, for example. In other instances, at least one interstitial void 1006 can be less than ten times larger than at least one intrastitial void 1010 and/or at least one interstitial void 1006 can be greater than one hundred times larger than at least one intrastitial void 1010, for example.

Referring still to FIG. 14, the size of the pores 1010 can vary between and among the foam fragments 1008. For example, different types of foam can have different size pores. Additionally, at least a portion of the pores 1010 can become compressed and shrink during the process of fusing the foam fragments 1008 together to form the body 1002. In various instances, more compressed foam fragments 1008 and/or portions thereof can comprise an increased density compared to less compressed foam fragments 1008 and/or portions thereof having the same material properties. The size of at least one interstitial void 1006 can also depend on the compression applied to the foam fragments 1008 during the fusing process.

In certain instances, foam fragments for an implantable layer can be randomly selected and combined to form an implantable layer. In other instances, the foam fragments can be sorted by size, shape, material, age, etc., and foam fragments having specific material properties can be recombined to form the implantable layer. In such instances, the properties of the resultant implantable layer can be adjusted based on the selected material properties of the foam fragments. For example, referring to FIG. 16, a portion of an implantable layer 1200 is depicted. The implantable layer 1200 includes foam fragments 1208 comprising different material properties. The foam fragments 1208 can be selected based on the material properties thereof to control various properties of the resultant implantable layer 1200. In certain instances, as further described herein, the foam fragments within an implantable layer can be organized or selectively arranged such that the implantable layer comprises different properties in different regions thereof.

The type of foam fragments can be selected based on the desired properties for the implantable layer. For example, the size(s) of the foam fragments can affect the properties of the implantable layer formed therefrom. In certain instances, the porosity of an implantable layer can be greater when larger foam fragments are used and the porosity of an implantable layer can be less when smaller foam fragments are used. For example, due to a decrease in packing efficiency, larger interstitial voids can exist between larger foam fragments than between smaller foam fragments. The densities of the foam fragments can also affect the properties of the implantable layer formed therefrom. In certain instances, the porosity of an implantable layer can be less when denser foam fragments are used and the porosity of an implantable layer can be greater when less dense foam fragments are used.

The size of the foam fragments can vary from approximately 1.5 mm to approximately 0.1 mm, for example. Referring to FIG. 15A, large foam fragments 1108 can be combined to form the body 1102 of an implantable layer. The foam fragments 1108 can be approximately 1.5 mm in at least one dimension, for example. In other instances, referring to FIG. 15C, small foam fragments 1118 can be combined to form the body 1112 of an implantable layer. The foam fragments 1118 can be approximately 0.1 mm in at least one dimension, for example. The interstitial voids 1106 formed between the large foam fragments 1108 (FIG. 15A) are larger than the interstitial voids 1116 formed between the small fragments 1118 (FIG. 15C). As a result, the body 1102 (FIG. 15A) is more porous than the body 1112 (FIG. 15C). In certain instances, different sized fragments can be combined in a single body. In such instances, smaller foam fragments can at least partially fill the larger voids formed between the larger foam fragments.

Referring to FIGS. 15A and 15B, the foam fragments 1108 are denser than the foam fragments 1128. The intrastitial voids 1110 formed in the foam fragments 1108 (FIG. 15A) are smaller than the intrastitial voids 1130 formed in the foam fragments 1128 (FIG. 15B). In other words, the foam fragments 1128 are more porous than the foam fragments 1108. As a result, the body 1102 (FIG. 15A) is less porous than the body 1122 (FIG. 15B). In certain instances, foam fragments having different porosities can be combined in a single body. The porosity of a foam fragment can depend on the porosity of the foam from which the fragment was taken. Additionally, the porosity of a foam fragment can depend on the material of the foam and the process of manufacturing the foam (e.g. the degree of compression).

In certain instances, adjunct materials, such as at least one fiber, collagen, and/or medicament, can be combined with foam fragments to form a body of an implantable layer. The adjuncts can be selected to affect different properties of the resultant implantable layer. Referring to FIG. 15D, a plurality of fibers 1134 can be combined with a plurality of foam fragments 1138 to form a body 1132 of an implantable layer. The fibers 1134 at least partially fill the interstitial voids 1136 between adjacent foam fragments 1138, and are configured to promote tissue ingrowth. More specifically, the addition or fibers 1134 to the body 1132 can increase the porosity of the body 1132 and/or provide additional footholds and/or inlets for tissue ingrowth. The fibers 1134 can be randomly-oriented, loose fibers, such as the collection of fibers 1144 depicted in FIG. 15E, and/or can comprise a woven or knitted matrix of fibers, such as the arrangement of fibers 1154 depicted in FIG. 15F.

Referring again to FIG. 16, the implantable layer 1200 is formed from the foam fragments 1208 that have been fused together, as further described herein. The foam fragments 1208 forming the body 1202 of the implantable layer 1200 comprise different material properties. For example, the foam fragments 1208 comprise different sizes and different materials. A plurality of first foam fragments 1208a fit within a first range of sizes and are formed from a first material, a plurality of second foam fragments 1208b fit within a second range of sizes and are formed from a second material, and a plurality of third foam fragments 1208c fit within a third range of sizes and are formed from a third material. The first foam fragments 1208a comprise a different density than the second foam fragments 1208b and the third foam fragments 1208c. Moreover, the second foam fragments 1208 comprise a different density than the third foam fragments 1208c. In various instances, as further described herein, the groups of foam fragments 1208a, 1208b, 1208c can also comprise different degradation or absorption rates. For instance, PCL foams degrade slower than PCL/PGA foams. The PCL foams will also be stiffer than the PCL/PGA foams. This is true even with similar morphologies, densities, etc.

In certain instances, the foam fragments can be systematically arranged within the body of the implantable layer. For example, a first group of foam fragments or the majority thereof, such as the foam fragments 1208a, can be positioned in a first region, a second group of foam fragments or the majority thereof, such as the foam fragments 1208b, can be positioned in a second region, and a third group of foam fragments or the majority thereof, such as the foam fragments 1208c, can be positioned in a third region. In such instances, the properties of the resultant implantable layer can vary between the regions. For example, the porosity, density, thickness, resiliency, compressibility, and/or flexibility of the implantable layer can vary between regions. In at least one instance, regions can correspond to the arrangement of staple cavities in a staple cartridge. For example, the regions can comprise elongate regions that overlie or substantially overlie rows of staple cavities in the staple cartridge. In at least one instance, the thickness of the implantable body can vary across rows of staple cavities. For example, the implantable body can comprise a first thickness in the elongate regions adjacent to a knife slot and/or a firing path through the staple cartridge and the thickness of the implantable body can gradually and/or incrementally decrease laterally outboard from the knife slot and/or the firing path. In other instances, other properties of the implantable body can vary laterally outboard from the knife slot and/or the firing path. For example, the porosity, density, resiliency, compressibility, and/or flexibility of the body can vary, increase or decrease, laterally outboard.

In certain instances, the adjuncts that are combined with various foam fragments can demonstrate antibacterial properties. Antibacterial medicaments in an implantable layer can be time-released, gradually released, and/or incrementally released from the implantable layer. Embodiments having controlled release of an antibacterial medicament may minimize and/or prevent the incidence and/or severity of infection at the surgical site, for example. In various instances, medicaments in the implantable layer can comprise additional and/or different medicinal properties.

The release rate of medicaments from an implantable layer that is comprised of fused foam fragments can depend on the properties of the foam fragments, such as the size, density, material, and/or age of the foam fragments. More specifically, certain foam fragments can degrade or absorb faster than other foam fragments. Additionally or alternatively, the age of the material that forms the foam fragment can affect the absorption rate. In certain instances, various foam fragments and/or adjuncts can be aged or matured prior to the formation of the implantable layer, which can accelerate the degradation profile of the composite implantable layer. To facilitate the desired release of medicament(s), the type of foam fragment(s) can be selected based on the degradation rate(s) thereof, and thus, the corresponding release rate(s) of any medicaments combined therewith.

Referring now to FIG. 17, a graph 1300 depicting the release of medicaments from an implantable layer over a period of time is depicted. In the depicted embodiment, the release of medicament A from a first group of foam fragments occurs faster and is completed sooner than the release of medicament B from a second group of foam fragments. The foam fragments in the first group comprise a degradation or absorption rate that exceeds the degradation or absorption rate of the foam fragments in the second group. In other instances, medicament A may be entirely or substantially released before medicament B is released or vice versa. In such instances, the release of medicament A and medicament B may not occur simultaneously. Additionally or alternatively, the rate of release of medicament A and medicament B can be equal or substantially equal and/or the volume of released medicament A and volume of released medicament B can be equal or substantially equal.

Additionally or alternatively, the degradation profile of an implantable layer can be selected to facilitate tissue ingrowth. For example, as portions of the implantable layer degrade, additional and/or larger tissue ingrowth passages can be formed in the implantable layer. In at least one instance, a first group of foam fragments can be configured to degrade more quickly than a second group of foam fragments such that tissue ingrowth passages in the implantable layer are quickly formed between the foam fragments of the second group in the absence of the foam fragments of the first group. In certain instances, the arrangement of foam fragments can be controlled to create predefined tissue ingrowth regions or passages in the implantable layer. For example, certain regions of the implantable layer can comprise a degradation or absorption rate that exceeds the degradation or absorption rate of the adjacent region(s) such that specific ingrowth passages are defined in the implantable layer after a predefined period of time.

In various instances, an implantable layer can comprise foam fragments having specific geometries. Referring now to FIGS. 18-20, implantable layers comprised of foam fragment having different geometries are depicted. The implantable layer 1400 includes arced, or arcuate, foam fragments 1408 (FIG. 18), the implantable layer 1500 includes spherical foam fragments 1508 (FIG. 19), and the implantable layer 1600 includes star-shaped foam fragments 1608. In certain instances, foam fragments can be ovoid, diamond-shaped, triangular, and/or other three-dimensional shapes, for example. The geometry of the foam fragments 1408, 1508, and 1608 affects how the foam fragments 1408, 1508, 1608 fit together and, thus, affects the voids or tissue ingrowth regions therebetween. For example, foam fragments of certain shapes can be configured to nest together, which results in a high packing efficiency and, thus, fewer and/or smaller tissue ingrowth voids therebetween. Alternatively, foam fragments of other shapes can be configured to maintain a low packing efficiency, which can result in more and/or larger tissue ingrowth voids therebetween. In certain instances, foam fragments comprising different geometries can be combined in an implantable layer.

Implantable layers comprising a plurality of foam fragments, such as the composite implantable layers 800, 900, 1000, 1200, 1400, 1500, and 1600 described above, for example, can be formed by fusing or otherwise adhering multiple foam fragments together to form a unitary piece. The foam fragments can be fused together under conditions of increased temperature and/or pressure. For example, a plurality of molded foam fragments can be positioned in a cavity of a mold. The cavity can define the desired geometry of the implantable layer. In other instances, the unitary conglomeration of foam fragments can be cut or otherwise trimmed to the desired size and/or geometry for the implantable layer after the temperature and/or pressure has been applied. In certain instances, foam fragments can be sorted before filling the mold cavity and only foam fragments comprising certain characteristics (e.g. within a defined size range and/or having certain material properties) can be positioned in the cavity of the mold. Foam fragments having different characteristics can be combined in the mold cavity and/or adjuncts can be combined with the foam fragments. Additionally, heat and pressure can be applied to the foam fragments, which can fuse the foam fragments together. Any adjunct material can also be molded into the unitary piece conglomeration between foam fragments. In certain instances, the foam fragments and/or the adjuncts, if any, can be randomly or uniformly dispersed throughout the mold cavity prior to the application of heat and/or pressure thereto. In other instances, the foam fragments and/or the adjuncts, if any, can be systematically arranged and/or organized in the mold cavity prior to the application of heat and/or pressure thereto.

Referring primarily to FIGS. 21 and 22, a portion of a mold 1730 for forming a composite implantable layer is depicted. The mold 1730 comprises sidewalls 1731 defining a cavity 1732 for receiving a plurality of foam fragments 1708. The cavity 1732 can comprise a geometry that corresponds to the desired geometry of a composite implantable layer. In other instances, a piece and/or sheet of composite implantable material can be formed in the mold cavity 1732, and the molded piece and/or sheet can be cut and/or otherwise trimmed to the desired size and/or shape for an implantable layer.

The foam fragments 1708 are randomly distributed and randomly oriented throughout the mold cavity 1732. Referring primarily to FIG. 23, a group of uncompressed and unfused foam fragments 1708 from the mold cavity 1732 are depicted. The foam fragments 1708 fill a first volume of space before the application of pressure thereto. In the depicted embodiment of FIG. 21, a portion of the foam fragments 1708 are positioned above a rim or top edge 1734 of the mold cavity 1732. In such instances, the first volume of space consumed by the foam fragments 1708 comprises a larger volume than the volume of the mold cavity 1732. In other instances, the mold cavity 1732 may not be entirely filled with foam fragments 1708 or the foam fragments 1708 may fill the mold cavity 1732 to the top edge 1734.

Referring primarily to FIG. 22, a press 1736 is configured to apply pressure to the foam fragments 1708 positioned in the mold cavity 1732. The press 1736 comprises a geometric shape that mates with the geometry of the mold cavity 1732 to form a flat or substantially flat composite implantable layer. For example, the press 1736 fits within the mold cavity 1732 with minimal clearance between the press 1736 and the sidewalls 1731 of the mold 1730. While the press 1736 is compressing the foam fragments 1708 positioned in the mold cavity 1732, the mold 1730 and/or the foam fragments 1708 therein are heated to an elevated temperature. For example, the mold 1730 is configured to be heated to a temperature above the ambient temperature before and/or while the foam fragments 1708 are being compressed by the press 1736. As the temperature of the mold 1730 increases, the heat is transferred to the foam fragments 1708 in the mold cavity 1732. As a result, the foam fragments 1708 are also heated above the ambient temperature. Specifically, the foam fragments 1708 can be heated to a temperature above the glass transition temperature and below the melting temperature thereof. In other instances, heat can be applied directly to the foam fragments 1708 positioned in the mold cavity 1732.

When the foam fragments 1708 are heated between their glass transition temperature and their melting temperature and/or concurrently subjected to pressure between the mold 1730 and the press 1736, the foam fragments 1708 become fused together. Referring primarily now to FIG. 24, the group of foam fragments 1708 shown in FIG. 23 are compressed and fused together with the application of heat and pressure. The foam fragments 1708 are compressed and the spaces between adjacent foam fragments 1708 are also compressed during the compression treatment by the press 1736 (FIG. 22). In other words, the interstitial voids and the intrastitial voids that existed prior to the forming process have been compressed, but not completely eliminated.

After the foam fragments 1708 have fused together, the foam fragments 1708 can be actively cooled and/or allowed to cool at ambient temperature. After the foam fragments 1708 have melded together and sufficiently cooled to form a consolidated amalgamation of foam fragments, the composite foam assembly can be removed from the mold cavity 1732 and applied or assembled to a staple cartridge. In certain instances, the composite foam assembly can undergo additional processing steps (e.g. cutting, reshaping, drilling, and/or various surface treatments) before being applied to a staple cartridge.

Referring primarily now to FIGS. 25-27, foam fragments for forming composite implantable layers, such as the various foam fragments described above, for example, can be ground from a piece of foam. For example, a homogenous or substantially homogenous piece of foam 1840 is fed through a grinder mechanism 1842 (FIG. 25), which grinds and/or cuts the foam 1840 into a plurality of fragments 1808. The fragments 1808 are then fed through a plurality of sieves or filters 1844a, 1844b, 1844c (FIG. 25), which sort the fragments 1808 by size. The filters 1844a, 1844b, 1844c also comprise conveyors for moving the sorted fragments 1808a, 1808b, 1808c. The largest fragments 1808a are captured by the first filter 1844a, while the smaller fragments 1808b and 1808c pass through the first filter 1844a. The second filter 1844b is configured to capture the mid-sized fragments 1808b, while the smaller fragments 1808c pass through the second filter 1844b. The third filter 1844c is configured to capture the smaller fragments 1808c.

In certain instances, fragments below a certain size and/or above a certain size may be undesirable. Referring now to FIGS. 26 and 27, foam fragments for forming composite implantable layers can preferably range in size from 1.5 mm to 0.1 mm, and foam fragments greater than 1.5 mm and less than 0.1 mm may not be combined to form a composite layer, for example. In other instances, at least one foam fragment can be greater than 1.5 mm in at least one dimension and/or less than 0.1 mm in at least one dimension.

The foam fragments can be sorted by size, as described above. Additionally or alternatively, foam fragments can be sorted by at least one material property thereof. In certain instances, an implantable layer can be formed from foam segments comprising similar sizes and/or material properties. In other instances, foam fragments comprising different sizes and/or material properties can be combined to tune and/or optimize various characteristics of the resultant implantable layer.

Various implantable layers described herein and/or at least a portion of the various implantable layers described herein can comprise a piece of lyophilized foam. For example, the implantable body portion of an implantable layer can comprise a piece of lyophilized foam. Lyophilized foam comprises an inherently porous structure, however, the pores defined in lyophilized foam can be small. For example, the pores defined in a piece of conventionally-molded lyophilized foam can be between approximately 5 μm and approximately 50 μm in diameter, for example. Larger pores may be more conducive to tissue ingrowth. For example, pores between approximately 100 μm and approximately 150 μm in diameter may promote and/or encourage tissue ingrowth. Moreover, pores larger than 125 μm in diameter, for example, may promote and/or encourage tissue ingrowth. That said, such pores may be spherical, but they frequently comprise an irregular shape. Additionally, a piece of conventionally-molded lyophilized foam can comprise an outer portion or shell that is denser and/or less porous than the inner portion. To promote tissue ingrowth, it may be desirable to increase the porosity and/or the pore size and/or to create additional tissue ingrowth inlets and/or passages into and/or through the lyophilized foam.

In at least one instance, gas bubbles can be introduced into a lyophilization solution for forming an implantable layer. The lyophilization solution can comprise polyglycolic acid (PGA) and/or polycaprolactone (PCL), for example. Gas bubbles can be introduced into the lyophilization solution by whipping and/or blowing gas into the solution prior to freezing of the solution. For instance, nitrogen gas can be whipped and/or blown into the lyophilization solution, for example. Moreover, the gas bubbles can be introduced before and/or during the cooling process which gels the solution. By whipping gas bubbles into the solution as it is gelling, the bubbles are dispersed within the frozen solution. When a vacuum is pulled on the environment surrounding the frozen solution, the solvent sublimates from the solid, i.e., lyophilizes, and the gas trapped within the bubbles escapes leaving behind cavities or pores. The size of the bubbles and, thus, the size of the pores, can be controlled by selecting the gas, the method in which the gas is introduced into the solution, and the whipping process parameters, for example. Due to the inherently porous structure of lyophilized foam, the foam also comprises smaller pores found in conventionally-molded lyophilized foam. As a result, the lyophilized foam can comprise a bimodal distribution of cells around the naturally-occurring smaller pores (the first mode) and the intentionally-created larger bubble cells (the second mode).

The addition of larger cells into the lyophilized foam is configured to promote tissue ingrowth. In various instances, the size of the larger cells can be controlled by adjusting the speed, duration, and/or tools used to form the bubbles (e.g. whipping and/or blowing). Additionally or alternatively, the position of the larger cells can be controlled by adjusting the viscosity of the lyophilization solution and/or the time between the bubble formation step and the freezing step. Additionally or alternatively, in at least one instance, additional energy can be applied to the lyophilization solution, such as by vibrating the lyophilization mold, for example, to control the position of the larger cells.

Referring now to FIGS. 28 and 29, a mold 2030 for forming a piece of lyophilized foam is depicted. The mold 2030 comprises sidewalls 2031 defining a cavity 2032 for receiving a lyophilization solution 2040. The cavity 2032 can comprise a geometry that corresponds to the desired geometry of an implantable layer and/or a body portion thereof. In certain instances, a piece and/or sheet of implantable material can be formed in the mold cavity 2032, and the molded piece and/or sheet can be cut and/or otherwise trimmed to the desired size and/or shape.

The lyophilization solution 2040 comprises a plurality of pores 2010 and a plurality of bubbles 2018 therein. The bubbles 2018 are formed by the introduction of gas into the solution. For example, the gas is blown and/or whipped into the lyophilization solution 2040. Referring to the embodiment depicted in FIG. 28, the gas was introduced into the lyophilization solution 2040 before the solution 2040 was provided to the mold 2030. In other instances, the gas can be introduced into the lyophilization solution 2040 when the solution 2040 is in the mold 2030.

The arrangement of pores 2010 and bubbles 2018 in the lyophilization solution 2040 depicted in FIG. 28 corresponds to an initial stage in the lyophilization process, and the arrangement of pores 2010 and bubbles 2018 in the lyophilization solution 2040 depicted in FIG. 29 corresponds to a secondary stage in the lyophilization process. More specifically, the bubbles 2018 are configured to move between the initial stage and the secondary stage. For example, the bubbles 2018 are configured to rise or migrate toward a top surface 2042 of the solution 2040 in the mold cavity 2032. As further described herein, the pace of the movement of the bubbles 2018 toward the surface 2042 of the solution 2040 can be controlled and/or adjusted. The pace can be adjusted by adjusting the temperature of the solution at the time of introducing the bubbles, the rate in which the solution is cooled/frozen, the rate in which the vacuum is applied, and/or the amount of vacuum, for example. As the bubbles 2018 move toward the surface 2042 of the solution 2040, tissue ingrowth passages 2020 are formed in the lyophilization solution 2040. When the lyophilized solution 2040 is frozen during the lyophilization process, various bubbles 2018 and the tissue ingrowth passages 2020 become frozen in the solution 2040, which results in bubbles 2018 and tissue ingrowth passages 2020 in the resultant lyophilized foam.

The size of the bubbles 2018 is affected by the speed, duration, and/or tools used to form the bubbles. For example, when the lyophilization solution 2040 is whipped at a higher speed and/or for a longer period of time, larger bubbles 2018 can form in the solution 2040. Additionally, the shape of the whip can affect the size of the bubbles 2018. The pace of bubble migration is affected by the viscosity of the lyophilization solution 2040 and the time interval between the bubble formation step and the freezing step. For example, bubbles 2018 can migrate more slowly when the lyophilization solution 2040 is more viscous, and the bubbles 2018 can migrate faster when the lyophilization solution 2040 is less viscous. Additionally, as the time interval between the bubble formation step and the freezing step lengthens, additional bubbles 2018 can migrate toward the surface 2042, which can form additional and/or longer tissue ingrowth channels 2020 in the lyophilization solution 2040. Additional energy can be applied to the lyophilization solution 2040 to increase the rate of bubble migration. For example, the mold 2040 can be vibrated to accelerate the rise of bubbles 2018 toward the surface 2042 and, thus, to form additional and/or longer tissue ingrowth channels 2020 in the solution 2040 and the resultant lyophilized foam.

In certain instances, an implantable layer can comprise at least one dissolvable insert and/or particulate. Dissolvable inserts can be configured to dissolve prior to implantation and/or after implantation of the implantable layer (i.e. in vivo). After the dissolvable inserts have dissolved, voids remain in the implantable layer in the space previously occupied by the dissolvable inserts. Voids remaining in the absence of dissolvable inserts can form tissue ingrowth channels and/or inlets that are configured to promote the ingrowth of tissue around, into and/or through the implantable layer. In instances where the dissolvable inserts are dissolved prior to the implantation of the implantable layer, the tissue ingrowth channels can facilitate tissue ingrowth upon implantation of the implantable layer. In other instances, the tissue ingrowth channels can propagate through the implantable layer after implantation of the layer, and the tissue ingrowth channels can be progressively and/or increasingly available for tissue ingrowth after implantation of the implantable layer.

Dissolvable insert(s) can comprise less than 50% of the overall volume of the implantable layer. In such instances, tissue ingrowth channel(s) formed in the place of the dissolvable insert(s) can occupy less than 50% of the overall volume of the implantable layer. A porous structure, such as lyophilized foam, for example, can occupy the remaining volume of the implantable layer. In other instances, the dissolvable insert can comprise approximately 50% or more than 50% of the overall volume of the implantable layer.

Dissolvable inserts can be bonded to the material that forms the body of the implantable layer. For example, dissolvable inserts can be incorporated into the implantable layer with solvent casting, particulate molding, and/or a secondary lyophilization process. Dissolvable inserts can comprise sugar crystals and/or salt crystals that are mixed with a lyophilization solution prior to freezing, or lyophilizing, of the solution. The sugar crystals and/or salt crystals can be liquefied during a secondary dissolving step, for example. After lyophilization, in at least one such instance, there will be a porous foam structure with dissolvable materials trapped within it. The dissolvable materials can be solubilized with a solvent that does not affect the base foam material. For instance, water doesn't rapidly dissolve PCL/PGA materials and, as a result, water could be used to dissolve salt and/or sugar inserts that were trapped within a PCL/PGA foam with several rinsing steps. The foam could then be dried to stop the degradation of the PCL/PGA. In certain instances, dissolvable inserts can be layered within the body of an implantable layer.

A dissolvable insert can comprise a three-dimensional shape. For example, the dissolvable insert can be formed in a mold. The molded insert can be comprised of sugar, salt, honey, and/or VICRYL RAPIDE, for example. VICRYL RAPIDE is a bioabsorbable material sold by Ethicon, Inc. that degrades quicker than ordinary VICRYL because it is sold pre-degraded, either by exposure to a moist environment and/or by gamma radiation exposure, for example. In certain instances, at least one dissolvable insert can be mixed into the material forming the body of the implantable layer and the implantable layer can be insert-molded around the at least one dissolvable insert. Alternatively, a lyophilization solution can be provided around at least one dissolvable insert and the implantable layer can be lyophilized around the at least one dissolvable insert.

Referring primarily to FIG. 30, a portion of a mold 2230 for forming a piece of lyophilized foam is depicted. The mold 2230 comprises sidewalls 2231 defining a cavity 2232 for receiving a lyophilization solution. The cavity 2232 can comprise a geometry that corresponds to the desired geometry of an implantable layer and/or a body portion thereof. In certain instances, a piece and/or sheet of implantable material can be formed in the mold cavity 2232, and the molded piece and/or sheet can be cut and/or otherwise trimmed to the desired size and/or shape for the body of an implantable layer.

A dissolvable insert 2270 is positioned in the mold cavity 2232. The dissolvable insert 2270 is formed from a syrup of sugar and water; however, any suitable material may be utilized. The syrup is reduced until the desired concentration is obtained. The syrup is then kneaded and forced into a supplemental mold in which the syrup is cooled to form the solidified dissolvable insert 2270. The dissolvable insert 2270 includes a plurality of vertical spokes 2272 and a plurality of horizontal spokes 2274. The vertical spokes 2272 are parallel or substantially parallel. The horizontal spokes 2274 form an interlocking web of spokes extending along the bottom portion of the insert 2270 and another interlocking web of spokes extending along the top portion of the insert 2270. The vertical spokes 2272 connect the horizontal spokes 2274 along the bottom portion of the insert 2270 with the horizontal spokes 2274 along the top portion of the insert 2270.

A lyophilization solution is provided around the dissolvable insert 2270 in the mold cavity 2232 to form the lyophilized foam. Upon completion of the lyophilization process, the dissolvable insert 2270 is dissolved out of the resultant piece of lyophilized foam. In at least one instance, water, for example, can be utilized to dissolve the insert 2270. A piece of lyophilized foam formed in the mold 2230 and with the dissolvable insert 2270 is depicted in FIG. 31. The lyophilized foam forms an implantable layer 2200 comprising a porous body portion 2202 having a plurality of pores 2210 defined therein.

The implantable layer 2200 also includes a plurality of tissue ingrowth passages 2220 defined therein. The tissue ingrowth passages 2220 are defined by the voids remaining behind after the insert 2270 (FIG. 30) has been dissolved. As a result, the tissue ingrowth passages 2220 comprise, one, a plurality of vertical channels which correspond to the vertical spokes 2272 and, two, webs of horizontal channels which correspond to the horizontal spokes 2274. The horizontal channels intersect the vertical channels along a face 2204a of the implantable layer 2200; however, the vertical channels can intersect in any suitable manner. In use, the face 2204a comprises a tissue-facing face and the tissue ingrowth passages 2220 propagating therefrom are configured to promote the ingrowth of tissue from the tissue-facing face 2204a around, into and/or through the implantable layer 2200.

Referring primarily to FIG. 32, a portion of a mold 2330 for forming a piece of lyophilized foam is depicted. The mold 2330 comprises sidewalls 2331 defining a cavity 2332 for receiving a lyophilization solution. The cavity 2332 can comprise a geometry that corresponds to the desired geometry of an implantable layer and/or a body portion thereof. In certain instances, a piece and/or sheet of implantable material can be formed in the mold cavity 2332, and the molded piece and/or sheet can be cut and/or otherwise trimmed to the desired size and/or shape for the body of an implantable layer.

A dissolvable insert 2370 is positioned in the mold cavity 2332. The dissolvable insert 2370 is formed from a syrup of sugar and water; however, any suitable material could be utilized. The syrup is reduced until the desired concentration is obtained. The syrup is then kneaded and forced into a supplemental mold in which the syrup is cooled to form the solidified dissolvable insert 2370. The dissolvable insert 2370 includes a plurality of vertical spokes 2372 and a plurality of horizontal spokes 2374. The vertical spokes 2372 are parallel or substantially parallel. Various vertical spokes 2372 comprise a variable diameter that tapers intermediate a top portion of the dissolvable insert 2370 and a bottom portion of the dissolvable insert 2370. The horizontal spokes 2374 form an interlocking matrix of spokes extending along the bottom portion of the insert 2370 and another interlocking matrix of spokes extending along the top portion of the insert 2370. The vertical spokes 2372 connect the horizontal spokes 2374 along the bottom portion of the insert 2370 with the horizontal spokes 2374 along the top portion of the insert 2370. The shape and/or various dimensions of the spokes 2372, 2374 can vary along the length and/or width of the dissolvable insert 2370. For example, thicker vertical spokes 2372 are positioned along a central portion of the dissolvable insert 2370. In various instances, the thicker vertical spokes 2372 at a central region in the dissolvable insert 2370 are configured to further promote tissue ingrowth in the central region of the resultant implantable layer.

A lyophilization solution is provided around the dissolvable insert 2370 in the mold cavity 2332 to form the lyophilized foam. Upon completion of the lyophilization process, the dissolvable insert 2370 is dissolved out of the resultant piece of lyophilized foam. A piece of lyophilized foam formed in the mold 2330 and with the dissolvable insert 2370 is depicted in FIG. 33. The lyophilized foam forms an implantable layer 2300 comprising a porous body portion 2302 having a plurality of pores 2310 defined therein. The implantable layer 2300 also includes a plurality of tissue ingrowth passages 2320 defined therein. The tissue ingrowth passages 2320 define the voids remaining in the absence of the dissolvable insert 2370 (FIG. 31).

The tissue ingrowth passages 2320 comprise a plurality of vertical channels, which correspond to the vertical spokes 2372, and webs of horizontal channels, which correspond to the horizontal spokes 2374. A web of horizontal channels is embedded in the body 2302 of the implantable layer 2300. Another web of horizontal channels intersects the vertical channels along a face 2304a of the implantable layer 2300. In use, the face 2304a comprises a tissue-facing face and the tissue ingrowth passages 2320 propagating therefrom are configured to promote the ingrowth of tissue around, into and/or through the implantable layer 2300. The tissue ingrowth channels 2320 are wider at the tissue-facing face 2304a of the implantable layer 2300 than the opposing face of the implantable layer 2300. Such structures are configured to further promote and/or enhance tissue ingrowth.

In various instances, an implantable layer can be comprised of a plurality of non-flush layers. In such instances, voids and/or passages can be defined between portions of adjacent layers in the implantable layer. Such voids and/or passages provide inlets and/or passages for tissue ingrowth into the implantable layer. The voids and/or passages also provide ample space for deformation of the layers. The layers can be comprised of a flexible and resilient material, which flexes under a load and rebounds upon removal of the load. For example, the layers can be comprised of a compressible film, nonwoven material, and/or foam, such as lyophilized foam, for example. In various instances, the implantable layer can comprise spring properties in a first direction and provide tissue ingrowth passages in a second direction that is perpendicular to the first direction. For example, the implantable layer can be compressible between a first face and a second, opposing, face, and the tissue ingrowth passages can extend between a third face and a fourth, opposing, face. The third and fourth faces can be perpendicular to the first and second faces.

Referring primarily to FIG. 34, a portion of an implantable layer 2500 is depicted. The implantable layer 2500 includes a plurality of corrugated layers 2502a, 2502b, 2502c, 2502d. Each corrugated layer 2502a, 2502b, 2502c, 2502d comprises an undulating, fluted and/or pleated sheet 2506, and each fluted sheet 2506 comprises alternating ridges and grooves. The ridges and grooves in each sheet 2506 are parallel; however, the ridges and grooves in the sheet 2506 of at least one corrugated layer 2502a, 2502b, 2502c, 2502d are angularly-oriented relative to the ridges and grooves in the sheet 2506 of another corrugated layer 2502a, 2502b, 2502c, 2502d. For example, the ridges and grooves in the sheet 2506 of the first layer 2502a are non-parallel to the ridges and grooves in the sheet 2506 of the adjacent second layer 2502b. In at least one instance, the ridges and grooves in the sheet 2506 of the first layer 2502a are perpendicular to the ridges and grooves in the sheet 2506 of the adjacent second layer 2502b. Additionally, the ridges and grooves in the sheet 2506 of the second layer 2502b are perpendicular to the ridges and grooves in the sheet 2506 of the adjacent third layer 2502c, and the ridges and grooves in the sheet 2506 of the third layer 2502c are perpendicular to the ridges and grooves in the sheet 2506 of the adjacent fourth layer 2502d. In such instances, the corrugated layers 2502a, 2502b, 2502c, and 2502d are arranged in an alternating manner in which the ridges and grooves of each layer are perpendicular to the ridges and grooves of the adjacent layers. A planar or substantially planar sheet 2508 is positioned between the fluted sheets 2506 in the implantable layer 2500, and a sheet 2508 is also positioned on opposing faces 2504 of the implantable layer 2500; however, embodiments are envisioned without one or more of the sheets 2508. In at least one embodiment, a stack of sinusoidal films can be used that create loft, or packing inefficiency, by not being parallel and nested to one another. The peaks of the sine waves of one layer will support the valleys of the sine waves above where they intersect at discrete points. Further to the above, corrugates don't have to be parallel or perpendicular to the primary axis of the device and/or knife slot. In at least one instance, corrugates are aligned +/−45 degrees to the primary axis of the staple reload.

Referring still to FIG. 34, owing to the corrugated structure of the layers 2502a, 2502b, 2502c, 2502d, the implantable layer 2500 comprises a minimal density and a plurality of voids and/or passages 2520 for promoting tissue ingrowth. The implantable layer 2500 comprises spring properties in a first direction (e.g. in the direction extending between planar sheets 2508) and comprises tissue ingrowth passages in second and third directions that are perpendicular to the first direction. The passages 2520 are defined by the ridges and grooves in the fluted sheets 2506. As a result, the passages 2520 in each layer 2502a, 2502b, 2502c, 2502d are parallel and the passages 2520 in a layer 2502a, 2502b, 2502c, 2502d are oriented perpendicular to the passages 2520 in the adjacent layer or layers 2502a, 2502b, 2502c, 2502d.

The implantable layer 2500 comprises four corrugated layers 2502a, 2502b, 2502c, 2502d. In other instances, the implantable layer 2500 can comprise less than four corrugated layers or more than four corrugated layers. For example, an implantable layer can comprise a single corrugated layer. The corrugated layers 2502a, 2502b, 2502c, 2502d of the implantable layer 2500 can be comprised of the same material. In other instances, at least one of the corrugated layers 2502a, 2502b, 2502c, 2502d can be comprised of a different material than at least one other corrugated layer 2502a, 2502b, 2502c, 2502d. Additionally or alternatively, an implantable layer can include at least one corrugated layer 2502a, 2502b, 2502c, 2502d and at least one non-corrugated layer. For example, at least one of the corrugated layers 2502a, 2502b, 2502c, 2502d can be combined with a non-corrugated film, foam layer, and/or fibrous layer.

In certain instances, at least one of the corrugated layers 2502a, 2502b, 2502c, 2502d in the implantable layer 2500 can comprise a different fluted and/or sinusoidal pattern than the other layers. For example, the ridges and/or grooves can be steeper in at least one layer than in at least one another layer. Additionally or alternatively, at least one layer can comprise a different height than at least one other layer. In certain instances, various fluted and/or sinusoidal layers can be stacked in parallel arrangement and/or in an angularly-oriented, non-perpendicular arrangement. In various instances, the corrugated layers can be multidirectional. For example, different layers can have axes of corrugation that are non-parallel to one another. At least one corrugated layer can comprise a conical and/or pyramidal shape, for example.

Referring again to FIG. 34, the implantable layer 2500 includes cut edges 2512. For example, the implantable layer 2500 can be cut from a sheet of alternating pleated sheets 2506 and planar sheets 2508 and each face of the implantable layer 2500 can be defined by a cut edge 2512, for example. The cut edges 2512 can be configured to provide a soft and/or non-abrupt face, which may reduce and/or prevent trauma to adjacent tissue.

In certain instances, at least one of the corrugated layers 2502a, 2502b, 2502c, 2502d can comprise a sinusoidal sheet. For example, at least one of the sheets 2506 can comprise a repetitive oscillatory sine pattern. A sinusoidal sheet can be positioned between planar sheets 2508. In certain instances, a sinusoidal sheet can be positioned in abutting engagement with another sinusoidal sheet. The adjacent sinusoidal sheets can form mirror image reflections, for example. In various instances, the frequency and/or the amplitude of the sine waves in the sinusoidal sheet can be tuned to control the spring properties of the implantable layer and/or the size of the tissue ingrowth passages therethrough.

Referring now to FIG. 35, a portion of a tissue thickness compensating implantable layer 2600 is depicted. The implantable layer 2600 includes a plurality of foam layers 2602a, 2602b, 2602c, 2602d and each layer 2602a, 2602b, 2602c, 2602d includes at least one spacer 2606 for providing a tissue ingrowth gap between adjacent layers 2602a, 2602b, 2602c, 2602d in the implantable layer 2600. For example, the spacers 2606 prevent the layers 2602a, 2602b, 2602c, 2602d from stacking flushly or flat relative to the adjacent layers 2602a, 2602b, 2602c, 2602d. In other words, the spacers 2606 are configured to reduce the packing efficiency of the layers 2602a, 2602b, 2602c, 2602d to less than 100%. The layers 2602a, 2602b, 2602c, 2602d can be combined and/or secured together with at least one suture, adhesive, and/or a heat pressing technique, for example. One or more of the layers 2602a, 2602b, 2602c, 2602d can be comprised of film.

The spacers 2606 comprise circular protrusions or nodes. In other instances, a spacer can comprise a ridge, bump, and/or an interlocking waffle pattern of ridges, for example. Spacers can be positioned on one or both sides of at least one of the foam, or film, layers 2602a, 2602b, 2602c, 2602d to provide a tissue ingrowth gap therebetween. Spacers can be created with lyophilization molds and/or felting operations, for example. Referring now to FIG. 36, an implantable layer 2700 includes a plurality of nonwoven layers 2702a, 2702b, 2702c, 2702d. Spacers can be added to the layers 2702a, 2702b, 2702c, 2702d using a felting operation, for example.

As described herein, the presence of different size voids (e.g. pores, or intrastitial voids, and tissue ingrowth passages, or interstitial voids, and/or different sized pores) within an implantable layer may promote the ingrowth of tissue around, into, and/or through the implantable layer. In instances where a body portion of an implantable layer is porous, additional tissue ingrowth inlets and/or passages can be incorporated into the porous body portion to further facilitate and/or encourage tissue ingrowth. The additional tissue ingrowth inlets and/or passages can be integrally formed in the porous body portion during the formation (e.g. lyophilization and/or molding) of the body portion. In other instances, tissue ingrowth inlets and/or passages can be added during a secondary processing step, as further described herein, for example.

In various instances, the addition of fibers to an implantable layer is configured to create additional tissue ingrowth inlets and/or passages into and/or within the body portion of the implantable layer. More specifically, when fibers are embedded within the body of an implantable layer, the fibers can cause additional voids or pockets to form within the body. For example, when fibers are added to a lyophilization solution, the resultant piece of lyophilized foam can include a plurality of pores defined therein and a plurality of pockets defined therein, wherein the pockets are larger than the pores. As further described herein, the arrangement of pockets extending through the porous material can depend on the type of fibers and/or the arrangement of fibers embedded in the porous material.

Referring to FIG. 37, an implantable layer 3000 is depicted. The implantable layer 3000 comprises a tissue thickness compensator. In other instances, the implantable layer 3000 comprises a piece of buttress material. The implantable layer 3000 includes a body 3002 having an inner portion 3006 and an outer portion 3008. The outer portion 3008 surrounds the inner portion 3006 such that the inner portion 3006 is defined within the boundary of the outer portion 3008. The outer portion 3008 includes a plurality of faces or sides 3004, which define the perimeter of the body 3002. In various instances, the body 3002 of the implantable layer 3000 comprises a rectangular prism having six faces including a first face 3004a. In other instances, the body 3002 can comprise a triangular prism or another three-dimensional shape, for example. In the depicted embodiment, the first face 3004a corresponds to a tissue-contacting surface of the implantable layer 3000. In other instances, the first face 3004a can correspond to a deck-contacting surface and/or a sidewall of the body 3002, for example.

The body 3002 of the implantable layer 3000 is a porous body. For example, the body 3002 comprises a piece of foam having a plurality of pores 3010 defined therein. In various instances, the body 3002 is a piece of lyophilized foam. The lyophilized foam can comprise polyglycolic acid (PGA) and/or polycaprolactone (PCL), for example. The body 3002 comprises an open cellular structure. For example, a pore 3010a is adjacent to the first face 3004a of the body 3002 and the boundary of the pore 3010a defines an outer surface of the body 3002. Open cell pores, such as the pore 3010a, for example, can provide a tissue ingrowth inlet and/or a foothold for tissue ingrowth. In other embodiments, the body 3002 can comprise a closed-cell structure. In such instances, the pores 3010 can be positioned entirely within the body 3002. Closed-cell pores are not open to an outer surface or face 3004 of the body 3002.

The body 3002 includes a plurality of fibers 3009. The fibers 3009 are embedded within the body 3002. Moreover, the fibers 3009 are randomly oriented and intertwined within the body 3002. Some fibers 3009 terminate within the inner portion 3006 of the body 3002, other fibers 3009 extend to the outer portion 3008 of the body 3002, and some fiber 3009 protrude beyond one of the faces 3004 of the body 3002. In other words, various fibers 3009 are embedded entirely within the body 3002 and other fibers 3009 are only partially embedded within the body 3002.

The various fibers 3009 depicted in FIG. 37 define different cross-sectional shapes and/or dimensions. For example, certain fibers 3009 are thicker than other fibers 3009. The fibers 3009 are loose fibers that randomly meet, cross, and/or curve. For example, the fibers 3009 can be non-woven fibers, such as melt-blown non-woven fibers. The fibers 3009 can be comprised of VICRYL® manufactured by Ethicon Inc., for example. In certain instances, the fibers 3009 can be interwoven. For example, the fibers 3009 can comprise a fibrous mesh within the body 3002.

The body 3002 also includes tissue ingrowth pockets 3020. The pockets 3020 are positioned around the fibers 3009. For example, the porous body 3002 and the fibers 3009 can comprise a phobic relationship, in which the fibers 3009 repel the body 3002 or vice versa. As a result, the pockets 3020 can separate the fibers 3009 from direct contact with the porous body 3002. The porous body 3002 can comprise arrays of porous regions that extend from the area around the fibers 3009 and crash into other porous regions and/or terminate at a pocket 3020 surrounding an adjacent fiber 3009.

The pockets 3020 are configured to follow the path of the fibers 3009 extending through the porous body 3002. Various passages formed by the pockets 3020 are oriented at different angles within the body 3002 and propagate in different directions within the body 3002. For example, a pocket 3020 can follow the curvature of the fiber 3009 disposed therein. The pockets 3020 are also configured to intersect where the fibers 3009 meet and/or closely cross paths within the body 3002. The size of the pockets 3020 can expand or grow in an additive manner where the pockets 3020 intersect. As a result, different size pockets or voids occur within the body 3002. Moreover, because the pockets 3020 follow the path of the fibers 3009, the pockets 3020 define passages and/or canals within the body 3002. In instances where one of the fibers 3009 extends to a face 3004 of the body 3002, the corresponding pocket 3020 also extends to the same face 3004 of the body 3002. Such a pocket 3020 comprises an open-cell pocket. In instances where the fiber 3009 is entirely embedded within the body 3002, the corresponding pocket 3020 can be positioned entirely within the body 3002. Such a pocket 3020 comprises a closed-cell pocket.

In various instances, a passage can extend between faces 3004 of the body 3002. For example, a single fiber 3009 and corresponding pocket 3020 can extend through the body 3002. In other instances, two or more pockets 3020 within the body 3002 can intersect or combine to extend a passage entirely through the body 3002. Because the pockets 3020 are larger than the pores 3010 defined in the porous body 3002, at least one pocket 3020 can entirely consume one or more of the pores 3010.

In various instances, the passages formed by the pockets 3020 within the body 3002 are conducive to tissue ingrowth. Specifically, tissue is encouraged to grow and/or propagate along the passages. In instances where the passages begin at a face 3004 of the implantable layer 3000, such as the tissue-facing face 3004a, the passages are configured to encourage the ingrowth of tissue from the outer portion 3008 of the body 3002 toward and/or into the inner portion 3006 of the body 3002. In at least one instance, the varied orientation of the passages is configured to promote the integration of the implantable layer 3000 into the surrounding tissue.

In various instances, the fibers 3009 can comprise a first absorption or degradation rate and the body 3002 can comprise a second absorption or degradation rate that is different than the first rate. In such instances, portions of the implantable layer 3000 can degrade at different rates. For example, the fibers 3009 can degrade, or substantially degrade, before the body 3002 degrades, or substantially degrades. In such instances, after degradation of the fibers 3009, the pockets 3020 can define an additional volume within the body 3002 prior to the degradation of the body 3002, which may enhance and/or accelerate tissue ingrowth. In certain instances, the degradation rates can be selected to tune various properties of the implantable layer 3000. For example, where the fibers 3009 provide significant spring-like qualities to the implantable layer 3000 and the body 3002 provides a scaffolding and/or buttressing property to the implantable layer 3000, the duration of the spring properties and the scaffolding properties can be tuned independently. In at least one instance, the springiness of the implantable layer 3000 can be sacrificed before the buttressing provided by the body 3002 is sacrificed. In other instances, the buttressing provided by the body 3002 can be sacrificed before the springiness provided by the fibers 3009 is sacrificed. The reader will appreciate that additional and/or different properties of the implantable layer 3000 may be tuned based on the absorption rate of the porous body 3002 and/or the fibers 3009 embedded therein.

In various instances, a lyophilized foam body, such as the body 3002, can include substantially smooth and/or flat surface portions and/or scalloped pore surfaces. Such surfaces may discourage cell adhesion. However, the fibers 3009 and the inlets to the pockets 3020 at the face(s) 3004 of the implantable body 3002 provide additional texture and/or sufficient inlets to the body 3002, which are configured to promote cell adhesion and/or cell motility. Additionally, fibrous tissue may more readily attach to a fibrous structure, such as the fibers 3009 positioned at the face(s) 3004 of the body 3002, than to the substantially smooth, flat and/or scalloped pore surfaces of the body 3002. As a result, the ingrowth of tissue along the passages formed by the intertwined and/or interconnected pockets 3020 in the body 3002 can be promoted by the texture and/or shapes formed along the face(s) of a porous body 3002 having fibers 3009 embedded therein and/or extending therefrom.

Referring primarily now to FIG. 38, a portion of a staple cartridge 3150 is shown. The staple cartridge 3150 includes a cartridge body 3152 having a deck 3156. A plurality of staple cavities are defined in the cartridge body 3152, and each staple cavity comprises an opening in the deck 3156. For example, a staple cavity 3154 is defined in the cartridge body 3152. The staple cartridge 3150 further includes a plurality of staples. For example, a staple 3160 is positioned in the staple cavity 3154. The staple cartridge 3150 includes an implantable layer 3100, which is positioned adjacent to the deck 3156 of the cartridge body 3152. The implantable layer 3100 extends over the openings in the deck 3156. The implantable layer 3100 can be releasably positioned relative to the deck 3156.

Referring to FIGS. 38 and 39, the implantable layer 3100 comprises a tissue thickness compensator. The implantable layer 3100 comprises a porous body 3102 having a plurality of fibers 3109 embedded therein. Additionally, the implantable layer 3100 comprises a plurality of pockets or passages 3120 that extend around the fibers 3109. The implantable layer 3100 also includes a first face 3104a and a second face 3104b. The first face 3104a comprises a tissue-contacting surface. For example, during a stapling operation, tissue T is positioned against and compressed against the first face 3104a of the implantable layer 3100. The second face 3104b is opposite to the first face 3104a. More particularly, in the orientation depicted in FIG. 38, the first face 3104a comprises a top surface of the implantable layer 3100, and the second face 3104b comprises a bottom surface of the implantable layer 3100. At least one passage 3120 in the implantable layer 3100 extends between the opposing first face 3104a and second face 3104b. Such passages 3120 provide pathways for tissue ingrowth between opposing sides of the implantable layer 3100 (e.g. between the top surface and the bottom surface).

During a stapling operation, tissue T is captured within the staple 3160 along with a portion of the implantable layer 3100. The tissue T and the implantable layer 3100 are compressed within the fired and deformed staple 3160 (FIG. 39). As depicted in FIG. 39, the height of the compressed implantable layer 3100 varies within the formed staple 3160 in response to various properties of the adjacent tissue T. For example, the implantable layer 3100 is configured to assume a greater height where the captured tissue T is thinner and is configured to assume a lesser height where the captured tissue T is thicker. The reader will further appreciate that the height of the compressed implantable layer 3100 can also vary from staple to staple in a staple line and/or in the unstapled regions between adjacent staples in the staple line in response to various properties of the tissue T.

Referring now to FIG. 40, a portion of an implantable layer 3200 is depicted. The implantable layer 3200 comprises a tissue thickness compensator. In other embodiments, the implantable layer 3200 comprises a piece of buttress material. The implantable layer 3200 includes a body 3202, which is comprised of a porous material. For example, the body 3202 comprises a piece of foam having a plurality of pores defined therein. In various instances, the body 3202 is a piece of lyophilized foam. The lyophilized foam can comprise polyglycolic acid (PGA) and/or polycaprolactone (PCL), for example. In various instances, the porous body 3202 comprises an open cellular structure.

The implantable layer 3200 also includes a plurality of fibers 3209, which are embedded within the porous body 3202. The fibers 3209 are arranged in an interwoven pattern. For example, the fibers 3209 create a three-dimensional mesh within the body 3202. The porous body 3202 and the fibers 3209 comprise a philic relationship, in which the fibers 3209 attract the body 3202 or vice versa. As a result, the body 3202 clings to the fibers 3209 and the fibers 3209 are encased by the body 3202. In other words, the implantable layer 3200 includes a plurality of foam-encased fibers 3209. The implantable layer 3200 also includes a plurality of pockets 3220. Because the body 3202 is immediately adjacent to the fibers 3209, the pockets 3220 are positioned intermediate portions of the body 3202. Various pockets 3220 intersect within the implantable layer 3200 to form a plurality of tissue ingrowth passages. A passage can extend between faces of the body 3202.

The passages formed by the pockets 3220 within the body 3022 are conducive to tissue ingrowth. Specifically, tissue is encouraged to grow and/or propagate along the passages. In instances where the passages begin at a face of the implantable layer, such as a tissue-contacting face, the passages are configured to encourage the ingrowth of tissue from the outer portion of the implantable layer 3200 toward and/or into the inner portion of the implantable layer 3202. In at least one instance, the varied orientation of the passages (e.g. horizontal, vertical, and diagonal within the implantable layer 3200) promotes the integration of the implantable layer 3200 into the surrounding tissue.

Referring now to FIG. 41, a mold 3330 for forming a piece of lyophilized foam is depicted. The mold 3330 comprises sidewalls 3331 defining a cavity 3332 for receiving a lyophilization solution 3340. The cavity 3332 can comprise a geometry that corresponds to the desired geometry of an implantable layer and/or a body portion thereof. In other instances, a piece and/or sheet of implantable material can be formed in the mold cavity 3332, and the molded piece and/or sheet can be cut and/or otherwise trimmed to the desired size and/or shape.

A lyophilization solution 3340 is provided to the mold cavity 3332. The lyophilization solution 3340 includes a plurality of fibers 3309. In other words, the fibers 3309 are injected into the mold cavity 3332 along with the lyophilization solution 3340. After the lyophilization solution 3340 and fibers 3309 have been added to the mold cavity 3332, the solution 3340 is lyophilized to form a piece of lyophilized foam having pores and pockets defined therein. In certain instances, the lyophilization solution 3340 can cling to the fibers 3309 distributed therein forming tissue ingrowth pockets between adjacent regions of the solution 3340 (i.e. between portions of the resultant porous body) and, in other instances, the fibers 3309 can repel the lyophilization solution 3340 forming tissue ingrowth pockets between the fibers 3309 and the solution 3340 (i.e. surrounding the embedded fibers 3309).

Referring now to FIGS. 42-44, a lyophilization solution can be insert-molded around a plurality of fibers to form an implantable layer or a portion thereof. For example, in the embodiment depicted in FIGS. 42-44, a mold 3430 comprising sidewalls 3431 and a cavity 3432 is shown. A plurality of loose fibers 3409 are positioned in the mold cavity 3432. The fibers 3409 are randomly oriented within the mold cavity 3432, and a lyophilization solution 3440 (FIGS. 42 and 43) is injected into the mold cavity 3432 around the fibers 3409. As shown in FIG. 43, the lyophilization solution 3440 fills the voids between the fibers 3409. Thereafter, the solution 3440 is lyophilized to form a piece of lyophilized foam 3400 (FIG. 44) having pores and tissue ingrowth pockets defined therein. In addition to or in lieu of the above, fibers can be mixed into the solution 3440 prior to the solution being poured into the mold cavity 3432. In any event, the lyophilized foam 3400 includes a porous body 3402 formed from the lyophilization solution 3440 (FIGS. 42 and 43). Referring primarily now to FIG. 44, the fibers 3409 provide crystal initiation points for the lyophilization solution 3440. As a result, porous arrays propagate from the fibers 3409 in different directions to form random arrays that crash into each other and/or terminate at tissue ingrowth pockets surrounding the embedded fibers 3409.

In the embodiment depicted in FIGS. 45 and 46, a mold 3530 comprising sidewalls 3531 and a cavity 3532 is shown. A plurality of woven fibers 3509 are positioned in the mold cavity 3532. The fibers 3509 are woven into a three-dimensional web or mesh positioned within the mold cavity 3532, and a lyophilization solution 3540 (FIG. 45) is injected into the mold cavity 3532 around the fibers 3509. The lyophilization solution 3540 is configured to fill the voids between the woven fibers 3509. Thereafter, the solution 3540 is lyophilized to form a piece of lyophilized foam 3500 (FIG. 46) having pores and tissue ingrowth pockets defined therein. The lyophilized foam 3500 includes a porous body 3502 formed from the lyophilization solution 3540 (FIG. 45). Referring primarily now to FIG. 46, the fibers 3509 provide crystal initiation points for the lyophilization solution 3540. As a result, porous arrays propagate from the fibers 3509 in different directions to form a system of porous arrays that crash into each other and/or terminate at tissue ingrowth pockets surrounding the embedded fibers 3509.

In various instances, a lyophilization solution, such as the lyophilization solutions 3340, 3440, and 3540, for example, can include at least one nucleation initiator. For example, a binary solvent of dioxane and water can be added to the lyophilization solution. The water percentage of the binary solvent can be between approximately 1% and 15%, for example. In other instances, the water percentage can be less than 1% or greater than 15%. The lyophilization solution is created by dissolving a polymer, such as PCL/PGA, for example, in the solvent, such as dioxane, for example. In at least one such instance, this is done with between approximately 2% to approximately 15% polymer, for example, and between approximately 98% to approximately 85% solvent, for example. In one exemplary dioxane/water binary solvent system, approximately 90% dioxane and approximately 10% water is preferred with approximately 85% dioxane and approximately 15% water as the limit. The nucleation initiator is configured to promote the formation of different sized pores in the lyophilization solution and in the resultant piece of lyophilized foam. For example, the addition of a nucleation initiator is configured to create a mix of large and small pores in the lyophilization solution and in the resultant piece of lyophilized foam. When the lyophilized foam is implanted into a patient, as further described herein, the variation in pore size can encourage tissue ingrowth. In at least one instance, tissue ingrowth can begin in a larger pore, gain traction within the implantable layer, and extend into at least one smaller pore.

In certain instances, additional materials can be added to a lyophilization solution, such as the lyophilization solutions 3340, 3440, and 3540, for example. For example, stearates can be incorporated into a lyophilization solution to provide lubrication. Additionally or alternatively, antibiotics can be incorporated into a lyophilization solution to reduce infection potentiation. For example, triclosan and/or silver beads can be added to a lyophilization solution to further reduce the risk of infection. Colloidal silver and/or silver-impregnated fibers could also be used in a lyophilization solution. Additionally or alternatively, radiopaque materials can be incorporated into a lyophilization solution to facilitate CT and/or x-ray visualization. For example, iopamidol can be added to a lyophilization solution. In various instances, additional and/or different materials can be incorporated into a lyophilization solution to obtain additional and/or different benefits.

The surgical instrument systems described herein have been described in connection with the deployment and deformation of staples; however, the embodiments described herein are not so limited. Various embodiments are envisioned which deploy fasteners other than staples, such as clamps or tacks, for example. Moreover, various embodiments are envisioned which utilize any suitable means for sealing tissue. For instance, an end effector in accordance with various embodiments can comprise electrodes configured to heat and seal the tissue. Also, for instance, an end effector in accordance with certain embodiments can apply vibrational energy to seal the tissue.

EXAMPLES
Example 1

A staple cartridge comprising a cartridge body comprising a plurality of staple cavities, a plurality of staples removably positioned in the staple cavities, and a porous implantable layer. The porous implantable layer comprises an inner portion, an outer portion positioned at least partially around the inner portion, and a plurality of passages formed through the outer portion toward the inner portion.

Example 2

The staple cartridge of Example 1, wherein the plurality of passages comprises a first passage and a second passage angularly-oriented relative to the first passage.

Example 3

The staple cartridge of Example 2, wherein the second passage traverses the first passage.

Example 4

The staple cartridge of Examples 1, 2, or 3, wherein at least one of the passages extends through the porous implantable layer.

Example 5

The staple cartridge of Examples 1, 2, 3, or 4, wherein the outer portion comprises a tissue-contacting surface, and wherein at least one of the passages extends through the tissue-contacting surface.

Example 6

The staple cartridge of Examples 1, 2, 3, 4, or 5, wherein the porous implantable layer comprises a lyophilized foam material.

Example 7

The staple cartridge of Example 6, wherein the lyophilized foam material comprises an open cellular structure.

Example 8

The staple cartridge of Examples 6 or 7, wherein at least one of the passages comprises a punched hole.

Example 9

The staple cartridge of Examples 6, 7, or 8, wherein the outer portion comprises a surface treatment.

Example 10

A method of forming an implantable layer for use with a surgical stapler, the method comprising, one, obtaining a piece of lyophilized foam, wherein the piece of lyophilized foam comprises an inner portion and an outer surface, and, two, forming at least one passage through the outer surface toward the inner portion.

Example 11

The method of Example 10, wherein forming at least one passage through the outer surface toward the inner portion comprises a mechanical punching treatment.

Example 12

The method of Examples 10 or 11, wherein forming at least one passage through the outer surface toward the inner portion comprises a laser treatment.

Example 13

The method of Examples 10, 11, or 12, wherein forming at least one passage through the outer surface toward the inner portion comprises a radiation treatment.

Example 14

The method of Examples 10, 11, 12, or 13, wherein forming at least one passage through the outer surface toward the inner portion comprises applying a surface treatment to the outer surface, wherein the surface treatment is selected from a group consisting of etching, blasting, grinding, milling, and combinations thereof.

Example 15

The method of Examples 10, 11, 12, 13, or 14, wherein forming at least one passage through the outer surface toward the inner portion comprises forming a first passage and forming a second passage that traverses the first passage in the inner portion.

Example 16

The method of Example 15, wherein the outer surface comprises a first face of the piece of lyophilized foam and a second face of the piece of lyophilized foam, wherein the first face is angularly-oriented relative to the second face, wherein the first passage extends from the first face of the outer surface, and wherein the second passage extends from the second face of the outer surface.

Example 17

A staple cartridge comprising a cartridge body comprising a plurality of staple cavities, a plurality of staples removably positioned in the staple cavities, and an implantable layer. The implantable layer comprises, one, an inner portion comprising a piece of foam and, two, an outer portion comprising a plurality of fibers, wherein the outer portion is positioned at least partially around the inner portion.

Example 18

The staple cartridge of Example 17, wherein the fibers form a woven pocket, and wherein the woven pocket is positioned around the inner portion.

Example 19

The staple cartridge of Examples 17 or 18, wherein the fibers form a woven layer, and wherein the woven layer is secured to the piece of foam.

Example 20

The staple cartridge of Example 19, wherein the implantable layer comprises a tissue-contacting surface, and wherein the woven layer comprises at least a portion of the tissue-contacting surface.

Example 21

A staple cartridge comprising a cartridge body comprising a plurality of staple cavities, a plurality of staples removably positioned in the staple cavities, and an implantable layer comprising a plurality of foam fragments, wherein each of the foam fragments is fused to at least one of the other of the foam fragments to form a unitary body.

Example 22

The staple cartridge of Example 21, wherein the implantable layer further comprises a plurality of intrastitial voids intermediate the foam fragments and a plurality of interstitial voids within the foam fragments.

Example 23

The staple cartridge of Examples 21 or 22, wherein the foam fragments are randomly oriented throughout the implantable layer.

Example 24

The staple cartridge of Examples 21, 22, or 23, wherein the plurality of foam fragments comprises a first foam fragment comprising a first porosity and a second foam fragment comprising a second porosity, wherein the second porosity is different than the first porosity.

Example 25

The staple cartridge of Examples 21, 22, 23, or 24, wherein the plurality of foam fragments comprises a first foam fragment comprising a first geometry and a second foam fragment comprising a second geometry, wherein the second geometry is different than the first geometry.

Example 26

The staple cartridge of Examples 21, 22, 23, 24, or 25, wherein the plurality of foam fragments comprises a first foam fragment comprising a first material and a second foam fragment comprising a second material, wherein the second material is different than the first material.

Example 27

The staple cartridge of Examples 21, 22, 23, 24, 25, or 26, wherein the plurality of foam fragments comprises a first foam fragment comprising a first absorption rate and a second foam fragment comprising a second absorption rate, wherein the second absorption rate is different than the first absorption rate.

Example 28

The staple cartridge of Examples 21, 22, 23, 24, 25, 26, or 27, wherein the implantable layer further comprises at least one medicament.

Example 29

The staple cartridge of Examples 21, 22, 23, 24, 25, 26, 27, or 28, wherein the implantable layer further comprises a plurality of fibers.

Example 30

The staple cartridge of Examples 21, 22, 23, 24, 25, 26, 27, 28, or 29, wherein the plurality of foam fragments comprises a first foam fragment comprising a first medicament and a second foam fragment comprising a second medicament, wherein the second medicament is different than the first medicament.

Example 31

A method of forming an implantable layer for use with a surgical stapler, the method comprising obtaining a plurality of foam fragments, heating the foam fragments, and compressing the foam fragments.

Example 32

The method of Example 31, wherein obtaining the plurality of foam fragments comprises grinding at least one piece of foam to form the plurality of foam fragments.

Example 33

The method of Examples 31 or 32, further comprising sorting the plurality of foam fragments.

Example 34

The method of Examples 31, 32, or 33, wherein heating the foam fragments comprises heating the foam fragments to a temperature above a glass transition temperature of the foam fragments and below a melting temperature of the foam fragments.

Example 35

The method of Examples 31, 32, 33, or 34, wherein heating the foam fragments and compressing the foam fragments occurs simultaneously.

Example 36

The method of Examples 31, 32, 33, 34, or 35, wherein the plurality of foam fragments comprises a first foam fragment comprising a first medicament and a second foam fragment comprising a second medicament, wherein the second medicament is different than the first medicament.

Example 37

The method of Examples 31, 32, 33, 34, 35, or 36, further comprising obtaining at least one adjunct and combining the at least one adjunct with the foam fragments before heating the foam fragments and before compressing the foam fragments.

Example 38

The method of Example 37, wherein the at least one adjunct is selected from a group consisting of an antibacterial adjunct, a fibrous adjunct, a collagen adjunct, and combinations thereof.

Example 39

A method of forming an implantable layer for use with a surgical stapler, the method comprising obtaining a mold comprising a cavity, generating bubbles within a solution, dispensing the solution into the cavity of the mold, and lyophilizing the solution in the cavity.

Example 40

The method of Example 39, further comprising applying vibrations to the mold after dispensing the solution into the cavity.

Example 41

The method of Examples 39 or 40, wherein generating bubbles within the solution comprises whipping the solution.

Example 42

A method of forming an implantable layer for use with a surgical stapler, the method comprising obtaining an insert mold comprising a first cavity, forming a dissolvable insert in the first cavity of the insert mold, removing the dissolvable insert from the first cavity, obtaining a layer mold comprising a second cavity, placing the dissolvable insert in the second cavity of the layer mold, dispensing a solution into the second cavity around the dissolvable insert, and lyophilizing the solution in the second cavity.

Example 43

A staple cartridge comprising a cartridge body comprising a plurality of staple cavities, a plurality of staples removably positioned in the staple cavities, and an implantable layer. The implantable layer comprises a piece of lyophilized foam and a plurality of fibers at least partially embedded in the piece of lyophilized foam.

Example 44

The staple cartridge of Example 43, wherein the implantable layer comprises a plurality of pores defined in the piece of lyophilized foam and a plurality of pockets, wherein a pocket at least partially surrounds a fiber.

Example 45

The staple cartridge of Example 44, wherein the plurality of pockets comprises a first pocket and a second pocket transecting the first pocket.

Example 46

The staple cartridge of Examples 43, 44, or 45, wherein the fibers are randomly oriented throughout the piece of lyophilized foam.

Example 47

The staple cartridge of Examples 43, 44, 45, or 46, wherein the fibers comprise an ordered matrix of fibers in the piece of lyophilized foam.

Example 48

The staple cartridge of Examples 43, 44, 45, 46, or 47, wherein the fibers comprise a first fiber comprising a first geometry and a second fiber comprising a second geometry, wherein the second geometry is different than the first geometry.

Example 49

The staple cartridge of Examples 43, 44, 45, 46, 47, or 48, wherein the fibers comprise a first fiber comprising a first material and a second fiber comprising a second material, wherein the second material is different than the first material.

Example 50

The staple cartridge of Examples 43, 44, 45, 46, 47, 48, or 49, wherein the foam of the piece of lyophilized foam encases and adheres to the fibers forming a plurality of foam-encased fibers.

Example 51

The staple cartridge of Example 50, wherein the implantable layer comprises a plurality of pores defined in the piece of lyophilized foam and a plurality of pockets, wherein each of the pockets is intermediate at least two of the foam-encased fibers.

Example 52

The staple cartridge of Examples 43, 44, 45, 46, 47, 48, 49, 50, or 51, wherein the piece of lyophilized foam comprises a first absorption rate, wherein at least one of the fibers comprises a second absorption rate, and wherein the second absorption rate is different than the first absorption rate.

Example 53

The staple cartridge of Examples 43, 44, 45, 46, 47, 48, 49, 50, 51, or 52, wherein the implantable layer comprises a tissue-contacting surface, and wherein at least one of the fibers extends to the tissue-contacting surface.

Example 54

A method of forming an implantable layer for use with a surgical stapler, the method comprising obtaining a mold comprising a cavity, placing a plurality of fibers in the cavity of the mold, dispensing a solution into the cavity around the fibers, and lyophilizing the solution in the cavity.

Example 55

The method of Example 54, wherein placing the plurality of fibers in the cavity comprises placing a woven mesh of fibers into the cavity.

Example 56

The method of Examples 54 or 55, wherein placing the plurality of fibers in the cavity comprises placing a plurality of loose fibers into the cavity.

Example 57

The method of Examples 54, 55, or 56, wherein the solution comprises dioxane and water.

Example 58

The method of Examples 54, 55, 56, or 57, wherein the solution comprises at least one medicament.

Example 59

A staple cartridge comprising a cartridge body comprising a plurality of staple cavities, a plurality of staples removably positioned in the staple cavities, and an implantable layer. The implantable layer comprises, one, a porous foam comprising a plurality of pores and, two, a plurality of pockets defined between portions of the porous foam.

Example 60

The staple cartridge of Example 59, wherein the implantable layer further comprises a plurality of fibers at least partially embedded in the porous foam.

Example 61

The staple cartridge of Example 60, wherein the pockets at least partially surround the fibers.

Example 62

The staple cartridge of Examples 60 or 61, wherein the foam encases the fibers.

Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. Also, where materials are disclosed for certain components, other materials may be used. Furthermore, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. The foregoing description and following claims are intended to cover all such modification and variations.

The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

By way of example only, aspects described herein may be processed before surgery. First, a new or used instrument may be obtained and when necessary cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container may keep the instrument sterile until it is opened in a medical facility. A device also may be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, plasma peroxide, or steam.

While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles.

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Claims

1. A staple cartridge, comprising: a cartridge body comprising a plurality of staple cavities;a plurality of staples removably positioned in said staple cavities; anda biocompatible implantable layer, comprising: a piece of lyophilized foam; anda frame comprising a plurality of fibers at least partially embedded in said piece of lyophilized foam before an implantation of said biocompatible implantable layer, wherein said fibers are configured to repel said lyophilized foam to form passages which are oriented at various angles to facilitate tissue ingrowth.
2. The staple cartridge of claim 1, wherein said biocompatible implantable layer comprises: a plurality of pores defined in said piece of lyophilized foam; anda plurality of pockets, wherein a said pocket at least partially surrounds a said fiber.
3. The staple cartridge of claim 2, wherein said plurality of pockets comprises: a first pocket; anda second pocket transecting said first pocket.
4. The staple cartridge of claim 1, wherein said fibers are randomly oriented throughout said piece of lyophilized foam.
5. The staple cartridge of claim 1, wherein said fibers comprise an ordered matrix of fibers in said piece of lyophilized foam.
6. The staple cartridge of claim 1, wherein said fibers comprise: a first fiber comprising a first geometry; anda second fiber comprising a second geometry, wherein said second geometry is different than said first geometry.
7. The staple cartridge of claim 1, wherein said fibers comprise: a first fiber comprising a first material; anda second fiber comprising a second material, wherein said second material is different than said first material.
8. The staple cartridge of claim 1, wherein said piece of lyophilized foam comprises a first absorption rate, wherein at least one said fiber comprise a second absorption rate, and wherein said second absorption rate is different than said first absorption rate.
9. The staple cartridge of claim 1, wherein said biocompatible implantable layer comprises a tissue-contacting surface, and wherein at least one said fiber extends to said tissue-contacting surface.
10. The staple cartridge of claim 1, wherein said lyophilized foam comprises a hydrophilic coating to attract water and increase cell adhesion.
11. The staple cartridge of claim 1, wherein said lyophilized foam comprises polyglycolic acid.
12. The staple cartridge of claim 1, wherein said lyophilized foam comprises polycaprolactone.
13. The staple cartridge of claim 1, wherein said lyophilized foam comprises a combination of polyglycolic acid and polycaprolactone.
14. The staple cartridge of claim 1, wherein said plurality of fibers are interwoven.
15. A staple cartridge, comprising: a cartridge body comprising a plurality of staple cavities;a plurality of staples removably positioned in said staple cavities; anda biocompatible implantable layer, comprising: a frame comprising a plurality of fibers;a porous foam comprising a plurality of pores; anda plurality of tissue ingrowth pockets defined between portions of said porous foam as said fibers repel said foam, and wherein said plurality of tissue ingrowth pockets define passages which are oriented at various angles within said biocompatible implantable layer.
16. The staple cartridge of claim 15, wherein some of said plurality of fibers are at least partially embedded in said porous foam.
17. The staple cartridge of claim 16, wherein said tissue ingrowth pockets at least partially surround said fibers.
18. The staple cartridge of claim 16, wherein said foam encases said fibers.
19. The staple cartridge of claim 15, wherein said porous foam comprises a hydrophilic coating to attract water and increase cell adhesion.
20. The staple cartridge of claim 15, wherein said porous foam comprises polyglycolic acid.
21. The staple cartridge of claim 15, wherein said porous foam comprises polycaprolactone.
22. The staple cartridge of claim 15, wherein said porous foam comprises a combination of polyglycolic acid and polycaprolactone.
23. The staple cartridge of claim 15, wherein said plurality of fibers are interwoven.

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3695646	Mommsen	Oct 1972	A
3709221	Riely	Jan 1973	A
3717294	Green	Feb 1973	A
3726755	R. F. Shannon	Apr 1973	A
3727904	Gabbey	Apr 1973	A
3734207	Fishbein	May 1973	A
3740994	De Carlo, Jr.	Jun 1973	A
3744495	Johnson	Jul 1973	A
3746002	Haller	Jul 1973	A
3747603	Adler	Jul 1973	A
3747692	Davidson	Jul 1973	A
3751902	Kingsbury et al.	Aug 1973	A
3752161	Bent	Aug 1973	A
3799151	Fukaumi et al.	Mar 1974	A
3808452	Hutchinson	Apr 1974	A
3815476	Green et al.	Jun 1974	A
3819100	Noiles et al.	Jun 1974	A
3821919	Knohl	Jul 1974	A
3826978	Kelly	Jul 1974	A
3836171	Hayashi et al.	Sep 1974	A
3837555	Green	Sep 1974	A
3841474	Maier	Oct 1974	A
3851196	Hinds	Nov 1974	A
3863639	Kleaveland	Feb 1975	A
3863940	Cummings	Feb 1975	A
3883624	McKenzie et al.	May 1975	A
3885491	Curtis	May 1975	A
3892228	Mitsui	Jul 1975	A
3894174	Cartun	Jul 1975	A
3902247	Fleer et al.	Sep 1975	A
3940844	Colby et al.	Mar 1976	A
3944163	Hayashi et al.	Mar 1976	A
3950686	Randall	Apr 1976	A
3952747	Kimmell, Jr.	Apr 1976	A
3955581	Spasiano et al.	May 1976	A
3959879	Sellers	Jun 1976	A
RE28932	Noiles et al.	Aug 1976	E
3972734	King	Aug 1976	A
3981051	Brumlik	Sep 1976	A
4025216	Hives	May 1977	A
4027746	Kine	Jun 1977	A
4034143	Sweet	Jul 1977	A
4038987	Komiya	Aug 1977	A
4054108	Gill	Oct 1977	A
4060089	Noiles	Nov 1977	A
4066133	Voss	Jan 1978	A
4085337	Moeller	Apr 1978	A
4100820	Evett	Jul 1978	A
4106446	Yamada et al.	Aug 1978	A
4106620	Brimmer et al.	Aug 1978	A
4108211	Tanaka	Aug 1978	A
4111206	Vishnevsky et al.	Sep 1978	A
4127227	Green	Nov 1978	A
4129059	Van Eck	Dec 1978	A
4132146	Uhlig	Jan 1979	A
4135517	Reale	Jan 1979	A
4154122	Severin	May 1979	A
4169990	Lerdman	Oct 1979	A
4180285	Reneau	Dec 1979	A
4185701	Boys	Jan 1980	A
4190042	Sinnreich	Feb 1980	A
4198734	Brumlik	Apr 1980	A
4198982	Fortner et al.	Apr 1980	A
4207898	Becht	Jun 1980	A
4213562	Garrett et al.	Jul 1980	A
4226242	Jarvik	Oct 1980	A
4239431	Davini	Dec 1980	A
4241861	Fleischer	Dec 1980	A
4244372	Kapitanov et al.	Jan 1981	A
4250436	Weissman	Feb 1981	A
4261244	Becht et al.	Apr 1981	A
4272002	Moshofsky	Jun 1981	A
4272662	Simpson	Jun 1981	A
4274304	Curtiss	Jun 1981	A
4274398	Scott, Jr.	Jun 1981	A
4275813	Noiles	Jun 1981	A
4278091	Borzone	Jul 1981	A
4282573	Imai et al.	Aug 1981	A
4289131	Mueller	Sep 1981	A
4289133	Rothfuss	Sep 1981	A
4290542	Fedotov et al.	Sep 1981	A
D261356	Robinson	Oct 1981	S
4293604	Campbell	Oct 1981	A
4296654	Mercer	Oct 1981	A
4296881	Lee	Oct 1981	A
4304236	Conta et al.	Dec 1981	A
4305539	Korolkov et al.	Dec 1981	A
4312363	Rothfuss et al.	Jan 1982	A
4312685	Riedl	Jan 1982	A
4317451	Cerwin et al.	Mar 1982	A
4319576	Rothfuss	Mar 1982	A
4321002	Froehlich	Mar 1982	A
4321746	Grinage	Mar 1982	A
4328839	Lyons et al.	May 1982	A
4331277	Green	May 1982	A
4340331	Savino	Jul 1982	A
4347450	Colligan	Aug 1982	A
4348603	Huber	Sep 1982	A
4349028	Green	Sep 1982	A
4350151	Scott	Sep 1982	A
4353371	Cosman	Oct 1982	A
4357940	Muller	Nov 1982	A
4361057	Kochera	Nov 1982	A
4366544	Shima et al.	Dec 1982	A
4369013	Abildgaard et al.	Jan 1983	A
4373147	Carlson, Jr.	Feb 1983	A
4376380	Burgess	Mar 1983	A
4379457	Gravener et al.	Apr 1983	A
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4382326	Rabuse	May 1983	A
4383634	Green	May 1983	A
4393728	Larson et al.	Jul 1983	A
4394613	Cole	Jul 1983	A
4396139	Hall et al.	Aug 1983	A
4397311	Kanshin et al.	Aug 1983	A
4402445	Green	Sep 1983	A
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4408692	Sigel et al.	Oct 1983	A
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4415112	Green	Nov 1983	A
4416276	Newton et al.	Nov 1983	A
4417890	Dennehey et al.	Nov 1983	A
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4428376	Mericle	Jan 1984	A
4429695	Green	Feb 1984	A
4430997	DiGiovanni et al.	Feb 1984	A
4434796	Karapetian et al.	Mar 1984	A
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4442964	Becht	Apr 1984	A
4448194	DiGiovanni et al.	May 1984	A
4451743	Suzuki et al.	May 1984	A
4452376	Klieman et al.	Jun 1984	A
4454887	Kruger	Jun 1984	A
4459519	Erdman	Jul 1984	A
4461305	Cibley	Jul 1984	A
4467805	Fukuda	Aug 1984	A
4468597	Baumard et al.	Aug 1984	A
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4470414	Imagawa et al.	Sep 1984	A
4471780	Menges et al.	Sep 1984	A
4471781	Di Giovanni et al.	Sep 1984	A
4473077	Noiles et al.	Sep 1984	A
4475679	Fleury, Jr.	Oct 1984	A
4478220	Di Giovanni et al.	Oct 1984	A
4480641	Failla et al.	Nov 1984	A
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4485816	Krumme	Dec 1984	A
4485817	Swiggett	Dec 1984	A
4486928	Tucker et al.	Dec 1984	A
4488523	Shichman	Dec 1984	A
4489875	Crawford et al.	Dec 1984	A
4493983	Taggert	Jan 1985	A
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4499895	Takayama	Feb 1985	A
4500024	DiGiovanni et al.	Feb 1985	A
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4503842	Takayama	Mar 1985	A
4505272	Utyamyshev et al.	Mar 1985	A
4505273	Braun et al.	Mar 1985	A
4505414	Filipi	Mar 1985	A
4506671	Green	Mar 1985	A
4512038	Alexander et al.	Apr 1985	A
4520817	Green	Jun 1985	A
4522327	Korthoff et al.	Jun 1985	A
4526174	Froehlich	Jul 1985	A
4527724	Chow et al.	Jul 1985	A
4530357	Pawloski et al.	Jul 1985	A
4530453	Green	Jul 1985	A
4531522	Bedi et al.	Jul 1985	A
4532927	Miksza, Jr.	Aug 1985	A
4540202	Amphoux et al.	Sep 1985	A
4548202	Duncan	Oct 1985	A
4556058	Green	Dec 1985	A
4560915	Soultanian	Dec 1985	A
4565109	Tsay	Jan 1986	A
4565189	Mabuchi	Jan 1986	A
4566620	Green et al.	Jan 1986	A
4569346	Poirier	Feb 1986	A
4569469	Mongeon et al.	Feb 1986	A
4571213	Ishimoto	Feb 1986	A
4573468	Conta et al.	Mar 1986	A
4573469	Golden et al.	Mar 1986	A
4573622	Green et al.	Mar 1986	A
4576165	Green et al.	Mar 1986	A
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4580712	Green	Apr 1986	A
4585153	Failla et al.	Apr 1986	A
4586501	Claracq	May 1986	A
4586502	Bedi et al.	May 1986	A
4589416	Green	May 1986	A
4589582	Bilotti	May 1986	A
4589870	Citrin et al.	May 1986	A
4591085	Di Giovanni	May 1986	A
RE32214	Schramm	Jul 1986	E
4597753	Turley	Jul 1986	A
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4606343	Conta et al.	Aug 1986	A
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4608981	Rothfuss et al.	Sep 1986	A
4610250	Green	Sep 1986	A
4610383	Rothfuss et al.	Sep 1986	A
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D286442	Korthoff et al.	Oct 1986	S
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4619262	Taylor	Oct 1986	A
4619391	Sharkany et al.	Oct 1986	A
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4671445	Barker et al.	Jun 1987	A
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4728020	Green et al.	Mar 1988	A
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4730726	Holzwarth	Mar 1988	A
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4747820	Hornlein et al.	May 1988	A
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4761326	Barnes et al.	Aug 1988	A
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4767044	Green	Aug 1988	A
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4790225	Moody et al.	Dec 1988	A
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4856078	Konopka	Aug 1989	A
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4865030	Polyak	Sep 1989	A
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4869415	Fox	Sep 1989	A
4873977	Avant et al.	Oct 1989	A
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4915100	Green	Apr 1990	A
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4930674	Barak	Jun 1990	A
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4943182	Hoblingre	Jul 1990	A
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4951860	Peters et al.	Aug 1990	A
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4954960	Lo et al.	Sep 1990	A
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8631987	Shelton, IV et al.	Jan 2014	B2
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WO-2013151888	Oct 2013	WO
WO-2013167427	Nov 2013	WO
WO-2013188130	Dec 2013	WO
WO-2014008289	Jan 2014	WO
WO-2014004199	Jan 2014	WO
WO-2014004209	Jan 2014	WO
WO-2014004294	Jan 2014	WO
WO-2014113438	Jul 2014	WO
WO-2014134034	Sep 2014	WO
WO-2014172213	Oct 2014	WO
WO-2014158882	Oct 2014	WO
WO-2015032797	Mar 2015	WO
WO-2015138760	Sep 2015	WO
WO-2015148136	Oct 2015	WO
WO-2015148141	Oct 2015	WO
WO-2015153642	Oct 2015	WO
WO-2015187107	Dec 2015	WO
WO-2016100682	Jun 2016	WO
WO-2016107448	Jul 2016	WO

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	Number	Date	Country
	20170049448 A1	Feb 2017	US

Implantable layers for a surgical instrument

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