Patent Application
20190144618
The present invention relates to a method for preparing a matrix of chitosan including a fiber reinforcement member sandwiched between two porous layers of chitosan. The present invention further relates to matrices obtained by this method and their use as, or in the manufacture of, wall reinforcement implant that may be used, for example, in the repair, reinforcement or replacement of soft tissues, e.g. treatment of hernias, reconstruction of a wall, such as a visceral or abdominal wall. The implants of the invention may also be used in vitro as a tissue engineering product or support for culturing live cells.
Chitosan is a polysaccharide which results from the deacetylation of chitin. Chitin is one of the most widespread natural polysaccharides on earth and is extracted from the exoskeletons of arthropods, from the endoskeletons of cephalopods and also from fungi.
Chitosan has properties, such as biodegradability, bioresorbability, biocompatibility, non-toxicity and mechanical properties, which make it particularly advantageous for medical applications. Thus, chitosan can be incorporated into medical devices as a constituent of implants, for example in the form of a porous structure such as a matrix. Chitosan in fact offers a good compromise, given the desired properties, for an abdominal wall reinforcement implant, namely good biological compatibility and good mechanical properties.
Chitosan matrices are usually obtained by lyophilization of a chitosan solution. Lyophilization involves a first step during which a solution is frozen in a particular structure, and then a second step, during which a controlled pressure is applied in order to cause sublimation of the water present in the frozen structure. At the end of the sublimation step, only the constituents present in the initial solution remain, thus producing a porous structure.
Indeed, the porous structure of such chitosan matrices is of particular interest in the manufacture of surgical implants for many reasons. When the implant is intended to repair a tissue defect, for example in the case of a hernia in the abdominal wall, a porous structure favors cell colonization and therefore reconstruction of the biological tissue.
Wall reinforcement implants, for example for reinforcing the abdominal wall, are widely used in surgery. These implants are intended to treat hernias by temporarily or permanently filling a tissue defect. These implants may show a number of shapes, for example rectangular, circular or oval, depending on the anatomical structure to which they are to adapt. These implants may be made entirely from bioresorbable elements when they are intended to disappear after they have performed their reinforcing function during the period of cellular colonization and tissue rehabilitation. Alternatively, these implants may include, or consist in, non-bioresorbable parts which are intended to remain permanently in the body of the patient.
In addition to exhibit a porosity favourable to cell growth, the structure of an abdominal wall reinforcement implant should at the same time possess mechanical properties allowing it to be easily handleable by the surgeon, to perform its reinforcement function once implanted and to maintain its integrity at least during the time necessary for reconstruction, even when submitted to potential tensions, generated for example either by sutures ensuring the fixation of the implant to the surrounding biological tissue or by the various movements of the patient in his daily life.
Depending on the level of mechanical properties desired for a wall reinforcement implant, it may be useful to reinforce a chitosan matrix obtained by lyophilization of a chitosan solution by combining it with a fiber reinforcement member, such as a mesh.
It is known to lyophilize a chitosan solution in which a fiber reinforcement member such as a mesh is previously immersed in order to obtain a mesh embedded in a chitosan matrix. Anyway, after lyophilization, the chitosan matrices are still very loaded with salts. The matrices must therefore be neutralized before being used as an implant.
It has been observed that the shrinkage of matrices that usually go along with the neutralization of these matrices induces high constraints in the embedded mesh. This phenomenon is detrimental to the use of the resulting matrix as an implant, as the mesh will not behave as expected after implantation.
It would therefore be desirable to implement a method of preparing chitosan matrices having a fiber reinforcement member embedded therein, where the fiber reinforcement member would not be damaged or affected by the preparation method and where the integrity of the matrix would be preserved.
The present invention relates to a method for preparing a chitosan-based matrix comprising a fiber reinforcement member embedded in said matrix comprising the following steps:
The method according to the invention makes it possible to obtain chitosan-based matrix including a fiber reinforcement member embedded in the matrix, where the matrix shows a good integrity and good mechanical properties. In particular, the fiber reinforcement member of the matrices of the invention is neither damaged nor affected by the preparation method of the matrix. The fiber reinforcement member of the matrices of the invention is not submitted to constraints tending to deform it in either direction. No shrinkage of the fiber reinforcement member is observed in the matrices of the invention.
In particular, the matrices obtained by the method of the invention show a good stability and a good cohesion of the various parts constituting the matrix, namely the two chitosan porous layers and the fiber reinforcement member. In the matrices obtained by the method of the invention, no delamination between the chitosan porous layers and the fiber reinforcement member is observed when immersed in water even after a long exposure time. In the matrices obtained by the method of the invention, the fiber reinforcement member is securely sandwiched between the two porous layers of chitosan.
The chitosan matrices obtained by means of the method according to the invention therefore make it possible to obtain particularly effective surgical implants, for example for reinforcing the abdominal wall. The chitosan matrices obtained by the method of the invention may be used on their own or in combination with another element, such as for example a film, an additional reinforcement member or an additional porous layer.
The invention and the advantages thereof will emerge more clearly from the detailed description below and the appended figures in which:
By “chitosan-based matrix” it is intended to mean according to the present application that the major compound of the solution(s) from which the porous layers forming the matrix of the invention are obtained by lyophilisation is chitosan. In embodiments, the solution(s) from which the chitosan porous layers are obtained is/are substantially free of any other polymer. In the present application, by “substantially free of any other polymer” is meant that the solution(s) contain less than 5%, preferably less than 1% in weight of other polymer. In embodiments, the chitosan solution(s) used in the method of the invention is/are free of any other polymer.
According to a first step of the method according to the invention, step a), two separate chitosan porous layers obtained from lyophilisation of layers of one or more solution(s) of chitosan are provided. The two chitosan porous layers may be identical or different in composition. For example, the compositions of the two chitosan porous layers may be different with respect to the concentration of chitosan, and/or to the degree of acetylation of the chitosan used, and/or to the origin of the chitosan used, etc. . . . . When it is intended to use two chitosan porous layers having different compositions in the method of the invention, two different chitosan solutions are prepared and each porous layer is obtained from lyophilisation of a layer of the corresponding chitosan solution. Alternatively, when it is intended to use two chitosan porous layers having identical compositions, a single chitosan solution may be prepared. In such a case, the two chitosan porous layers may be obtained either by lyophilisation of two separate layers of the single chitosan solution, or by cutting in two one thicker porous layer obtained by lyophilisation of one appropriate layer of the single chitosan solution.
Chitosan is a biocompatible biopolymer resulting from the deacetylation of chitin. Chitin is extracted from exoskeletons of arthropods such as lobster, crab or shrimp, from the endoskeleton of cephalopods such as squid, or else from fungi. The extraction of chitin involves steps of protein and lipid hydrolysis, of depigmentation and of demineralization. Usually, the protein and lipid hydrolysis is carried out in the presence of sodium hydroxide, the demineralization requiring the use of hydrochloric acid.
Once the chitin has been extracted, the chitosan is obtained by means of a deacetylation step, which consists of hydrolysis of the acetamide groups. This reaction is generally carried out at high temperature in an alkaline solution, for example a solution of sodium hydroxide (NaOH) at 48% in water, at 90° C.
The following publications also describe methods for deacetylation of chitin in order to obtain chitosan: “Lamarque, G., C. Viton, and A. Domard, New Route of Deacetylation of α- and β-Chitins by Means of Freeze-Pump Out-Thaw Cycles. Biomacromolecules, 2005. 6(3): p. 1380-1388.”, “Lamarque, G., C. Viton, and A. Domard, Comparative Study of the First Heterogeneous Deacetylation of α- and β-Chitins in a Multistep Process. Biomacromolecules, 2004. 5(3): p. 992-1001.”, “Lamarque, G., C. Viton, and A. Domard, Comparative Study of the Second and Third Heterogeneous Deacetylations of α- and β-Chitins in a Multistep Process. Biomacromolecules, 2004. 5(5): p. 1899-1907.”, “Tolaimate, A., et al., Contribution to the preparation of chitins and chitosans with controlled physico-chemical properties. Polymer, 2003. 44(26): p. 7939-7952.”
Chitosans which are suitable as starting materials for the method according to the invention are available from the companies Kitozyme (fungus extract), Heppe Medical chitosan (shrimp or crab extract), Primex (shrimp extract) and Novamatrix (shrimp extract).
Chitosan is a biodegradable compound. The degree of acetylation of chitosan can have an influence on the chitosan degradation kinetics. Thus, depending on the biodegradation kinetics desired for the each chitosan porous layer of the matrix prepared according to the method of the invention, the chitosan used in each porous layer may have a degree of acetylation of 2, 3, 10, 20, 30, 40 or else 50%: the desired degree of acetylation can also be obtained by preparing a mixture of several chitosans having various degrees of acetylation. In particular, the degree of acetylation of the chitosan used for one chitosan porous layer may be different from the degree of acetylation of the chitosan used for the other chitosan porous layer.
The chitosan solutions of step a) of the method according to the invention are generally prepared by solubilization of chitosan in powder form in water. The solutions may be adjusted to the desired pH, for example by adding acetic acid. In embodiments of the method according to the invention, the pH of each chitosan solution is adjusted to a value ranging from 3 to 5, preferably to 3.5, for example by adding acetic acid. Such a pH makes it possible to obtain, in the end, a chitosan-based porous matrix which has good mechanical properties.
In embodiments of the method according to the invention, each solution of step a) is a solution of chitosan in water, the chitosan concentration in said solution ranging from 0.1% to 10%, preferably from 0.5% to 3% and more preferably from 0.8% to 1% by weight, relative to the total weight of the solution.
Such chitosan concentrations make it possible to obtain, in the end, chitosan porous layers/matrices having good mechanical properties. Also preferably, each chitosan solution of the method according to the invention is free of any other polymer. The presence of a polymer other than chitosan in the solution could affect the mechanical or biological properties of the matrices.
Two separate chitosan porous layers are prepared from the lyophilisation of layer(s) of the chitosan solution(s) prepared as described above. When the two separate chitosan porous layers to be used in the method of the invention are of different compositions, two different chitosan solutions are prepared. A part of each solution is poured in a mould in order to form a solution layer. Each mould is in general in the shape of a rectangle having dimensions compatible with the chitosan porous layer to be prepared. Each chitosan porous layer is obtained from lyophilisation of the corresponding solution layer. When it is intended to use two chitosan porous layers of identical compositions, parts of the single chitosan solution may be poured into two moulds in order to form two solution layers. The two separate chitosan porous layers will be obtained from lyophilisation of the two solution layers. Alternatively, a larger volume of the single chitosan solution may be poured in a bigger mould in order to form a thicker solution layer. The two separate chitosan porous layers intended to be used in the method of the invention are then obtained by cutting the thicker porous layer obtained by lyophilisation of the thicker solution layer into two thinner chitosan porous layers.
In the present application, the term “porous layer” is intended to mean a layer which has pores, or gaps, alveoli, holes, orifices, which are evenly or unevenly distributed not only at the surface, but also within the thickness of said layer, and which are more or less interconnected, depending on the lyophilization process used. Such lyophilization processes are known. It is known practice to vary the freezing temperature and speed and also the characteristics of the polymer solution to be lyophilized (pH, concentration, etc.), in this case chitosan, as a function of the structure of the sponge or porous layer that it is desired to obtain (see U.S. Pat. No. 4,970,298; Doillon et al, J Biomed Mater Res, 1986; Schoof, J Biomed Mater Res, 2001; O'Brien et al, Biomaterials, 2004).
According to a second step of the method according to the invention, step b), the chitosan porous layers of step a) are neutralized and washed.
The chitosan porous layers may for example be neutralized by immersion in a neutralizing solution. The neutralizing solution may be a basic solution, such as a NaOH or NH4OH solution in water or in an alcohol such as ethanol. For example, each chitosan porous layer may be dipped during five minutes in about 600-800 mL of neutralizing solution, such as a solution of NaOH 0.5M in pure ethanol.
The neutralized chitosan porous layers are then submitted to one or more washing steps. The washing step makes it possible to eliminate from a chitosan porous layer any salts still remaining in the layer, for instance sodium acetate or ammonium acetate salts.
For example, each neutralized chitosan porous layer is dipped in one or more baths of sterile water until a washing water with a pH close to 7 is obtained.
According to a third step of the method according to the invention, step c), a face of each chitosan porous layer obtained in b) is acidified with an acid. For example, a superficial layer of each chitosan porous layer is acidified with a fine layer of acid. The acidification of the face is preferably limited to a superficial layer of the chitosan porous layer so as not to degrade the chitosan porous layer. The acid is preferably spread out on the face of the chitosan porous layer in a quantity so as to cause a gentle and slight resolubilization of a superficial layer of said face. For example, the thickness of the superficial layer which is acidified may represent up to 5%, preferably up to 2% of the total thickness of the chitosan porous layer.
In embodiments, the face is acidified by spraying a solution of said acid on said face. The spraying may be repeated twice.
In embodiments, the acid is selected from acetic acid, hydrochloric acid, citric acid, sulphuric acid, lactic acid, and mixtures thereof. In embodiments, the acid is acetic acid.
In embodiments, the face is acidified by spraying a solution of acetic acid at 0.1 M on said face, for example twice.
In a fourth step of the method according to the invention, step d), a fiber reinforcement member is provided.
Some suitable non-limiting examples of the fiber reinforcement member include fabrics, meshes, monofilaments, multifilament braids, chopped fibers (sometimes referred to in the art as staple fibers) and combinations thereof.
In embodiments, the fiber reinforcement member is a porous mesh. The fiber reinforcement member may be prepared using any technique known to those skilled in the art, such as knitting, weaving, tatting, knipling or the like. Illustrative examples of suitable meshes include any of those that are presently commercially available for abdominal wall repair. In embodiments where a mesh is used as the fiber reinforcement member, the mesh will bring mechanical properties to the matrix or implant and will aid in affixing the matrix or implant comprising the matrix to the surrounding biological tissue.
Where monofilaments or multifilament braids are used as the reinforcement member, the monofilaments or multifilament braids may be oriented in any desired manner. Where chopped fibers are used as the reinforcement member, the chopped fibers may be oriented in any desired manner. For example, the chopped fibers may be randomly oriented or may be oriented in a common direction. The chopped fibers can thus form a non-woven material, such as a mat or a felt.
The fiber reinforcement member may be made from any biocompatible polymer material. The biocompatible polymer may be synthetic or natural. The biocompatible polymer may be biodegradable, non-biodegradable or a combination of biodegradable and non-biodegradable. The term “biodegradable” as used herein is defined to include both bioabsorbable and bioresorbable materials. By biodegradable, it is meant that the materials decompose, or lose structural integrity under body conditions (e.g., enzymatic degradation or hydrolysis) or are broken down (physically or chemically) under physiologic conditions in the body such that the degradation products are excretable or absorbable by the body.
The biocompatible polymer may be selected from the group consisting of biodegradable polymers, non-biodegradable polymers, and combinations thereof.
In embodiments, the reinforcement member may include at least a non-bioabsorbable material to provide long term tissue support. In other embodiments, the reinforcement member is formed entirely of bioabsorbable material, for example when the implant of the invention is not intended to be a long lasting tissue support.
In embodiments, the biocompatible polymer material is selected from polypropylene (PP), polyester such as polyethylene terephthalates (PET), polyamide, silicone, polyether ether ketone (PEEK), polyarylether ether ketone (PAEK) polylactic acid (PLA), polycaprolactone (PCL), polydioxanone (PDO), trimethylene carbonate (TMC), polyvinyl alcohol (PVA), polyhydroxyalkanoate (PHA), polyglycolic acid (PGA), copolymers of these materials, and mixtures thereof.
In embodiments, the biocompatible polymer material is selected from polypropylene, polyethylene terephthalates and mixtures thereof.
The fiber reinforcement member is positioned between the two acidified faces of the chitosan porous layers. Wth reference to
The fiber reinforcement 3 is therefore sandwiched between the two chitosan porous layers (1, 2), and imprisoned in the two acidified superficial layers (1a, 2a) which melt together, as shown on
In embodiments, the pressure applied may range from about 2.5 to about 10 kPa, preferably is about 3.5 kPa.
In a fifth step of the method of the invention, step e), the fiber reinforcement member and the two chitosan porous layers are let to dry.
The drying may take place under a hood for example, for a time ranging from about 8 hours to about 12 hours for instance.
During the drying step, the resolubilized superficial layers (1a, 2a) of the chitosan porous layers which surround the fiber reinforcement member 3 solidify. The fiber reinforcement member 3 eventually strongly adheres to the faces of the chitosan porous layers (1, 2). At the end of the drying step, the two chitosan porous layers (1, 2) and the fiber reinforcement member 3 are securely bound together, as shown on
The matrix obtained 4 is under the form of a fiber reinforcement member 3 sandwiched between two porous layers (1, 2) of chitosan, as shown on
In embodiments, in step d) above, the fiber reinforcement member is impregnated with a solution of acid before being positioned between the two acidified faces of the two chitosan porous layers. In embodiments, the solution of acid may be a solution of an acid selected from acetic acid, hydrochloric acid, citric acid, sulphuric acid, lactic acid, and mixtures thereof, and preferably a solution of acetic acid.
In embodiments, the fiber reinforcement member is impregnated with a solution of acetic acid. For example, the fiber reinforcement member is dipped into a solution of acetic acid at 0.1 M. Such embodiments allow obtaining an excellent and homogeneous bonding between the fiber reinforcement member and the two chitosan porous layers.
In embodiments, the chitosan porous layers and the fiber reinforcement member having substantially bidimensional structures, the area of the fiber reinforcement member is smaller than that of each chitosan porous layers. Such embodiments show a very good resistance to natural delamination as well as to provoked delamination.
By “substantially bidimensional structure” is meant in the present application that the structure has one of its three dimensions which is significantly smaller than the two others so that the structure is substantially planar, such as a layer having a small thickness, or a mesh.
For example, the chitosan porous layers may have the same dimensions and may be under the form of rectangular layers having a length L and a width W, and a thickness much smaller than L and W. The fiber reinforcement member may be under the shape of a bidimensional textile having a length LF and a width WF. In embodiments, the area LF×WF of the fiber reinforcement member is smaller than the area L×W of each chitosan porous layers.
The matrix obtained by the method of the invention can be part of or constitute the whole of a surgical implant, for example for reinforcing the abdominal wall.
Thus, another aspect of the invention relates to a chitosan-based matrix obtained by the method described above.
Another aspect of the invention relates to an implant, in particular for reinforcing the abdominal wall, comprising at least one matrix obtained by means of the method described above.
The invention and the advantages thereof will emerge more clearly from the examples below.
1°) Production of Two Separate Chitosan Porous Layers:
Porous layers of chitosan of DA (degree of acetylation) 4% were produced according to the following procedure.
A 1% (w/w) chitosan solution is prepared as follows: 4.70 g of chitosan were first suspended in 445 g sterile water and dissolved under mechanical stirring by adding 1.56 ml of acetic acid to achieve the stoechiometric protonation of free amine groups of D-glucosamine residues. Usually, an excess of 10% of acetic acid is added to enhance the dissolution.
This operation is realized in a STEPHAN unit with mechanical stirring at 300 rpm and room temperature. To avoid any temperature increase, the bowl is equipped with a cooling bath to maintain the room temperature at a temperature T<25° C. The dissolution takes about 2 to 3 hours in these conditions.
After complete dissolution of the polymer, the pH of the chitosan solution is 4.5. The pH is then adjusted to pH 3.5 by addition of 7.5 ml of acetic acid. Solutions of pH 3.5 allow improving the mechanical properties of the resulting chitosan porous layer. The 1% (w/w) chitosan solution is then degassed under static vacuum : such a step allows removing air bubbles that could impact both porosity and mechanical properties of the resulting matrices. For example, the solution is degassed at 150 mbars, 300 rpm and 25° C. for 30 min. 2 or 3 degassing cycles are usually necessary to achieve complete degassing.
121 g of degassed chitosan solution are then poured in a plastic mould of 12 cm×17 cm dimensions in order to form a layer which is freeze-dried in a TELSTAR Lyobeta freeze drier according to a 28 hours cycle, namely a freezing step of about 4 hours and a primary drying step of about 24 hours.
A first chitosan porous layer is obtained. The same procedure is repeated in order to obtain a second chitosan porous layer.
In the present example, the two chitosan porous layers have identical compositions. In other embodiments, the composition of one chitosan porous layer could be different from that of the other chitosan porous layer, in particular regarding the concentration of chitosan and/or the degree of acetylation of chitosan, and/or the origin of the chitosan, etc. . . . .
2°) Neutralization of the Chitosan Porous Layers Produced at 1°):
The chitosan porous layers obtained at point 1°) above were neutralized by immersion during 10 minutes into a neutralizing solution of NaOH 0.5M in 96% ethanol. The chitosan porous layers were then washed in sterile water baths during 10 min (typically 1 L/matrix) to remove the excess of sodium hydroxide and residual salts. Washings were repeated until the washing solution reached a neutral pH and a conductivity below 2 μS/cm.
After neutralization, the chitosan porous layers show dimensions of 10 cm×15 cm and were further recut at the following dimensions: 6 cm×4 cm. They have a thickness ranging from about 4 mm to about 5 mm.)
3°) Assembling of a Matrix of the Invention:
A fiber reinforcement member under the form of a knit made of polyethylene terephthalate and having dimensions of 6 cm×4 cm is provided.
A face of each chitosan porous layer obtained at point 2°) above is acidified by spraying thereon a fine layer of a solution of acetic acid at a concentration of 0.1 M. The spraying is repeated twice in a homogeneous way. Only a superficial layer of the face is acidified so that the integrity of the chitosan porous layer is preserved. This acidification of the face has as a consequence to resolubilize a superficial layer of said chitosan porous layer. The thickness of the acidified superficial layer represents about 1% of the total thickness of the chitosan porous layer.
The fiber reinforcement member is positioned between the two chitosan porous layers with the acidified faces of the chitosan porous layers directed towards the fiber reinforcement member.
A pressure of about 3.5 kPa is applied on the two chitosan porous layers towards the fiber reinforcement member, by depositing on the chitosan porous layers a mass of 850 g during about 20 seconds.
The mass is then removed and the matrix, made of the fiber reinforcement member sandwiched between the two chitosan porous layers, is let to dry under a hood for about 8-12 hours at room temperature (about 20° C.).
During the drying step, the resolubilized superficial layers of the chitosan porous layers which surround the fiber reinforcement member solidify and eventually imprison the fiber reinforcement member which strongly adheres to the faces of the chitosan porous layers. At the end of the drying step, the two chitosan porous layers and the fiber reinforcement member are securely bound together.
Once the matrix is dried, it is very stable and no delamination of the fiber reinforcement member from the two chitosan porous layers occurs.
The matrix is put in a water bath for 1 hour. No delamination of the fiber reinforcement member from the two chitosan porous layers is observed.
A matrix of the invention is prepared in the same manner as in EXAMPLE 1 above, except that the fiber reinforcement member is dipped into a solution of acetic acid at a concentration of 0.1 M prior to be positioned between the two acidified faces of the chitosan porous layers.
The matrix is dried in the same manner as in EXAMPLE 1.
The matrix obtained is very stable and no delamination of the fiber reinforcement member from the two chitosan porous layers occurs.
The matrix is put in a water bath for 1 hour. No delamination of the fiber reinforcement member from the two chitosan porous layers is observed. In addition, if one attempts to delaminate the two chitosan porous layers of the matrix by pulling out in opposite directions the end of each chitosan porous layer, a significant resistance to said delamination is observed: in particular, if two jaws of a holder grasp the opposite chitosan porous layers of the matrix and are then taken away one from the other, the matrix breaks at the place it is grasped by one of the jaws but no delamination is observed between the fiber reinforcement member and the chitosan porous layers.
A matrix of the invention is prepared in the same manner as in EXAMPLE 1 above, except that the fiber reinforcement member has the following dimensions: 4 cm×4 cm.
The matrix obtained is very stable and no delamination of the fiber reinforcement member from the two chitosan porous layers occurs.
The matrix is put in a water bath for 1 hour. No delamination of the fiber reinforcement member from the two chitosan porous layers is observed.
A matrix of the invention is prepared in the same manner as in EXAMPLE 2 above, except that the fiber reinforcement member has the following dimensions: 4 cm×4 cm.
The matrix obtained is very stable and no delamination of the fiber reinforcement member from the two chitosan porous layers occurs.
The matrix is put in a water bath for 1 hour. No delamination of the fiber reinforcement member from the two chitosan porous layers is observed.
In addition, if one attempts to delaminate the two chitosan porous layers of the matrix by pulling out in opposite directions the end of each chitosan porous layer, a significant resistance to delamination and to tearing is observed. In particular, in such conditions, a greater resistance to delamination and to tearing is observed with the matrix of the present example compared to the matrices of Examples 1-3.
Matrices of the invention prepared in the four examples above may be used on their own as wall reinforcement implants to be implanted in a patient for hernia repair for example. Alternatively, these matrices may be used in combination with a anti-adhesion barrier film or with one or more additional matrices/porous layers in order to manufacture a composite surgical implant.
| Number | Date | Country | Kind |
|---|---|---|---|
| 15305236.0 | Feb 2015 | EP | regional |
This application is a divisional of U.S. patent application Ser. No. 15/003,975 filed Jan. 22, 2016, which claims benefit of and priority to European Patent Application Serial No. 15305236.0 filed Feb. 17, 2015, the disclosure of the above-identified application is hereby incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15003975 | Jan 2016 | US |
| Child | 16243359 | US |
