Calendered surgical meshes comprising polyhydroxyalkanoates
Calendered surgical meshes comprising polyhydroxyalkanoate polymers have been developed. These meshes, preferably made from poly-4-hydroxybutyrate or copolymer thereof, have a thickness that is between 50 to 99% of the thickness of the mesh prior to calendering, and a burst strength that is not less than 20% of the burst strength of the mesh prior to calendering. The thinner calendered meshes are particularly suitable for surgical applications where a thinner profile mesh with high burst strength is required, and where it is advantageous to have a mesh with a smooth surface. The meshes may be partially or fully resorbable, and are particularly suitable for use in the treatment of pelvic organ prolapse.
1. A calendered surgical mesh comprising monofilament fiber of a poly-4-hydroxybutyrate homopolymer or copolymer thereof, wherein the calendered mesh has a pore size not less than 40% of the pore size of the mesh prior to calendering.
2. The calendered surgical mesh of claim 1 , wherein the mesh is knit or woven.
3. The calendered surgical mesh of claim 1 , wherein the fiber is oriented.
4. The calendered surgical mesh of claim 1 , wherein the mesh is resorbable.
5. The calendered surgical mesh of claim 1 , wherein the mesh is: (i) three-dimensional and can be temporarily deformed for implantation, (ii) contoured to fit a patient's tissue, or (iii) shaped into a plug.
6. The calendered surgical mesh of claim 1 , wherein the mesh can be deformed for placement in a patient by a minimally invasive method.
7. The calendered surgical mesh of claim 1 , further comprising a bioactive agent or additive.
8. The calendered surgical mesh of claim 7 , wherein the bioactive agent is an antimicrobial agent selected from the following group: rifampin; minocycline and its hydrochloride, sulfate, or phosphate salt; triclosan; chlorhexidine; vancomycin and its hydrochloride, sulfate, or phosphate salt; tetracycline and its hydrochloride, sulfate, or phosphate salt, and derivatives; gentamycin; cephalosporin antimicrobials; aztreonam; cefotetan and its disodium salt; loracarbef; cefoxitin and its sodium salt; cefazolin and its sodium salt; cefaclor; ceftibuten and its sodium salt; ceftizoxime; ceftizoxime sodium salt; cefoperazone and its sodium salt; cefuroxime and its sodium salt; cefuroxime axetil; cefprozil; ceftazidime; cefotaxime and its sodium salt; cefadroxil; ceftazidime and its sodium salt; cephalexin; cefamandole nafate; cefepime and its hydrochloride, sulfate, and phosphate salt; cefdinir and its sodium salt; ceftriaxone and its sodium salt; cefixime and its sodium salt; cefpodoxime proxetil; meropenem and its sodium salt; imipenem and its sodium salt; cilastatin and its sodium salt; azithromycin; clarithromycin; dirithromycin; erythromycin and hydrochloride, sulfate, or phosphate salts, ethylsuccinate, and stearate forms thereof, clindamycin; clindamycin hydrochloride, sulfate, or phosphate salt; lincomycin and hydrochloride, sulfate, or phosphate salt thereof, tobramycin and its hydrochloride, sulfate, or phosphate salt; streptomycin and its hydrochloride, sulfate, or phosphate salt; neomycin and its hydrochloride, sulfate, or phosphate salt; acetyl sulfisoxazole; colistimethate and its sodium salt; quinupristin; dalfopristin; amoxicillin; ampicillin and its sodium salt; clavulanic acid and its sodium or potassium salt; penicillin G; penicillin G benzathine, or procaine salt; penicillin G sodium or potassium salt; carbenicillin and its disodium or indanyl disodium salt; piperacillin and its sodium salt; ticarcillin and its disodium salt; sulbactam and its sodium salt; moxifloxacin; ciprofloxacin; ofloxacin; levofloxacins; norfloxacin; gatifloxacin; trovafloxacin mesylate; alatrofloxacin mesylate; trimethoprim; sulfamethoxazole; demeclocycline and its hydrochloride, sulfate, or phosphate salt; doxycycline and its hydrochloride, sulfate, or phosphate salt; oxytetracycline and its hydrochloride, sulfate, or phosphate salt; chlortetracycline and its hydrochloride, sulfate, or phosphate salt; metronidazole; dapsone; atovaquone; rifabutin; linezolide; polymyxin B and its hydrochloride, sulfate, or phosphate salt; sulfacetamide and its sodium salt; clarithromycin; and silver ions, salts, and complexes.
9. The calendered surgical mesh of claim 1 , wherein the monofilament fiber comprises poly-4-hydroxybutyrate homopolymer.
10. The calendered surgical mesh of claim 9 , wherein the calendered mesh has one or more of the following properties: (i) a burst strength not less than 80% of the burst strength of the surgical mesh prior to calendering; (ii) a burst strength between 30 N and 300 N measured by test method ASTM D6797-02 “Standard test method for bursting strength of fabrics constant rate of extension (CRE) ball burst test,” using a MTS Q-Test Elite universal testing machine or similar device and a testing fixture with a ⅜-inch diameter ball, (iii) a thickness between 50 to 99% of the mesh prior to calendering (iv) a thickness between 0.05 mm and 5 mm, (v) a pore size not less than 30% of the pore size of the mesh prior to calendering, (vi) a pore size between 0.05 mm 2 and 10 mm 2 , (vii) a suture pullout strength between 1 N and 100 N, (viii) a stiffness between 0.01 N and 5 N, (ix) an areal density between 5 gm/m 2 and 250 g/m 2 , (x) a surface area ratio between 0.5 cm 2 /cm 2 and 5 cm 2 /cm 2 , and (xi) oriented fibers, wherein the fibers have been stretched 6-11X their unoriented length.
11. The calendered surgical mesh of claim 10 , wherein the mesh has a thickness between 0.1 mm and 1 mm.
12. The calendered surgical mesh of claim 10 , wherein the mesh has a pore size not less than 20% of the pore size of the mesh prior to calendering.
13. A method of forming the calendered surgical mesh of claim 1 , the method comprising the steps of: knitting or weaving a mesh, and calendering the mesh in order to reduce the thickness of the mesh.
14. The method of claim 13 , wherein the mesh is calendered by heating the mesh under pressure.
15. The method of claim 14 , wherein the mesh is heated to a temperature between 25° C. and 50° C. under a pressure of 1-100 pounds per linear inch of the mesh width.
16. The method of claim 13 , further comprising one or more of the following steps: (i) heat setting the mesh, (ii) washing the mesh with an alcoholic solution, or (iii) sterilizing the mesh with ethylene oxide, electron beam irradiation or gamma-irradiation.
17. The method of claim 13 , wherein the mesh is formed from monofilament fiber with one or more of the following properties: (i) diameter between 20 μm and 900 μm, (ii) tensile strength between 100 MPa and 1,500 MPa, (iii) tensile modulus between 70 MPa and 2 GPa, (iv) elongation to break between 10% and 1100%, and (v) polymer or copolymer weight average molecular weight between 50 kDa and 1,200 kDa.
18. A method of using the calendered surgical mesh of claim 1 , wherein the calendered surgical mesh is implanted in a patient' body.
19. The method of claim 18 , wherein the calendered surgical mesh is implanted by a minimally invasive method.
20. The method of claim 19 , where the calendered surgical mesh is implanted laparoscopically for repair of a hernia, a breast lift, or pelvic organ prolapse.