Medical tissue wrap

Abstract

The present invention relates to medical tissue wraps for internal anatomical structures, and to uses and methods for treating nerve damage using such medical tissue wraps. In particular, the present invention relates to medical tissue wraps for nerve tissue that support the repair of peripheral nerve damage by facilitating the reliable application of the medical tissue wrap. Thus, a medical tissue wrap (10) for the internal anatomical structures of mammals is proposed. The medical tissue wrap (10) is formed by a coiled wall (12) having a circumferentially medial end portion (20) and a circumferentially lateral end portion (22) that extends around and overlaps the circumferentially medial end portion (20). As a result, the wall (12) defines a longitudinal through-hole (16) for accommodating a portion of the anatomical structure. According to one aspect of the present invention, the circumferentially lateral end portion (22) is radially separated from the circumferentially medial end portion (20) by a discontinuous circumferential spacing. In a further embodiment, the tissue wrap comprises structural external modifications at the longitudinal end portions of its walls that are opposite each other.

Description

Detailed Description of the Invention

[0001] 〔Technical Field〕 The present invention relates to a medical tissue wrap for mammalian internal anatomical structures, as well as the use and method of treating nerve injury using such a medical tissue wrap. In particular, the present invention relates to a medical tissue wrap for nerve tissue that supports the repair of peripheral nerve injury.

[0002] 〔Technical Background〕 When a human is injured, tissue damage may occur in internal anatomical structures (e.g., muscle tissue, tendons, blood vessels, or nerve tissue). Such internal anatomical structures usually extend longitudinally and may include a substantially cylindrical or tubular shape. As a result of such tissue damage, deterioration of motor skills and / or partial loss of sensation may occur. Consequently, treatment is required to at least partially promote the repair and functional recovery of the affected tissue.

[0003] Deterioration of motor skills and / or partial loss of sensation can be particularly pronounced when nerve tissue is damaged. Damage to nerve tissue may be accompanied by damage or trauma to one or more nerves of the peripheral nervous system. Such trauma involving nerve injury occurs particularly in the upper extremities (e.g., a human hand or finger). As a result, if the nerve injury is not properly treated, a human may suffer, for example, loss of tactile or haptic feedback and / or have difficulty controlling fine motor skills in the trauma area.

[0004] Current treatments for nerve damage involve joining nerve ends using various suturing techniques so that the nerve ends are connected to each other in a substantially tension-free manner. In cases of more severe defects where nerve ends are not directly adjacent to each other, reconstruction may be necessary to overcome the corresponding gap. Reconstruction may be performed, for example, with autologous or allogenic nerve grafts. Alternatively, reconstruction may be performed by providing a tubular structure to serve as a nerve guide. Such a tubular structure may be provided, for example, with autologous or allogenic venous structures, or with artificially created nerve conduits made from biocompatible materials.

[0005] The use of tubular structures can further facilitate injury repair, regardless of the presence of gaps, for example, by providing additional mechanical support and structural stability, offering tension-free repair, guiding axonal growth to limit the risk of neuroma, reducing inflammatory responses at the site of injury, and / or limiting the spread of fibrous tissue growth.

[0006] Such tubular structures may be provided in the form of a medical tissue wrap (e.g., a sheet material). The medical tissue wrap may be coiled or rolled around the damaged internal tissue. The medical tissue wrap can be applied to a prepared peripheral nerve by, for example, guiding the medical tissue wrap around a designated portion of the nerve when it is at least partially unwound, and allowing or ensuring that the tissue wrap can be rewound after it has been properly positioned. Thus, in contrast to conduits, medical tissue wraps can also be advantageously applied to damaged anatomical structures that are not separated by gaps and that include at least partially continuous longitudinal extensions. The closure of the medical tissue wrap is then typically secured by multiple sutures around its periphery.

[0007] The elements of the present invention are described below. These elements are listed together with specific embodiments, but it should be understood that additional embodiments can be created by combining them in any manner and in any number. The various examples and preferred embodiments described should not be interpreted as limiting the invention to only the explicitly described embodiments. It should be understood that this specification supports and encompasses embodiments in which any number of disclosed and / or preferred elements are combined with the explicitly described embodiments. Furthermore, unless otherwise specified, any rearrangement and combination of all elements described in this application should be considered disclosed by the specification of this application.

[0008] Unless otherwise requested, throughout this specification and the subsequent claims, the term “comprise,” and variations such as “comprises” and “comprising,” are understood to imply the inclusion of specified components, integers, or processes, but not the exclusion of any other unspecified components, integers, or processes. The term “consist of” is a specific embodiment of the term “comprise,” in which case any other unspecified components, integers, or processes are excluded. In the context of the present invention, the term “comprise” encompasses the term “consist of.” Therefore, the term “comprising” encompasses “including” and “consisting.” For example, the construction “comprising” X may consist of X alone, or it may include something additional (e.g., X + Y).

[0009] In the context describing the present invention (particularly in the context of the claims), the terms “a,” “an,” “the,” and similar references should be understood to encompass both singular and plural forms, unless otherwise specified herein or unless there is a clear inconsistency with the context. Descriptions of ranges of values ​​herein are intended merely as a concise way of referring individually to each separate value that falls within that range. Unless otherwise specified herein, each individual value is incorporated herein as if it were described individually. No term herein should be understood to refer to any unclaimed element essential to the practice of the present invention.

[0010] The term "approximately" in relation to the numerical value x means x ± 10%.

[0011] In numbers with decimal places, commas (",") or periods (".") are used interchangeably in this specification, i.e., throughout this specification and the claims. Therefore, numbers with decimal places can be represented by either commas (",") or periods ("."). For example, the exemplary value "0.5" can also be represented as "0,5". This is similar to other values ​​with decimal places. In particular, commas (",") in numbers indicate decimal places but are not used as "digit separators".

[0012] [Summary of the Invention] Building upon known prior art, there is a need to further facilitate the repair of damage to internal anatomical structures (especially nerves or tendons).

[0013] According to the present invention, it is recognized that proper closure and fixation of medical tissue wraps applied to internal anatomical structures (e.g., injured peripheral nerves or tendons) is often difficult to achieve. Such closure and fixation are necessary to prevent the contained injured tissue from unintentionally protruding from the medical tissue wrap, and conversely, to avoid undesirable tissue growth within the medical tissue wrap, particularly scar tissue or fibrous tissue. In other words, undesirable communication between the injured tissue and surrounding tissue is preferably avoided by proper closure and fixation of the medical tissue wrap.

[0014] The closure and fixation of a medical tissue wrap can be improved by providing excess material, i.e., by increasing the number of layers of the medical tissue wrap wrapped around the damaged anatomical structure (as described in US9,061,464), or by incorporating an interlocking portion into the flexible body to facilitate wrapping and attachment around the tissue (as described in EP3662940). However, the inventors have found that such additional wrapping or interlocking systems can be cumbersome to perform in the correct location, or even anatomically impossible. Furthermore, adding a number of layers can make it more difficult to provide the medical tissue wrap in at least partially spread out to create a gap sufficient to insert and / or accommodate the damaged anatomical structure. In addition, adding material can result in an increase in the radial dimensions of the medical tissue wrap and / or alter the overall properties of the medical tissue wrap, for example, in terms of structural stability, resilience, optical properties, and / or biochemical properties. Furthermore, the addition of an extra layer may affect the inner diameter of the medical tissue wrap, potentially requiring excessive sizing to avoid compression of the damaged anatomical structure.

[0015] As mentioned above, the closure and fixation of a medical tissue wrap can be ensured by multiple sutures. However, this complicates the surgical procedure. This is because, on the one hand, perforation of delicate, damaged anatomical structures should generally be avoided because it generates tension and leads to poor tissue regeneration, and on the other hand, the structural stability or integrity of the medical tissue wrap may be reduced. Furthermore, the use of sutures increases the time required to perform the surgical procedure.

[0016] In addition, the addition of extra layers and / or sutures makes it more difficult to perform surgical procedures reproducibly.

[0017] Furthermore, attempting to secure a medical tissue wrap to the anatomical structure it contains by providing sutures at multiple longitudinal ends of the medical tissue wrap can reduce the reproducibility of the surgical procedure. Moreover, such fixation methods may be unsuitable for the anatomical structure contained by the medical tissue wrap, or may complicate the surgical procedure and / or the handling of delicate tissues. Alternatives using medical adhesives have been found to be difficult to apply reproducibly and / or to maintain the fixation of the medical tissue wrap to damaged internal anatomical structures.

[0018] Therefore, one objective of the present invention is to further facilitate the repair of damaged internal anatomical structures (e.g., nerve or tendon damage), and in particular to ensure proper closure and / or fixation of the medical tissue wrap without impairing the insertion of the internal anatomical structure into the medical tissue wrap.

[0019] The above objectives are achieved by the independent claims. A preferred embodiment is shown in the dependent claims, specification, and drawings.

[0020] Accordingly, in a first embodiment, a medical tissue wrap for the internal anatomical structure of a mammal is provided. The medical tissue wrap is formed by a rolled wall having a circumferential inner end portion and a circumferential outer end portion extending around and overlapping the circumferential inner end portion. As a result, the wall defines a longitudinal through-hole for accommodating at least a portion of the anatomical structure. According to the present invention, the circumferential outer end portion is radially separated from the circumferential inner end portion by a discontinuous spacing in the circumferential direction.

[0021] Generally, the circumferential outer end portion and the circumferential inner end portion of the wall substantially correspond to the overlapping inner and outer portions of the wall. Therefore, the circumferential extension of the circumferential outer end portion substantially corresponds to the circumferential extension of the circumferential inner end portion of the wall, resulting in the outer end portion (completely) overlapping the inner end portion. This avoids a circumferential gap in the wrapped wall. As a result, it is ensured that at least one internal anatomical structure housed within the through-hole is retained within the medical tissue wrap and substantially completely covered and / or surrounded along its (entire) circumference. Thus, the medical tissue wrap can provide improved support, protection, and / or suspension for the anatomical structure housed therein.

[0022] The circumferential outer end portion is radially separated (overall) from the circumferential inner end portion. In other words, the circumferential outer end portion does not directly contact the circumferential inner end portion due to the radial spacing between the inner and outer end portions. Because there is radial spacing with respect to the entire overlapping portion when the medical tissue wrap is rolled up, unrolling or unfolding the medical tissue wrap may be easier, at least partially, compared to a medical tissue wrap configuration in which one or more (outer) layers overlap and directly contact adjacent (inner) layers. Therefore, when the walls are rolled up, the overlapping portions are separated and do not contact each other. As a result, a sufficient gap may be provided for inserting internal anatomical structures into the through-holes. Furthermore, such radial spacing may facilitate the optional application of medical adhesive to bring a bond between the outer and inner end portions, for example, once the medical tissue wrap has been properly applied and positioned.

[0023] According to the first embodiment, the radial spacing is discontinuous. In this specification, “discontinuous” spacing means that the radial distance between the circumferential outer end portion and the circumferential inner end portion changes along the circumferential extension of the radial spacing (i.e., the circumferential extension of the overlap). Thus, the distance between the circumferential outer end portion and the circumferential inner end portion is usually smaller in one part of the radial spacing compared to another part of the (same) radial spacing. Thus, a portion with reduced radial spacing (but without creating a contact surface between the circumferential inner end portion and the circumferential outer end portion) is usually present in the overlap. Furthermore, the discontinuous spacing results in the presence of at least one overlap with reduced radial spacing. This facilitates the closure of the through-hole to the surrounding tissue environment. As a result, the risk of external tissue growing into the through-hole can be effectively reduced, while at the same time improving the retention of anatomical structures within the through-hole. Furthermore, this discontinuity may define a barrier for medical adhesives to be optionally applied at the outer surface and / or the boundary between the outer and inner end portions, which may be dimensioned based on the viscosity of the medical adhesive used and the minimum radial spacing required to facilitate the unwinding or unfolding of the medical tissue wrap.

[0024] In other words, the discontinuous spacing ensures that improved closure of the medical tissue wrap can be achieved while still allowing for the temporary formation of a circumferential gap between the lateral and medial end portions, facilitating the accommodation of damaged internal anatomical structures (e.g., damaged nerves or tendons).

[0025] Preferably, the medical tissue wrap is configured to accommodate nerve tissue, preferably a damaged peripheral nerve. The medical tissue wrap is configured to accommodate the proximal and distal ends of a single damaged peripheral nerve, for example, the proximal and distal ends of a single damaged peripheral nerve having a predetermined gap between them due to trauma, or the proximal and distal ends of a single damaged peripheral nerve with substantially no gap.

[0026] Therefore, through-holes can be adapted and sized to accommodate the corresponding diameter of the nerve or nerve end. For example, the diameter of the through-hole (understandable as the diameter of the inner portion) may be 1 mm to 12 mm, depending on the diameter of the nerve (end). To accommodate smaller nerves, the diameter of the through-hole may be, for example, 1 mm or 1.5 mm to 6.5 mm (e.g., 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, 5.5 mm, 6 mm, or 6.5 mm). Such dimensions have been found to be particularly advantageous in providing the necessary support for the nerve (end) and / or nerve growth or repair. Depending on the desired therapeutic effect of the medical tissue wrap and the nerve, the extension of the wall and through-hole is preferably 5mm to 25mm, more preferably 7mm to 22mm, in the longitudinal direction (e.g., 7mm, 7.5mm, 8mm, 8.5mm, 9mm, 9.5mm, 10mm, 10.5mm, 11mm, 11.5mm, 12mm, 12.5mm, 13mm, 13.5mm, 14mm, 14.5mm, 15mm, 15.5mm, 16mm, 16.5mm, 17mm, 17.5mm, 18mm, 18.5mm, 19mm, 19.5mm, 20mm, 20.5mm, 21mm, 21.5mm, or 22mm). Furthermore, such dimensions may be particularly advantageous for bridging nerve defects or damage. As a result, these desired or predetermined dimensions may provide a continuous guide structure for internal anatomical structures, which is particularly advantageous for inducing and / or facilitating neurogenesis.

[0027] Note that the above preferred dimensions relate to the application to (peripheral) nerves, but it should be understood that the medical tissue wrap can also be applied to provide a support structure for tendons, blood vessels (veins and / or arteries), or ligaments. Therefore, such a support structure may be adapted to the corresponding dimensions, the nature of the tissue, and / or the level of support to be provided. For example, the diameter of the through-hole may be selected such that direct contact with the internal anatomical structure is ensured, for example, for very delicate tissue structures, or a predetermined radial spacing is provided between the wall and the internal anatomical structure, for example, to provide cushioning upon impact with adjacent tissues. Further, the wall thickness may be selected based on the structural support required and the elasticity of the wall from the perspective of the internal anatomical structure to be treated.

[0028] To facilitate the application of the medical tissue wrap, the wall preferably defines a through-hole having a tubular shape with a continuous inner diameter. Such a configuration also corresponds to the typical cylindrical and / or tubular extension of the preferred internal anatomical structure accommodated within the through-hole. Further, thereby, a predetermined and / or more homogeneous structural stability of the medical tissue wrap can be achieved. Optionally, the wall defining the through-hole may include grooves, internal structures, and / or holes on its inner surface. Such (inner) wall modifications can improve the mechanical properties of the medical tissue wrap and / or promote the repair of the internal anatomical structure retained within the through-hole, for example, by promoting nerve growth to damaged peripheral nerves. However, in some embodiments, the inner surface of the wall defining the through-hole may be smooth, i.e., may not include grooves, internal structures, and / or holes.

[0029] The tube shape can cause the outer dimensions to be substantially continuous. This can be advantageous for implanting (inserting) the medical tissue wrap into the surrounding tissue. Furthermore, the tubular or cylindrical shape can provide sufficient structural stability and / or prevent sudden bending or twisting during tissue movement, i.e., contraction or stretching. A homogeneous structure that reacts in a predetermined manner when a force acts on the wall (e.g., during impact) can be provided by the tube shape.

[0030] Furthermore, the tubular structure may substantially correspond to the shape of the through-hole without undesirable biasing so that a continuous guiding structure for tissue repair or support (protection), for example, a continuous guiding structure for neurogenesis or nerve growth, can be obtained. As a result, it is achieved that the sizing of the through-hole can be maintained at the desired and / or required minimum value.

[0031] The wall, particularly its inner surface, may contain a drug, for example, by coating or incorporating the drug into the material of the wall. The drug may be released over time and the drug may, for example, promote tissue repair. In some embodiments, the wall may be covered / coated with a composition (e.g., a gel) containing a drug and the like (thus, the through-hole may be at least partially or completely filled with the composition). For example, the drug may be a biologically active agent (e.g., an anti-inflammatory agent, an immunosuppressive agent, a neurotrophic factor, and a neuroprotective agent). Examples of such biologically active agents can be cytokines, nerve growth factors, hyaluronic acid, tacrolimus, cyclosporin A, melatonin, vitamin B12, methylprednisolone, riluzole, taxol, cetuximab, 4-aminopyridine (4-AP), tesamorelin. A preferred example is tacrolimus.

[0032] The circumferential outer end portion is preferably formed by a single wall layer that overlaps the circumferential inner end portion. This can significantly facilitate the application of the medical tissue wrap compared to a configuration having multiple adjacent layers that overlap each other radially. For example, when treating gapless internal anatomical structures, these single wall layers can facilitate the unwrapping and rewrapping of the medical tissue wrap to accommodate the internal anatomical structures.

[0033] While various winding configurations of the wall may be provided, it is preferable that the wall is wound only in the circumferential direction (single or double), and in particular, only around one or two longitudinal axes extending through (along the through hole). As a result, helical extension of the wall is avoided. In other words, the wall is preferably wound around one or two longitudinal axes (corresponding to the circumferential outer end portion of the wall and the circumferential inner end portion of the wall, respectively), but without extension in the direction of the longitudinal axes. As a result, a substantially continuous and / or gapless circumferential cover of the internal anatomical structure can be provided. This not only improves the support and / or protection of the contained tissue, but also facilitates unwinding and / or rewinding when applying a medical tissue wrap.

[0034] Preferably, the inner and outer circumferential end portions are located on the ends of the wall that are circumferentially opposite to each other. Therefore, the wall does not extend circumferentially beyond the inner and outer circumferential end portions, whether rolled or partially unrolled. When rolled, the wall preferably defines a substantially cylindrical shape for the medical tissue wrap. In this case, the cross-section of the through-hole is preferably substantially circular. By providing the outer and inner end portions on the ends of the wall that are circumferentially opposite to each other, the radial dimensions of the medical tissue wrap can be reduced when rolled.

[0035] As described above, it is advantageous that the discontinuous interval includes at least a portion that defines the reduced radial spacing. Here, radial spacing should be understood as the radial distance between radially adjacent surfaces of the circumferential inner end portion and the circumferential outer end portion.

[0036] Preferably, the discontinuous interval includes a reduced radial interval formed by the curved portion of the circumferential inner end and / or the curved portion of the circumferential outer end. The reduced radial interval may be formed in particular as a gradually decreasing interval, and / or the reduced radial interval may extend from an overlapping portion having a continuous radial interval.

[0037] For example, a curved portion may be provided at the outer circumferential end portion. In this case, the overlapping portion defines a gradually decreasing radial spacing, that is, in the circumferential direction from the inner circumferential end portion to the outer circumferential end portion, or from the outer circumferential end portion to the inner circumferential end portion. Furthermore, a curved portion may be provided at the inner circumferential end portion. In this case, the overlapping portion defines a gradually decreasing radial spacing, that is, in the circumferential direction from the outer circumferential end portion to the inner circumferential end portion, or from the inner circumferential end portion to the outer circumferential end portion.

[0038] These curves may be provided separately. That is, they may be either a (gradual) reduction in the circumferential direction from the inner circumferential end portion to the outer circumferential end portion, or a (gradual) reduction in the circumferential direction from the outer circumferential end portion to the inner circumferential end portion. However, these curves may be provided simultaneously (within the same lap). In this case, a continuous radial spacing and / or a local maximum radial spacing are provided between the multiple curves. In this regard, two curves of the outer circumferential end portion may form a reduced radial spacing. These two curves surround the inner circumferential end portion having a substantially continuous pitch (slope) or radius, defining a radial spacing that gradually decreases in the circumferential direction in opposite directions. Similarly, two curves of the inner circumferential end portion may form a reduced radial spacing. These two curves surround the outer circumferential end portion having a substantially continuous pitch or radius, defining a radial spacing that gradually decreases in the circumferential direction in opposite directions.

[0039] In some embodiments, the radial spacing at the circumferential end face of the inner circumferential end portion is smaller than the radial spacing at the circumferential end face of the outer circumferential end portion. As a result, the radial spacing can be reduced (gradually) toward the circumferential end face of the inner circumferential end portion. Therefore, the maximum radial spacing can be provided at the circumferential end face of the outer circumferential end portion, and / or the minimum radial spacing can be provided at the circumferential end face of the inner circumferential end portion. For example, the radial spacing at the circumferential end face of the inner circumferential end portion may be approximately 80-99%, preferably 85-95%, and more preferably about 90% of the radial spacing at the circumferential end face of the outer circumferential end portion. Furthermore, the minimum radial spacing may be approximately 80-99%, preferably 85-95%, and more preferably about 90% of the maximum radial spacing.

[0040] Preferably, the radial spacing at the circumferential end face of the outer circumferential end portion is smaller than the radial spacing at the circumferential end face of the inner circumferential end portion. As a result, the radial spacing can be reduced (gradually) toward the circumferential end face of the outer circumferential end portion. Therefore, the maximum radial spacing can be provided at the circumferential end face of the inner circumferential end portion, and / or the minimum radial spacing can be provided at the circumferential end face of the outer circumferential end portion. For example, the radial spacing at the circumferential end face of the outer circumferential end portion may be approximately 80-99%, preferably 85-95%, and more preferably about 90% of the radial spacing at the circumferential end face of the inner circumferential end portion. Furthermore, the minimum radial spacing may be approximately 80-99%, preferably 85-95%, and more preferably about 90% of the maximum radial spacing.

[0041] A reduced radial spacing is provided at the end faces, and preferably, this radial spacing gradually decreases toward each end face. This can significantly improve the closing of the through holes.

[0042] In some embodiments, the radial spacing at the circumferential end face of the inner circumferential end portion and the radial spacing at the circumferential end face of the outer circumferential end portion are smaller than the radial spacing at the overlapping portion or point between the circumferential end face of the inner circumferential end portion and the circumferential end face of the outer circumferential end portion (resulting in a maximum radial spacing, which is neither at the circumferential end face of the inner circumferential end portion nor at the circumferential end face of the outer circumferential end portion).

[0043] In particular, it has been found that reducing the radial spacing between the circumferential end faces of both the circumferential inner end portion and the circumferential end faces of the circumferential outer end portion creates a double barrier, resulting in further improvement of the closure of the through-hole, thereby ensuring stable retention of internal anatomical structures within the through-hole and maximizing the risk of external tissue growth into the through-hole. It should be noted that such a configuration may also be provided by the corresponding curved portions described above, in which case the overlapping portions between the end faces and / or between such curved portions may define a continuous radial spacing or a local maximum radial spacing.

[0044] Depending on the required closure and the dimensions of the medical tissue wrap, the reduced radial spacing may be provided only on the circumferential end face of the circumferential outer end portion. This can result in a more rounded outer surface of the medical tissue wrap and provide sufficient closure on the outside of the overlapping portion.

[0045] Furthermore, the reduced radial spacing may be provided only at the circumferential end face of the circumferential inner end portion. This allows for easier opening or unwrapping of the medical tissue wrap, as the radial spacing is greater at the circumferential end face of the circumferential outer end portion, and can also provide sufficient closure within the overlapping portion. Such a configuration can also facilitate the optional application of medical adhesive by, for example, forming longitudinal grooves determined by the reduced radial spacing near each end face. While the reduced radial spacing itself may be sufficient to maintain the closure of the medical tissue wrap and eliminate the need for one or more sutures in the wall, providing such grooves for applying medical adhesive can improve retention and may be advantageous in providing a more reproducible material bond between the circumferential inner and circumferential outer end portions.

[0046] In some embodiments, the radial spacing at the circumferential end face that defines the reduced radial spacing may be 50 to 99 percent of the maximum radial spacing of the discontinuous spacing, preferably 60 to 99 percent, more preferably 80 to 98 percent, even more preferably 85 to 95 percent, even more preferably 87 to 92 percent, and for example, about 90 percent. The reduced spacing may depend, for example, on the inner diameter defined by the through hole and / or the outer diameter of the wall, and / or on the circumferential extension of the circumferential outer end portion.

[0047] The radial spacing at the circumferential end face that determines the reduced radial spacing is preferably 50 μm to 300 μm. In particular, the radial spacing may be 80 μm to 200 μm. Furthermore, the maximum radial spacing of the discontinuous spacing is preferably 100 μm to 350 μm, and in particular may be 150 μm to 250 μm. For example, the maximum radial spacing may be about 200 μm, and the reduced (or minimum) radial spacing may be 100 μm to 190 μm. Such dimensionalization can lead to optimization of the closure of the medical tissue wrap when the walls are rolled, while the radial spacing facilitates unrolling the walls to accommodate internal anatomical structures when the medical tissue wrap is applied. Furthermore, such sizing has been found to be particularly advantageous for closing medical tissue wraps with relatively small inner diameter through-holes, such as 1 mm to 6.5 mm or 1 mm to 5 mm (e.g., 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, 4 mm, 4.5 mm, 5 mm, 5.5 mm, 6 mm, or 6.5 mm), suitable for peripheral nerves with small diameters.

[0048] The overlapping portion can be appropriately sized to ensure that no circumferential gap is provided between the circumferential outer end portion and the circumferential inner end portion when the wall is rolled up. The circumferential extension of the circumferential outer end portion may correspond to 5 degrees to about 120 degrees, preferably 10 degrees to 100 degrees, and more preferably 20 degrees to 90 degrees, of the outer circumference of the tissue wrap.

[0049] Therefore, the wall may form fewer than 1.5 turns, i.e., the overlapping portion provided by the circumferential outer end portion defines less than half a turn along the circumference. The preferred degree is the portion of the circumferential outer end portion relative to the circumference of the medical tissue wrap as a whole when wound (i.e., relative to a single complete turn without overlap), but the degree may be defined as a corresponding percentage. Thus, the circumferential extension of the circumferential outer end portion may correspond to about 2.8 percent to about 28 percent of the outer circumference of the medical tissue wrap, preferably about 5.6 percent to about 25 percent.

[0050] More preferably, the circumferential extension of the circumferential outer end portion may be 20 to 60 degrees of the outer circumference of the tissue wrap, and even more preferably 30 to 45 degrees. According to the above description, the angular extension may correspond to about 5.6 percent to about 17 percent of the outer circumference of the medical tissue wrap, or to about 8.3 percent to about 13 percent.

[0051] It has been found that the overlapping portion provided by the circumferential outer end portion can be advantageously selected based on the inner diameter of the through hole. The circumferential extension may preferably be less than 45 degrees for inner diameters up to about 3 mm (for example, for relatively small peripheral nerves in the fingers or hands of the patient being treated), and greater than 20 degrees and up to 45 degrees for inner diameters of about 4 mm or more (for relatively large peripheral nerves, such as peripheral nerves in the wrist or arm of the patient being treated). The circumferential extension may particularly be greater than 25 degrees of the outer circumference of the medical tissue wrap, for example, about 30 degrees of the outer circumference of the medical tissue wrap, or about 30 to about 45 degrees of the outer circumference of the medical tissue wrap.

[0052] It has been found that providing discontinuous intervals, i.e., portions with reduced radial spacing, along with such circumferential extension, improves the closure of the medical tissue wrap and its through-holes while still facilitating the opening or unwrapping of the medical tissue wrap for application in the target tissue. If the circumferential extension is greater than 45 degrees, unwrapping may not be as easy. However, a larger such extension may be selected, for example, based on the internal anatomical structure contained within the through-hole and / or based on the required mechanical and / or closing properties of the medical tissue wrap.

[0053] Furthermore, the radial distance between the circumferential inner end portion and the circumferential outer end portion may be gradually reduced in the circumferential direction in opposite directions, with equal angular extensions, starting from the maximum radial distance of the discontinuous interval. As described above, such reduction may be brought about by corresponding curved portions having different pitches or radii from adjacent wall portions. In this case, multiple such curved portions in the outer end portion and / or inner end portion may have the same angular extension (e.g., about 30 degrees each on the outer circumference of the medical tissue wrap) such that the circumferential outer end portion forms an overall angular extension of about 60 degrees.

[0054] Medical tissue wraps may be applied to internal anatomical structures separated by gaps, for example, due to trauma or amputation. In this case, the opposite ends of the anatomical structures may be inserted into the through-holes of the medical tissue wrap through corresponding openings at the longitudinal ends opposite the through-holes, and such application may be cumbersome and / or undesirable for small-diameter anatomical structures and / or in terms of reproducibility.

[0055] Therefore, it is preferable that the wall is at least partially circumferentially unwound and rewound. Preferably, the wall may be completely unwound so as to define a sheet-like structure extending only in the longitudinal direction. Ensuring that the wall is unwound allows it to be wrapped around an internal anatomical structure to be treated (e.g., a damaged peripheral nerve or tendon) and rewound after the wall has been properly positioned.

[0056] The wall may be formed, at least partially, of a resilient or elastic material, preferably a material that is three-dimensionally printed. Such resilience can be advantageous not only in providing a level of flexibility that conforms to the movement of the desired support and / or surrounding tissue, but also in facilitating the unwinding and rewinding of the wall for applying a medical tissue wrap around the internal anatomical structure to be treated. Such resilience may be provided, for example, by three-dimensional printing, and the corresponding biasing force may be provided by local stress within the material.

[0057] Depending on the structural support provided to the internal anatomical structure by the medical tissue wrap, the wall thickness may be appropriately selected. Preferably, the wall has a thickness of 50 μm to 400 μm, and more preferably 150 μm to 250 μm. Such thickness has been found to provide sufficient support for various applications while ensuring a certain level of transparency so that the accommodation of the internal anatomical structure within the through-hole can be monitored or inspected once the wall is rolled up. Depending on the material used for the wall, the thickness may be adapted to the required biodegradation rate of the medical tissue wrap. Furthermore, such thickness may facilitate the unrolling of the wall and improve the flexibility for handling the medical tissue wrap. This preferred range of thickness may be advantageous, for example, for unrolling the wall. A wall thickness of about 200 μm has been found to be particularly advantageous for the above embodiments.

[0058] The wall includes a continuous portion having the preferred thickness range, but the wall thickness may be locally increased to provide or support further functionality of the medical tissue wrap.

[0059] In particular, the reduced radial spacing may be achieved by the curvature of the circumferential inner end portion. In some embodiments, the reduced radial spacing may be achieved by a (gradual) increase in the wall thickness of the circumferential inner end portion and / or a (gradual) increase in the wall thickness in adjacent sections of the non-overlapping portion of the wall. Such an increase in wall thickness may be applied generally to medical tissue wraps, but such an increase in wall thickness may be particularly advantageous in structural external modification portions, especially portions of medical tissue wraps having a retaining surface, as will be described later herein. Therefore, as will be described later herein, it is preferable that the wall thickness be increased in such a manner in structural external modification portions, especially in longitudinal end portions having a retaining surface.

[0060] Therefore, the wall of the circumferential inner end portion may be thinner in the circumferential direction compared to the wall of the outer end portion and the wall of (most of) the non-overlapping circumferential portion of the wall. In particular, if the medical tissue wrap has a structural external modification portion (e.g., a retaining surface) at the longitudinal end portion, as described later herein, and therefore has an increased wall thickness, the wall thickness of the circumferential inner end portion at such longitudinal end portion may be approximately the same as the wall thickness at the central portion (in the central portion, it is preferable that the wall thickness is substantially the same throughout the circumferential direction).

[0061] In some embodiments, the wall thickness of the circumferential inner end portion can be reduced by up to 75%, preferably 30% to 65%, more preferably 40% to 60%, for example, about 50%, compared to the wall thickness of the circumferential outer end portion and / or the wall thickness of (most of) the non-overlapping circumferential portion of the wall.

[0062] However, the non-overlapping circumferential portion of the wall may also include a section having a reduced wall thickness, which is directly adjacent to the circumferential inner end portion having the reduced wall thickness. This allows for a smooth transition between (i) the (substantially constant) wall thickness between the outer end portion and (most) the non-overlapping circumferential portion of the wall and (ii) the inner end portion having a reduced wall thickness compared to (i). As a result, the wall thickness may gradually decrease (beginning) toward the inner end portion in the section of the non-overlapping circumferential portion of the wall, thereby reaching the minimum wall thickness (in the circumferential direction) at the inner end portion (the circumferential end face). This preferably avoids sharp edges, resulting in a homogeneous, step-free outer surface without sharp edges.

[0063] The section of the non-overlapping circumferential portion of the wall having a reduced wall thickness may span a circumferential angle (circumferential offset) of 1° to 90°, preferably 2° to 45°, more preferably 3° to 30°, and even more preferably 5° to 20°.

[0064] The inner end portion has a reduced wall thickness, and optionally, the adjacent non-overlapping circumferential section 35 of the wall 12 also has a reduced wall thickness, which may facilitate manufacturing, and the circumferential outer end portion 22 may be better aligned with the adjacent outer circumference of the wall. Furthermore, this may facilitate the handling of the medical tissue wrap 10, particularly the accessibility of the circumferential outer end portion 22, and as a result, the unwinding of the wall 12 and the medical tissue wrap 10 may be supported by the provision of visual cues and small gripping recesses.

[0065] It may be advantageous to apply medical adhesive to fix the internal anatomical structure to the medical tissue wrap so as to ensure that relative movement between the internal anatomical structure and the medical tissue wrap is reduced or avoided under normal physiological conditions.

[0066] In a second embodiment, the present invention further provides a medical tissue wrap for the internal anatomical structure of a mammal. The medical tissue wrap is formed by a coiled wall having a circumferential inner end portion and a circumferential outer end portion extending around and overlapping the circumferential inner end portion, so that the wall defines a longitudinal through-hole for accommodating a portion of the internal anatomical structure. Here, the circumferential outer end portion is radially separated from the circumferential inner end portion, and the wall is provided with structural external modifications at the longitudinal end portions opposite each other. A detailed description of this wrap substantially corresponds to the detailed description of the medical tissue wrap according to the first embodiment, except that the radial spacing in the wrap according to the second embodiment is not necessarily discontinuous. Furthermore, the medical tissue wrap according to the second embodiment is provided with structural external modifications at least at one of the longitudinal end portions opposite each other of the wall. In all other respects, the above (and below) descriptions relating to the first aspect correspond to the second aspect.

[0067] Accordingly, the medical tissue wrap according to the present invention may have either the discontinuous spacing described above, or a continuous spacing that also includes a structural external modification on at least one of the longitudinal end portions of the wall that are opposite each other. However, it is preferable that the medical tissue wrap has both features, namely the discontinuous spacing described above and a structural external modification on at least one (preferably both) of the longitudinal end portions of the wall that are opposite each other. Accordingly, it is preferable that the wall of the medical tissue wrap according to the first embodiment has a structural external modification on at least one (preferably both) of the longitudinal end portions of the wall that are opposite each other. Similarly, it is preferable that the wrap according to the second embodiment has the typically discontinuous spacing described in detail above.

[0068] With respect to a wall having structural exterior modifications on its opposite longitudinal end portions, it is preferable that the wall has a longitudinally extending central portion adjacent to the opposite longitudinal end portions. In this case, only a plurality of the longitudinal end portions (or at least one thereof) have the structural exterior modifications. At least one, most preferably both, of the plurality of longitudinal end portions have a surface roughness formed by the structural exterior modifications that is increased compared to the surface roughness of the outer surface of the central portion.

[0069] The structural external modification and / or increased surface roughness have the advantage that the bonding strength of optionally applicable medical adhesives may be improved on the modified surface. As a result, the fixation and / or adhesion of the medical adhesive to each surface may be enhanced. For example, the modification may result in an increased surface area and / or shape conformity with respect to the applied medical adhesive, and / or improved adhesion by changing the surface tension. As a result, it may be ensured that the medical tissue wrap is held in place and / or remains stably fixed in the correct position relative to the internal anatomical structure being treated by the medical adhesive applied to the adjacent tissue and modified surface of the internal anatomical structure protruding from the through-hole.

[0070] The structural external modification portion may be formed on a wall portion of each longitudinal end portion that is thicker than the wall thickness of the central portion. For example, the thickness of the thickened wall portion may be 1.1 to 5.0 times, preferably 1.5 to 2.5 times, the thickness of the adjacent central portion. The thickness of the thickened wall portion may be 100 μm to 600 μm, preferably 300 μm to 500 μm. As described above, the wall portion that is not locally modified may have a thickness of 50 μm to 400 μm, preferably 150 μm to 250 μm.

[0071] Alternatively, a continuous wall of substantially uniform thickness may be provided. In this case, the structural exterior modification is embedded within the wall. In such a case, the overall wall thickness may be adapted to the structural exterior modification so as to ensure structural stability in the modified portion, and for example, have a minimum wall thickness of about 50 μm, preferably (at least) 50 μm to 100 μm.

[0072] The thickened wall portion may be offset circumferentially from the circumferential inner end portion. The offset preferably includes a gradual increase in wall thickness from the inner end portion to the thickened wall portion (in the non-overlapping circumferential wall portion). The circumferential offset may have a circumferential extension of 5 to 25 degrees on the outer circumference of the medical tissue wrap. Preferably, the circumferential extension of the offset is 10 to 20 degrees, more preferably about 15 degrees, on the outer circumference of the medical tissue wrap. The circumferential inner end portion may have no structural external modifications and may have a corresponding (reduced) wall thickness. The offset has the advantage of facilitating alignment of the circumferential outer end portion with the circumferential inner end portion, and facilitating handling of the circumferential outer end portion, for example, with respect to unwinding the wall. The gradual transition between the thickened wall portion and the wall portion of the circumferential inner end portion ensures that sharp edges or steps can be avoided.

[0073] The structural external modification is preferably formed as one or more retaining surfaces (e.g., structures that are at least partially external and have a specific geometric shape or irregular surface). These one or more retaining surfaces are configured to fix the medical adhesive to their respective longitudinal end portions. This allows the medical adhesive applied to each longitudinal end portion region and / or adjacent tissue portions of the internal anatomical structure to remain in place without significant displacement even after the medical adhesive has cured. In other words, the retaining surfaces allow the medical adhesive to be held in place, preferably conformably to the shape of one or more retaining surfaces. The retaining surfaces may increase the contact surface with the medical adhesive. Furthermore, the retaining surfaces may provide a certain surface roughness, thereby improving the effectiveness of the medical adhesive bonding to each longitudinal end portion. Therefore, loosening or slipping of the medical adhesive can be effectively prevented by the shape and / or surface of the retaining surfaces.

[0074] The retaining surface of each longitudinal end portion may be formed as a plurality of (e.g., ellipsoidal or circular) holes that can be arranged in at least one row in the circumferential direction of the wall. The plurality of holes may be arranged linearly along the circumferential direction of the wall. The number of rows is preferably 1 to 10. Each row preferably contains 2 to 20 holes. The plurality of holes may be advantageously spaced equally apart in the circumferential direction of the elongated body. Preferably, the holes are arranged in 2 to 4 rows and / or each row contains 4 to 8 holes. Thus, it is preferable that the plurality of holes in adjacent rows are arranged in a staggered manner. For example, two rows may be provided in each end region, and each row may contain, for example, 6 holes.

[0075] The number and arrangement of holes and rows have been found to be advantageous in providing and maintaining the necessary structural stability while simultaneously improving the retention of the medical adhesive for fixing it to the medical tissue wrap. Furthermore, such embodiments may exhibit rotational symmetry. This rotational symmetry can facilitate the precise placement of the medical tissue wrap at the target tissue site. In certain embodiments, the size or diameter of the holes may be 50 μm to 750 μm, and for further improvement of structural stability, the size or diameter of the holes may be preferably 150 μm to 600 μm, and in particular, about 500 μm.

[0076] Each hole may be formed as a cut-out, recess, or radial through-hole in the wall. This can result in improved fixation of the medical adhesive. Radial through-holes may be particularly advantageous. Such radial through-holes can facilitate the medical adhesive surrounding the wall at each longitudinal end portion, particularly both externally and internally, of the medical tissue wrap. This may depend on the selected dimensions and / or, in particular, the diameter of the hole. Furthermore, this may allow the medical adhesive to come into contact with the internal anatomical structures contained within the through-hole. Thus, the hole may have a radial height or depth corresponding to the strength or thickness of the wall, or it may have a reduced height. Preferably, the hole has a minimum height or depth of about 50 μm. The hole may have a height or depth of 50 μm to 500 μm or 50 μm to 600 μm, and more preferably 150 μm to 300 μm or 150 μm to 400 μm.

[0077] In some embodiments, one or more of the retaining surfaces of each longitudinal end portion may preferably be formed as at least one groove extending helically along the longitudinal axis defined by the wall. This helical shape may define a ridge extending along the outer surface of each longitudinal end portion.

[0078] One or more of the grooves may have sharp edges, but preferably at least one of the grooves has a rounded edge. A rounded edge should be understood as one where there are no straight (angular) edges or steps at the boundary between the groove and the top outer surface of each longitudinal end portion, and / or at the bottom surface where the groove and the side wall face each other. Instead, a gentle transition may be provided at the corner of the groove. The rounded edge can reduce stress within the wall material, thereby reducing the occurrence of fracture or breakage. Therefore, by providing a rounded edge, the required thickness of the wall, at least at the longitudinal end portion supporting the groove, can be reduced.

[0079] Instead of, or (preferably) in addition to, a rounded edge, at least one of the grooves may define at least one undercut. Providing an undercut can improve the fixation of the medical adhesive to each longitudinal end portion. The undercut may be formed such that the bottom portion of the groove is at least partially covered by the outer surface of the wall; that is, the outer wall surface may extend at least partially over the groove in the longitudinal direction. Preferably, such extension forms an angle of 45 to 90 degrees, preferably 60 to 85 degrees, more preferably 70 to 80 degrees, and even more preferably about 75 or 90 degrees (between the bottom of the groove and the side wall). As a result, the shape fit or positive locking between the applied medical adhesive and each longitudinal end portion can be improved.

[0080] To reduce the overall radial extension of the elongated body and nerve wrap, at least one of the grooves may define the outermost edge of each of the longitudinal end portions in the longitudinal direction of the wall. Therefore, the groove may terminate at the longitudinal end face of the wall and extend along the circumference of that end face, resulting in reduced radial extension at that end. This may reduce the overall dimensions of the medical tissue wrap. Alternatively, the groove may terminate longitudinally offset (shifted) from the longitudinal end face. This may be advantageous for further improving structural stability.

[0081] The depth or (top) longitudinal extension of the groove may be substantially constant along the circumference and over the entire longitudinal extension. Preferably, the groove may have a minimum depth of about 50 μm. The groove may have a depth of 50 μm to 500 μm, and more preferably 150 μm to 300 μm. Preferably, the groove may have a minimum (top) longitudinal extension of about 20 μm. The groove may have a thickness (width) of 10 μm to 100 μm, and more preferably 15 μm to 50 μm. According to the present invention, the (top) longitudinal extensions between convex grooves and between concave grooves may be equal or different.

[0082] The extension and / or angle of at least one of the grooves may vary. Preferably, at least one of the grooves extends 0.5 to 10 turns around the longitudinal axis defined by the wall, resulting in a helical structure (in one or more longitudinal end portions). Preferably, the groove extends for more than one turn around the longitudinal axis defined by the wall. In particular, the number of turns may be 2 to 6, preferably 3 to 5, or 4.

[0083] In some embodiments, the longitudinal end portion (or each of two longitudinal end portions) may have a single groove. In other embodiments, each (one or more) longitudinal end portion may have at least two grooves. In particular, if two or more grooves are provided on the same longitudinal end portion, each groove may extend 0.5 to 5 turns around the longitudinal axis. At least two grooves may extend in parallel, for example, forming two or more parallel (non-intersecting) helices. As a result, preferably, the arc length, curvature, and torsion of these parallel grooves / helices are the same, differing only in their position (on the longitudinal end portion). Preferably, the distance between two or more parallel grooves / helices is regular (i.e., approximately the same).

[0084] In some embodiments, at least two of the grooves may extend in opposing circumferential directions and intersect each other. Both embodiments may be combined, that is, two or more grooves may extend in parallel, and two or more additional grooves may extend in opposing circumferential directions, optionally also in parallel (so that multiple parallel intersecting grooves create a "checkered" or "pineapple" pattern). The number of grooves in each circumferential direction may be 1 to 10, preferably 6 to 8, or 7, depending on the longitudinal extension and groove angle of each end portion. Furthermore, it is preferable that the number of grooves is equal in each circumferential direction. Furthermore, in a single longitudinal end portion (or in each end portion), the grooves / spirals preferably differ only in their direction (and position on the end portion), and preferably other helical parameters are the same. In other words, (except for the direction of intersecting spirals) the arc length, curvature, and torsion may be substantially the same for all grooves / spirals in a given longitudinal end portion. By providing multiple grooves (e.g., two or more grooves) in each circumferential direction, a diamond-shaped or rhombus-shaped pattern is provided on the outer surface of each longitudinal end portion, which may resemble a pineapple surface. As a result, multiple retaining surfaces with numerous edges may be provided, which may be advantageous for fixing medical adhesives to each longitudinal end portion.

[0085] In some embodiments, one or more of the retaining surfaces at each end portion may be formed as one or more circumferential ribs (elongated projections) extending from the outer surface of the wall. The extension of one or more of the ribs may be arranged linearly (for example, parallel) along the circumferential direction in the longitudinal direction of the wall, or inclined with respect to the circumferential direction (for example, diagonally). Preferably, if there are multiple ribs, for example, three to six ribs, at each end portion, the multiple ribs may be spaced equally apart from each other, and the multiple ribs may not intersect, i.e., preferably, be arranged parallel to each other.

[0086] One or more retaining surfaces may generally be provided on thickened wall portions at each longitudinal end portion, in accordance with the desired implementation of the retaining surfaces and the structural requirements at the longitudinal end portions. Examples of preferred thicknesses or ranges of thickness are given above. The thickened wall portions may be made flush with the outer surface of the central portion by providing appropriate rounding or filleting.

[0087] Furthermore, one or more holes, and in particular grooves, may be provided as convex (positive) features on the outer surface of a wall having otherwise substantially continuous thickness. Thus, the wall may have convex projections or protrusions at each longitudinal end portion defining each groove or hole, while the wall portions between opposite longitudinal end portions do not have such convex features. In such cases, the outer surface of the wall preferably defines the inner radius of each groove or hole.

[0088] Furthermore, in order to enhance the effectiveness of the medical adhesive, and preferably to improve the shape compatibility or interlock between the medical adhesive and the medical tissue wrap, the retaining surface may be at least partially included on a portion of the wall directly adjacent to each of the longitudinal end portions. For example, one or more grooves may extend on a portion of the wall directly adjacent to a longitudinal end portion without increasing the wall thickness (for example, they may start from or end in the middle or intermediate portion of the wall). Such extension of the retaining surface may provide a gradual transition of the retaining surface while improving load distribution on the wall (and the entire medical tissue wrap).

[0089] One or more of the retaining surfaces may be provided on only one of each end portion of the medical tissue wrap. Preferably, one or more retaining surfaces are provided on both end portions that are longitudinally opposite to each other, i.e., on two end portions that are opposite to each other. Multiple longitudinal end portions (of the same medical tissue wrap) may have different types of retaining surfaces, i.e., one longitudinal end portion may include grooves and other end portions may include multiple holes. However, it is preferable that the longitudinal end portions have retaining surfaces that are formed in the same way.

[0090] The retaining surfaces of the end portions opposite each other may be mirror symmetric with respect to the transverse central plane of the wall (or medical tissue wrap). As a result, they are aligned in opposite directions to each other. For example, each of the end portions (of the same medical tissue wrap) that are opposite each other longitudinally may contain one or more grooves / spirals as described above. In this case, the grooves or spirals of the different longitudinal end portions may be substantially corresponding to each other (for example, they may have the same number and / or pattern). However, these different longitudinal end portions differ in that their grooves / spirals are formed in a mirror symmetric configuration with respect to the transverse central plane of the wall (or the entire medical tissue wrap), and as a result, they are aligned in opposite directions to each other. For example, the grooves may extend clockwise on one longitudinal end portion while extending counterclockwise on the other longitudinal end portion. However, alternatively, the retention surfaces of different longitudinal end portions of the same medical tissue wrap may be oriented or positioned in the same direction, for example, having grooves or ridges in the same direction (clockwise or counterclockwise).

[0091] In a special embodiment, the outermost edge of each longitudinal end portion is offset longitudinally in the wall, and the wall thickness may be reduced in this offset portion (which allows for an increase in the amount of medical adhesive applied to the edge of the medical tissue wrap). In this special case, if a retaining surface is present, the retaining surface may be included on the portion of the wall between the offset and the central portion of the longitudinal end portion.

[0092] The walls of medical tissue wraps described herein may be formed from biocompatible materials, inert materials, implantable materials, and / or biodegradable materials. The materials may be selected to provide a certain level of structural stability while substantially avoiding, or at least reducing, the inflammatory response of the patient being treated. For example, biocompatible materials may be selected. These biocompatible materials may gradually degrade over time after implantation, but may initially provide sufficient structural support for adequately repairing, for example, nerve damage during tissue movement.

[0093] Furthermore, to improve treatment outcomes, certain materials may be favorably selected to promote or support repair (e.g., nerve growth) by comprising, incorporating, or including, for example, a biologically active agent and / or a corresponding coating of one or more neurotrophic factors. Other examples of such biologically active surface functionalities include, but are not limited to, anti-inflammatory agents, immunosuppressants, neurotrophic factors, and neuroprotective agents. Examples of such biologically active agents include cytokines, nerve growth factors, hyaluronic acid, tacrolimus, cyclosporine A, melatonin, vitamin B12, methylprednisolone, riluzole, taxol, cetuximab, 4-aminopyridine (4-AP), and tesamorelin. A preferred example is tacrolimus. The bioactive agent may be surface-bound and / or entrapped within a structure (e.g., its wall) that defines the medical tissue wrap.

[0094] Preferably, the wall is formed from a polymer-based material, and more preferably from an elastomer. This has the advantage that multiple manufacturing methods can be applied and / or that specific properties of the material can be derived, for example, based on polymer units. In particular, the polymer-based material may be a biocompatible material that further possesses elastic properties so that, in the implanted state, the medical tissue wrap can adapt to the movement of the tissue surrounding the internal anatomical structure to be treated.

[0095] The wall may be formed of polymerized and / or crosslinked polymer units, which preferably contain an ester group component and an acidic ester group component. The ester group component is preferably a polyol. The acidic ester group component is preferably a polyacid.

[0096] The material used for the wall may preferably be identical throughout its periphery and along its longitudinal extension. This may further facilitate manufacturing and allow the structural properties of the wall to be substantially homogeneous along the longitudinal direction of the medical tissue wrap. In this regard, if the medical tissue wrap is properly constructed, biodegradation (and / or bioreabsorption) may occur in a predetermined or expected manner. However, at least a portion of the wall may be formed from a different material than one or more other portions of the wall. For example, such a configuration may be advantageous if one longitudinal end portion has a specific functionality and may require different properties (e.g., if such a longitudinal end portion is configured as a primary inlet for the application of medical adhesive).

[0097] The medical tissue wrap may be formed by a 3D printing process. The 3D printing process is particularly advantageous when the material of the medical tissue wrap is polymer-based, in which case the material can be cured substantially instantaneously, for example, using (UV) light. Furthermore, this provides a level of precision that cannot be (easily) achieved by extrusion and / or dipping processes and / or molding. In particular, the 3D printing process makes it possible to achieve specific shapes for the medical tissue wrap. For example, the printing process may incorporate specific bioactive agents into a 3D structure in a predetermined pattern (for example, within mesh structures formed by the 3D structure, and / or especially within pockets or cavities). This can further improve the coordination and support of tissue repair and / or allow biodegradation to be achieved in a more controllable manner. Furthermore, such a 3D printing process may introduce local material stress. This can provide a predetermined biasing force, for example, by producing a predetermined elasticity, thereby promoting the re-wrapping function of the walls.

[0098] Furthermore, the above objectives are achieved by the use of the medical tissue wrap described above for repairing, supporting, and / or guiding nerve tissue, particularly for repairing peripheral nerve damage. Furthermore, the nerve wrap may be used in combination with a medical adhesive. The medical adhesive according to the present invention may be any medical adhesive in the art. In some embodiments, the medical adhesive can polymerize when exposed to light. Prior to such polymerization, the medical adhesive may be fluid or viscous. Preferably, the medical adhesive is a light-curable compound. In some embodiments, the photoinitiator is sensitive to ultraviolet (UV) radiation. According to a preferred embodiment, the medical adhesive is polyglycerol sebacate acrylate (PGSA) or PGSAA, or comprises PGSA or PGSAA (e.g., as described in WO2021 / 078962).

[0099] In a further embodiment, the present invention also provides a parts kit comprising at least one of the above-described medical tissue wraps. In some embodiments, the parts kit comprises at least two (e.g., one, two, three, four, five, six, seven, eight, nine, ten, or more) distinct medical tissue wraps. The multiple distinct medical tissue wraps may differ, for example, in their dimensions (e.g., inner diameter and / or longitudinal extension). In some embodiments, the parts kit comprises at least one of the above-described medical tissue wraps and the above-described medical adhesive.

[0100] According to another aspect of the present invention, a method for treating peripheral nerve injury is proposed. The method is - The process of preparing the medical tissue wrap described above, -The step of unwinding the wall of the medical tissue wrap so that a circumferential gap is created between the circumferential end face of the circumferential inner end portion and the circumferential end face of the circumferential outer end portion, - The step of inserting the damaged nerve into the medical tissue wrap through the gap, - The process of fixing the damaged nerve within the wall by re-wrapping the wall, Includes.

[0101] In a further embodiment, the present invention also provides a method for supporting (protecting) nerves. - A step of preparing a medical tissue wrap according to any one of claims 1 to 45, -The step of unwinding the wall of the medical tissue wrap so that a circumferential gap is created between the circumferential end face of the circumferential inner end portion and the circumferential end face of the circumferential outer end portion, - The step of inserting the nerve to be supported into the medical tissue wrap through the gap, - A step of fixing the nerve to be supported within the wall by re-wrapping the wall, Includes.

[0102] Preferably, the step of fixing the nerve (the damaged nerve or the nerve to be supported) is further carried out by applying a medical adhesive to the outside of the through hole, the circumferential end face of the circumferential outer portion, and / or the longitudinal end portions on opposite sides of the wall, and / or the boundary with nerve tissue.

[0103] Similarly, the method of the present invention can also be used to fix (damaged or supported) tendons or blood vessels.

[0104] [Brief explanation of the drawing] This disclosure will be more readily understood by considering and referring to the following detailed description in conjunction with the attached drawings. Figure 1 is a schematic diagram showing a medical tissue wrap according to the present invention in a schematic perspective view. Figure 2 is a schematic diagram showing a cross-sectional view of the medical tissue wrap according to the present invention. Figure 3 is a schematic diagram showing a perspective side view of a medical tissue wrap according to the present invention, which has a longitudinal end portion with a retention surface. Figure 4 is a longitudinal cross-sectional view showing the medical tissue wrap according to Figure 3. Figure 5 shows a cross-sectional view of one longitudinal end portion of the medical tissue wrap according to Figure 3. This is a diagram. Figures 6 to 9 are schematic diagrams showing a medical tissue wrap according to the present invention, having an end portion with an alternative retention surface, in a perspective side view. Figure 10 is a schematic diagram of the undercut defined by the groove shown in Figure 3. Figure 11 is a cross-sectional view of a medical tissue wrap according to the present invention, having an alternative configuration for the circumferential inner end portion and the circumferential outer end portion. Figure 12 is a schematic diagram of a medical tissue wrap according to the present invention, in which the outermost edges of each longitudinal end portion are offset in the longitudinal direction of the wall.

[0105] [Detailed description of preferred embodiments] The present invention will be described in more detail below with reference to the attached drawings. In the drawings, similar elements are denoted by the same reference numerals, and redundant explanations may be omitted to avoid redundancy.

[0106] Figure 1 schematically shows a medical tissue wrap 10 according to the present invention in a perspective view. The medical tissue wrap is substantially formed by a wall 12, which extends in the longitudinal direction. The wall 12 is also rolled up to define a substantially continuous through-hole 16. The wall 12 is rolled up around two longitudinal axes such that, when the wall 12 is rolled up, the through-hole 16 is closed to the outside and completely surrounded by the wall around its entire circumference. This closure is provided by a circumferential inner end portion 20 of the wall 12 and a circumferential outer end portion 22 of the wall 12 that overlaps the circumferential inner end portion 20, as shown in more detail in Figure 2.

[0107] In this non-limiting embodiment, the through-hole 16 has a tubular shape, and in particular, a substantially circular shape in cross-sectional view, and a continuous inner diameter. Such a configuration may be advantageous because it corresponds to the typical cylindrical and / or tubular extension of the preferred internal anatomical structure (particularly the damaged peripheral nerve) that it accommodates within the through-hole 16. Furthermore, this allows for the achievement of a certain structural stability and / or more homogeneous structural stability of the medical tissue wrap. Furthermore, in this embodiment, the wall thickness is substantially continuous throughout the entire longitudinal extension of the medical tissue wrap 10 and along the periphery of the medical tissue wrap 10. The wall thickness may be selected based on the structural support and resilience of the wall 12 required in consideration of the internal anatomical structure being treated.

[0108] Furthermore, the tubular shape and continuous wall thickness of the wall 12 allow the external dimensions to be substantially continuous. This may be advantageous for transplanting the medical tissue wrap 10 with consideration for the surrounding tissue. In addition, the tubular or cylindrical shape can provide sufficient structural stability, preventing abrupt bending or twisting during tissue movement, i.e., contraction or extension.

[0109] As shown in Figure 2, the closure of the through-hole 16 is achieved by the overlapping portion of the wall 12 in the circumferential direction. When rolled up, this overlap is achieved when the circumferential outer end portion 22 surrounds the corresponding circumferential inner end portion 20 in the region of the circumferential end faces 28, 28' of the wall 12. In other words, the circumferential extension 40 of the circumferential outer end portion 22 corresponds to the circumferential extension of the circumferential inner end portion 20, so as to provide a complete overlap. The circumferential extension 40 shown in this embodiment corresponds to approximately 30 degrees of the outer circumference of the medical tissue wrap 10 defined by the wall 12. The circumferential extension 40 ensures that there are no circumferential gaps between the circumferential end faces 28, 28' of the wall 12 when rolled up, so that the internal anatomical structures contained within the through-hole 16 are securely held within the through-hole 16.

[0110] Furthermore, as shown in Figure 2, the circumferential outer end portion 22 is separated from the circumferential inner end portion 20 by a radial spacing 24. That is, the circumferential outer end portion 22 is radially separated from the circumferential inner end portion 20 along its entire circumferential extension 40. As a result, the handling of the medical tissue wrap 10 for application around the target tissue to be treated is improved by facilitating the unwinding of the wall 12.

[0111] However, the radial spacing 24 is discontinuous. That is, in the overlapping portion, there is a portion where the radial spacing 24 is reduced (however, there is a portion that does not result in a contact surface between the circumferential inner end portion 20 and the circumferential outer end portion 22). In this embodiment, this reduction in radial spacing 24 is brought about by the curved portion 26 of the circumferential outer end portion 22, and this curved portion 26 defines a gradual reduction in radial spacing 24 from the level of the circumferential end face 28' of the circumferential inner end portion 20 toward the circumferential end face 28 of the circumferential outer end portion 22. As a result, improved closure of the through-holes 16 to the surrounding tissue is achieved while maintaining improved usability and the possibility of unwrapping the medical tissue wrap 10. In particular, as a result of the reduction in radial spacing 24, the maximum radial spacing 38 is obtained at the level of the circumferential end face 28' of the circumferential inner end portion 20.

[0112] Figures 3 to 5 show various diagrams of one embodiment of a medical tissue wrap 10 according to the present invention, having longitudinal end portions 18 with a retaining surface 42. The medical tissue wrap 10 is shown in a perspective view in Figure 3. The wall 12 defines a central portion 14 and includes two longitudinal end portions 18. These end portions 18 are located at the ends of the wall 12 that are longitudinally opposite to each other and are positioned directly adjacent to the central portion 14. As shown in the schematic diagram in Figure 3, the outer surfaces of both longitudinal end portions 18 are aligned with or flush with the outer surface of the central portion 14, resulting in a homogeneous, stepless outer surface without sharp edges, recesses, and / or protrusions that could adversely affect the surrounding tissue when the medical tissue wrap 10 is implanted.

[0113] In this embodiment, these longitudinal end portions 18 have the same shape and dimensions so as not to affect the procedure even if the orientation of the medical tissue wrap 10 is reversed during transplantation.

[0114] The medical tissue wrap 10 is substantially similar to the embodiment shown in Figure 1. However, these longitudinal end portions 18 are provided with retaining surfaces 42 configured to facilitate the fixation of the medical adhesive to each longitudinal end portion 18 on the outer surface of the wall 12. In an optional alternative embodiment, the retaining surfaces 42 may also be at least partially included on the central portion 14 directly adjacent to each longitudinal end portion 18.

[0115] According to the embodiments shown in Figures 3 to 5, the multiple retaining surfaces 42 are provided in the form of grooves 46. The grooves 46 extend spirally along the outer surface of the wall 12 and along the longitudinal axis defined by the wall 12. This spiral shape of the grooves 46 substantially defines a linear shape extending along the outer surface of each longitudinal end portion 18. The grooves 46 or linears are formed in a mirror-symmetric configuration with respect to the transverse central plane of the wall 12. As a result, the grooves 46 or linears are positioned (oriented) in opposite directions to each other, i.e., extending in a clockwise and counterclockwise direction. The number of rotations may vary. In this embodiment, grooves 46 having four rotations are shown, which has been found to be particularly advantageous in that it promotes the fixation of medical adhesives while maintaining the structural stability and flexibility of the medical tissue wrap 10. Furthermore, the grooves 46 terminate longitudinally offset from the longitudinal end faces of each end portion 18, which is further advantageous in terms of structural stability.

[0116] Furthermore, as shown below in more detail with reference to Figure 10 (shown as a dashed circle in Figure 3), the groove 46 may include a rounded edge and may define a substantially continuous undercut. This improves the effectiveness of the medical adhesive by forming a shape-conforming geometric shape.

[0117] Furthermore, as directly shown in the longitudinal section view of Figure 4, the structural external modification portion in the form of the retaining surface 42 is provided on the thicker portion of the wall 12 compared to the thickness 30 of the wall 12 that defines the central portion 14.

[0118] In Figure 5, the radial spacing 24 is discontinuous. That is, there are portions where the radial spacing 24 is reduced in the overlapping areas. In particular, as a result of the reduction in radial spacing 24, the maximum radial spacing 38 is obtained at the level of the circumferential end face 28' of the circumferential inner end portion 20. In this embodiment, this reduced radial spacing 24 is brought about by the curved portion of the circumferential outer end portion 22. More specifically, the reduced radial spacing 24 at the circumferential end faces (28, 28') is approximately 90 percent of the maximum radial spacing 38 of the discontinuous spacing.

[0119] As described above, the longitudinal end portion 18 is provided with a structural external modification in the form of a retaining surface 42, and this structural external modification is provided on the thickened portion of the wall 12. Therefore, the wall 12 of the circumferential inner end portion 20 is thinner in the circumferential direction compared to the (thickened) wall 12 of the outer end portion 22 and the (thickened) wall 12 of (most of) the non-overlapping circumferential portion of the (thickened) wall 12. However, as shown in Figure 5, the non-overlapping circumferential portion of the wall 12 may also include a section 35 having a reduced wall thickness. Section 35 is directly adjacent to the circumferential inner end portion 20 having a reduced wall thickness. This allows for a smooth transition between (i) the substantially constant wall thickness between the outer end portion and (most of) the non-overlapping circumferential portion of the wall 12 and (ii) the inner end portion 20 having a reduced wall thickness compared to (i). Therefore, the wall thickness can be gradually reduced (starting) toward the inner end portion 20 in the non-overlapping circumferential portion section 35 of wall 12, thereby reaching the minimum wall thickness (in the circumferential direction) at the inner end portion 20 (the circumferential end face 28'). This preferably avoids sharp edges, resulting in a homogeneous, step-free outer surface without sharp edges. The thinned section 35 of the non-overlapping circumferential portion of wall 12 is provided at the circumferential offset 36. Because the inner end portion has a reduced wall thickness, and optionally, the adjacent non-overlapping circumferential portion section 35 of wall 12 also has a reduced wall thickness, manufacturing may be easier, and the circumferential outer end portion 22 may be better aligned with the adjacent outer circumference of the wall. Furthermore, this may facilitate the handling of the medical tissue wrap 10, particularly the accessibility of the circumferential outer end portion 22, and as a result, the unwrapping of the wall 12 and the medical tissue wrap 10 may be supported by the provision of visual cues and small gripping recesses.

[0120] Figures 6 to 9 show alternative embodiments of the retaining surface 42 in the embodiments of Figures 3 to 5. Figure 6 shows one embodiment in which the retaining surface 42 is located on longitudinal end portions 18 that are opposite each other. Each longitudinal end portion 18 includes a plurality of grooves 46 that extend in opposing circumferential directions and intersect each other, as indicated by the corresponding arrows. In this embodiment, four grooves 46 are provided in each circumferential direction in each end portion 18, and the number of grooves 46 is equal in each circumferential direction. As shown in Figure 6, the plurality of grooves 46 in each circumferential direction make a diamond shape or rhombic shape on the outer surface of each longitudinal end portion 18 by spiraling half a turn along the longitudinal axis defined by the wall 12. The outer surface often resembles the surface of a pineapple. As a result, a plurality of retaining surfaces 42 with a plurality of edges can be provided, which may be advantageous for fixing medical adhesive to each end portion 18. Such a pineapple surface can also be obtained by providing a plurality of rhombic chambers. In this case, the opposing circumferential grooves 46 are not perfectly aligned with each other.

[0121] In the embodiment shown in Figure 7, the multiple retaining surfaces 42 are provided in the form of holes 44. The holes 44 in this embodiment are substantially circular but have a slight ellipsoidal shape. The holes 44 may occur, for example, during manufacturing and are formed as through-holes that penetrate the wall 12 defining the medical tissue wrap 10. In the exemplary embodiment, the holes 44 are arranged in two longitudinally spaced rows in the circumferential direction of the wall 12, that is, the holes 44 are arranged linearly along the circumferential direction of the wall 12 within each row, and the rows are longitudinally offset from each other. One row of the multiple holes 44 in each longitudinal end portion 14 may be provided (at least partially) in the central portion 14 directly adjacent to each longitudinal end portion 18, or at the boundary between the central portion 14 and each longitudinal end portion 18. If the wall thickness does not vary, the central portion 14 and the longitudinal portions 18 may be characterized, for example, by structural and / or (bio)chemical properties, and / or by the material used for the wall portions. It will also be understood that the holes 44 may be provided only at each longitudinal end portion 18. Each row contains six holes 44 spaced equally apart in the circumferential direction of the wall 12, and the holes 44 are arranged in a staggered pattern between adjacent rows.

[0122] The embodiments shown in Figures 8 and 9 are substantially similar to the embodiment shown in Figure 3. However, instead of having grooves embedded within the thickened wall portion at the longitudinal end portion, the longitudinal end portion 18 includes a plurality of positive (convex), for example, raised ribs 41. These ribs 41 are located on a substantially continuous wall that defines the through-hole 16 and the medical tissue wrap 10. In the embodiment of Figure 8, the plurality of ribs 41 are arranged substantially spirally, whereas in the embodiment of Figure 9, the plurality of ribs 41 are arranged linearly and circumferentially.

[0123] Figure 10 shows a schematic diagram in longitudinal section of the undercut defined by the groove 46 corresponding to the dashed line in Figure 3. As shown, the top outer surface and the bottom surface of the groove 46 correspond to the outer radius 50 and inner radius 48, respectively, and define the groove depth 54. These are rounded, thereby reducing the stress that would occur in a material having a groove 46 with sharp edges if it were not rounded. Furthermore, the top surface extends longitudinally above the bottom surface. As a result, an angle 52 of the groove 46 and a corresponding undercut are formed on the bottom surface, as shown by the dashed line. In this case, the longitudinal extension of the bottom may be greater than the longitudinal extension of the top of the groove 46. The angle 52 (preferably about 75 degrees) and the corresponding undercut enable shape compatibility or positive locking between the applied medical adhesives. Each longitudinal end portion 18 may also be provided in the radial direction. This further improves the effectiveness of medical adhesives for fixing internal anatomical structures to each longitudinal end portion 18.

[0124] Figure 11 shows a cross-sectional view of a medical tissue wrap 10 according to the present invention having an alternative configuration of circumferential inner end portions and circumferential outer end portions 20, 22. The embodiment may be substantially similar to the embodiment shown in Figure 5. However, in this embodiment, the circumferential inner end portion 20 and the circumferential outer end portion 22 each include a curved portion. These curved portions extend in opposite circumferential directions. As a result, a radial spacing 24 is provided that gradually decreases toward each of the circumferential end faces 28, 28'. In this case, the radial spacing 24 decreases starting from a local maximum radial spacing 38.

[0125] The maximum radial spacing 38 shown in this embodiment is configured such that the circumferential extension 40 of each curved portion is substantially the same, that is, each curved portion spans approximately equal angles on the outer circumference of the medical tissue wrap 10. For example, the entire angle or entire circumferential extension of the circumferential outer end portion 22 may be about 60 degrees on the outer circumference of the medical tissue wrap 10. Therefore, each curved portion spans an angle of about 30 degrees.

[0126] Similar to the embodiment shown in Figure 5, the embodiment in Figure 11 also has an inner end portion 20 with reduced wall thickness and a non-overlapping section 35 of the wall 12. The section 35 has reduced wall thickness and is located adjacent to the inner end portion 20. As shown in Figure 11, the wall 12 of the circumferential inner end portion 20 is thinner in the circumferential direction compared to the (thickened) wall 12 of the outer end portion 22 and the (thickened) wall 12 of (most of) the non-overlapping circumferential portion of the (thickened) wall 12.

[0127] Figure 12 shows a schematic diagram of the medical tissue wrap according to the present invention, in which the outermost edges of each longitudinal end portion are offset in the longitudinal direction of the wall. The grooves are started in such a way that additional thickness at the conduit edge is minimized.

[0128] It will be apparent to those skilled in the art that these embodiments and items merely illustrate a number of possible examples. Therefore, the embodiments described herein should not be understood as limiting these features and configurations. Any possible combinations and configurations of the described features can be selected in accordance with the scope of the invention.

[0129] [List of reference figures] 10 Medical tissue wraps 12 walls 14 Central part 16 through holes 18 Longitudinal end portion 20 Circumferential inner end portion 22 Circumferential outer end portion 24 radial spacing 26 Curved section 28, 28´ Circumferential end face 30 wall thickness 32 Inner curved section 34 Outer curved part 35 Section of a wall with reduced wall thickness, non-overlapping circumferential portion 36 offset 38 Maximum radial spacing 40 Circumferential extension 41 Ribs 42 Retaining surface 44 holes 46 Groove 48 Inner radius 50 outer radius 52 angle 54. Depth of groove [Brief explanation of the drawing]

[0130] [Figure 1] This is a schematic diagram showing a medical tissue wrap according to the present invention in a schematic perspective view. [Figure 2] This is a schematic diagram showing a cross-sectional view of the medical tissue wrap according to the present invention. [Figure 3] This is a schematic diagram showing a medical tissue wrap according to the present invention, having a longitudinal end portion with a retention surface, in a perspective side view. [Figure 4] Figure 3 is a longitudinal cross-sectional view showing a medical tissue wrap. [Figure 5] Figure 3 shows a cross-sectional view of the medical tissue wrap at one of the longitudinal ends. [Figure 6] This is a schematic diagram showing a medical tissue wrap according to the present invention, having an end portion with an alternative retention surface, in a perspective side view. [Figure 7] This is a schematic diagram showing a medical tissue wrap according to the present invention, having an end portion with an alternative retention surface, in a perspective side view. [Figure 8] This is a schematic diagram showing a medical tissue wrap according to the present invention, having an end portion with an alternative retention surface, in a perspective side view. [Figure 9] This is a schematic diagram showing a medical tissue wrap according to the present invention, having an end portion with an alternative retention surface, in a perspective side view. [Figure 10] Figure 3 is a schematic diagram of the undercut defined by the groove. [Figure 11] This is a cross-sectional view of a medical tissue wrap according to the present invention, having an alternative configuration for the circumferential inner end portion and the circumferential outer end portion. [Figure 12]This is a schematic diagram of a medical tissue wrap according to the present invention, in which the outermost edges of each longitudinal end portion are offset in the longitudinal direction of the wall.

Claims

1. Medical tissue wrap (10) for the internal anatomical structures of mammals, The tissue wrap (10) is formed by a rolled wall (12) having a circumferential inner end portion (20) and a circumferential outer end portion (22) that extends around the circumferential inner end portion (20) and overlaps with the circumferential inner end portion (20). As a result, the wall (12) defines a longitudinal through-hole (16) for accommodating at least a portion of the internal anatomical structure. The circumferential outer end portion (22) is radially separated from the circumferential inner end portion (20) by a discontinuous interval in the circumferential direction. The circumferential outer end portion (22) of the medical tissue wrap (10) is not in direct contact with the circumferential inner end portion (20).

2. The medical tissue wrap (10) according to claim 1, wherein the discontinuous spacing includes a reduced radial spacing (24) formed by the curved portion (26) of the circumferential inner end portion (20) and / or the curved portion (26) of the circumferential outer end portion (22).

3. The reduced radial spacing (24) is formed as a gradually decreasing spacing, and / or The reduced radial spacing (24) extends from an overlapping portion having a continuous radial spacing, the medical tissue wrap (10) according to claim 2.

4. The medical tissue wrap (10) according to any one of claims 1 to 3, wherein the radial spacing (24) at the circumferential end face (28') of the circumferential inner end portion (20) is smaller than the radial spacing (24) at the circumferential end face (28) of the circumferential outer end portion (22).

5. The medical tissue wrap (10) according to any one of claims 1 to 3, wherein the radial spacing (24) at the circumferential end face (28) of the circumferential outer end portion (22) is smaller than the radial spacing (24) at the circumferential end face (28') of the circumferential inner end portion (20).

6. The medical tissue wrap (10) according to any one of claims 1 to 3, wherein the radial spacing (24) at the circumferential end face (28') of the circumferential inner end portion (20) and the radial spacing (24) at the circumferential end face (28) of the circumferential outer end portion (22) are smaller than the radial spacing (24) in the overlapping portion between the circumferential end face (28') of the circumferential inner end portion (20) and the circumferential end face (28) of the circumferential outer end portion (22).

7. The medical tissue wrap (10) according to any one of claims 4 to 6, wherein the radial spacing (24) at the circumferential end faces (28, 28') that define the reduced radial spacing (24) is 50 to 99 percent of the maximum radial spacing (38) of the discontinuous spacing, preferably 60 to 99 percent, more preferably 80 to 98 percent, even more preferably 85 to 95 percent, and even more preferably 87 to 92 percent, for example, about 90 percent.

8. The medical tissue wrap (10) according to any one of claims 4 to 7, wherein the radial spacing (24) at the circumferential end faces (28, 28') that determine the reduced radial spacing (24) is 50 μm to 300 μm, preferably 80 μm to 200 μm.

9. The maximum radial spacing (38) of the discontinuous intervals is 100 μm to 350 μm, preferably 150 μm to 250 μm, according to any one of claims 1 to 8, for the medical tissue wrap (10).

10. The circumferential extension (40) of the circumferential outer end portion (22) corresponds to 10 to 100 degrees, preferably 20 to 90 degrees, of the outer circumference of the tissue wrap (10), according to any one of claims 1 to 9.

11. The circumferential extension (40) of the circumferential outer end portion (22) corresponds to 20 to 60 degrees, preferably 30 to 45 degrees, of the outer circumference of the tissue wrap (10), according to claim 10.

12. The medical tissue wrap (10) according to claim 10 or 11, wherein the radial spacing (24) between the circumferential inner end portion (20) and the circumferential outer end portion (22) gradually decreases, starting from the maximum radial spacing (38) of the discontinuous spacing, in opposite circumferential directions, preferably with equal angular extensions.

13. Medical tissue wrap (10) for the internal anatomical structures of mammals, The tissue wrap (10) is formed by a rolled wall (12) having a circumferential inner end portion (20) and a circumferential outer end portion (22) that extends around the circumferential inner end portion (20) and overlaps with the circumferential inner end portion (20). As a result, the wall (12) defines a longitudinal through-hole (16) for accommodating a portion of the internal anatomical structure. The circumferential outer end portion (22) is radially separated from the circumferential inner end portion (20), The wall (12) is a medical tissue wrap (10) having a structural external modification portion at least on one of the longitudinal end portions (18) of the wall (12) that are opposite to each other.

14. The central portion (14) of the tissue wrap (10) extending in the longitudinal direction is positioned adjacent to the longitudinal end portions (18) of the tissue wrap (10) on opposite sides, Preferably, the medical tissue wrap (10) according to claim 13, wherein only the plurality of longitudinal end portions (18) are provided with the structural external modification portion.

15. The multiple longitudinal end portions (18) include a surface roughness that is increased compared to the surface roughness of the outer surface of the central portion (14), The medical tissue wrap (10) according to claim 14, wherein the surface roughness is formed by the structural external modification portions of the plurality of longitudinal end portions (18).

16. The medical tissue wrap (10) according to claim 14 or 15, wherein the structural external modification portion is formed on a wall portion of each of the longitudinal end portions (18) that is thicker than the wall thickness (30) of the central portion (14).

17. The medical tissue wrap (10) according to claim 16, wherein the thickness (30) of the thickened wall portion is 1.1 to 5.0 times, preferably 1.5 to 2.5 times, the thickness (30) of the adjacent central portion (14), and / or 100 μm to 600 μm, preferably 300 μm to 500 μm.

18. The aforementioned thickened wall portion is offset (36) in the circumferential direction from the circumferential inner end portion (20), The medical tissue wrap (10) according to claim 16 or 17, wherein the offset (36) preferably includes a gradual increase in the wall thickness (30) and / or has a circumferential extension of 5 to 25 degrees on the outer circumference of the tissue wrap (10).

19. The medical tissue wrap (10) according to any one of claims 13 to 18, wherein the structural external modification portion is formed as one or more retaining surfaces (42) configured to fix a medical adhesive to each of the longitudinal end portions (18).

20. The medical tissue wrap (10) according to claim 19, wherein one or more of the retaining surfaces (42) of each longitudinal end portion (18) are formed as a plurality of ellipsoidal or circular holes (44) arranged in at least one row in the circumferential direction of the wall (12).

21. The medical tissue wrap (10) according to claim 20, wherein the plurality of holes (44) are arranged in 2 to 4 rows, each row preferably containing 4 to 8 holes (44), and / or the plurality of holes (44) in adjacent rows preferably arranged in a staggered pattern.

22. The medical tissue wrap (10) according to claim 20 or 21, wherein each hole (44) is formed as a cutout, recess, or through hole in the wall (12).

23. The medical tissue wrap (10) according to claim 19, wherein one or more of the retaining surfaces (42) of each longitudinal end portion (18) are formed as at least one groove (46) extending spirally along the longitudinal axis defined by the wall (12).

24. At least one of the grooves (46) includes a rounded edge, and / or The medical tissue wrap (10) according to claim 23, wherein at least one of the grooves (46) defines at least one undercut.

25. The medical tissue wrap (10) according to claim 23 or 24, wherein at least one of the grooves (46) defines the outermost edge of each of the longitudinal end portions (18) in the longitudinal direction of the wall (12).

26. The medical tissue wrap (10) according to any one of claims 23 to 25, wherein at least one of the grooves (46) extends for 0.5 to 10 turns around the longitudinal axis defined by the wall (12).

27. The medical tissue wrap (10) according to claim 26, wherein at least one of the grooves (46) extends two to six turns around the longitudinal axis defined by the wall (12).

28. Each of the aforementioned longitudinal end portions (18) is provided with at least two grooves (46) that extend in opposing circumferential directions and intersect each other. The medical tissue wrap (10) according to claim 26, wherein each groove (46) extends for 0.5 to 5 turns around the longitudinal axis.

29. The medical tissue wrap (10) according to claim 19, wherein one or more of the retaining surfaces (42) of each longitudinal end portion (18) are formed as one or more circumferential ribs (41) extending from the outer surface of the wall (12).

30. The medical tissue wrap (10) according to claim 29, wherein the extension of one or more ribs (41) is arranged linearly along the circumferential direction in the longitudinal direction of the wall (12), or is arranged inclined with respect to the circumferential direction.

31. The medical tissue wrap (10) according to any one of claims 1 to 12, wherein the wall (12) is provided with structural external modification portions at least in the longitudinal end portions (18) opposite to each other of the wall (12) as defined in any one of claims 13 to 30.

32. The medical tissue wrap (10) according to any one of claims 1 to 31, wherein the medical tissue wrap (10) is configured to accommodate nerve tissue, preferably a damaged peripheral nerve, more preferably the proximal and distal ends of a single damaged peripheral nerve.

33. The medical tissue wrap (10) according to any one of claims 1 to 32, wherein the circumferential outer end portion (22) is formed by a single wall layer overlapping the circumferential inner end portion (20).

34. The wall (12) is wound only in the circumferential direction, the medical tissue wrap (10) according to any one of claims 1 to 33.

35. The medical tissue wrap (10) according to any one of claims 1 to 34, wherein the circumferential inner end portion (20) and the circumferential outer end portion (22) are arranged on end portions (20, 22) of the wall (12) that are circumferentially opposite to each other.

36. The medical tissue wrap (10) according to any one of claims 1 to 35, wherein the wall (12) is at least partially able to be unwound and rewound in the circumferential direction.

37. The medical tissue wrap (10) according to any one of claims 1 to 36, wherein the wall (12) is at least partially formed of an elastic or resilient material, preferably a material that can be three-dimensionally printed.

38. The medical tissue wrap (10) according to any one of claims 1 to 37, wherein the wall (12) has a thickness (30) of 50 μm to 400 μm, preferably 150 μm to 250 μm.

39. The medical tissue wrap (10) according to any one of claims 1 to 38, wherein the wall (12) is formed of a biocompatible material, an inert material, a bioimplantable material, and / or a biodegradable material.

40. The medical tissue wrap (10) according to any one of claims 1 to 39, wherein the wall (12) is formed of a polymer-based material, preferably an elastomer.

41. The wall (12) is formed of polymerized and / or crosslinked polymer units which preferably contain an ester group component and an acidic ester group component. The medical tissue wrap (10) according to any one of claims 1 to 40, wherein the ester group component is preferably a polyol and / or the acidic ester group component is preferably a polyacid.

42. A medical tissue wrap (10) according to any one of claims 1 to 41, formed by a 3D printing process.

43. Use of the medical tissue wrap (10) according to any one of claims 1 to 42 for repairing, supporting and / or guiding nerve tissue, in particular for repairing peripheral nerve damage.

44. Use of the medical tissue wrap (10) according to claim 43 in combination with a medical adhesive.

45. A method for treating peripheral nerve damage, - A step of preparing a medical tissue wrap according to any one of claims 1 to 44, - A step of unwinding the wall of the medical tissue wrap so that a circumferential gap is created between the circumferential end face of the circumferential inner end portion and the circumferential end face of the circumferential outer end portion, - The step of inserting the damaged nerve into the medical tissue wrap through the gap, - A step of fixing the damaged nerve within the wall by re-wrapping the wall, Methods that include...

46. A method of supporting the nerves, - A step of preparing a medical tissue wrap according to any one of claims 1 to 45, - A step of unwinding the wall of the medical tissue wrap so that a circumferential gap is created between the circumferential end face of the circumferential inner end portion and the circumferential end face of the circumferential outer end portion, - The process of inserting the nerve to be supported into the medical tissue wrap through the gap, - A step of fixing the nerve to be supported within the wall by re-wrapping the wall, Methods that include...

47. The method according to claim 45 or 46, wherein the step of fixing the nerve is further performed by applying a medical adhesive to the outside of the through hole, the circumferential end face of the circumferential outer portion, and / or the longitudinal end portions of the wall opposite each other.

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