System for reinforcing closure of an abdominal surgical incision and method for closing an abdominal incision with such a system

Abstract

This system (100) for reinforcing closure of an abdominal surgical incision (I) comprises at least one set of at least two strips (102, 104) of bio-compatible and bio-absorbable material. Each strip has a length between 50 à 300 mm, a width between 5 and 25 mm, a thickness between 0.75 and 2.5 mm and a series (S102, S104) of markings (1022, 1042) for the identification of suture thread passages. The markings are arranged in at least one line, with a longitudinal spacing, between two consecutive markings of a series (S102, S104) of markings, between 3 and 10 mm.

Description

[0001] TITLE: System for reinforcing closure of an abdominal surgical incision and method for closing an abdominal incision with such a system

[0002] The present invention concerns a system for reinforcing closure of an abdominal surgical incision. The present invention also relates to a method for closing an abdominal incision, using such a system

[0003] TECHNICAL FIELD OF INVENTION

[0004] The invention belongs to the field of abdominal surgery, where a midline incision is frequent. Such an incision may result in an incisional hernia, a clinical complication which may affect up to 30% of high-risk patients. This complication carries significant clinical and economic burdens, often leading to chronic pain, reduced quality of life, and severe surgical complications that may necessitate emergency intervention. The repair of an incisional hernia is also complex, associated with a high risk of recurrence, and contributes to a substantial increase in healthcare costs.

[0005] Advancements in surgical techniques include the "Small Bite Small Stitch" method mentioned by Muysoms et al in the European Hernia Society guidelines on the closure of abdominal wall incisions “Hernia” 201 ; 19(1):1-24. While the "Small Bite, Small Stitch" technique effectively reduces the rates of incisional hernia, it poses significant challenges, particularly in patients with fragile abdominal walls. In these situations, reduced tissue strength increases the risk of tearing under tension, especially when stitches are placed too closely together or when there is insufficient slack in the tissue. This can result in complications like suture pull-through or dehiscence, making the procedure more complex. Additionally, in contaminated environments, the risk of infection is heightened, compromising wound healing and potentially leading to further complications.

[0006] Prophylactic mesh placement, although beneficial in reducing hernia incidence, also presents notable limitations. These include a considerable recurrence rate, unsuitability in contaminated surgical fields due to the risk of mesh infection and a lack of reproducibility across different surgeons and settings. The variability in outcomes based on surgical experience and the specific conditions of each case poses a challenge to standardizing its use.

[0007] On the other hand, US2016 / 0120630A1 discloses a reinforcement device including a sheet of bio-compatible material equipped with a plurality of hooks. This reinforcement device is supposed to cover an abdominal incision, like a mesh. This induces the same kind of inconvenient. Given these limitations, there is a need for a new system for reinforcing closure of an abdominal surgical incision compatible with reliable and universally applicable prophylactic strategies for closing midline laparotomies. This all the more crucial for complex cases and contaminated regions

[0008] SUMMARY OF THE INVENTION

[0009] The present invention aims at solving this problem by providing a new system for reinforcing closure of an abdominal surgical incision, i.e. a laparotomy, in an efficient and safe way, more effective to prevent hernias than the known techniques, in particular in complex cases and contaminated fields.

[0010] With this respect, according to a first aspect, the present invention relates to a system for reinforcing closure of an abdominal surgical incision, the system comprising at least one set of at least two strips of bio-compatible material, each strip having

[0011] - a length between 50 a 300 mm

[0012] - a width between 5 and 25 mm

[0013] - a thickness between 0.75 and 2.5 mm

[0014] - a series of markings for the identification of suture thread passages, the markings being arranged in at least one line, with a longitudinal spacing, between two consecutive markings of a series of markings, between 3 and 10 mm.

[0015] Thanks to the invention, the set of two strips of the invention allow closing an abdominal incision by making a suture strip circulate between the two strips and through the adjacent edge of the abdominal incision. Pulling on the suture thread allows bringing the strips together, which also brings together the two edges of the abdominal incision. The two strips allow distributing a shear stress induced by the suture thread crossing the edge of the abdominal incision. This limits the risks of tearing the edges of the incision, which is favorable in terms of stability of the closure of the abdominal incision. This reduces the risk of incisional hernia. The use of strips for fascia reinforcement overcomes many of the limitations of the known techniques. The strips reduce tissue shearing by evenly distributing tension across a broader surface area, minimizing the risk of tearing in fragile abdominal walls. A method implemented with the system of the invention may utilizes "pledget" sutures, which provide additional mechanical compression and enhance wound surface coverage, further securing the closure and reducing the likelihood of dehiscence.

[0016] Moreover, strips made of bio-compatible and bio-absorbable material offer particular advantages in contaminated surgical environments, where traditional mesh is contraindicated. Made from bio-compatible materials, the strips are less likely to provoke adverse reactions or become a nidus for infection, making them safer in situations where contamination is a concern.

[0017] Additionally, the system of the invention allows for a more reproducible technique, as it depends less on the surgeon's individual experience and more on a standardized approach to placement and securing of the strips, thereby enhancing the consistency of outcomes across different settings.

[0018] According to advantageous and optional aspects of the invention, a system for reinforcing closure of an abdominal surgical incision may incorporate one or several of the following features:

[0019] The series of markings extends on the entire length of each strip.

[0020] The longitudinal spacing, between two consecutive markings of a series of markings, is constant along each strip.

[0021] The markings include through holes made in each strip, preferably with a diameter between 0.2 and 0.8 mm, most preferably equal to 0.5 mm.

[0022] The markings includes symbols printed on at least one side of each strip. The markings include coloured zones made on at least one side of each strip. The material of the strips is selected among biocompatible materials, which may be biological, bio-absorbable, partially bio-absorbable, non-bio-absorbable, or some combination of one or more of these. The biocompatible material may comprise any of a number of materials. By way of non-limiting examples, biological materials may comprise materials derived from human or animal tissues, which may comprise porcine dermal collagen, porcine small intestinal submucosa, bovine pericardium mesh, human dermal matrix, bovine fetal or neonatal dermis, and hybrid biological-synthetic. By way of non-limiting examples, bioabsorbable materials may comprise polyhydroxyacids, polylactides, polyglycolides, polyhydroybutyrates, polyhydroxyvaleriates, polycaprolactones, polydioxanones, synthetic and natural oligo- and polyaminoacids, polyphosphazenes, polyanhydrides, poly orthoesters, polyphosphates, polyphosphonates, polyalcohols, polysaccharides, and polyethers. By way of non-limiting examples, partially bio-absorbable material may comprise an association of bio-absorbable and non-bio-absorbable materials. By way of non-limiting examples, non-bio- absorbable materials may comprise polyalkenes, polyethylene, fluorinatedpolyolefins, polytetrafluoroethylene, polyvinylidenefluoride, polyamides, polyurethanes, polyisoprenes, polystryrenes, poly silicones, polycarbonates, polyaryletherketones, polymetacrylates, polyacrylates, aromatic polyesters and polyimides. The system further comprises a monofilament absorbable suture thread with a diameter between between 0.3 mm and 0.7 mm.

[0023] The monofilament absorbable suture thread has a remaining tensile strength after six weeks equal to at least 50% of its initial tensile strength and a complete absorption period shorter than eight months, preferably shorter than six months. The monofilament absorbable suture thread is made of polydioxanone.

[0024] The system further comprising a needle with a diameter in the range 0.05 to 0.1 mm.

[0025] The length of each strip is between 100 and 200 mm.

[0026] The width of each strip is about 10 mm.

[0027] The thickness of each strip is between 1 and 2 mm.

[0028] The longitudinal spacing between two consecutive markings of a series of markings is about to 5 mm.

[0029] According to a second aspect, the invention relates to a method for closing an abdominal surgical incision, this method including at least the following steps consisting in: a) placing a first strip along a first edge of the incision and a second strip along a second edge of the incision, opposite to the first edge; b) crossing the first strip and the adjacent edge of the incision with a suture thread, at the positions of several markings made on the first strip; c) crossing the second strip and the adjacent edge of the incision with the suture thread, at the positions of several markings made on the second strip; d) circulating the suture thread between the first strip and the second strip, between the markings crossed by the suture thread; e) bringing the two strips together by tensioning the suture thread between two regions, respectively belonging to the first strip and to the second strip, crossed by the suture thread; and f) tying the suture thread in a tensioned configuration where it keeps the two strips close together.

[0030] The method of the invention brings the same advantages as the system mentioned here above. In particular, it is safer, more adapted to complex cases and contaminated zones, and more reproducible than know techniques.

[0031] Advantageously, during step b), each strip is sutured to an anterior fascia, along the corresponding edge of the incision.

[0032] In addition, it is possible that suture of each strip to the anterior facia is made with the interrupted horizontal mattress suture technique. BRIEF DESCRIPTION OF THE DRAWINGS

[0033] The invention will be better understood, based on the following description, given as a non-limiting example and made in reference to the following figures:

[0034] [Fig.1] Figure 1 shows several steps of a method for closing an abdominal surgical incision according to the invention, using a system for reinforcing a closure according to the invention;

[0035] [Fig.2] Figure 2 is a schematic representation of the system for reinforcing a closure according to the invention, used in the method of figure 1 , in position on two parts of the fascia of a patient;

[0036] [Fig.3] Figure 3 is a front perspective view of a strip of the system of figure 2; and [Fig.4] Figure 4 is a schematic view of an interrupted horizontal mattress suture technique, which can be used with the system of figure 2.

[0037] DETAILED DESCRIPTION OF SOME EMBODIMENTS

[0038] Inserts A) to F) of figure 1 show different steps of a method for closing an abdominal surgical incision I with a system 100 schematically represented on figures 2 and 3.

[0039] In the preliminary step of figure A, an incision I has been made in the abdominal wall W of a patient. This incision has two longitudinal edges E1 and E2, which extend roughly parallel to each other, on either side of the incision I.

[0040] In order to reinforce the closure of the incision I, one uses the system 100 schematically represented on figures 2 and 3. This system 100 includes a set made of a first strip 102 and a second strip 104 made of bio-compatible and bio-absorbable material.

[0041] Advantageously, the two strips 102 and 104 are identical. Thus, the description of strip 102 made in reference to figure 3 also applies to strip 104.

[0042] The system 100 also includes a suture thread 106 and a needle 108. For the sake of simplicity, the needle 108 is represented only on figure 2.

[0043] As shown on figure 3, the strip 102 has a rectangular shape and extends along a longitudinal axis X102. L102 denotes the length of the strip 102. W102 denotes the width of the strip 102. T102 denotes the thickness of the strip 102.

[0044] The material of the strip 102 is selected to be bio-compatible. Bio-compatible means that this material must not induce inflammatory reactions from the body of the patient when it is installed and as long as it remains in this body. Bio-absorbable means that this material must be absorbed by the body of the patient within a given time period of at least six months, e.g. eight or twelve months, with no permanent material left in the body.

[0045] The material of the strips 102 and 104 must show a resistance to mechanical stress on the abdominal wall, in particular to sheer stress exerted by the suture thread 106. The material of the strips 102 and 104 is advantageously compatible with the "Small Bite Small Stitch" method.

[0046] In view of these constrains, the material of the strips 102 and 104 is selected among biocompatible materials, which may be biological, bio-absorbable, partially bio-absorbable, non-bio-absorbable, or some combination of one or more of these. The biocompatible material may comprise any of a number of materials. By way of non-limiting examples, biological materials may comprise materials derived from human or animal tissues, which may comprise porcine dermal collagen, porcine small intestinal submucosa, bovine pericardium mesh, human dermal matrix, bovine fetal or neonatal dermis, and hybrid biological-synthetic. By way of non-limiting examples, bioabsorbable materials may comprise polyhydroxyacids, polylactides, polyglycolides, polyhydroybutyrates, polyhydroxyvaleriates, polycaprolactones, polydioxanones, synthetic and natural oligo- and polyaminoacids, polyphosphazenes, polyanhydrides, poly orthoesters, polyphosphates, polyphosphonates, polyalcohols, polysaccharides, and polyethers. By way of non-limiting examples, partially bio-absorbable materials may comprise an association of bioabsorbable and non-bio-absorbable materials. By way of non-limiting examples, non-bio- absorbable materials may comprise polyalkenes, polyethylene, fluorinatedpolyolefins, polytetrafluoroethylene, polyvinylidenefluoride, poly amides, polyurethanes, polyisoprenes, polystryrenes, poly silicones, polycarbonates, polyaryletherketones, polymetacrylates, polyacrylates, aromatic polyesters and polyimides. Such materials fulfill the requirements mentioned here above for the strips 102 and 104.

[0047] The length L102 of a strip 102 or 104 is selected between 50 and 300 mm, which allows using it on most edges E1 or E2 of abdominal incisions. If the length of an edge E1 or E2 is shorter than 300 mm, then the corresponding strip can be cut for adjusting its length to the length of the edge E1 or E2 prior to placing it along this edge.

[0048] Preferably, the length L102 is chosen between 100 and 200 mm, which is adapted to the majority of the cases.

[0049] The width W102 of a strip 102 or 104 is between 5 and 25 mm, preferably about 10 mm. This width is sufficient to provide each strip with a satisfactory mechanical resistance, in particular to sheer stress, while each strip is not too bulky and does not create a traumatic zone on the anterior fascia F, around each edge, on a large extent.

[0050] The thickness T102 of each strip 102 or 104 is between 0,75 and 2,5 mm, preferably between 1 and 2 mm. In view of the materials mentioned here above, this thickness provides the strips 102 and 104 with a flexibility sufficient to adapt to the geometry, in particular the curvature, of each edge E1 or E2. On the other hand, the minimum value of this thickness T102 also provides a good mechanical resistance to each strip 101 and 102, in particular a good resistance to sheer stress.

[0051] Each strip 102 and 104 is equipped with a series of markings.

[0052] The strip 102 is provided with a series S102 of markings 1022, which extend along a straight line 1024, with a longitudinal spacing LS.

[0053] The longitudinal spacing S is measured in a direction parallel to the axis X102 and to the length L102 of the strip 102. Its value is between 3 and 10 mm, preferably equal to about 5 mm.

[0054] Advantageously, the longitudinal spacing LS is constant along the length of the first strip 102.

[0055] In an non-represented variant of the invention, the longitudinal spacing LS varies along the strip 102 or 104, within the range 3-10 mm mentioned above.

[0056] In the example of figures 2 and 3, the straight line 1024 of the first strip 102 coincides with a projection of the longitudinal axis X102 on a lateral face of the strip 102 visible on figure 3. This is advantageous but not compulsory.

[0057] The second strip 104 is also equipped with a series S104 of markings 1042, with the same repartition as the markings 1022 of the first strip 102, in particular the same spacing LS between its markings.

[0058] The markings 1022 and 1042 identify suture thread passages through the strips 102 and 104, for the suture thread 106. In other words, the markings 102 and 104 provide the surgeon with information as to where the suture thread 106 should cross the strips 102 and 104. This allows a regular, neither too dense neither too loose, repartition of the suture thread crossings along the strips 102 and 104. This is favorable in terms of repartition of sheer stress along these strips.

[0059] In the example of the figures 2 and 3, each marking 1022 is a through-hole, which crosses the strip 102 in the direction of its thickness T102 and each marking 1042 is a through-hole, which crosses the strip 104 in the direction of its thickness.

[0060] Advantageously, the diameter of each through hole is between 0.2 and 0.8 mm preferably equal to 0.5mm. The diameter of the through holes is chosen depending on the diameter of the suture thread 106 and of the needle 108. The minimum value of the diameter of the through holes is chosen so that each marking 1022 or 1042 is easy for the surgeon to locate.

[0061] Preferably, and as shown on figures 2 and 3, the series S102 and S104 of markings 1022 and 1042 extend on the entire length of each strip 102 and 104. The suture thread 106 is preferably a monofilament absorbable suture thread, with a diameter between 0.3 mm and 0.7 mm, which corresponds approximatively to the ranges USP 2 / 0 to USP 2 of the United States pharmacopeia.

[0062] By absorbable, one means that the suture thread 106 can be absorbed by the body in a given period of time of at least six months, with no permanent material left in the body. In other words, the suture thread has a complete absorption period shorter than eight months, preferably shorter than six months.

[0063] Advantageously, the suture thread 106 has a remaining tensile strength six weeks after introduction in the body equal to at least 50% of its initial tensile strength.

[0064] As a non-limited example, the suture thread can be made of polydioxanone (PDS). Other materials such as synthetic braided (Polyglycolic Acid (PGA) - Dexon), Polyglactin 910 (Vicryl), or synthetic monofilament (Poliglecaprone (Monocryl), Gut Sutures (Catgut), Polyglytone 6211 (Caprosyn), Glycomer 631 (Biosyn)) might also be considered.

[0065] The needle 108 has a diameter compatible with the diameter of the suture thread 106, preferably in the range 0.01 to 0.1 mm.

[0066] When it is necessary to close the incision I, the first strip 102 is placed on the anterior fascia F, along the first edge E1 and the second strip 104 is placed on the anterior fascia along the second edge E2, opposite to the first edge E1 , as shown on insert B) of figure 1.

[0067] Then, suturing of the two strips and the fascia is implemented with horizontal mattress suture technique. Several steps of this technique are represented on figure 4. The suture thread 106 crosses two adjacent markings 1022 of the first strip 102 and two adjacent markings 1042 of the second strip 104. It bridges two such adjacent markings 1022 on one of the strips, strip 102 in the example of figure 4, and is knotted between the two adjacent markings 1042 of the other strip, strip 104 in the example of figure 4.

[0068] In the left-most representation of the suture thread 106 on figure 4, the suture thread 106 is not tied yet. In the second representation starting from the left of figure 4, the suture thread 106 starts to tie but the knot is not tight yet. Figure 4 shows the result of this technique in the other three representations of the thread, on the right of this figure, when the knot is tight.

[0069] The interrupted horizontal mattress suture technique is implemented in different steps visible on inserts B) to E) of figure 1.

[0070] Once the strips 102 and 104 have been placed on the anterior fascia, along the edges E1 and E2, the needle 108 is used to cross the first strip 102 then the ipsilateral anterior fascia at the level of the first edge E1 , with the suture thread 106, at the position of a first mark 1022. Then, the needle 108 is used for crossing the contralateral anterior fascia at the level of the second edge E2, then the second strip 104 with the same suture thread at the position of a first mark 1042. Afterwards, the needle 108 is used for crossing the second strip 104, then the contralateral anterior fascia at the level of the second edge E2 with the suture thread, at the position of a second marking 1042. After that, the needle 108 is used for crossing the ipsilateral anterior fascia at the level of the first edge E1 , then the first strip 102 with the suture thread, at the position of a second mark 1022. Then, the suture thread is cut. An individual suture thread portion is thus formed, which crosses the two strips 102 and 104 and the two edges E1 and E2, in a way comparable to the left most representation on figure 4.

[0071] Insert B) of figure 1 shows the situation when the needle and the suture thread have been used five times as explained here above and a sixth operation is ongoing. For the first five times, the suture thread portion is as represented on the left of figure 4.

[0072] Insert C) shows the situation when the needle and the suture thread have been used as many times as necessary to have the suture thread portions distributed all along the strips 102 and 104. A suture thread crosses each marking 1022 of the strip 102 and each marking 1042 of the strip 104.

[0073] It is then possible to bring the two strips 102 and 104 together, by tensioning the suture thread 106 between two regions, respectively belonging to the first strip 102 and to the second strip 104, crossed by the suture thread 106. Here above, the two regions correspond to the regions of the markings 1022 and 1042 crossed by the suture thread portions.

[0074] Bringing the two strips together allows achieving wound approximation, as shown by the comparison of inserts C) and D) on figure 1.

[0075] Thereafter, it is possible to tie each suture thread portion in a tensioned configuration where it keeps the two strips 102 and 104 close together, as shown on insert E) of figure 1.

[0076] Once all suture thread portions have been tied and the knots K are tight, the abdominal incision is closed in a safe way, as shown on insert F) of figure 1 .

[0077] Thanks to the system 100, the shear stress exerted by the individual portions of the suture thread 106, when bringing the edges E1 and E2 together, is absorbed by the strips 102 and 104, which prevents the fascia from tearing. The strips 102 and 104 also absorb shear stress after the abdominal incision has been closed, during the future life of the patient, when he / she moves or breathes.

[0078] In a non-represented variant of the invention, another suture technique can be used, instead of the interrupted horizontal mattress suture technique for circulating the suture thread 106 between the strips 102 and 104, for instance interrupted suture techniques (simple interrupted suture, vertical interrupted mattress suture, figure-of-eight suture) or continuous (running) suture techniques (simple continuous suture, locking continuous suture, vertical and horizontal continuous mattress sutures). Independently of the technique used for circulating the suture thread 106 between the strips 102 and 104, after having placed the first strip 102 along the first edge E1 of the incision and the second strip 104 along the second edge E4, the following steps are implemented: crossing the first strip 102 and the adjacent edge E1 with the suture thread 106, at the positions of several of the markings 1022; crossing the second strip 104 and the adjacent edge E2 with the suture thread 106, at the position of several of its markings 1042; circulating the suture thread between the first and second strips 102 and 104, between the markings crossed by the suture thread 106; bringing the two strips 102 and 104 together by tensioning the suture thread 106 between two regions, respectively belonging to the first strip and to the second strip, crossed by the suture thread.

[0079] This brings the incision I in the configuration of insert D) of figure 1 .

[0080] It is then possible to tie the suture thread, taken as whole or in individual portions, in a tensioned configuration where it keeps the two strips 102 and 104 close together

[0081] Thus, the system 100 of the invention allows a surgeon to close an abdominal incision I in a reliable and reproducible way.

[0082] In a non-represented variant of the invention, the markings 1022 and 1042 are symbols, such as dots, crosses, circles or alphanumerical characters.

[0083] Advantageously, the symbols are printed on at least one side surface of each strip 102 or 104. A side surface of a strip is a surface parallel to its length L102 and its width W102. Such side surface is visible on figures 2 and 3.

[0084] In another non-represented variant of the invention, the markings 1022 or 1042 are made by color zones defined on at least one side surface, preferably on the two side surfaces, of each strip 102 or 104. A color zone is a zone in a color different from the color of the rest of a side surface, e.g. the natural color of the material of the strip 102 or 104.

[0085] Advantageously, the symbols or the color zones are printed in register on the two side surfaces of each strip, which facilitates the use of the strips 102 and 104 with any side surface on the top.

[0086] In a non-represented variant of the system of the invention, the markings 1022 and / or 1042 may be a mix of through holes, painted symbols and / or color zones.

[0087] In a non-represented variant of the invention, the two strips 102 and 104 are different. In particular, they can have different lengths, when they are cut in a ribbon, on demand, depending on the actual length of the edges E1 and E2. In a non-represented variant of the system of the invention, the system 100 includes more than two strips, for instance several sets of two strips. These strips may have different lengths and the surgeon may choose the most suitable strips before placing them along the edges E1 and E2 of the abdominal incision I. In a non-represented variant of the method of the invention, not all markings 1022 and

[0088] 1042 are used to circulate a suture thread 106. Some markings can be left without threads in some regions, or between two other markings, of one or both strips 102 and 104. This may occur when the strips 102 and 104 have different lengths, after adjustment to the lengths of the two edges E1 and E2. The embodiment and variants of the invention mentioned here above may be combined, in any technically feasible way, in order to generate new embodiments of the invention, in the framework of the appended set of claims.

Claims

CLAIMS1. A system (100) for reinforcing closure of an abdominal surgical incision (I), the system comprising at least one set of at least two strips (102, 104) of bio-compatible material, each strip having- a length (L102) between 50 a 300 mm- a width (W102) between 5 and 25 mm- a thickness (T102) between 0.75 and 2.5 mm- a series (S102, S104) of markings (1022, 1042) for the identification of suture thread passages, the markings being arranged in at least one line, with a longitudinal spacing (LS), between two consecutive markings (1022, 1042) of a series (S102, S104) of markings, between 3 and 10 mm.

2. The system according to claim 1 , wherein the series (S102, S104) of markings (1022, 1042) extends on the entire length of each strip (102, 104).

3. The system according to any preceding claim, wherein the longitudinal spacing (LS), between two consecutive markings (1022, 1042) of a series (S102, S104) of markings, is constant along each strip (102, 104).

4. The system according to any preceding claim, wherein the markings (1022, 1042) include through holes made in each strip (102, 104), preferably with a diameter between 0.2 and 0.8 mm, most preferably equal to 0.5 mm.

5. The system according to one of claims 1 to 3, wherein the markings (1022, 1042) includes symbols printed on at least one side of each strip.

6. The system according to one of claims 1 to 3, wherein the markings (1022, 1042) include coloured zones made on at least one side of each strip.

7. The system according to any preceding claim, wherein the material of the strips (102, 104) is selected among the following bio-compatible materials which may be- biological, such as materials derived from human or animal tissues, which may comprise porcine dermal collagen, porcine small intestinal submucosa, bovine pericardium mesh, human dermal matrix, bovine fetal or neonatal dermis, and hybrid biological-synthetic;- bioabsorbable, such as polyhydroxyacids, polylactides, polyglycolides, polyhydroybutyrates, polyhydroxyvaleriates, polycaprolactones, polydioxanones, synthetic and natural oligo- and polyaminoacids, polyphosphazenes, polyanhydrides, poly orthoesters, polyphosphates, polyphosphonates, polyalcohols, polysaccharides, and polyethers;- partially bio-absorbable;- non-bio-absorbable, such as polyalkenes, polyethylene, fluorinatedpolyolefins, polytetrafluoroethylene, polyvinylidenefluoride, polyamides, polyurethanes, polyisoprenes, polystryrenes, poly silicones, polycarbonates, polyaryletherketones, polymetacrylates, polyacrylates, aromatic polyesters and polyimides;- or some combination of one or more of these.

8. The system according to any preceding claim, further comprising a monofilament absorbable suture thread (106) with a diameter between between 0.3 mm and 0.7 mm.

9. The system according to claim 8, wherein the monofilament absorbable suture thread (106) has a remaining tensile strength after six weeks equal to at least 50% of its initial tensile strength and a complete absorption period shorter than eight months, preferably shorter than six months.

10. The system according to any one of claims 8 and 9, wherein the monofilament absorbable suture thread (106) is made of polydioxanone (PDS).

11. The system according to any preceding claim, further comprising a needle (108) with a diameter in the range 0.05 to 0.1 mm.

12. The system according to any preceding claim, wherein the length (L102) of each strip (102, 104) is between 100 and 200 mm.

13. The system according to any preceding claim, wherein the width (W102) of each strip (102, 104) is about 10 mm.

14. The system according to any preceding claim, wherein the thickness (T102) of each strip (102, 104) is between 1 and 2 mm.

15. The system according to any preceding claim, wherein the longitudinal spacing (LS) between two consecutive markings (1022, 1042) of a series (S102, S104) of markings is about to 5 mm.

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