CA2740009C

CA2740009C - Methods of making collagen fiber medical constructs and related medical constructs, including nerve guides and patches

Info

Publication number: CA2740009C
Application number: CA2740009A
Authority: CA
Inventors: Mengyan Li; Thomas J. Koob
Original assignee: Mimedx Group Inc
Current assignee: Mimedx Group Inc
Priority date: 2008-10-09
Filing date: 2009-10-09
Publication date: 2017-09-26
Anticipated expiration: 2029-10-09
Also published as: CA2740008C; US10238773B2; EP2349363A4; CA2976265C; WO2010042205A2; US20100094404A1; US9179976B2; CA2806396A1; EP2575911B1; CA2976265A1; US9125759B2; WO2010042207A3; US20160022874A1; US9078775B2; CA2740009A1; CA2740008A1; EP2349364A4; WO2010042205A3; US20100094318A1; EP2349363A2

Abstract

A method of manufacturing a medical construct comprises placing a length of cylindrical collagen gel about an outer surface of a support member before a winding step;
allowing the cylindrical collagen gel to dry to form a film on the support member before the winding step;
then winding at least one collagen fiber a number of revolutions over the cylindrical collagen film about a length of the support member having a long axis, the winding having at least one defined pitch and/or fiber angle relative to the long axis of the support member, while applying a liquid and/or gel of soluble collagen to a surface of the at least one fiber on the support member;
and allowing the wound collagen fiber with the soluble collagen to dry; then applying a collagen gel over the dried collagen fiber with the soluble collagen and allowing the applied collagen to dry to form an outer layer of film to form the construct.

Description

METHODS OF MAKING COLLAGEN FIBER MEDICAL CONSTRUCTS
AND RELATED MEDICAL CONSTRUCTS, INCLUDING NERVE GUIDES
AND PATCHES
FIELD OF THE INVENTION

(0002] The invention relates to biomedical materials and products, BACKGROUND OF THE INVENTION

(0003] Koob et al. have described methods of producing nordihydroguaiaretic acid (NDOA) polymerized collagen fibers for various biomedical applications, some with tensile strengths similar to that of natural tendon (e.g., about 91 MF1a). See, for example, Koob and Hernandez, Material properties of polymerized NDGA-collagen composite fibers: development of biologically based tendon constructs, I3iomaterials 2002 Jan; 23 (I): 203-12; and U.S. Patent Number 6,565,960-SUMMARY OF EMBODIMENTS OF THE INVENTION
100041 Embodiments of the present invention are directed to methods of making collagen constructs for medical use and related constructs.
[00051 Particular embodiments are directed to nerve guides having a tube with a wall having at least three laminated layers, including an interrnediate layer of at least one collagen fiber arranged in a repeating pattern sandwiched by a collagen film outer surface and a collagen film inner surface.
[0006] The collagen film can be applied as a collagen gel to and the tube can be cross-linked with nordihydroguaiaretic acid (NDGA) to create a polymerized collagen tube.
[0007] Some embodiments are directed to methods of manufacturing a medical construct. The methods can include winding at least one collagen fiber a number of revolutions about a length of a support member having a long axis, the winding can have at least one defined pitch and/or fiber angle relative to the long axis of the support member to form the construct.
[0008] The method may include placing a liquid or gel comprising soluble collagen onto the at least one wound collagen fiber during or after the winding step so that the elongate construct is wetted and/or so that the outer surface is covered in a collagen film, when the soluble collagen is dry.
[0009] The method may also optionally include providing a spooled supply of at least one collagen fiber for the winding step. The at least one collagen fiber may optionally be introduced to the support member from the spooled supply in a substantially dry state.
[0010] The winding step may be carried out to create multiple adjacent overlying layers of the at least one fiber, the adjacent layers being coextensive for at least a major portion of a length of the construct. The pitches on the different layers on some portion of each layer may differ. For example, the winding step can be carried out to have a first pitch for the winding of the at least one collagen fiber on the first layer and a second smaller or greater pitch for the winding of the at least one collagen fiber on the second layer.
[0011] In some particular embodiments, the at least one fiber on the second layer resides between gaps defined by the at least one fiber wound with the defined pitch on the first layer.
[0012] The method may include placing collagen gel about an outer surface of the support member before the winding step and allowing the collagen gel to dry to form a film on the support member. Then, the collagen fiber winding can be carried out while applying soluble collagen to a surface of the at least one fiber on the support member. The wound collagen fiber with the soluble collagen is actively or passively dried, then a collagen gel can be applied over the dried collagen fiber with the soluble collagen and, again allowed to dry, to form an outer layer of film.
(0013] Other embodiments are directed to medical devices. The devices may be a material, an implant themselves or on or in implants. For example, the devices can include a tube with a wall surrounding an axially extending cavity. The wall has at least one collagen fiber (typically of a continuous length of fiber) having a number of revolutions over at least a major length of the tube with a pattern of intersecting segments. The tube may also optionally have an inner layer of a collagen film and/or an outer layer of collagen film, each integrally attached to the at least one collagen fiber.
100141 The at least one collagen fiber can be derived from soluble dermal collagen, and wherein the collagen film comprises soluble dermal collagen having a collagen concentration of between about 0.1-4% weight per volume.
[0015] Particular embodiments are directed to nerve guides. The nerve guides include a tubc with a wall surrounding an axially extending cavity, the wall having at least onc wound collagen fiber arranged with a number of revolutions over at least a major length of the tube on at least one layer. Optionally, the nerve guide can include an inner layer of a collagen film and/or an outer layer of collagen film which may be integrally attached to the collagen fiber.
100161 The medical nerve guide or cuff can include an elastic tube with a wall surrounding an axially extending cavity, The wall can have at least one collagen fiber of a continuous length arranged in a fiber mesh pattern of intersecting segments over at least a major length of the tube. The at least one collagen fiber can be embedded in a collagen film that extends over interstitial spaces defined bYthe fiber mesh pattern.
[0017] Other embodiments are directed to medical patches. The patches have at least one collagen fiber having a length arranged in an angular pattern with adjacent layers defining fiber orientations that intersect. The patches may optionally have an inner layer of a collagen film and/or an outer layer of collagen film, [0017a] In accordance with an aspect, there is provided a method of manufacturing a medical construct, comprising:
placing a length of cylindrical collagen gel about an outer surface of a support member before a winding step;
allowing the cylindrical collagen gel to dry to form a film on the support member before the winding step; then winding at least one collagen fiber a number of revolutions over the cylindrical collagen film about a length of the support member having a long axis, the winding having at least one defined pitch and/or fiber angle relative to the long axis of the support member, while applying a liquid and/or gel of soluble collagen to a surface of the at least one fiber on the support member;
and allowing the wound collagen fiber with the soluble collagen to dry; then applying a collagen gel over the dried collagen fiber with the soluble collagen and allowing the applied collagen to dry to form an outer layer of film to form the construct.
10017b1 In accordance with an aspect, there is provided a medical device, comprising a tube with a wall surrounding an axially extending cavity, the wall having an at least one collagen fiber, the fiber having a length arranged in a pattern of overlying intersecting segments over at least a major length of the tube, the tube further comprising an inner layer of a collagen film attached to the at least one collagen fiber defining an inner surface of the tube wall and an outer layer of collagen film attached to the at least one collagen fiber defining an outer surface of the tube wall.
[0017c]
In accordance with an aspect, there is provided a medical device, comprising a medical patch comprising at least one collagen fiber arranged in an angular pattern of a plurality of adjacent layers, with a first layer has a first fiber orientation and a second layer has a second fiber orientation arranged so that the first and second fiber orientations intersect, the patch further comprising an inner layer of a collagen film and an outer layer of collagen film that are attached to the at least one collagen fiber.
[0017c11 In accordance with an aspect, there is provided a medical device, comprising:
a tube with a wall surrounding an axially extending cavity, the wall having at least one collagen fiber with a continuous length arranged in a wound pattern having a number of revolutions about the tube cavity with overlying intersecting segments over at least a major 3a portion of a length of the tube, and an inner layer and outer layer of collagen film each extending over a length of the wall, wherein the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.
10017e1 In accordance with an aspect, there is provided a medical patch comprising at least one collagen fiber arranged in an angular pattern of a plurality of adjacent layers, wherein a first layer has a first fiber orientation and a second layer has a second fiber orientation arranged so that the first and second fiber orientations intersect, an inner layer of collagen film, and an outer layer of collagen film; and wherein the patch is substantially planar and the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.
[0017f] In accordance with an aspect, there is provided a medical nerve guide or cuff, comprising:
a tube with a wall surrounding an axially extending cavity, the wall having at least one wound collagen fiber arranged with a number of revolutions in a plurality of layers forming an overlapping pattern over at least a major length of the tube;
an inner layer of a collagen film attached to the at least one collagen fiber defining an inner surface of the wall; and an outer layer of collagen film integrally attached to the at least one collagen fiber defining an outer surface of the wall, wherein the tube with the inner and outer layers of film is permeable, wherein the collagen fiber pattern is visually observable, and wherein the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.
[0017g] In accordance with an aspect, there is provided a medical nerve guide or cuff, comprising:
an elastic tube with a wall surrounding an axially extending cavity, the wall having at least one collagen fiber of a continuous length arranged in a fiber mesh pattern of overlying intersecting segments over at least a major length of the tube, the at least one collagen fiber between inner and outer layers of a collagen film that extend over interstitial spaces defined by the fiber mesh pattern, and wherein the fiber mesh pattern is visually observable, and wherein the collagen film layers comprise collagen fibers, fibrils and/or microfibrils.
3b . .
[0017h] In accordance with an aspect, the at least one collagen fiber is a single collagen fiber having a diameter between about 0.05 mm to about 0.2 mm (average, dry) arranged in multiple stacked layers of coils, and wherein the wall thickness is between about 1 and 10 mm, and the tube has a length that is between about 1-6 cm.
[0018] It is noted that aspects of the invention described with respect to one embodiment, may be incorporated in a different embodiment although not specifically described relative thereto. That is, all embodiments and/or features of any embodiment can be combined in any way and/or combination. Applicant reserves the right to change any originally filed claim or file any new claim accordingly, including 3c the right to be able to amend any originally filed claim to depend from and/or incorporate any feature of any other claim although not originally claimed in that manner. These and other objects and/or aspects of the present invention are explained in detail in the specification set forth below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0019] Figure 1A is a schematic cross-section (in an axial direction) of an exemplary collagen fiber construct on an exemplary support member according to embodiments of the present invention.
[0020] Figure 1B is an end view of the device shown in Figure 1A
(shown without the support member) according to embodiments of the present invention.
[0021] Figures 2A-2D are digital photographs of a prototype of a collagen fiber construct that may be particularly suitable for a nerve guide according to embodiments of the present invention.
[0022] Figure 3A is a top perspective view of a lathe that can be used to wind collagen fiber(s) onto a tubular support member according to embodiments of the present invention.
100231 Figure 3B is a side perspective view of the device shown in Figure 3A, [0024] Figure 3C is a side perspective view of the lathe with a substantially planar elongate support member according to embodiments of the present invention.
[0025] Figure 3D is a side perspective view of a planar support member with a wound collagen fiber(s) according to other embodiments of the present invention.
[0026] Figure 3E is a side perspective view of a tubular support member with an insert according to embodiments of the present invention.
[0027] Figure 4 is a schematic illustration of different collagen fiber configurations that may be used for winding a construct according to embodiments of the present invention.
100281 Figure 5A is a schematic illustration of a tubular construct with segments having increased fiber density according to embodiments of the present invention.

4 [0029] Figure 5B is a schematic illustration showing that the tubular structure of Figure 5A can be separated or cut into multiple different components (shown as two) according to embodiments of the present invention.
[0030] Figure 6A is a schematic illustration of a substantially planar construct with segments having increased fiber density according to embodiments of the present invention.
[0031] Figure 6B is a schematic illustration of the construct shown in Figure 6A illustrating that the construct can be separated into multiple components (shown as four) according to embodiments of the present invention.
[0032] Figure 7 is a front view of a winding apparatus that can be used to wind (braid) collagen fiber according to embodiments of the present invention.
[0033] Figure 8A is a schematic illustration of a collagen nerve guide according to embodiments of the present invention.
[0034] Figure 8B is a schcmatic illustration of a collagen cuff according to embodiments of the present invention.
[0035] Figure 9 is a schematic illustration of a medical kit according to embodiments of the present invention.
[0036] Figure 10 is a flow chart of operations that can be used to fabricate a construct according to embodiments of the present invention.
[0037] Figure 11 is a flow chart of an exemplary winding protocol according to particular embodiments of the present invention.
DETAILED DESCRIPTION
[0038] The present invention now is described more fully hereinafter with reference to the accompanying drawings, in which embodiments of the invention are shown. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein;
rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art.
100391 Like numbers refer to like elements throughout. In the figures, the thickness of certain lines, layers, components, elements or features may be exaggerated for clarity. Broken lines illustrate optional features or operations unless specified otherwise.

100401 The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprises" and/or "comprising," when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items. As used herein, phrases such as "between X
and Y" and "between about X and Y" should be interpreted to include X and Y.
As used herein, phrases such as ''between about X and Y" mean "between about X
and about Y." As used herein, phrases such as "from about X to Y" mean "from about X
to about Y."
[0041] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the specification and relevant art and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein. Well-known functions or constructions may not be described in detail for brevity and/or clarity.
[0042] It will be understood that when an element is referred to as being "on", "attached" to, "connected" to, "coupled" with, ''contacting", etc., another element, it can be directly on, attached to, connected to, coupled with or contacting the other element or intervening elements may also be present. In contrast, when an element is referred to as being, for example, "directly on", "directly attached" to, "directly connected" to, "directly coupled" with or "directly contacting"
another element, there are no intervening elements present. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed "adjacent" another feature may have portions that overlap or underlie the adjacent feature.
[0043] It will be understood that, although the terms first, second, etc.
may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one element, component, region, layer or section from another region, layer or section.
Thus, a first element, component, region, layer or section discussed below could be termed a second element, component, region, layer or section without departing from the teachings of the present invention. The sequence of operations (or steps) is not limited to the order presented in the claims or figures unless specifically indicated otherwise.
[0044] Spatially relative terms, such as "under", "below", "lower", "over", "upper" and the like; may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if a device in the figures is inverted, elements described as "under" or "beneath" other elements or features would then be oriented "over" the other elements or features. Thus, the exemplary term "under" can encompass both an orientation of over and under. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms "upwardly", "downwardly", "vertical", "horizontal" and the like are used herein for the purpose of explanation only unless specifically indicated otherwise.
[0045] The term "patch" refers to a piece or segment of biomaterial that can be placed on and/or affixed to target anatomical structure, typically soft tissue, to treat, protect, repair and/or reinforce a target site. The patch can be any geometric shape but is typically substantially planar and may, in position, conform to the shape of underlying or overlying tissue.
[0046] The term "implantable" and derivatives thereof means the device can be inserted, embedded, grafted or otherwise acutely or chronically attached or placed in or on a patient. The term ''construct" refers to a device and/or material in a final form for use or in a pre-final form. The term pitch" means winding or wound at an angle relative to a first plane normal to the longitudinal axis of a core or cavity.
100471 The terms "winding" and "wound" and derivatives thereof means to wrap about an object or center at least once, typically repeatedly, e.g., to turn in a series of circular motions. In some embodiments, at least one collagen fiber (multiple fibers, one or more fiber bundles) turns or rotates its circumferential position about a centerline or long axis. The winding may define a coil (e.g., a series of connected typically substantially concentric rings or spirals), woven and/or braided fiber arrangement with a number of revolutions or turns about a core and/or tube, typically in a regular pattern (but an irregular pattern may also be used) about a length of at least one layer of a tube or cylindrical shape.
100481 Embodiments of the present invention comprise collagen, typically dermal collagen. However, the collagen can be of any form and from any origin.
The collagen can be any of the identified collagen genotypes, for example, the interstitial fiber forming collagen types I, It and III, as well as any other substantially fiber forming types of collagen, for example collagen VI. The collagen can be acid soluble collagen or pepsin solubilized or soluble collagen. The collagen can be from mammalian cells synthesized in vitro. The collagen can be from molecularly engineered constructs and synthesized by bacterial, yeast or any other molecularly manipulated cell type. For example, the collagen can be sea cucumber dermis collagen, bovine, caprine, porcine, ovine or other suitable donor mammal, marine animal collagen such as chinoderms, molecularly engineered collagen, or gelatin (e.g., in any suitable form including solid, gel, hydrogels, liquids, or foams). In addition, the collagen can be digested with a protease before, where used, oxidizing and polymerizing steps. The collagen can be in the form of microfibrils, fibrils, natural fibers, or synthetic fibers.
100491 In some embodiments, the collagen can be solubilized, dissolved or otherwise transferred into an acid solution, for example, acetic acid (e.g., about 0.01M
to about 1.0M, typically about 0.5M), hydrochloric acid (between about pH 1 to about pH 3, typically about pH 2.0), or any other suitable acid at appropriate concentration (e.g., about pH 1.0 to about pH 3.0, typically about pH 2.0). Dialysis may optionally be used to neutralize a soluble collagen solution. The collagen can also or alternatively be dissolved in a neutral buffered solution either with or without salts, e.g., phosphate buffer at about pH 7.0, or phosphate buffered saline at about pH 7Ø
The phosphate buffer can be at any concentration of sodium phosphate between about 0.01 and 0.5, but more typically between about 0.02 and about 0.1M. The buffer can also be any buffer, including, but not limited to, for example, sodium acetate, HEPES, or MOPS. The collagen can be present in a quantity that is at least about 0.1%
to about 10%, typically between 0,1% to about 5% (e.g., about 0.1, 0.2, 0.3, 0.4, 1.0, 2.0, 4.0%) by weight per volume, or by weight per volume in the neutral buffer solution before fibrillogenesis and fiber formation. In a dried fiber collagen, collagen can be present in an amount of weight by volume of between about 50-100% (e.g, at least about 75%, 90%, 95% or l 00%) before crosslinking (where crosslinking is used).
100501 Collagen "microfibrils," "fibrils," 'fibers," and "natural fibers"
refer to naturally-occurring structures found in a tendon. Microfibrils are about 3.5 to 50 nm in diameter. Fibrils are about 50 rim to 50 pm in diameter. Natural fibers are above 50 pm in diameter. A "synthetic fiber" refers to any fiber-like material that has been formed and/or chemically or physically created or altered from its naturally-occurring state. For example, an extruded fiber of fibrils formed from a digested tendon is a synthetic fiber but a tendon fiber newly harvested from a mammal is a natural fiber.
[00511 Of course, synthetic collagen fibers can include non-collagenous components or biocompatible materials, such as particulates, hydroxyapatite and other mineral phases, or drugs that facilitate tissue growth or other desired effects. See, US
Patent 6,821,530- For example, the fibers and/or constructs formed from same, can include compositions that can contain carbon nano-tubes, zinc nano-wires, nano-crystalline diamond, or other nano-scale particulates; and larger crystalline and non-crystalline particulates such as calcium phosphate, calcium sulfate, apatite minerals. For example, the compositions can also or alternatively contain therapeutic agents such as bisphosphonates, anti-inflammatory steroids, growth factors such as basic fibroblast growth factor, tumor growth factor beta, bone morphogenic proteins, platelet-derived growth factor, and insulin-like growth factors; chemotactic factors such fibronectin and hyaluronan; and extracelIular matrix molecules such as aggrecan, biglycan, decorin, fihromodulin, COMP, elastin, and fibrillin. In some embodiments, rhe fibers and/or fiber-derived constructs can contain cells, engineered cells, stem cells, and the like. Combinations of the above or other materials can be embedded, coated and/or otherwise directly or indirectly attached to the collagen fibers and/or construct formed of same.
[0052] The term "collagen gel" means a semi-solid (e.g., gelatinous density) material that includes collagen fiber, fibrils and/or rnicrofibrils, typically dermal collagen, that has been acid or pepsin solubilized (e.g., soluble collagen) and processed to maintain the collagen in its molecular form. The collagen concentration of the soluble collagen and/or resulting soluble collagen gel can be between about 0.1% to about 4% weight per volume. The soluble collagen gel may be formed to be in a cylindrical shape of a defined length and diameter, typically with a diameter of between about 0.1 to 1 cm, and a length of between about 5 cm to about 100 m, more typically between about 1m to about 50m.
100531 The collagen fibers and collagen gel can be produced in batch or continuous-type systems, including wet gel collagen extrusion systems, which produce cylindrical lengths of gel that cart be allowed to substantially dry (actively or passively) to obtain a suitable length of fiber. Examples of some collagen fiber production processes that can generate soluble collagen in suitable lengths are described in U.S. Patent No, 6,565,960, and pending U.S. Patent Application Publication No. US-2008-0188933-A I =
100541 The collagen fibers can be spooled for supplying to an automated or semi-automated winder to form the biomedical construct. The collagen fibers may be formed with a relatively thin diameter, such as, for example between about .05 mm to about 0,2 mm (average), such as about .08 mm dry diameter (average) and about a 0.13 mm wet diameter (average).
100551 The term "film" refers to a thin layer of collagen gel that has dried.
The film is typically present in a thickness that is between about 5 and 200 microns.
The Elm may be permeable and flexible and optically transmissive, e.g., translucent or transparent, or may bc opaque. Several layers of the gel can be applied to generate the desired film thickness or coverage. The color or transmissve characteristics may change when hydrated. The film can infuse into, migrate and/or bond to a coiled or wound (dry) collagen fiber to form a collagen fiber laminate. The gel/film is not required, but where used can provide a smooth (and typically a substantially constant diameter) surface over or under the fiber.
100561 Referring now to the figures, Figure 1A, an exemplary elongate construct 10 is shown on a support member 20. As shown, the construct 10 includes an inner layer of collagen film 11, an intermediate layer of at least one wound collagen fiber 13, and an outer layer of collagen film 15.
100571 In other embodiments, the construct 10 can be formed without the inner and/or outer layer of film 11 and/or may optionally include other materials or constituents and/or layers. For example, hydroxyapatite can be placed into the collagen fiber and/or collagen gel material. This configuration can be particularly suitable to augment interference screw fixation of autograft tendons.
[0058] As shown in Figure 1B, the construct 10 can have a wall lOw with a suitable thickness defined by the at least one collagen fiber 13 and the film layers (where used) and/or other coatings and/or materials placed thereon. The construct 10 can have an open through cavity or may be filled or partially filled with a nerve-growth media or other therapeutic material (e.g., an anti-inflammatory, antibiotic and/or the like).
[0059] As also shown, the at least one collagen fiber 13 has an angular fiber pattern 13p of repeating intersecting collagen fiber segments along its length.
The angular pattern 13p can be defined by a number of revolutions of the at least one fiber 13 about the support member 20 at a given pitch or pitches for at least one layer (typically more than one layer). The support member 20 is used to wrap the at least one collagen fiber around its exterior surface to form a desired shape. The support member 20 can include a lubricious and/or smooth surface, or an embossed surface with lower contact surface area, typically of a polymer material. In other embodiments, the support member 20 can include an anti-slip surface with ridges or a sleeve can be placed over the support member (not shown) to contact the next layer (e.g., inner film 11 or fiber 13). In some embodiments, the support member 20 comprises Teflon or other suitable low friction and/or anti-stick material.
The support member 20 can be tubular, e.g., cylindrical, as shown in Figures 1A, 3A, 3B
and 3E or may be substantially flat and rectangular 20' as shown in Figures 3C
and 3D. Other geometries may also be used, such as, for example, a frustoconical or funnel shape. Typically, the support member 20 is elongate and has a substantially circular, oval, polygonal or other cross-sectional shape.
[0060] The at least one collagen fiber 13 can be organized into various arrays including braids, weaves, knits, parallel arrays, and various patterns.
The orientation of one or more of the fibers 13 within the resulting material 10 (see, e.g., Figures 2A-2D) can be targeted to meet the specific mechanical requirements of the medical application. Fiber density can vary from dense to loose geometries and the numbers and size of the one or more collagen fibers used can vary as well as the thickness of the film to provide specific mechanical properties. The fiber(s) 13 can be continuous length fibers or may be formed by attaching a scrics of collagen fibers in an end-to-end orientation 13j (Figure 4).

[0061] Figures 2A-2D are digital photographs of a prototype of a construct 10. This construct 10 may be particularly suitable as a nerve tube or guide 10n (Figure 8A). The construct 10 is tubular 10t with an open cavity and has a flexible elastic configuration. The construct 10 may be configured as a nerve guide 10n. The nerve guide 10n can be formed using a single fiber 13 formed in wound multiple layers, the fiber 13 can have a length between about 1- 6 m, typically about 5 m. The nerve guide 10n can be formed using a single fiber 13 of a continuous length that is wrapped in several layers about the support member 20. Use of a single fiber 13 can reduce the likelihood of any fraying associated with multiple fibers (such as those wound in one lengthwise direction). The nerve guide 10n can have a length between about 1 cm to about 6 cm (or more), and the inner diameter can be between about 1-10 m with the wall thickness being about 0.1 mm to about 3 mm.
[0062] The construct 10 can have reversible elasticity with sufficient rigidity or strength to prevent undue nerve compression, while allowing flexibility sufficient to allow the construct 10 to spring back into its original shape after being exposed to a strain or tension caused by normal body movement that deforms the shape. The nerve guide 10n can be used for any nerve location, e.g., peripheral nerves (such as in a hand or finger), spinal cord nerves, and the like. The construct 10 can be used for other repairs or treatments as will be discussed further below. The construct 10 is biocompatible (or at least non-cytotoxic) and can provide a desired half-life suitable for its intended function.
[0063] The construct 10 and/or the fiber 13 can be cross-linked with a suitable polymerizing material, such as, but not limited to, NDGA, or may be used in a non-cross-linked state. The NDGA cross-linking can increase the strength of the device 10 but may decrease the resiliency, elasticity or flexibility. In some embodiments, the collagen fiber 13 is not cross-linked during the winding process, but may optionally be cross-linked after the winding process (typically after the collagen film has been applied to the outer surface and dried).
[0064] The support member 20 can be configured to facilitate removal of the construct 10. For example, the construct 10 may be wound tightly against the outer surface of the support member 20 and allowed to dry. The support member can be configured to reduce in cross-sectional size or disassemble with the construct held thereon to allow easy removal of the elongate construct. In some embodiments, the support member 20 can be a multi-piece device that provides this size change. In other embodiments, the support member 20 may be cooled while the construct is heated to provide a size difference. In particular embodiments, the support member 20 can cooperate with an insert 201 (Figure 3D) that provides the desired size adjustability. In other embodiments, the construct 10 can be removed from the support member without such a size adjustment (e.g., its inner surface may be suffiCiently lubricous or a suitable liquid or other material can be used to slide the construct off the support member. In other embodiments, the construct 10 can be cut in a lengthwise (e.g., "X") direction and taken off the support member 20. In some embodiments, the construct 10 may be cut or otherwise separated in a long axis direction with a longitudinal slit lOs and used for a cuff 10c (Figure 8B) that can be positioned about a nerve or other tissue to protect that tissue (and the cuff may be sutured together along at least a portion of the long axis and/or may be sutured or otherwise anchored into position). The cuff 10c may be configured to provide a snug or alternatively, a non-constricting, encasement for injured peripheral nerves for protection of the neural environment. The wall of the cuff with the longitudinal slit lOs can be spread open for easy placement over the injured nerve or other target tissue. The resilience of the collagen conduit allows the cuff to recover and maintain closure once the device is placed around the nerve.
100651 As shown in Figures 3A-3B, the construct 10 can be made by winding at least one collagen fiber 13 around a support member 20 using a computer-guided and/or controlled lathe system 100. The lathe system can be configured to rotate the support member 20 and to move the support member back and forth in a length direction to alter the location of the fiber on the support member 20 relative to the introduction point of the fiber (e.g., the fiber introduction point may be stationary). In other embodiments, the fiber(s) 13 can be supplied through a head that moves relative to the support member 20 (e.g., the support member can be stationary) or both the fiber introduction head and the support member may move relative to teach other.
100661 Different size (e.g., diameter) support members 20 can be used depending on the target product. For example, transverse small cross-section support members (e.g., diameter rods) can be used for manufacturing devices for use in vein and artery replacements or repairs, while larger transverse cross-section support members (e.g. diameter rods) can be used to manufacture devices for aortic or large artery replacements or repairs and/or various shunts.

100671 An example of a small lathe 100, typically a micro or miniature lathe, suitable for fabricating embodiments of the constructs is the Model 4410 lathe available from Sherline Products, Inc., having a place of business in Vista, CA. Two user-selectable inputs can operate the lathe system: one controls the speed that the support member that spins and the other controls the pattern (fiber angle) in which the at least one fiber 13 is laid onto the support member. The operation can be configured so that the fiber is self-pulling'from a spool in communication with a channel in the feeder head based on the speed of the spinning support member 20. The lathe 100 can co-wind a plurality of fibers or fiber bundles substantially concurrently about the support member 20.
100681 The at least one collagen fiber 13 can be coated with one or more layers of collagen gel 11, 15 and/or other suitable bio-compatible material during and/or after winding the at least one collagen fiber 13 to seal the fiber(s) 13 within the biocomposite material and/or to form a smooth inner and/or outer surface of the construct 10. Figure 3B illustrates that collagen gel can be applied to the fiber 13 on the support member during the winding. Figure 3B illustrates that a brush 111 can be used to apply the gel. Other application techniques may be used, such as spray, pour, drop, and the like. The application of the soluble collage gel may be manual or automated and applied by electro-mechanical devices.
100691 The winding can be performed so that at least one layer of the at least one collagen fiber has a substantially constant pitch for at least a major portion of a length thereof or so that at least one layer of the at least one collagen fiber has a variable pitch for at least a major portion of a length thereof.
[0070] Figure 4 illustrates that different configurations of fibers 13 may be used. Examples of fiber configurations include a single fiber 131, a plurality of fibers 131_ 13n (typically n=2 to 100) that can be concurrently co-wound about the support member 20, a fiber bundle 13b, and a twisted, woven or braided fiber bundle 13t. For the fiber bundles 13b, 131, two or more fibers 13 can be grouped together to form the fiber bundle 13b, 13t and that bundle 13b, 13t applied or wrapped about the support member 20, similar to a single fiber. One or more fiber bundles 13b, 13t may be used to form the construct 10. Combinations of the different fiber types may also be used for some constructs 10. That is, for example, a twisted fiber 13t can be co-wound with a single fiber 131 and/or a single fiber 131 may be used to form one layer and a twisted 13t to form a different layer, and the like.

100711 The collagen fiber 13 can be wound using various fiber angles (e.g., pitch angles), such as, angles between about 2-70 degrees, typically between about 5-60 degrees, such as, for example, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 54 and 55 degrees, or other odd or even numbers between 5-70. Where constructs of multiple layers are used, one layer may have a first pitch and another layer may have a different pitch, 100721 Figure SA illustrates that a construct 10 can be wound with increased fiber density 52 along certain segments, typically forming end rings 52r.
This increased fiber density 52 can provide sufficient rigidity to allow a suture to attach thereto. As shown in Figure SA, the construct 10 is tubular 10t and may optionally include an increased density segment 52 at an intermediate location.
Figure 5B illustrates that the construct 10 can be used as formed, or may be cut or separated along a Y-axis into two components 10ta, 10tb. For the latter, the intermediate increased density ring 52 can form end rings for the separated construct 10ta, 10tb.
100731 Figure 6A illustrates a construct 10 that is relatively flat 10f and/or rectangular. Again, the construct 10f cart optionally include increased fiber density segments 52 that may be suitable for end rings 52r. Figure 6B illustrates that the construct 10f can be cut along the X-axis and separated into at least two components that form biocompatible patches. The intermediate increased density ring(s) 52, where used, can optionally form end rings 52 for the separated construct 10fa, 10fb, 10fc, 10fd, etc.
100741 Figure 7 illustrates an example of another automated winding system 100' that can be used to form the construct 10. This embodiment uses several fibers 13, each independently wound and/or wrapped to weave or braid the fibers about the support member 20 to form the construct 10. The system 100' includes a plate 122 supporting spindles 124, a forming plate 126, a support member (shown as a cylindrical mandrel) 20 that extends through an aperture in the forming plate 126, and braid puller 128. An exemplary microbraider is believed to be available from Kokubun Ltd of Japan. See also, Figure 2 and col. 2 of U.S. Patent No.
7,135,040.
100751 The fibers 13 can be wound before or after cross-linking (or not cross-linked at all). If wound before, the fibers can, where desired, be polymerized with any suitable cross-linking materials, to promote collagen organization, such as, for example, NDGA, but other cross-linking materials may be used, including, for example, glutaraldehyde. The (dried) collagen fiber can also be treated with other methods to improve the tensile properties of the fiber. The (dried) collagen fibers 13 can be cross-linked with agents such as glutaraldehyde, formaldehyde, epoxy resins, tannic acid, or any other chemical agent that produces covalent cross-links between collagen molecules within fibrils or between fibrils. Alternatively, the fiber 13 can be treated to induce cross-linking between collagen molecules such as, but not limited to, one or more of a carbodiimide treatment, ultraviolet irradiation either with or without carbohydrates to initiate glycation adducts, and dehydrothermal treatment coupled with any of the aforementioned methods.
[0076] Figure 9 illustrates a medical kit 250 that includes a medical device or implant 10 or 10'. The kit 250 may optionally include other components, such as, for example, a container of surgical adhesive, sutures 210, suture anchors, and the like. The device or implant 10, 10' may be held hydrated in a flexible sealed package of sterile liquid 230. The kit 250 may include a temperature warning so that the construct 10, 10' is not exposed to unduly hot temperatures that may degrade the implant. A temperature sensor 252 may optionally be included on the package of the kit to alert the clinician as to any excessive or undue temperature exposure prior to implantation. For example, it may be desirable to hold or store the kit 250 (and implant or device 10, 10') at a temperature that is less than about 37 C
and/or 100 F
prior to implantation. The kit 250 may be packaged in a housing with a temperature controlled or insulated chamber 250c to facilitate an appropriate temperature range.
[0077] Figure 10 is a flow chart of operations that can be used to carry out embodiments of the present invention. In some embodiments, the at least one collagen fiber is wound a number of revolutions about a length of a support member having a long axis. The winding can have a defined pitch and/or fiber angle relative to the long axis of the support member to form an elongate construct with at least one wound collagen fiber (block 150). The winding step can form multiple overlying layers of the at least one collagen fiber in one or more fiber angles so that the at least one fiber intersects itself at different locations along a length of the construct.
[0078] Optionally, a collagen gel can be placed onto the support member and the gel can dry to form a film on the outer surface of the support member before the winding step (block 155). The collagen film can be dried or allowed to dry on the support member (e.g., rod). As the fiber(s) is wound about the support member, a soluble collagen can be applied (e.g., wrapped, painted, sprayed, dripped and the like) onto the fiber(s) and/or support member so that the fiber(s) become wet while one or more layers are wound on the lathe.
[0079] The at least one collagen fiber can be supplied to the winder/support member in a substantially dry state and may be provided as a spooled (dry) quantity of the at least one collagen fiber (block 152). The fiber(s) can be supplied and wound in a non-cross-linked state.
100801 In some embodiments, the winding step can be carried out to create multiple adjacent overlying layers of the at least one fiber, the adjacent layers being coextensive for at least a major portion of a length of the construct (block 153). A
liquid or gel comprising soluble collagen can be placed onto the at least one wound collagen fiber to cover at least the outer surface in a collagen film (block 165).
100811 Optionally, the placing of the collagen gel or liquid is carried out by placing collagen gel having a cylindrical shape around the at least one wound collagen fiber and the support member (block 158).
[0082] Optionally, the collagen can be polymerized while the elongate construct is held on the support member using a suitable cross-linker, such as, for example, NDGA, then removing the construct from the support member (block 166).
[0083] The winding can be carried out so that the at least one fiber tums about the support member in one of a clockwise or counterclockwise direction along a first lengthwise direction for a first layer, then reverses to travel in an opposing lengthwise direction and continues to turn about the support member in the same clockwise or counterclockwise direction for a second adjacent layer (block 180, Figure 11). Alternatively, in particular embodiments, the winding may be carried out so that the at least one collagen fiber turns (is wrapped) about the support member in one of a clockwise or counterclockwise direction along a first lengthwise direction for a first layer, then reverses to travel in an opposing lengthwise direction and turns about the support member in the other clockwise or counterclockwise direction a second adjacent layer.
100841 In some embodiments, the winding step has a first pitch for the winding of the at least one collagen fiber on the first layer and a second smaller or greater pitch for the winding of the at least one collagen fiber on the second layer. In some embodiments, the at least one fiber on the second layer resides between gaps defined by the at least one fiber wound with the defined pitch on the first layer.

100851 The method can include cutting the construct in an axial direction to form a flat collagen fiber patch. The method can include winding the collagen fibers in a plurality of axially spaced apart segments with increased collagen fiber density, at least some of which are provided as reinforced segments for suturing. The reinforced segments can be formed at end portions of the tube and optionally at one or more intermediate locations therebetween. The methods can produce a nerve guide having sufficient strength and elasticity to withstand buckling and to be able to bend and to elastically return to its original shape after bending to inhibit occlusive pressures or restrictions on nerves.
[0086] Embodiments of the invention can be used for a number of different medical applications, including, but not limited to, nerve guides, wound bed patches, muscle or organ patches, cardiac patches, valve replacements or repairs, hernia patches, skin patches, burn treatment patches, skin/tissue repair patches or cuffs, blood vessel (artery, vein, and the like) repairs, sleeves that can reside about repairing tendon to prevent or inhibit adhesions, indwelling tubes for delivery of therapeutic agents, ducts such as lymphatic, hepatic, pancreatic and cystic ducts, tubes such as ureter and urethra tubes and the like.
[0087] The present invention is explained in greater detail in the following non-limiting Examples.
EXAMPLE
[0088] Figures 2A-2D illustrate exemplary sleeves or tubes of wound NDGA-collagen fibers that may be particularly suitable for nerve guides. The inner diameter of the tube can vary between about 1 and 10mm. The thickness of the wall can vary between about 0.1 and 3 mm. The length of the tube can vary from between about 1 to 6 cm or more.
[00891 The tube can be made of dermal collagen that is acid or pepsin soluble. The soluble collagen can be made by neutralizing acid soluble collagen and keeping the soluble collagen at a desired low temperature to maintain the collagen in molecular form, (e.g., about 4 C). Collagen gels can be produced from acid soluble collagen by neutralization, injection molding in a Teflon tube of diameter between 0.1 cm to 1.0 cm and incubation for at least about 4 hours at 37 C. The resulting gel can be extruded into deionized water to form a gel cylinder with a diameter between about 0.1 cm to 1.0 cm (and can have a length between about 1 -100 m. Collagen concentration of the soluble collagen and collagen gel can be from about 0.1-4%
weight per volume. The gel cylinder can be used in the gel form or allowed to dry, actively or passively (suspended in air), to form a collagen fiber having a diameter between about 0,05 mm (average) to about 0.2 mm (average).
[0090] The first step to make this prototype tube is to wrap the collagen gel of specified collagen concentration and diameter onto a Teflon rod of selected diameter. The collagen gel layer was allowed to dry on the rod at room temperature to forrn a thin layer of collagen film. The thickness of this collagen film can be varied by applying more or less layers of collagen gel, either is a single application of in several applications.
[00911 The second step is to wind dry collagen fibers on to the collagen film coated Teflon rod. The pitch of the fiber relative to the long axis of the tube can be specified. The thickness of the collagen winding can be adjusted, for example, corresponding to the number of layers of fibers that are laid on (and/or the number of fibers bundled together for the winding). During the fiber winding process, soluble collagen is applied (e.g., painted) onto the surface of the laid-on fibers.
The thickness of the final soluble collagen layer can be varied to achieve specific thickness. The soluble collagen coated fiber wound cylinder is allowed to dry.
[00921 The third step in making the tube is the same as the first step, e.g., to wrap a collagen gel on to the collagen fiber would Teflon rod and the gel layer is allowed to dry to form a collagen film enwrapping the collagen fiber tube. The thickness of the penultimate collagen film can be varied by the number of layers of wrapped gel.
[0093] The dried tube can be used "as- is" (used in a non-cross-linked state and hydrated when in the body or prior to placement in the body), or it can be cross-linked with any agent or action that cross-links the collagen. The (nerve) tube is then taken off the Tenon rod. In the present example, the tube is cross-linked with nor-dihydroguaiaretic acid (NIDGA), see, e.g., U.S. Patent No. 6,565,960, and U.S.
Patent Application Publication No. US-2008-0161917-A 1 .
[00941 The foregoing is illustrative of the present invention and is not to be construed as limiting thereof, Although a few exemplary embodiments of this invention have been described, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention.
Accordingly, all such modifications are intended to be included within the scope of this invention as defined in the claims. The invention is defined by the following claims, with equivalents of the claims to be included therein.

Claims

WHAT IS CLAIMED IS:

1. A method of manufacturing a medical construct, comprising:
placing a length of cylindrical collagen gel about an outer surface of a support member before a winding step;
allowing the cylindrical collagen gel to dry to form a film on the support member before the winding step; then winding at least one collagen fiber a number of revolutions over the cylindrical collagen film about a length of the support member having a long axis, the winding having at least one defined pitch and/or fiber angle relative to the long axis of the support member, while applying a liquid and/or gel of soluble collagen to a surface of the at least one fiber on the support member;
and allowing the wound collagen fiber with the soluble collagen to dry; then applying a collagen gel over the dried collagen fiber with the soluble collagen and allowing the applied collagen to dry to form an outer layer of film to form the construct.

2. A method according to claim 1, further comprising either of the following steps:
(i) providing a spooled supply of a continuous length of the at least one collagen fiber that is between 1 m to 100 m for the winding step, wherein the winding step is carried out to create multiple adjacent overlying layers of the at least one fiber, the adjacent layers being coextensive for at least a major portion of a length of the construct; and (ii) winding the collagen fibers in a plurality of axially spaced apart segments with increased collagen fiber density, at least some of which are provided as reinforced segments for suturing.

3. A method according to claim 1 or 2 further comprising the step of cutting the construct in an axial direction to form a substantially flat collagen fiber patch.

4. A method according to any one of claims 1 to 3, wherein the support member is either substantially cylindrical or substantially rectangular and has a longitudinal axis, and wherein the winding step winds a continuous length of at least one collagen fiber at a first pitch on a first layer and winds a continuous length of the at least one collagen fiber at a second smaller or greater pitch for a second layer.

5. A method according to any one of claims 1, 2 and 4 wherein the construct is a nerve cuff, and wherein the at least one collagen fiber is a single collagen fiber that is wound in a first axial direction relative to the support member for a length of the construct then wound in a second opposing axial direction relative to the support member for a length of the construct thereby providing an anti-fray configuration for the nerve cuff

6. A method according to any one of claims 1 to 4, wherein the at least one collagen fiber is either:
(i) a single fiber that is wound in a first axial direction for a length of the construct, then wound in a second opposing axial direction for a length of the construct to form multiple overlying layers of the single collagen fiber; or (ii) a plurality of fibers, wherein the winding step comprises winding the plurality of fibers substantially concurrently about the support member, and wherein collagen film resides on the inner and outer surfaces of the construct and defines a smooth inner surface and smooth outer surface.

7. A method according to any one of claims 1 to 6, wherein the winding step is carried out to form multiple overlying layers of the at least one collagen fiber in one or more fiber angles so that the at least one fiber intersects itself at different locations along a length of the construct.

8. A method according to any one of claims 1, 2 and 4 to 7, wherein the construct is a nerve guide.

9. A medical device, comprising a tube with a wall surrounding an axially extending cavity, the wall having an at least one collagen fiber, the fiber having a length arranged in a pattern of overlying intersecting segments over at least a major length of the tube, the tube further comprising an inner layer of a collagen film attached to the at least one collagen fiber defining an inner surface of the tube wall and an outer layer of collagen film attached to the at least one collagen fiber defining an outer surface of the tube wall.

10. A medical device, comprising a medical patch comprising at least one collagen fiber arranged in an angular pattern of a plurality of adjacent layers, with a first layer has a first fiber orientation and a second layer has a second fiber orientation arranged so that the first and second fiber orientations intersect, the patch further comprising an inner layer of a collagen film and an outer layer of collagen film that are attached to the at least one collagen fiber.

11. A medical device according to claim 9 or 10, wherein the at least one collagen fiber comprises any one or more of the following features:
(i) it is derived from extruded soluble dermal collagen, and wherein the collagen film comprises soluble dermal collagen having a collagen concentration of between 0.1-4% weight per volume;
(ii) it comprises a first fiber layer of a continuous wound length of at least one collagen fiber extending about a core or cavity at an angle of between 0° to 90° relative to first plane normal to a longitudinal axis of the tube, and wherein the at least one collagen fiber comprises a second fiber layer with the at least one collagen fiber extending about the longitudinal axis of the tube at an angle of between 5° to 55° relative to the first plane normal to the longitudinal axis;
(iii) it is a single collagen fiber arranged in multiple stacked wound layers, the single fiber having a continuous length with an average diameter when dry of between 0.05 mm to 0.2 mm;
(iv) it is selected from the group comprising dermal, interstitial fiber forming collagen types I, II and III and other fiber forming types of collagen VI; and/or (v) it is derived from the group comprising sea cucumber dermis collagen, bovine, caprine, porcine, ovine or other suitable donor mammal, marine animal collagen, molecularly engineered collagen and gelatin.

12. A medical device according to any one of claims 9 to 11, wherein the at least one collagen fiber is cross-linked with an agent selected from the group comprising glutaraldehyde, formaldehyde, epoxy resins, tannic acid, carbodiimide and NDGA.

13. A medical device according any one of claims 10 to 12, wherein the patch comprises a greater density of fibers on end portions thereof.

14. A medical device according to any one of claims 9, 11 and 12, wherein the device is a tube nerve guide or cuff.

15. A medical device according to claim 14 wherein the tube has a wall thickness of between 1 and 10 mm, and the tube has a length that is between 1-6 cm and wherein the tube wall comprises a longitudinally extending slit.

16. A medical device, comprising:
a tube with a wall surrounding an axially extending cavity, the wall having at least one collagen fiber with a continuous length arranged in a wound pattern having a number of revolutions about the tube cavity with overlying intersecting segments over at least a major portion of a length of the tube, and an inner layer and outer layer of collagen film each extending over a length of the wall, wherein the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.

17. A medical device according to claim 16, wherein the at least one collagen fiber is derived from extruded soluble dermal collagen, and wherein the inner layer and/or outer layer of collagen film comprises soluble dermal collagen having a collagen concentration of between about 0.1 to about 4% weight per volume.

18. A medical device according to claim 16, wherein the collagen film and collagen fiber are cross-linked with NDGA.

19. The medical device of claim 18, wherein the inner and/or outer collagen film layer is optically transmissive.

20. A medical device according to claim 16, wherein the at least one collagen fiber comprises a first fiber layer of a continuous wound length of at least one collagen fiber extending about the tube cavity at an angle of between about 0° to about 90° relative to a first plane normal to a longitudinal axis of the axially extending tube cavity, and wherein the at least one collagen fiber forms a second fiber layer with the at least one collagen fiber extending about the longitudinal axis of the tube over the first fiber layer.

21. A medical device according to claim 16, wherein the at least one collagen fiber forms a wound pattern of at least first and second fiber layers with the at least one collagen fiber extending about the longitudinal axis of the tube cavity at an angle of between about 5° to about 55° relative to a first plane normal to the longitudinal axis of the tube cavity.

22. A medical device according to claim 16, wherein the medical device is a nerve guide or nerve cuff, wherein the at least one collagen fiber forms a mesh cylindrical wall of the tube and is configured to have at least one defined pitch and/or fiber angle relative to the axially extending cavity, and wherein the mesh is visually observable, and wherein the nerve guide or nerve cuff has sufficient strength and elasticity to, in use, withstand buckling and to be able to bend and to elastically return to its original shape after bending to inhibit occlusive pressures or restrictions on a nerve.

23. A medical device according to claim 16, wherein the at least one collagen fiber is a single collagen fiber arranged in multiple stacked wound layers the single collagen fiber extending a plurality of revolutions about the tube cavity, the single collagen fiber having a continuous length with an average diameter when dry of between about 0.05 mm to about 0.2 mm.

24. A medical device according to claim 16, wherein the inner layer of a collagen film is attached to the at least one collagen fiber defining an inner surface of the tube wall and the outer layer of collagen film is attached to the at least one collagen fiber defining an outer surface of the tube wall.

25. The medical device of claim 16, wherein the nerve guide comprises a greater density of fibers at different defined segmens of the device.

26. The medical device of claim 16, wherein the nerve guide comprises a greater density of fibers in a ring at end portions thereof relative to other portions.

27. A medical device according to claim 16, wherein the inner layer and outer layer of collagen film each independently have a thickness of between about 5 microns to about 200 microns, and wherein the tube has reversible elasticity.

28. A medical device according to claim 16, wherein the at least one collagen fiber forms a wound pattern of at least first and second fiber layers with the at least one collagen fiber in the second fiber layer residing between gaps defined by the at least one fiber collagen fiber in the first fiber layer.

29. A medical patch comprising at least one collagen fiber arranged in an angular pattern of a plurality of adjacent layers, wherein a first layer has a first fiber orientation and a second layer has a second fiber orientation arranged so that the first and second fiber orientations intersect, an inner layer of collagen film, and an outer layer of collagen film; and wherein the patch is substantially planar and the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.

30. A medical patch according to claim 29, wherein the patch is implantable or the patch is an external patch for a wound closure or treating a burn.

31. A medical patch according to claim 29, wherein the patch comprises a greater density of fibers on end portions thereof.

32. A medical patch according to claim 29, wherein the collagen is cross-linked with NDGA.

33. A medical patch according to claim 29, wherein the inner layer of collagen film resides under the adjacent layers and the outer layer of collagen film resides over the adjacent layers.

34. The patch of claim 29, wherein the patch, when implanted or positioned on a subject, is adapted to be substantially planar and conformable to target tissue.

35. A medical nerve guide or cuff, comprising:
a tube with a wall surrounding an axially extending cavity, the wall having at least one wound collagen fiber arranged with a number of revolutions in a plurality of layers forming an overlapping pattern over at least a major length of the tube;
an inner layer of a collagen film attached to the at least one collagen fiber defining an inner surface of the wall; and an outer layer of collagen film integrally attached to the at least one collagen fiber defining an outer surface of the wall, wherein the tube with the inner and outer layers of film is permeable, wherein the collagen fiber pattern is visually observable, and wherein the inner layer and outer layer of collagen film comprise collagen fibers, fibrils and/or microfibrils.

36. A nerve guide or cuff according to claim 35, wherein the tube is elastic with sufficient rigidity to be able to elastically deform when exposed to normal bending while providing resistance against nerve compression, then return to an original length and configuration when the bending force is removed or reduced, and wherein the fiber pattern of each layer has a fiber pitch angle of between about 5 to about 60 degrees.

37. A nerve guide or cuff according to claim 35, wherein the at least one collagen fiber is a soluble dermal collagen fiber, wherein the collagen film comprises soluble dermal collagen having a collagen concentration of between about 0.1 to about 4% weight per volume.

38. A nerve guide or cuff according to claim 35, wherein the collagen film and collagen fiber are derived from soluble dermal collagen, and wherein the collagen film and fiber are cross-linked with NDGA.

39. A nerve guide or cuff according to claim 35, wherein the at least one collagen fiber is a single collagen fiber having an average diameter when dry of between about 0.05 mm to about 0.2 mm arranged in multiple stacked layers of coils, and wherein the wall has a thickness of between about 1 and about 10 mm, and the tube has a length that is between about 1 to about 6 cm.

40. A nerve guide or cuff according to claim 35, wherein the tube wall comprises a longitudinally extending slit.

41. The nerve guide or cuff of claim 35, wherein the nerve guide comprises a greater density of fibers at different defined segments of the device.

42. The nerve guide or cuff of claim 35, wherein the nerve guide comprises a greater density of fibers in a ring at end portions thereof relative to other portions.

43. The nerve guide or cuff of claim 35, wherein the collagen film layers are optically transmissive.

44. A medical nerve guide or cuff, comprising:
an elastic tube with a wall surrounding an axially extending cavity, the wall having at least one collagen fiber of a continuous length arranged in a fiber mesh pattern of overlying intersecting segments over at least a major length of the tube, the at least one collagen fiber between inner and outer layers of a collagen film that extend over interstitial spaces defined by the fiber mesh pattern, and wherein the fiber mesh pattern is visually observable, and wherein the collagen film layers comprise collagen fibers, fibrils and/or microfibrils.

45. A medical nerve guide or cuff according to claim 44, wherein the tube wall comprises a longitudinally extending slit.

46. The nerve guide or cuff of claim 44, wherein the nerve guide comprises a greater density of fibers at different defined segments of the device.

47. The nerve guide or cuff of claim 44, wherein the nerve guide comprises a greater density of fibers in a ring at end portions thereof relative to other portions.

48. The nerve guide or cuff of claim 44, wherein the collagen film layers are optically transmissive.

49. The nerve guide or cuff of claim 44, wherein the fiber mesh pattern has a plurality of abutting layers with fiber pitch angle of a respective at least one continuous length collagen fiber that is between 5-60 degrees.