CN1956689A - Wound contact device - Google Patents

Abstract

This invention provides a therapeutic article for promoting wound healing in mammals. An exemplary article includes a permeable structural member having a plurality of recesses formed on its surface. In use, the surface with the recesses is placed adjacent to a wound surface. A method of treating a wound includes the steps of: providing a permeable structural member comprising a plurality of randomly arranged fibers and having i) a plurality of wound surface contact elements disposed between ends of the structural member and ii) a plurality of gaps defined by said contact elements; and applying the permeable structural member to at least one surface of the wound.

Description

Wound Contact Supplies

related application

This application claims priority to US Provisional Patent Application Serial No. 60/561,745, filed April 13, 2004, the contents of which are incorporated herein by reference.

technical field

The present invention relates to an article and method for treating wounds. More specifically, the present invention relates to a contact article for treating wounds.

Background technique

Wound healing is a fundamental human restoration process. Dressing wounds with suitable materials has long been known to aid the body's natural regeneration process. Historically, these materials were made of cotton fibers; such as gauze. These dressings are beneficial to the healing process because they isolate damaged tissue from external contaminants and remove potentially harmful wound exudate.

Numerous studies have concluded that wound healing depends on the interplay of complex mechanisms involving cell proliferation, migration, adhesion as well as angiogenesis. Application of traditional gauze or other substantially flush materials is substantially suboptimal for these mechanisms. In vitro wound healing studies are performed in cell culture media that ensure cell function. Therefore, in the study of wound healing, it is ideal to provide cell culture equivalents or bioreactor systems to optimize the interplay of cell proliferation, migration and adhesion functions. In addition, other bodily functions must be added which facilitate the supply of fibronectin, plasma proteins, oxygen, platelets, growth factors, immune chemicals, and the like.

As science and medicine have advanced, the techniques incorporated into wound healing articles have improved greatly. Highly absorbent wound dressings capable of absorbing many times their own weight in liquid are used. Systems are available that temporarily seal wounds and use suction to drain exudates. Dressings incorporating antimicrobial and biohealing agents are also in use. have found use in an article that provides a moist wound environment to promote healing.

Despite some technological advances in wound healing supplies and dressings, many people still suffer from chronic wounds. These chronic wounds are debilitating and can persist for years, greatly reducing a person's quality of life. These wounds often lead to amputation. Individuals may even die from complications such as infection.

Therefore, there is a great need for more effective wound healing articles and methods.

Contents of the invention

In order to promote wound healing, the present invention provides a wound contact material, a method for manufacturing the wound contact material and a treatment method using the wound contact material.

According to an exemplary embodiment of the present invention, a therapeutic article for promoting wound healing in a mammalian body is provided. The article includes a permeable matrix or structure having a plurality of recesses formed in a surface thereof, wherein said surface having said recesses is positioned in surface contact with a wound.

According to another exemplary embodiment of the present invention, a therapeutic article for promoting wound healing in a mammalian body is provided. The article includes a permeable structure having a plurality of wound surface contacting elements disposed between ends of the structure and a plurality of voids defined by the contacting elements.

According to yet another exemplary embodiment of the present invention, there is provided a therapeutic article for promoting wound healing on a mammalian body, the article comprising a permeable structure comprising a plurality of interconnected fibers, wherein the structure The member has a plurality of wound surface contacting elements disposed between ends of the structural member and a plurality of voids defined by the contacting elements.

According to yet another exemplary embodiment of the present invention, there is provided a therapeutic article for promoting wound healing on a mammalian body, the article comprising a polymeric mat having a plurality of A wound surface contacting element and a plurality of voids bounded by the contacting element.

In accordance with yet another exemplary embodiment of the present invention, there is provided a method of making a therapeutic article for promoting wound healing on a mammalian body, comprising the steps of: providing a molten matrix material; providing a matrix material defining and forming a plurality of recesses and a mold for a plurality of contact elements; and applying molten matrix material to the mold.

According to a further exemplary embodiment of the present invention, there is provided a method of manufacturing a therapeutic article for promoting wound healing on a mammalian body, comprising the steps of: providing a permeable structure; A plurality of recesses are formed in the surface.

According to another exemplary embodiment of the present invention, there is provided a method of treating a wound comprising the steps of: providing a permeable structure, wherein the structure includes a plurality of wound surface contacting elements disposed between ends of the structure and a plurality of voids defined by the contact elements; applying the permeable structure to at least one surface of the wound; and applying a force to the structure to maintain the structure in intimate contact with the wound surface.

The above and other aspects and objects will become apparent from the following description.

Description of drawings

The present invention is best understood from the following detailed description when read with reference to the accompanying drawings. It is emphasized that, according to common practice, the various features in the drawings are not drawn to scale. On the contrary, the dimensions of the various features are arbitrarily expanded or reduced for clarity. Wherein said drawings include:

1 is a perspective view of a wound contact patch provided with channels according to a first exemplary embodiment of the present invention;

Figure 2A is a perspective view of a wound contact assembly provided with a channel according to a second exemplary embodiment of the present invention;

Fig. 2B is a cross-sectional view of a wound contacting assembly provided with channels according to the second exemplary embodiment shown in Fig. 2A;

Fig. 3A is a perspective view of a wound dressing with recessed holes according to a third exemplary embodiment of the present invention;

Fig. 3B is a top view of the wound dressing provided with concave holes as shown in Fig. 3A;

Fig. 3C is a bottom view of the wound dressing provided with concave holes as shown in Fig. 3A;

Fig. 3D is a cross-sectional view of the wound dressing with concave holes as shown in Fig. 3A;

Fig. 4A, 4B, 4C have shown the usage situation of the wound dressing that is provided with concave hole as shown in Fig. 3A;

5A is a perspective view of an irregular wound contact patch according to a fourth exemplary embodiment of the present invention;

Fig. 5B is a cross-sectional view of the irregular wound contact patch as shown in Fig. 5A.

Detailed ways

A wound dressing with an intermittent contact layer has the advantages that tissue growth is promoted under the action of wound surface contact elements, and the void volume (void) required for subsequent tissue growth is set at the discontinuity. volume) to enable tissue growth. Ideally, the structure of the contacting material is physically sufficiently corrugated to resist and not flatten when forces are applied to the material that are required to press the material to the wound surface.

The material is ideally capable of retaining its structure when exposed to aqueous fluids or other bodily fluids. Many conventional sheet materials soften when exposed to moisture, causing changes in their geometry. The contact layer is permeable, allowing the underlying wound to breathe and allowing drainage of the wound. The absorbency of the contact layer should not be too great, as this would lead to structural damage. The layer consists of a base material that is resistant to changes in the presence of moisture and aqueous liquids.

In the current embodiment, when the structure is pressed onto the wound surface, the size of the void remaining on the wound surface is preferably at least 0.1 mm. The width of the interspace bounded by contact elements adjacent to the interspace is preferably greater than 0.1 mm. A more preferred width is between about 0.5 and 10 mm, and a more preferred height is between about 0.2 and 5 mm.

Wound healing is considered to be a complex process. When a wound contacting material as described is pressed onto a wound surface, several biological processes are believed to occur. Mechanical stress is applied to the underlying tissue. A discontinuity in the contact surface will cause a catenary shape of force to press on the tissue. These mechanical stresses promote cell survival and angiogenesis, and the discontinuity begins to fill with granular tissue. Excess fluid is diverted from the wound, and tissue grows in such a manner and pattern that after removal of the contact surface, damage to the newly grown tissue is minimized.

Fiber matrix or structural parts have various flexible adaptability brought by spinning technology. Fibrous fabrics can be made into structural members for use in the present invention by a number of methods known in the art. Among these methods, there are knitting, weaving, embroidery, weaving, felting, spunbonding, meltblowing, and melt spinning. Each of these methods can be further adapted to produce materials whose structure matches that of the materials of the invention. With the meltblown method, the desired structure can be obtained during the production of the structural part, for example by spraying the molten material directly onto the mold. Alternatively, the structure may be produced by machining the formed structural member after production, for example by hot stamping or vacuum forming. Additionally, fibers can be mixed with a binder and sprayed onto the engraved surface.

The versatility of the fiber fabric also extends to its easy adaptability in combined applications. The monofilament material can be varied to optimize physical parameters such as stiffness or flexibility. Monofilament materials can also be selected for their known properties to aid in wound healing. Examples of such fibrous materials are calcium alginate and collagen. Alternatively, the fibers may be treated with known wound healing agents, such as hyaluronic acid or antimicrobial silver. The ratio of fibrous materials can be varied to suit the needs of the wound. According to a desirable aspect of the present invention, different fibers having various wound healing properties can be added as desired.

Other fiber structures expected to be beneficial additions include:

1. Fibers that absorb fluid

2. Non-absorbent fibers

3. Bioabsorbable fiber

4. Wicking fibers that drain the wound surface

5. Fibers known to have healing properties, such as calcium alginate

6. Bioerodible fibers for releasing curing agent in a controlled manner

7. Conductive fibers for the transmission of charge or current

8. Adhesive fibers for selectively removing undesirable tissues, substances or microorganisms

9. Non-adhesive fibers for protecting delicate tissues

Figure 1 shows an exemplary embodiment of the present invention. As shown in FIG. 1 , a channeled wound dressing 100 is constructed of a generally conformable polymeric mat material 102 . Alternative fabrics are also available for most applications such as knitted, woven or woven fabrics. Polyolefins, such as polyethylene or polypropylene, and polyurethanes, such as nylon, with similar physical properties are also contemplated. Especially desirable is the creep resistance of the polymer. Interstitial channels 104 are cut into the mat material 102 to provide discontinuities that promote upgrowth of new tissue. In use, the channeled wound dressing 100 is pressed onto the wound so that it comes into intimate contact with the injured tissue. Ideally, a force of 0.1 psi or greater is applied to the contact layer to press the contact element onto the wound surface. The wound contacting element 106 is thus in intimate contact with the injured tissue.

Figures 2A and 2B illustrate a wound dressing assembly 200 comprising a channeled dressing 100 and a moisture vapor permeable adhesive backing sheet 202 . In general, adhesive vapor permeable backsheets are well known in the art and are believed to aid in wound healing by maintaining optimum moisture levels relative to certain specific wounds. In use, the patch assembly 200 is placed on a wound surface with the channeled patch portion 100 in contact with the wound. The adhesive sheet 202 covers the channeled patch 100 and adheres to the skin adjacent the wound. Assembly 200 provides the advantages of channeled patch 100 . Additionally, the adhesive sheet 202 secures the assembly 200 while enabling moisture vapor transmission, and protects the wound from bacterial infection and the like.

Figures 3A, 3B, 3C and 3D illustrate another satisfactory embodiment of the invention. The base body or structural parts for the recessed wound dressing 300 can be constructed from materials similar to those used in the channeled dressing 100 and produced in a similar manner thereto. FIG. 3A depicts a perspective view of a patch 300 provided with recesses, with a contact surface 320 on top. FIG. 3D is a cross-sectional view of a patch 300 with recesses, best showing contact elements 332 and recess voids 330 . Preferably, the total recessed void area occupies at least 25% of the total sheet area. More preferably, the total recessed void area occupies at least 50% of the total sheet area. The pocket void 330 is partially bounded by sidewalls 332 . The side walls 332 then function in part to provide the rigidity required to resist the compaction of the recessed sheet 300 . Preferably, the contact element is configured with an arcuate contact surface. In a preferred embodiment, the radius of contact is between about 0.1 mm and 1 mm.

The pocket void 330 can be made into a variety of regular or irregular shapes. Preferably, the pocket voids are configured so that they are not "undercut", such that the perimeter of each orifice is smaller than the perimeter of the corresponding inner void. The "undercuts" or network of voids can cause tissue damage when the dressing 300 is removed because any tissue that has grown into the voids is torn away as the material is removed from the wound. Additionally, an undercut or meshed void structure is more likely to cause shedding of the patch material into the newly growing wound tissue.

In a preferred embodiment, the substrate material used for the sheet 300 is Masterflo R™, manufactured by the BBA Group of Wakefield, Mass., USA. In this exemplary embodiment, the base material has a thickness of approximately 1.0 mm. A concave void 330 is hot stamped into the base material to a depth of approximately 0.75 mm and a diameter of approximately 2 mm.

Since the contact layer is typically replaced every few days, it is important to allow for the possibility of aligning newly formed tissue with the void of the new contact layer. Therefore, according to the exemplary embodiment of the present invention: 1) the concave hole gap 330 can be arranged randomly, so that the concave hole gap 330 is not aligned with the new tissue growth after each patch replacement; or 3) different spacing of the holes can be used each time the material is changed.

Figures 3B and 3C show corresponding top and bottom views, respectively, of a patch 300 provided with recesses. A variant of this embodiment is also conceivable with the recessed aperture 330 and/or the contact element 322 provided on both the top and the bottom of the sheet 300 provided with the recess. A second variant is also conceivable with respect to the wound dressing 300 provided with dimples, wherein some or all of the dimple voids 330 are replaced by perforations through the entire thickness of the structural member, so that the top and bottom views of this variant The graph will look like the view shown in Figure 3B.

In an exemplary embodiment, the well void 330 may be partially filled with a therapeutic substance. For example, an antiseptic substance may be placed in void 330 to treat an infected wound. Additionally, biohealing agents can be delivered into the void to increase the rate of new tissue formation. In yet another exemplary embodiment, the layers of the sheet 300 may have different functions on each side. For example, one side of the patch 300 can be optimized for new tissue growth while the other side can be optimized for antimicrobial delivery.

The use of a patch provided with wells is illustrated in Figures 4A, 4B and 4C. A wound surface 400 is shown in FIG. 4A . Note that wound surface 400 may represent a small interior portion of a deep tissue wound, or the majority of a shallow superficial wound. FIG. 4B shows the application of the patch 300 provided with dimples to a wound surface 400 , with corresponding tissue growths 410 located in the voids 330 of the dimples. Finally in FIG. 4C , the debossed patch 300 is shown removed leaving only the tissue growth 410 . As will be discussed in detail below, it is desirable to provide an external force for maintaining the dressing 300 pressed against the wound surface.

Figures 5A and 5B illustrate another embodiment of the present invention, a rough irregular sheet 500. Referring to the perspective view, FIG. 5A depicts an irregular patch 500 having irregular voids 510 and an irregular contact surface 520 that acts as a "hook" element that acts as a "hook" element in placing the substrate on the wound. Can contact and adhere to necrotic tissue during medium time. When the matrix is removed from the wound, the necrotic tissue can be removed from the wound as it adheres to the hook-shaped protrusions 520 . Removal of the substrate clears the wound. Removal of dead tissue is an important part of wound healing. The substrate of the sheet 500 may be made from a polymer mat or batting. In an exemplary embodiment, the mat is charred with hot air so that a percentage of the fibers melt to form a textured surface with some hook elements 520 . Another suitable configuration may be a hook material, for example used with a hook or loop fabric.

Although the methods and substrates used are conducive to the growth of new tissue, after proper removal of necrotic tissue, the wound can still become infected and can be treated with, for example, substances including antibacterial silver which kill the Bacteria play a role.

Generally, the phase of wound healing where new tissue is formed is referred to as the proliferative phase. Once the wound has healed sufficiently and the bacterial load has sufficiently decreased during the proliferative phase, a substrate free of antimicrobial silver and optionally containing a growth promoting material may be used to facilitate continued proliferation of new tissue.

FIG. 5B shows a random cross-section of an irregular sheet 500 . The roughened surface of the irregular sheet 500 can be made by passing a suitable substrate under convective heat at or near the melting point of the constituent materials of the substrate. For example, polymeric materials typically melt in a range from about 250 degrees Celsius to about 290 degrees Celsius. A polymeric mat material briefly passing beneath a convective heat source operating in this range will undergo a process of surface melting and subsequent fusing of the polymeric filaments on its surface. The extent of surface melting can be controlled by temperature and exposure time to produce a surface with a desired roughness exhibiting irregular voids 510 and irregular contact elements. Although the irregular sheet 500 is shown with only one roughened surface, the invention is not so limited as both the upper and lower surfaces can be equally roughened. Such a patch would be quite useful in the treatment of damaged wounds.

As noted above, treatment using the present wound dressing invention involves depressing the inventive bandage into intimate contact with the wound surface. Generally, the force should be at least 0.1 psi. Various methods and systems for maintaining said intimate contact state are conceivable. These methods and systems may include: applying the adhesive film to the inventive bandage and adjacent to the wound surface; wrapping the bandage over the dressing and wrapping it around the injured area; The object is fastened to the structural member, and the bladder is filled with gas or liquid. In an exemplary embodiment, pressure is applied to the bladder intermittently. The conformable seal can be placed over the wound and brought into contact with the structure, and the rigid seal can then be fastened over the wound in contact with the structure, thereby transferring force to the contacting structure. Pressure is then applied between the rigid seal and the flexible seal, pressing the contact structure against the wound surface. Intimate contact can be improved by using a conformable shield to seal the wound area while applying suction. A wound dressing 300 provided with dimples is particularly well suited for the application when suction is used. Generally, the magnitude of the suction ranges between 0.25PSI and 5psi. The use of suction can be further improved by wrapping wound dressing material onto the back of the patch. One such suitable wound dressing material is described in US Provisional Patent Application Serial No. 60/554,158, filed March 18,2004.

Example analysis 1

Patient A, a 70-year-old male, had a second-degree decubitus ulcer on his right buttock with obvious ulceration. A contact structure of the invention is applied to a wound, an adhesive film is placed over the wound, and brought into contact with the structure. A suction force of 1.1 psi was applied underneath the adhesive film to transfer the force to the contact structure. Suction is generally maintained continuously. Change contact materials every two to four days. After using this product for 30 days, the festering part of the wound was healed substantially, and the opening area of the wound was reduced from 66 square centimeters to 45 square centimeters. Multiple layers of skin grafts are applied to the wound.

Example analysis 2

Patient B, a 50-year-old male, suffered a fracture of the right ankle and exposed bones. A plate is used for fracture reduction and a free rectus abdominis flap is performed to cover exposed bone and hardware. The flap survives only partially, resulting in an open wound with exposed bone and hard objects. A contact structure of the invention is applied to a wound, and an adhesive film is placed over the wound and contacts the structure. The force is applied to the contacting structure by wrapping a superb bandage around the ankle, or by application of suction. Typically, the suction is applied for about half a day, and the force of the bandage wrap is maintained for the remainder of the day, and after a few days, only the bandage wrap is used to provide force. When providing force by suction, use between 1 and 2 psi of suction. In less than two weeks, new tissue had grown on the exposed hard objects. The wound area shrunk from 50 cm2 to 28 cm2 over the 7 week period.

While preferred embodiments of the invention have been shown and described in this specification, it should be understood that these embodiments are provided by way of example only. Many variations, modifications and substitutions can be imagined by those skilled in the art without departing from the spirit of the invention. Accordingly, the appended claims are to cover all such modifications as fall within the scope and spirit of the invention.

Claims (42)

1, a kind of treatment articles that is used to promote wound healing on the mammalian body, described articles for use comprise:

A permeable structure, it has a plurality of its lip-deep recesses that are formed on;

Wherein, the described surface with described a plurality of recesses is positioned to at least one surface of wound and contacts, and has in wound at least under the fluidic situation, and described structural member can maintain predetermined configuration basically.

2, articles for use according to claim 1, wherein, described structural member comprises synthetic polymer.

3, articles for use according to claim 2, wherein, described synthetic polymer comprises polyolefin.

4, articles for use according to claim 3, wherein, described polyolefin is a polyethylene or polyacrylic a kind of.

5, articles for use according to claim 2, wherein, described synthetic polymer comprises polyurethane.

6, articles for use according to claim 4, wherein, described polyurethane is nylon.

7, articles for use according to claim 2, wherein, described synthetic polymer comprises polyester.

8, articles for use according to claim 1, wherein, described structural member comprises textile material.

9, articles for use according to claim 1, wherein, described structural member comprises knit materials.

10, articles for use according to claim 1, wherein, described structural member comprises braided material.

11, articles for use according to claim 1, wherein, described structural member comprises embroidery material.

12, articles for use according to claim 1, wherein, described structural member comprises that felt knits material.

13, articles for use according to claim 1, wherein, described structural member comprises spunbond material.

14, articles for use according to claim 1, wherein, described structural member comprises melt-blown material.

15, articles for use according to claim 1, wherein, described structural member comprises melt-spun material.

16, articles for use according to claim 1, wherein, described structural member comprises fibrous material, described fibrous material comprises at least one fiber.

17, articles for use according to claim 16, wherein, described fiber further comprises consolidant.

18, articles for use according to claim 17, wherein, described consolidant is at least a in hyaluronic acid and/or the antimicrobial silver.

19, articles for use according to claim 16, it further comprises one second fiber, this second fiber comprises the healing material that is selected from collagen and calcium alginate.

20, articles for use according to claim 1, it further comprises the bonding film at least a portion that is attached to permeable structure.

21, a kind of treatment articles that is used to promote wound healing on the mammalian body, described articles for use comprise:

One permeable structure, it has:

A plurality of wound surface contact elements that are arranged between the structural member end,

And a plurality of spaces of defining by described contact element,

Wherein, have in wound at least under the fluidic situation, described structural member can maintain predetermined configuration substantially.

22, articles for use according to claim 21, wherein, described structural member comprises first sidepiece with first surface zone and second sidepiece with second surface zone.

23, articles for use according to claim 22, wherein, described a plurality of spaces are arranged on in described first sidepiece and/or described second sidepiece at least one.

24, articles for use according to claim 23, wherein, the area that described a plurality of spaces occupy is greater than about 25% of the surface area of its place sidepiece.

25, articles for use according to claim 23, wherein, the area that described a plurality of spaces occupy is greater than about 50% of the surface area of its place sidepiece.

26, a kind of treatment articles that is used to promote wound healing on the mammalian body, described articles for use comprise:

One permeable structure, this structural member comprise many that connect, random arrangement each other fibers and have:

A plurality of wound surface contact elements that are arranged between the structural member end;

And a plurality of spaces of defining by described contact element.

27, a kind of treatment articles that is used to promote wound healing on the mammalian body, described articles for use comprise:

One polyester felt, this felt have a plurality of wound surface contact elements that are arranged between the structural member end; And

A plurality of spaces of defining by described contact element.

28, a kind of manufacturing is used to promote the method for the treatment articles of wound healing on the mammalian body, may further comprise the steps:

One fused matrix material is provided;

Provide one to define the mould that forms a plurality of recesses and a plurality of contact elements;

Fused matrix material is coated onto on the mould;

Cool off described fused matrix material; And

The articles for use that are shaped are taken out from mould.

29, a kind of manufacturing is used to promote the method for the treatment articles of wound healing on the mammalian body, may further comprise the steps:

One permeable structure is provided; And

In the surface of described permeable structure, form a plurality of recesses.

30, method according to claim 29, wherein, the step of a plurality of recesses of described formation comprises drop stamping.

31, method according to claim 29, wherein, the step of a plurality of recesses of described formation comprises vacuum forming.

32, method according to claim 29, wherein, the step of a plurality of recesses of described formation comprises mold pressing processing.

33, method according to claim 29, wherein, the step of a plurality of recesses of described formation comprises cutting processing.

34, method according to claim 29, wherein, the step of a plurality of recesses of described formation comprises that transmitting convection of heat crosses on wherein at least one surface of structural member, wherein said convection of heat probably is in the melting temperature of structural member material.

35, a kind of method of handling wound may further comprise the steps:

One permeable structure is provided, and described structural member comprises many fibers and has: i) a plurality of wound surface contact elements that are arranged between the structural member end; Ii) a plurality of spaces of defining by described contact element;

Permeable structure is applied at least one surface of wound.

36, method according to claim 35, it further may further comprise the steps:

Bonding film is attached at least a portion of permeable structure, this part is relative with contact element; And

Use bonding film to keep permeable structure closely to contact liftedly with wound surface.

37, method according to claim 35, it further comprises the step of using the binder jacket to keep permeable structure and wound surface closely to contact liftedly.

38, method according to claim 35, it further comprises the step of using suction to keep permeable structure and wound surface closely to contact liftedly.

39, method according to claim 35, it further comprises the step of using wound dressing spare to keep permeable structure and wound surface closely to contact liftedly.

40, method according to claim 35, it further comprises the step of using the Puffer-type bladder to keep permeable structure maintenance and wound surface closely to contact liftedly.

41, a kind of method of handling wound may further comprise the steps:

One first permeable structure is provided, and it comprises:

I) a plurality of wound surface contact elements that are arranged between the structural member end;

Ii) a plurality of spaces of defining by described contact element;

First permeable structure is applied on the wound, makes that at least a portion in the contact element engages with the part of wound surface;

After a preset time section, first permeable structure is pulled down from wound, be at least a portion on a plurality of elements that are attached in the contact element, in the slough together with what pull down;

One second permeable structure is provided, and this second permeable structure comprises the medicament based on the wound situation; And

Behind one second predetermined amount of time, second permeable structure is pulled down from wound.

42, according to the described method of claim 41, it further may further comprise the steps:

One the 3rd permeable structure is applied on the wound, and described the 3rd structural member has a plurality of its lip-deep recesses that are formed on.

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