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1994 | Buch

Biomaterials, Medical Devices and Tissue Engineering: An Integrated Approach

verfasst von: Frederick H. Silver, PhD

Verlag: Springer Netherlands

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Über dieses Buch

are then selected and must meet the general 'biocompatibility' require­ ments. Prototypes are built and tested to include biocompatibility evalua­ tions based on ASTM standard procedures. The device is validated for sterility and freedom from pyrogens before it can be tested on animals or humans. Medical devices are classified as class I, II or III depending on their invasiveness. Class I devices can be marketed by submitting notification to the FDA. Class II and III devices require either that they show equivalence to a device marketed prior to 1976 or that they receive pre-marketing approval. The time from device conception to FDA approval can range from months (class I device) to in excess of ten years (class III device). Therefore, much planning is necessary to pick the best regulatory approach. 2. Wound Dressings and Skin Replacement 2.1 Introduction Wounds to the skin are encountered every day. Minor skin wounds cause some pain, but these wounds will heal by themselves in time. Even though many minor wounds heal effectively without scarring in the absence of treatment, they heal more rapidly if they are kept clean and moist. Devices such as Band-Aids are used to assist in wound healing. For deeper wounds, a variety of wound dressings have been developed including cell cultured artificial skin. These materials are intended to promote healing of skin damaged or removed as a result of skin grafting, ulceration, burns, cancer excision or mechanical trauma.

Inhaltsverzeichnis

Frontmatter
1. Scope and Markets For Medical Implants
Abstract
Medical devices are used routinely in the practice of medicine not only in the United States but throughout the world. The use of polymers, metals, ceramics and composite materials in the formulation of medical devices dates back centuries to the use of plant and animal skins for the amelioration of pathological conditions that resulted from mechanical, chemical or pathogenic trauma to tissues and organs. The word ‘device’ as defined by the US Federal Drug and Food Administration (FDA) includes any instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or a combination of these elements that is intended for diagnosis, prevention or treatment of a disease (Phelps and Dormer, 1986). Materials such as synthetic and natural polymers, metals, ceramics, and composites of these materials are by themselves not considered devices and are approved by the FDA when formulated into an end-use device. Prior to 1976, the use of medical devices was unregulated in the US. In 1976, the US Congress enacted the Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act of 1938, which called for the regulation of three classes of devices. Class I devices are those that present little or no risk to the user. Class II devices present some risk and are subject to performance standards while class III devices are the most dangerous and require pre-market approval prior to their widespread distribution.
Frederick H. Silver
2. Wound Dressings and Skin Replacement
Abstract
Wounds to the skin are encountered every day. Minor skin wounds cause some pain, but these wounds will heal by themselves in time. Even though many minor wounds heal effectively without scarring in the absence of treatment, they heal more rapidly if they are kept clean and moist. Devices such as Band-Aids are used to assist in wound healing. For deeper wounds, a variety of wound dressings have been developed including cell cultured artificial skin. These materials are intended to promote healing of skin damaged or removed as a result of skin grafting, ulceration, burns, cancer excision or mechanical trauma.
Frederick H. Silver
3. Replacement of Skeletal Tissues
Abstract
Injury to the musculoskeletal system is caused by traumatic injury as well as the end-stage of diseases such as osteoarthritis and rheumatoid arthritis. These processes lead to impaired locomotion and high levels of pain and therefore must be surgically corrected. Tissue grafts and synthetic polymeric materials are used to repair damaged tendons and ligaments while joint replacement is achieved using primarily metals and polymeric materials. Fixation devices including bone plates and screws are used to reinforce bone fractures. These devices are made of metals, although some polymeric materials have been studied experimentally.
Frederick H. Silver
4. Biomaterials Used In Ophthalmology
Abstract
Ophthalmology is a field that has rapidly advanced as a result of the development of new techniques and materials (Table 4.1). For instance correction of vision using contact lenses has been accomplished since the 1960s and will eventually be replaced using a procedure in which a biomaterial and laser surgery are used to change the curvature of the cornea. Viscous solutions containing large molecules are used during surgical procedures to protect the cellular linings of the eye chambers and to allow insertion of intraocular lenses. These lenses are used to replace natural lenses containing cataracts. Polymer solutions are used to replace the fluid contained in the posterior eye chamber to force the retina backward and maintain its position after surgery. Scleral buckling materials are used to indent the retina inward toward a site of retinal detachment.
Frederick H. Silver
5. Cardiovascular Implants
Abstract
Although major advances in the treatment and prevention of heart disease have been achieved in the last two decades, diseases of the cardiovascular system contribute to about 20% of the fatalities in people between the ages of 36 and 74. Atherosclerosis, a process affecting the large and medium-sized diameter muscular arteries, especially the aorta, coronary arteries and cerebral arteries, is a major cause of death. In addition, valvular leakage results in insufficient cardiac output thereby making even moderate exercise difficult. Atherosclerotic vessels as well as leaky heart valves are routinely replaced by materials that are synthetic or of natural origin.
Frederick H. Silver
6. Facial Implants
Abstract
Use of autografts, homografts and synthetic polymers was, up to the 1990s, sufficient to generate acceptable cosmetic results in facial surgery (Glasgold and Silver, 1991). However, during the last ten years advances in surgical techniques, appreciation of the consequences of homograft resorption and decreased use of homografts because of the increased risk of viral contamination, have led to the need for more available implant materials.
Frederick H. Silver
7. Dental Implants
Abstract
A number of materials are used in the practice of dentistry including impression materials to copy the contours of the gum, appliances and dentures to replace or correct deficiency of the grinding surfaces, and restorative materials to correct defects in natural surfaces (Table 7.1).
Frederick H. Silver
8. Breast implants
Abstract
An estimated 150 000 women undergo breast augmentation each year (Sprague Zones, 1992). About 80% of these women have the surgery to increase the size of their breasts for cosmetic reasons, the remainder have implants that are inserted for reconstruction after removal of breast tissue for health related reasons. The US market alone for these implants is about $100 million annually which is about three times the European market. Major commercial suppliers include Aesthetech, Cox-Uphoff, Dow Corning Wright, McGhan, Mentor and Surgitek. Implant classifications include smooth gel-filled, textured gel-filled, polyurethane covered, saline-filled, double lumen and permanent expander (Table 8.1). The smooth gel-filled implant is most commonly used based on published estimates (Sprague Zones, 1992). The total breast implant market has been estimated to be 300 000 units per year in 1986.
Frederick H. Silver
9. 510 (k) and PMA Regulatory Filings in The US
Abstract
There are two primary pathways to gain approval to market a medical device in the US, 510 (k) notification and pre-market approval (PMA). These processes were introduced in chapter 1 (see section 1.6.1). 510 (k) notification involves marketing a device that is substantially equivalent to a device on the market prior to 1976.
Frederick H. Silver
Backmatter
Metadaten
Titel
Biomaterials, Medical Devices and Tissue Engineering: An Integrated Approach
verfasst von
Frederick H. Silver, PhD
Copyright-Jahr
1994
Verlag
Springer Netherlands
Electronic ISBN
978-94-011-0735-8
Print ISBN
978-94-010-4316-8
DOI
https://doi.org/10.1007/978-94-011-0735-8