This disclosure describes a membrane configured to guide bone and tissue regeneration for a bone defect (1402). The membrane comprises a first layer, a second layer, one or more perforations (18), a flexible reinforcement or binder (12), and/or other components. The first layer of the membrane is configured to contact bone (1400). The first layer includes pores configured to promote ingrowth of bone regenerating cells into the first layer. The second layer is configured to substantially prevent fibrous connective tissue from growing into the bone defect. The second layer comprises a relatively dense structure and is fixedly coupled to the first layer. The perforations (18) may comprise co-axial through-holes having common dimensions through the first layer and the second layer. The perforations enhance ossification.
