U.S. patent application number 10/762884 was filed with the patent office on 2004-09-30 for device and method for treating a wound.
Invention is credited to Boehringer, John R., Karpowicz, John, Mitra, Amitabha, Radl, Christopher L., Timm, Jacob L..
Application Number | 20040193187 10/762884 |
Document ID | / |
Family ID | 32994211 |
Filed Date | 2004-09-30 |
United States Patent
Application |
20040193187 |
Kind Code |
A1 |
Boehringer, John R. ; et
al. |
September 30, 2004 |
Device and method for treating a wound
Abstract
A device for placement in a wound and for use with sutures to
repair the wound of a patient. The device comprises a body having
at least one aperture extending radially through the body. A shaft
is disposed within and rotatably coupled to the body, and the shaft
has at least one receiver substantially in line with the aperture
in the body. One method comprises the steps of placing the body and
shaft of the device within a cavity of the wound; attaching a first
end of at least one suture to a first side of the wound; passing a
second end of the at least one suture through the body and coupling
it to the shaft; attaching a second end of the at least one suture
to the second side of the wound; and rotating the shaft with
respect to the body to pull the first side of the wound and the
second side of the wound toward one another.
Inventors: |
Boehringer, John R.;
(Wynnewood, PA) ; Karpowicz, John; (Chester
Springs, PA) ; Radl, Christopher L.; (Malvern,
PA) ; Timm, Jacob L.; (Hancock, NH) ; Mitra,
Amitabha; (Voorhees, NJ) |
Correspondence
Address: |
RATNERPRESTIA
P O BOX 980
VALLEY FORGE
PA
19482-0980
US
|
Family ID: |
32994211 |
Appl. No.: |
10/762884 |
Filed: |
January 22, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60442603 |
Jan 25, 2003 |
|
|
|
Current U.S.
Class: |
606/144 ;
606/216 |
Current CPC
Class: |
A61B 17/0466
20130101 |
Class at
Publication: |
606/144 ;
606/216 |
International
Class: |
A61B 017/04 |
Claims
What is claimed:
1. A device for aiding in the closure of a wound for use with at
least one suture, said device comprising: an external member; and
an internal member rotatably coupled to said external member, said
internal member having at least one receiver for receiving said at
least one suture wherein said device is for placement within said
wound.
2. The device according to claim 1, wherein said at least one
suture is passed through said at least one receiver in said
internal member, said at least one suture being coupled to portions
of said wound and tightened by rotating said internal member in a
first direction to draw said portions of said wound toward one
another.
3. The device according to claim 1, wherein said at least one
receiver is at least one of i) an aperture extending radially
through said shaft, ii) a hook disposed within said shaft, iii) a
substantially "T" shaped element coupled to an external portion of
said shaft, and iv) a substantially hook shaped element coupled to
an external portion of said shaft.
4. A device for use with sutures to repair a wound of a patient,
said device comprising: a body having a at least one aperture
extending radially through said body; and a shaft at least
partially disposed within and rotatably coupled to said body, said
shaft having a plurality of apertures and/or slots substantially in
line with said at least one aperture in said body, said plurality
of apertures spaced apart from one another and extending radially
through said shaft.
5. The device according to claim 4, wherein said device is for
placement within said wound.
6. The device according to claim 5, wherein said sutures are passed
through said at least one aperture in said body and said plurality
of apertures in said shaft, said sutures being coupled to portions
of said wound and tightened by rotating said shaft in a first
direction to draw said portions of said wound toward one
another.
7. The device according to claim 6, further comprising means for
preventing said shaft from rotating in a direction opposite to said
first direction.
8. The device according to claim 7, wherein said means is a coil
spring disposed between an outer surface of said shaft and an inner
surface of said body.
9. The device according to claim 8, wherein a diameter of said coil
spring increases as said shaft is rotated in said first
direction.
10. The device according to claim 9, further comprising means for
releasing tension of said coil spring to permit said shaft to
rotate in said second direction.
11. The device according to claim 10, wherein said means for
releasing tension comprises an end portion of said coil spring,
said end portion being moved in a direction to increase said
diameter of said coil spring to permit said shaft to be rotated in
a direction opposite to said first direction.
12. The device according to claim 11, wherein said end portion at
least one of extends through a portion of said body and extends
beyond an end of said body.
13. The device according to claim 4, wherein said body further
comprises a coupling for providing a vacuum to an interior of said
wound to extract exudates from said wound.
14. The device according to claim 13, wherein said shaft has an
orifice extending at least partially along a longitudinal axis of
said shaft, said orifice coupled to said coupling and at least one
of said plurality of holes and/or slots of said shaft for providing
said vacuum to said interior of said wound.
15. The device according to claim 14, wherein said body has at
least one orifice extending from an outer portion of said body in
fluid tight relation with said coupling for providing said vacuum
to said interior of said wound.
16. The device according to claim 4, further comprising a means for
applying a rotational force to an end of said shaft to rotate said
shaft with respect to said body.
17. The device according to claim 4, wherein said patient is a
human.
18. The device according to claim 4, wherein said patient is an
animal.
19. A method for facilitating the healing of a wound, said method
comprising the steps of: placing at least one suture between points
on a margin of said wound; applying tension to said at least one
suture from within said wound; and maintaining said tension on said
at least one suture for a predetermined period of time.
20. The method according to claim 19, further comprising the steps
of: disposing a first body within a second body; coupling said at
least one suture to at least one of said first body and said second
body; rotating said second body with respect to said first body to
apply said tension to said at least one suture.
21. The method according to claim 19, further comprising the step
of applying a vacuum to said wound.
22. A method for facilitating the healing of a wound, the method
comprising the steps of: providing a body having at least one
aperture extending radially through said body; rotatably coupling a
shaft to said body, said shaft having at least one aperture and/or
slot capable of being aligned with said at least one aperture in
said body; placing said body and said shaft within a cavity of said
wound; attaching a first end of at least one suture to a first side
of said wound; passing a second end of said at least one suture
through said body and said shaft; attaching said second end of said
at least one suture to second side of said wound; and rotating said
shaft with respect to said tubular body to pull said first side of
said wound and said second side of said wound toward one
another.
23. The method according to claim 22, further comprising the steps
of: coupling a vacuum source to said body; and forming a vacuum
within said wound from said vacuum source to extract exudates from
said wound.
24. The method according to claim 22, further comprising the step
of further rotating said shaft to apply a predetermined tension
between sides of said wound.
25. The method according to claim 24, further comprising the step
of detachably coupling a driver to said shaft to apply said
predetermined tension.
26. A method for facilitating the healing of a wound, the method
comprising the steps of: providing a substantially tubular body
having a plurality of apertures extending radially through said
tubular body; rotatably coupling a shaft to said tubular body, said
shaft having a respective plurality of apertures and/or slots
capable of being aligned with said holes in said tubular body;
placing said tubular body and said shaft within a cavity of said
wound; attaching a first end of at least one suture to a first side
of said wound; passing a second end of said at least one suture
through said tubular body and said shaft; attaching said second end
of said at least one suture to second side of said wound; and
rotating said shaft with respect to said tubular body to pull said
first side of said wound and said second side of said wound toward
one another.
27. A device for use with sutures to repair a wound of a patient,
said device comprising: a tubular body having a first plurality of
apertures extending radially through said tubular body, said
plurality of apertures spaced apart from one another along a length
of said tubular body; and a shaft disposed within and rotatably
coupled to said tubular body, said shaft having a respective
plurality of apertures and/or slots substantially in line with said
apertures in said tubular body, said respective plurality of
apertures spaced apart from one another and extending radially
through said shaft.
28. A device for use with sutures to repair a wound of a patient,
said device comprising: a substantially U shaped body having a
first passage and a second passage in line with one another; and a
shaft rotatably coupled to said body at said first and second
passage, said shaft having a plurality of receivers spaced apart
from one another and one of extending radially through or coupled
to said shaft.
29. A method for facilitating the healing of a wound using at least
one suture, the method comprising the steps of: placing said at
least one suture between points on a margin of said wound; applying
tension to said at least one suture; maintaining said tension on
said at least one suture for a predetermined period of time; and
applying a vacuum to said wound.
30. The method according to claim 29, further comprising the step
of periodically re-tensioning said at least one suture.
31. A method for facilitating the healing of a wound, the method
comprising the steps of: securing an apparatus for applying a force
to margins of said wound to at least a portion of said wound;
applying the force to the margins of the wound with said apparatus;
and applying vacuum to said wound.
32. The method according to claim 31, wherein said tension is
applied from within said wound.
33. The method according to claim 31, wherein said wound is an open
wound.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority to provisional application
serial No. 60/442,603 filed on Jan. 25, 2003.
FIELD OF THE INVENTION
[0002] This invention relates to a device and method for treating
and closing wounds. More particularly this invention relates to a
device and method for treating and closing wounds from within the
wound cavity.
BACKGROUND OF THE INVENTION
[0003] Historically there have been efforts to close difficult
wounds by utilizing skin stretching devices that apply tension on
the skin surrounding the wound. The application of tension to the
skin causes the skin to stretch and ultimately the wound can be
closed. While this technique has been effective for shallow wounds,
it has not been successful for large wounds, especially those that
form large cavities. Often, the skin surrounding the cavity wound
is stretched such that it completely covers the cavity and is
sutured closed. This can lead to the formation of a fluid filled
pocket, seroma, beneath the stretched skin at the location of the
wound. An infection can form in the seroma and ultimately the
original cavity wound returns. These wounds may become chronic in
nature and can persist for many months or even years. They are a
tremendous burden on the patient and society. As such, there is a
need for a device that applies tension to the tissue surrounding a
wound, so that this tissue can be pulled in to fill the cavity.
Additionally, some surgical wounds can be difficult to close and
often there is a benefit to delayed surgical closure. A device that
can aid in gradual closure over a period of time is beneficial.
[0004] A second conventional technique to heal wounds is the
application of suction to the wound to drain the wound. Wound
drainage has been known to be an important technique in the
promotion of wound healing for many decades and is used for both
open and closed wounds. For open wounds, drainage is accomplished
by placing a drain tube in the wound, covering the wound and
attaching suction to the drain tube. The application of suction is
thought to promote wound healing by draining the wound of
deleterious wound exudate and encouraging wound healing activity in
the surrounding tissue. Existing wound tensioning devices extend
outward and upward beyond the margins of the wound, making it
impossible or impractical to seal the wound so that suction may be
applied in combination with tension.
SUMMARY OF THE INVENTION
[0005] To overcome the deficiencies of conventional wound treatment
techniques and devices, the present invention is a device for use
with sutures to repair a wound of a patient.
[0006] The device is for placement within an open wound and
comprises an external member and an internal member rotatably
coupled to the external member. The internal member has at least
one receiver for receiving the at least one suture.
[0007] According to one aspect of the invention, at least one
suture is passed through or otherwise coupled to the at least one
receiver in the internal member. The at least one suture is coupled
to portions of the wound and tightened by rotating the internal
member in a first direction to draw portions of the wound toward
one another.
[0008] According to another aspect of the invention, the at least
one receiver is an aperture extending radially through the shaft, a
hook disposed within the shaft, a substantially "T" shaped element
coupled to an external portion of the shaft, and/or a substantially
hook shaped element coupled to an external portion of the
shaft.
[0009] According to a further aspect of the invention, the device
comprises a body having at least one aperture extending radially
through the body. A shaft is at least partially disposed within and
rotatably coupled to the body, and the shaft has a plurality of
apertures and/or slots substantially in line with the at least one
aperture in the body. The plurality of apertures are spaced apart
from one another and extend radially through said shaft.
[0010] According to one aspect of the invention, sutures are
applied to the tissue near the perimeter of the wound and then
passed through the device. Once all sutures have been secured, the
device is used to pull the sutures and tissue inward toward the
central portion of the wound. This tensioning and resulting
movement is accomplished by winding the sutures around the shaft
within the outer tubular portion of the device. The amount and
direction of force applied to the tissue can be controlled by the
caregiver.
[0011] Applying tension to the tissue near the perimeter of the
wound serves to pull the tissue towards the central portion of the
wound, which ultimately decreases the size of the wound and then
allows for complete closure of the wound. As the wound size
decreases, the caregiver can check the wound and adjust the device
to maintain tension on the tissue.
[0012] According to a further aspect of the present invention, the
device can also incorporate a port for attachment to a drain tube.
The device can be placed in the wound, a drain tube attached to the
device, and the wound and device can be covered with a sealing
film. The drain tube can then be attached to a source of suction so
that the wound may benefit from all of the positive aspects of
wound drainage.
[0013] The invention also provides methods for treating a wound.
One such method comprises the steps of placing at least one suture
between points on a margin of the wound, applying tension to the at
least one suture from within the wound, and maintaining the tension
on the at least one suture for a predetermined period of time.
[0014] According to another aspect of the invention, a method for
treating a wound comprises the steps of placing the at least one
suture between points on a margin of the wound; applying tension to
the at least one suture; maintaining the tension on the at least
one suture for a predetermined period of time; and applying a
vacuum to the wound.
[0015] According to another aspect of the invention, a method for
treating a wound comprises the steps of providing a tubular body
having at least one aperture and/or slot extending radially through
the tubular body; rotatably coupling a shaft within the tubular
body, the shaft having a plurality of receivers capable of being
substantially aligned with the at least one aperture and/or slot in
the tubular body; placing the tubular body and the shaft within a
cavity of the wound; attaching a first end of at least one suture
to a first side of the wound; passing a second end of the at least
one suture through the tubular body and the shaft; attaching the
second end of the at least one suture to second side of the wound;
and rotating the shaft with respect to the tubular body to pull the
first side of the wound and the second side of the wound toward one
another.
[0016] According to another aspect of the present invention, the
wound is sealed with the device within the wound cavity, and
suction is applied to the device for draining the wound.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The invention is best understood from the following detailed
description when read in connection with the accompanying drawing.
It is emphasized that, according to common practice, the various
features of the drawing are not to scale. On the contrary, the
dimensions of the various features are arbitrarily expanded or
reduced for clarity. Included in the drawing are the following
Figures:
[0018] FIG. 1 is a cross sectional view of an exemplary embodiment
of the present invention;
[0019] FIG. 2 is a cut away view of a portion of the exemplary
embodiment of FIG. 1;
[0020] FIG. 3A is a perspective view of the exemplary embodiment of
FIG. 1 installed in a cavity wound, illustrating sutures attached
to the subcutaneous tissue at the perimeter of the wound;
[0021] FIG. 3B is a perspective view of another exemplary
embodiment of FIG. 1 installed in the cavity wound;
[0022] FIG. 4 is a side-view of the wound with the exemplary
embodiment of FIG. 1 in place;
[0023] FIG. 5 is an end view of the device of FIG. 1 illustrating
tensioning of the sutures;
[0024] FIGS. 6A-6B illustrate an exemplary apparatus that can be
used to tighten the exemplary embodiment of FIG. 1;
[0025] FIG. 7 illustrates another exemplary embodiment of the
present invention; and
[0026] FIGS. 8A-8B illustrate a further exemplary embodiment of the
present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0027] Referring to FIG. 1, a cut-away side view of a first
exemplary embodiment of the present invention is illustrated. As
shown in FIG. 1, device 100 comprises external tube 102 having a
hollow portion 106, and internal shaft 104 rotatably coupled to
tube 102 at bearing portion 105. Internal shaft 104 has a plurality
of receivers 108, such as holes or slots that pass through the
radius of internal shaft 104 (best shown in FIG. 5A). As used
herein, receiver is intended to refer to a feature of shaft 104 for
interfacing and or attaching with sutures described below. Although
hollow portion 106 is illustrated between an outer surface of shaft
104 and an inner wall of tube 102, it is possible to construct
device 100 such that shaft 104 and tube 102 are in a close spaced
relationship such that there is a minimum clearance allowing for
rotation of shaft 104 without binding against tube 102.
[0028] Referring now to FIGS. 3A, 4 and 5A-5C, in use, device 100
is placed within the interior of wound 140. Sutures 132 are passed
through holes 109 in external tube 102 (best shown in FIGS. 3 and
5A) and through holes 108 in internal shaft 104. Sutures 132 are
desirably attached to opposing portions 134, 136 of wound 140.
[0029] Driving mechanism 200 (best shown in FIGS. 6A-6B) can be
detachably connected to end 130, such as a slotted or hex head for
example, and used to rotate internal shaft 104 within external tube
102. As illustrated in FIGS. 5A-5C, internal shaft 104 is rotated
and sutures 132 are wrapped around an exterior portion 107 of shaft
104. This, in turn, pulls sutures 132 and the attached tissue of
wound 140 towards device 100, which is desirably located in the
central portion of wound 140, thereby creating tension on the
subcutaneous tissue and pulling the tissue toward the center of the
wound, thus promoting healing of the wound.
[0030] Referring now to FIGS. 1 and 2, in one exemplary embodiment
of the present invention, coil spring 110 may be disposed around a
portion of internal shaft 104 with a first end of coil spring 110
coupled to a first portion of tube 102. In one desirable
implementation, coil spring 110 fits snuggly around shaft 104 at
end 112. A first end 114 of coil spring 110 is coupled to external
tube 102, by passing through hole 116 of tube 102 for example. A
second end 124 of coil spring 110 may pass through an opening 117,
such as slot, in tube 102 or may extend beyond the end of tube 102,
for example. In this configuration, coil spring 110 acts as a
clutch permitting shaft 104 to easily rotate in only one direction
during normal use. In operation, coil spring 110 is wound in a
counterclockwise direction about shaft 104 as coil spring 110
progresses from an inner portion of internal shaft 104 toward an
end of internal shaft 104. As shaft 104 is rotated in a direction
opposite to the direction of the coil spring, that is in clockwise
direction, coil spring 110 is forced to open, thus increasing the
diameter of coil spring 110. This increase in diameter allows the
shaft to rotate freely. When the shaft rotates slightly in the
direction of the spring, counter clockwise, the spring diameter
decreases preventing shaft 104 from unintentional unwinding, thus
ensuring that tension remains on sutures 132 and the tissue.
[0031] If it is necessary to loosen the sutures by unwinding the
shaft 104, the pressure exerted by coil spring 110 may be relieved
by moving end 124 of coil spring 110 in a clockwise direction. This
in turn relieves the pressure exerted by coil spring 110. Shaft 104
will then be able to rotate in the counterclockwise direction as
desired.
[0032] Referring now to FIGS. 3A and 4-5C, use of device 100 is
illustrated. As shown in FIG. 3A, device 100 is desirably placed in
the central portion of the wound 140. Sutures 132 are secured to
tissue 134 on one side of wound 140 and then passed through the
holes 108, 109 of tube 102 and shaft 104, respectively. Sutures 132
are then secured to the tissue 136 on the opposite sides of wound
140. Once sutures 132 have been secured, device 100 is used to pull
sutures 132 and connected tissue towards the center of wound
140.
[0033] In one exemplary embodiment of the present invention, the
amount of tension applied to the tissue by sutures 132 can be
controlled by using a torque wrench. A ratcheting torque wrench or
screwdriver, for example, may be used to wind sutures 132 around
shaft 104. A torque wrench is desirable because it can indicate the
amount of torque applied to shaft 104. The torque applied to shaft
104 is proportional to the tension on sutures 132 and the attached
tissue. Each time shaft 104 is turned, the caregiver will apply a
predetermined force to the sutures. For example, one (1) pound of
force per suture is adequate to effect closure of the wound.
Alternately the clinician may choose to tighten the wound based on
feel. As healing of wound 140 progresses, the tissue moves toward
the device in the central portion of wound 140; thus, the tension
may decrease. In view of this decrease in tension, device 100 will
then need to be tightened again.
[0034] In addition to applying tension to the tissue near the
perimeter of wound 140, it may also be necessary to drain wound 140
with suction. Referring again to FIGS. 1 and 3A, in one exemplary
embodiment, drainage tube 150 may be attached to vacuum port 122 of
device 100. In the illustrated configuration, vacuum port 122 is
coupled to an end portion of tube 102. In one configuration, vacuum
port 122 may be coupled to and in a fluid tight relationship with
ports 118 that exit tube 102. In a second configuration, shaft 104
may include a longitudinal orifice 120 that extends from one end of
tube 104 adjacent vacuum port 122. Orifice 120 is coupled to vacuum
port 122 and radial holes 108 in a fluid tight relationship so that
vacuum provide at port 122 is imparted into wound 140 through holes
108. It is also contemplated that ports 118 may be combined with
this latter configuration to provide vacuum in a greater area of
the wound, if desired.
[0035] Vacuum port 122 is optional and is not needed to treat
wounds that do not require suction drainage. In the event that
suction drainage is required, the wound is preferably covered with
an airtight dressing (not shown) to ensure that suction is
maintained and to prevent drying and bacteria incursion. Drainage
tube 150 desirably extends beyond such a wound cover. Drainage tube
150 may then be attached to a standard hospital wall suction
canister or to a standard manually actuated wound drainage device
(not shown), such as a squeeze bulb for example. Generally the
wound may also be filled with a wound packing material (not shown)
such as gauze or other suitable packing material. In cases where
suction drainage is used, the wound exudate that has accumulated in
the wound packing and surrounding wound is sucked into the device
and then into drainage tube 150. Wound exudate may enter the device
through a number of openings. In the exemplary embodiment of FIG.
1, the exudate may enter through ports 118. Additionally, exudate
may enter outer tube 102 through holes 109, enter shaft 104 through
holes 108, pass through longitudinal orifice 120 and then
ultimately out through vacuum port 122 and into drainage tube
150.
[0036] Alternatively, it is possible to dispose drainage tube 150
adjacent device 100 within the cavity of wound 140. In such a case,
the aforementioned ports and coupling in device 100 are not
necessary.
[0037] Referring now to FIG. 3B, an alternate embodiment of the
device illustrated in FIG. 1 is shown. As shown in FIG. 3B, device
300 comprises a body 302 having an elongate passage 309 that is in
alignment with receivers 108. As mentioned above, receivers 108 may
be holes that extend radially through internal shaft 104, or may be
another feature by which sutures 132 are held in proximity to shaft
104 so that sutures 132 are tensioned as shaft 104 is rotated with
respect to body 302.
[0038] FIG. 7 illustrates another exemplary embodiment of the
present invention. As shown in FIG. 7, device 700 comprises shaft
704 and body 702. Body 702 is formed substantially in a "U" shape
with couplings 703 disposed at opposite ends. Shaft 704, having
receivers 708 for receiving and/or capturing sutures 132 disposed
along at least a portion of the length of shaft 704, is rotatably
coupled to body 702 at couplings 703. Similar to the exemplary
embodiments described above, coil spring 710 may be optionally
disposed around the circumference of shaft 704 at one end to allow
rotation in a desired direction and prevent unintentional reversal
of shaft 704 in operation. To maintain coil spring 710 in place,
one end 716 is desirably coupled to a portion of body 702. In all
other respects this exemplary embodiment is similar to the
aforementioned embodiments and may include various other features
of those embodiments.
[0039] FIGS. 8A-8B illustrate yet another exemplary embodiment of
the present invention. As shown in FIG. 8A, device 800 comprises
body portion 802 and a shaft portion 804 rotatably coupled to body
portion 802. Body portion 802 has at least one aperture 809
extending radially through body portion 802 such that sutures 132
may be passed into the central portion of body 802 to gain access
to shaft 804. One difference between this embodiment and the
embodiments of FIG. 1 is the use of receivers 808 disposed on the
surface of shaft 804. Receivers 808 may have a "T" shape for
example (best shown in FIG. 8B) and spaced apart from one another
along a portion of the length of shaft 804. Although a "T" shape is
illustrated the invention is not so limited in that other types of
receivers may be used, such a those having a hooked or "U" shape
for example, or any other type of receiver capable of attaching to
and/or grabbing a portion of suture 132 such that suture 132 may be
tensioned as shaft 804 is rotated with respect to body 802. In all
other respects this embodiment is similar to the aforementioned
embodiments.
[0040] An exemplary embodiment of a torque driver 200 such as that
discussed above is illustrated in FIGS. 6A-6B. The exemplary driver
is intended for the application of a specified torque desirably at
right angles to the suture tensioner previously described. Other
embodiments can be readily visualized in accordance with the
following description.
[0041] Torque driver 200 is releasably attached to coupling 130 of
device 100 by head end 201, such as a hex head. Drive portion 202
desirably engages coupling 130 of device 100. In the illustrated
embodiment, drive portion 202 is driven at right angles by bevel
gears 203 that are in turn driven by shaft 204 which is disposed
within handle 205. Alternately, bevel gears 203 may be replaced
with a flexible shaft (not shown). Shaft 204 is coupled to knob
206, such as a calibrated knob, via a spring 207. Indicator 209 on
knob 206, such as an arrow, desirably points to calibrated scale
208 on a face of driver 200. Spring 207 is desirably calibrated to
provide a predetermined amount of torque to gears 203 and
ultimately to device 100 that is attached to the soft tissue in a
patient.
[0042] Spring 207 can be wound such that the attachment point 210
of spring 207 to knob 206 carries a calibrated release
characteristic such that a maximum torque will not be exceeded so
as to protect the soft tissue of the patient.
[0043] The handle-knob arrangement can be so configured as to
desirably permit one-handed operation. So that the entire assembly
can be steadied in the wound cavity and the knob turned between the
index and forefinger, for example.
[0044] The invention also includes methods for treating a wound. A
first exemplary method comprises the steps of placing a tensioning
device within a wound cavity, securing the tensioning device to the
tissue near the perimeter of a wound and then applying tension to
the tissue to draw the tissue towards the interior of the wound. A
second exemplary method comprises the steps of applying a tissue
tensioning device to a wound, the device being placed in the wound
cavity, sealing the wound with the device within the wound cavity
and attaching suction to the wound for wound drainage.
[0045] It is obvious to one skilled in the art that there are
alternate embodiments of the invention that are useful. For
example, while the preferred device is a linear device, a radial
configuration in which sutures extend outward from a central point
is useful, especially for wounds that are generally round. In
another exemplary embodiment, the device may be sutured to the
bottom of the wound. In this alternate embodiment, tightening of
the device will put tension on the tissue on the bottom of the
wound pulling generally upward, as well as tension on the tissue at
the perimeter of the wound. In yet another embodiment of the
present invention, a built in torque indicator may be
incorporated.
[0046] Other features may be included in the invention. For
example, the holes that pass through the internal shaft and tube
may be replaced with slots. The inclusion of slots will give the
doctor a broader range of options for the placement of sutures. A
clamping element may also be included to lock the sutures to the
central shaft and eliminate the need for knotting of the sutures.
It may also be desirable to have sutures extend in the x, y and z
directions.
[0047] Although the invention is illustrated and described herein
with reference to specific embodiments, the invention is not
intended to be limited to the details shown. Rather, various
modifications may be made in the details within the scope and range
of equivalents of the claims and without departing from the
invention.
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