U.S. patent application number 11/851942 was filed with the patent office on 2007-12-27 for wound irrigation device.
Invention is credited to Richard C. Vogel.
Application Number | 20070299412 11/851942 |
Document ID | / |
Family ID | 37718501 |
Filed Date | 2007-12-27 |
United States Patent
Application |
20070299412 |
Kind Code |
A1 |
Vogel; Richard C. |
December 27, 2007 |
Wound Irrigation Device
Abstract
An apparatus includes a fluid permeable dressing and a cover
membrane configured to extend over the fluid permeable dressing. A
tube is coupled to the fluid permeable dressing and is configured
to apply suction through the fluid permeable dressing. A fluid
reservoir is coupled to the cover membrane, the fluid vessel
including an inlet port configured to receive a fluid and an outlet
port fluidically coupled to the fluid permeable dressing.
Inventors: |
Vogel; Richard C.; (Potomac,
MD) |
Correspondence
Address: |
COOLEY GODWARD KRONISH LLP;ATTN: PATENT GROUP
Suite 1100
777 - 6th Street, NW
WASHINGTON
DC
20001
US
|
Family ID: |
37718501 |
Appl. No.: |
11/851942 |
Filed: |
September 7, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11237880 |
Sep 29, 2005 |
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11851942 |
Sep 7, 2007 |
|
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11198148 |
Aug 8, 2005 |
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11237880 |
Sep 29, 2005 |
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Current U.S.
Class: |
604/305 |
Current CPC
Class: |
A61F 13/0226 20130101;
A61M 2205/3344 20130101; A61M 2209/088 20130101; A61F 13/0216
20130101; A61F 2013/0054 20130101; A61M 1/0088 20130101; A61M
2205/42 20130101; A61M 1/005 20140204; A61M 1/0031 20130101; A61M
1/0058 20130101; A61M 2205/3317 20130101; A61M 1/0052 20140204;
A61M 2205/15 20130101; A61M 1/0096 20140204; A61F 2013/00536
20130101 |
Class at
Publication: |
604/305 |
International
Class: |
A61F 13/40 20060101
A61F013/40 |
Claims
1. An apparatus, comprising: a housing; a control panel coupled to
the housing; a fluid vessel defined within the housing; a
collection container coupled to the housing; and a wound dressing
fluidically coupled between the fluid vessel and the collection
container, the wound dressing including a porous substrate.
2. The apparatus of claim 1, further comprising a vacuum pump
coupled to the housing.
3. The apparatus of claim 1, further comprising a tube having a
first lumen fluidically coupled to the fluid vessel and the wound
dressing and a second lumen fluidically coupled to the collection
container and the wound dressing.
4. The apparatus of claim 1, wherein the collection container is
removably coupled to the housing.
5. An apparatus, comprising: a portable housing configured to be
worn by a patient, the portable housing including a control panel
and a vacuum pump; a fluid vessel defined within the portable
housing; a collection container coupled to the portable housing;
and a wound dressing fluidically coupled to the collection
container.
6. The apparatus of claim 5, wherein the wound dressing includes a
porous substrate.
7. The apparatus of claim 5, further comprising a fluid vessel
defined within the portable housing, the wound dressing being
fluidically coupled between the fluid vessel and the collection
container.
8. The apparatus of claim 5, further comprising a fluid vessel
defined within the portable housing, a tube having a first lumen
fluidically coupled to the fluid vessel and a second lumen
fluidically coupled to the collection container.
9. The apparatus of claim 5, wherein the collection container is
removably coupled to the portable housing.
10. The apparatus of claim 5, further comprising a battery disposed
within the portable housing and operably coupled to the control
panel and the vacuum pump, the control panel and the vacuum pump
configured to be operational while a location of the portable
housing is changed.
11. The apparatus of claim 5, wherein the portable housing is
configured to be worn around a waist of a user.
12. The apparatus of claim 5, wherein the portable housing is
configured to be carried in a pouch over a shoulder of a user.
13. An apparatus, comprising: a portable housing configured to be
worn by a patient, the portable housing including a control panel
and a vacuum pump; a fluid vessel defined within the portable
housing; a collection container coupled to the portable housing;
and a battery disposed within the portable housing and operably
coupled to the control panel and the vacuum pump, the control panel
and the vacuum pump configured to be operational while a location
of the portable housing is changed.
14. The apparatus of claim 13, further comprising a wound dressing
fluidically coupled between the fluid vessel and the collection
container, the wound dressing including a porous substrate.
15. The apparatus of claim 13, further comprising a tube having a
first lumen fluidically coupled to the fluid vessel and a wound
dressing and a second lumen fluidically coupled to the collection
container and the wound dressing.
16. The apparatus of claim 13, wherein the collection container is
removably coupled to the housing.
17. The apparatus of claim 13, wherein the portable housing is
configured to be worn around a waist of a user.
18. The apparatus of claim 13, wherein the portable housing is
configured to be carried in a pouch over a shoulder of a user.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application is a divisional of U.S. patent application
Ser. No. 11/237,880, entitled "Wound Irrigation Device," filed on
Sep. 29, 2005, which is a continuation of U.S. patent application
Ser. No. 11/198,148, entitled "Wound Irrigation Device," filed Aug.
8, 2005; each of which is hereby incorporated by reference in its
entirety.
BACKGROUND
[0002] The invention is generally directed to a method and
apparatus for the promotion of wound healing. More particularly,
the present invention relates to providing fluid irrigation and
vacuum drainage of a wound. Negative pressure wound therapy, also
known as vacuum drainage or closed- suction drainage is known. A
vacuum source is connected to a semi-occluded or occluded wound
dressing. Various porous dressings comprising gauze, felts, foams,
beads and/or fibers can be used in conjunction with an occlusive
semi-permeable cover and a controlled vacuum source.
[0003] In addition to using negative pressure wound therapy, many
devices employ concomitant wound irrigation. For example, a known
wound healing apparatus includes a porous dressing made of
polyurethane foam placed adjacent a wound and covered by a
semi-permeable and flexible plastic sheet. The dressing further
includes fluid supply and fluid drainage connections in
communication with the cavity formed by the cover and foam. The
fluid supply is connected to a fluid source that can include an
aqueous topical antibiotic solution or isotonic saline for use in
providing therapy to the wound. The fluid drainage can be connected
to a vacuum source where fluid can be removed from the cavity and
subatmospheric pressures can be maintained inside the cavity. The
wound irrigation apparatus, although able to provide efficacious
therapy, is somewhat cumbersome, difficult to use, and generally
impractical. Such a device does not address various factors
concerning patients, specifically ease of use, portability and the
ability to provide therapy with a minimum amount of unwanted
mechanical noise.
[0004] Other devices use vacuum sealing of wound dressings
consisting of polyvinyl alcohol foam cut to size and stapled to the
margins of the wound. The dressings are covered by a semi-permeable
membrane while suction and fluid connections are provided by small
plastic tubes introduced subcutaneously into the cavity formed by
the foam and cover. Such devices alternate in time between vacuum
drainage and the introduction of aqueous medicaments to the wound
site. Such devices also fail to address portability, ease of use
and noise reduction.
SUMMARY OF THE INVENTION
[0005] One embodiment of the invention is directed to a wound
irrigation system using an electromechanical vacuum apparatus that
includes a microprocessor-based device having stored thereon
software configured to control the electromechanical vacuum
apparatus. A first vacuum pump is electrically associated with the
microprocessor and is capable of generating a vacuum. An optional
second vacuum pump is electrically associated with the
microprocessor and is capable of maintaining a predetermined vacuum
level. A first electronic vacuum-pressure sensor is operably
associated with the vacuum pump(s) and said microprocessor for
monitoring vacuum level. A fluid-tight collection canister includes
an integrated barrier to prevent contents from escaping the
canister. Canulated tubing is associated with the canister and
vacuum pump(s) for communicating vacuum pressure therefrom. A
second electronic vacuum-pressure sensor is operably associated
with the canister and the microprocessor for monitoring canister
vacuum. A dressing includes of a porous material and semi-permeable
flexible cover, Canulated tubing is associated with the dressing
and the canister to communicate vacuum pressure therefrom. An
irrigation vessel contains a fluid to be used in irrigating the
wound. Canulated tubing is associated with the irrigation vessel
and the dressing to communicate fluid thereto. The
electromechanical vacuum apparatus has an integrated compartment
that can hold the irrigation vessel. The electromechanical vacuum
apparatus may optionally include a device for regulating the
quantity of fluid flowing from said irrigation vessel to said
dressing. The electromechanical vacuum apparatus may include
batteries enabling portable operation thereof.
[0006] An embodiment of the invention includes a method for
improving the generation and control of a therapeutic vacuum. In
this embodiment, a multi-modal algorithm monitors pressure signals
from a first electronic vacuum-pressure sensor associated with a
vacuum pump and capable of measuring the output pressure from the
pump. The algorithm further monitors pressure signals from a second
electronic vacuum-pressure sensor associated with a collection
canister and capable of measuring the subatmospheric pressure
inside the canister. The canister is connected to the vacuum pump
by a canulated tube that communicates subatmospheric pressure
therefrom. The canister is connected to a suitable dressing by a
canulated tube that communicates subatmospheric pressure thereto.
At the start of therapy, both the first and second electronic
vacuum-pressure sensors indicate the system is equilibrated at
atmospheric pressure. A first-mode control algorithm is employed to
remove rapidly the air in the canister and dressing, and thus
create a vacuum. The first-mode implemented by the control
algorithm is subsequently referred to herein as the "draw down"
mode. Once the subatmospheric pressure in the canister and dressing
have reached a preset threshold as indicated by the first and
second electronic vacuum-pressure sensors respectively, the
algorithm employs a second-mode that maintains the desired level of
subatmospheric pressure in both the canister and the dressing for
the duration of the therapy. The second-mode implemented by the
control algorithm is subsequently referred to herein as the
"maintenance" mode. The second-mode control algorithm is configured
to operate the vacuum pump at a reduced speed thus minimizing
unwanted mechanical noise. In an alternative embodiment, a second
vacuum pump can be used for the maintenance mode, which has a
reduced capacity, is smaller, and produces significantly lower
levels of unwanted mechanical noise. The second-mode control
algorithm is configured to permit the maintenance of vacuum in the
presence of small leaks, which invariably occur at the various
system interfaces and connection points. The method can be
performed by, for example, a microprocessor-based device.
[0007] In another embodiment application-specific dressings are
configured according to the individual needs of varying wound
types. A myriad of new materials that broadly fall into the
categories of antibacterial, biodegradable, and bioactive can be
used to create highly efficacious wound dressings. For a material
to function with a wound irrigation and vacuum drainage system, the
dressing composition can be porous enough to permit the uniform
distribution of subatmospheric pressure throughout the dressing and
subsequently to facilitate the removal of fluids therethrough. In
addition, the dressings possess various mechanical properties that
can create the proper macro-strain and micro-strain on the wound
bed believed to contribute to the production of growth factors and
other cytokines that promote wound healing. Accordingly, some
embodiments include several dressing arrangements that use, for
example, the aforementioned materials to produce dressings for
specific wound types.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] FIG. 1 is a schematic block diagram of an embodiment of the
invention for providing wound irrigation and vacuum drainage.
[0009] FIG. 2 is a flow diagram for a method according to an
embodiment of the invention.
[0010] FIG. 3 is an illustration of a maintenance-mode control
circuit according to an embodiment of the invention.
[0011] FIG. 4 is an illustration of a maintenance-mode control
circuit according to another embodiment of the present
invention.
[0012] FIG. 5 is a first illustration of a device according to an
embodiment of the invention for providing portable wound irrigation
and vacuum drainage.
[0013] FIG. 6 is a second illustration of a device according to an
embodiment of the invention for providing portable wound irrigation
and vacuum drainage.
[0014] FIG. 7 is a third illustration of a device according to an
embodiment of the invention for providing portable wound irrigation
and vacuum drainage.
[0015] FIG. 8 is an illustration of an application-specific
dressing according to an embodiment of the invention incorporating
an antibiotic silver mesh between the dressing substrate and
wound.
[0016] FIG. 9 is an illustration of an application-specific
dressing according to an embodiment of the invention incorporating
biodegradable materials in the dressing.
[0017] FIG. 10 is an illustration of an application-specific
dressing according to an embodiment of the invention incorporating
bioactive materials in the dressing.
DETAILED DESCRIPTION
[0018] Although those of ordinary skill in the art will readily
recognize many alternative embodiments, especially in light of the
illustrations provided herein, this detailed description is of an
embodiment of the invention, the scope of which is defined only by
the claims appended hereto.
[0019] As illustrated in FIG. 1, a wound irrigation and vacuum
drainage system is referred to by the numeral 100 and generally
includes a microcontroller 101 having an embedded microprocessor
102, Random Access Memory (RAM) 103 and Read Only Memory (ROM) 104.
ROM 104 contains the programming instructions for a control
algorithm 150 (see FIG. 2). ROM 104 is non-volatile and retains its
programming when the power is terminated. RAM 103 is utilized by
the control algorithm for storing variables such as pressure
measurements, alarm counts and the like, which the control
algorithm 150 uses while generating and maintaining the vacuum. A
membrane keypad and display 160 is electrically associated with
microcontroller 101 through communication cable 164. Membrane
switches 161 provide power control and membrane switches 162 are
used to preset the desired vacuum levels. Light emitting diodes
(LEDs) 163 are provided to indicate alarm conditions associated
with canister fluid level and dressing leaks.
[0020] Microcontroller 101 is electrically associated with, and
controls the operation of, a first vacuum pump 105 and an optional
second vacuum pump 107 through electrical cables 106 and 108
respectively. First vacuum pump 105 and optional second vacuum pump
107 can be one of many types including, for example, the pumps sold
under the trademarks Hargraves.RTM. and Thomas.RTM.. Vacuum pumps
105 and 107 can use, for example, a reciprocating diaphragm or
piston to create vacuum and are typically powered by a D.C. motor
that can also optionally use a brushless commutator for increased
reliability and longevity. Vacuum pumps 105 and 107 are
pneumatically associated with an exudate collection canister 114
through a single-lumen tube 115. In one embodiment, canister 114
has a volume which does not exceed 1000 ml. This can prevent
accidental exsanguination of a patient in the event hemostasis has
not yet been achieved at the woundsite. Canister 114 can be of a
custom design or one available off-the-shelf and sold under the
trademark Medi-VAC.RTM.. In addition, a fluid barrier 129 is
associated with canister 114 and is configured to prevent fluids
collected in canister 114 from escaping into tubing 115 and fouling
the vacuum return path. Barrier 129 can be of a mechanical float
design or may have one or more membranes of hydrophobic material
such as those available under the trademark GoreTex.TM.. A
secondary barrier 113 using a hydrophobic membrane is inserted
inline with pneumatic tubing 115 to prevent fluid ingress into the
system in the event barrier 129 fails to operate as intended.
Pneumatic tubing 115 connects to first vacuum pump 105 and optional
second vacuum pump 107 through "T" connectors 111 and 112
respectively.
[0021] Vacuum-pressure sensor 109 is pneumatically associated with
first vacuum pump 105 and optional vacuum pump 107 and electrically
associated with microcontroller 101 through electrical cable 110.
Pressure sensor 109 provides a vacuum-pressure signal to the
microprocessor 102 enabling control algorithm 150 to monitor vacuum
pressure at the outlet of the vacuum pumps 105 and 107. An acoustic
muffler 128 is pneumatically associated with the exhaust ports of
vacuum pumps 105 and 107 and is configured to reduce induction
noise produced by the pumps during operation. In normal operation
of irrigation system 100, first vacuum pump 105 is used to generate
the initial or "draw-down" vacuum while optional second vacuum pump
107 can be used to maintain a desired vacuum within the system
compensating for any leaks or pressure fluctuations. Vacuum pump
107 can be smaller and quieter than vacuum pump 105 providing a
means to maintain desired pressure without disturbing the
patient.
[0022] A battery 127 is optionally provided to permit portable
operation of the wound irrigation system 100. Battery 127, which
can be Nickel-Metal-Hydride (NiMH), Nickel-Cadmium, (NiCd) or their
equivalent, is electrically associated with microcontroller 101
through electrical cables 136 and 137. Battery 127 is charged by
circuits related with microcontroller 101 while an external source
of power is available. When an external source of power is not
available and the unit is to operate in a portable mode, battery
127 supplies power to the wound irrigation system 100.
[0023] A second pressure sensor 116 is pneumatically associated
with canister 114 through a single-lumen tube 119. Pressure sensor
116 is also electrically associated with microcontroller 101 and
provides a vacuum-pressure signal to microprocessor 102 enabling
control algorithm 150 to monitor vacuum pressure inside canister
114 and dressing 123. A "T" connector 118 is connected pneumatic
tube 119 to pressure sensor 116 and a vacuum-pressure relief
solenoid 120 configured to relieve pressure in the canister 114 and
dressing 123 in the event of an alarm condition, or if power is
turned off. Solenoid 120, can be, for example, one available under
the trademark Pneutronics.RTM.; Solenoid 120 is electrically
associated with, and controlled by, microprocessor 101 through
electrical cable 130. Solenoid 120 is configured to vent vacuum
pressure to atmosphere when the electrical coil is de-energized as
would be the case if the power is turned off. An orifice restrictor
121 is provided inline with solenoid 120 and pneumatic tube 119 to
regulate the rate at which vacuum is relieved to atmospheric
pressure when solenoid 120 is de-energized. Orifice restrictor 121
is, for example, available under the trademark AirLogic.RTM..
[0024] A wound dressing 123 includes a sterile porous substrate
131, which can be a polyurethane foam, polyvinyl alcohol foam,
gauze, felt or other suitable material, a semi-permeable adhesive
cover 132 such as that sold under the trademark Avery Denison.RTM.,
an inlet port 134 and a suction port 135. Dressing substrate 131 is
configured to distribute evenly the vacuum pressure throughout the
entire wound bed and has mechanical properties suitable for
promoting the formation of granular tissue. In addition, when
vacuum is applied to dressing 123, substrate 131 creates micro- and
macro-strain at the cellular level of the wound stimulating the
production of various growth factors and other cytokines and
promoting cell proliferation. Dressing 123 is fluidically
associated with canister 114 through a single-lumen tube 122. The
vacuum pressure in the cavity formed by substrate 131 of dressing
123 is largely the same as the vacuum pressure inside canister 114
minus the weight of any standing fluid inside tubing 112. A fluid
vessel 124, which can be a standard I.V. bag, contains medicinal
fluids such as aqueous topical antibiotics, physiologic bleaches,
or isotonic saline. Fluid vessel 124 is removably connected to
dressing 132 though port 134 and single-lumen tube 125. An optional
flow control device 126 can be placed inline with tubing 125 to
permit accurate regulation of the fluid flow from vessel 124 to
dressing 123. In normal operation, continuous woundsite irrigation
is provided as treatment fluids move from vessel 124 through
dressing 123 and into collection canister 114. This continuous
irrigation keeps the wound clean and helps to manage infection. In
addition, effluent produced at the woundsite and collected by
substrate 131 will be removed to canister 114 when the system is
under vacuum.
[0025] Referring to FIG. 2, an example of the general processing
steps of algorithm 150 are illustrated. Algorithm 150 includes a
continuously executing "Main Loop" 270 having six functional
software modules: Initialization module 210, Check Membrane
Switches module 220, Update Display module 230, Update Vacuum
Control module 240, Check for Alarms (full canister, leak,
internal) module 250, and Reset Watchdog Timer module 260.
[0026] At initialization step 210, all the variables associated
with the operation of the control algorithm 150 are reset. The
initialization step 210 can execute, for example, when power is
applied to the system. The variables that can be reset include, for
example, alarm flags, alarm time counters, pressure targets,
pressure limits and internal variables used for storing
mathematical calculations.
[0027] At step 220, the algorithm 150 checks for any user input via
the membrane keypad. At step 221, any keypresses are checked. At
step 222, all therapy-related parameters are updated. For example,
a user may press the vacuum-level-preset switch 162 which would be
detected at step 221. The new target pressure selected by the user
would then be stored as a therapy parameter in step 222. If no keys
are pressed, or once the therapy parameters have been updated
subsequent any key press, algorithm 150 updates the display at step
230.
[0028] At step 230, all status LED's are updated including any
alarm indications that may have been identified in the previous
pass through the main loop 270.
[0029] At step 240, algorithm 150 monitors and updates control of
the vacuum pump(s) 105 and 107, and vent solenoid 120. At step 241,
the actual pressure at the pump(s) 105 and 107 and the canister 114
is read via electronic vacuum-pressure sensors 109 and 116,
respectively. These analog readings are digitized and stored for
use on the next pass through main loop 270. At step 242, vacuum
limits and targets are selected based on the pre-determined therapy
parameters identified in step 220. At step 243, a decision is made
regarding in which mode the pump(s) will be operated. If the
first-mode is selected at step 243, algorithm 150 will operate
vacuum pump 105 at full-power minimizing the time to remove the air
from canister 114 and dressing 132. If the second-mode is selected
at step 243, algorithm 150 will operate vacuum pump 105 at
partial-power providing just enough airflow to keep up with any
leaks in the system as described in detail earlier. In this mode,
pump 105 operates very quietly and would not disturb the patient.
Alternatively, and described in more detail hereinbelow, an
optional pump 107 can be utilized in conjunction with pump 105
during second-mode operation. In this embodiment, pump 107 is
smaller and quieter than pump 105 and has reduced airflow capacity.
Pump 107 is configured to provide just enough airflow to compensate
for system leaks or other loss of vacuum.
[0030] Once the mode is selected at step 243, algorithm 150
produces electronic control signals that turn the vacuum pump(s)
105 and 107 on or off at step 244. In addition, and as described in
detail hereinabove, a solenoid valve 120 vents vacuum pressure to
atmosphere when power is terminated, or in the event vacuum
pressure exceeds the preset limits established at step 242. At step
245, the control signals are provided and are based on comparisons
between actual pressure, target pressure and the preset
high-pressure limit. Mode determination, vacuum pump control, and
vent control are all based on comparisons between the pre-selected
target pressure levels and actual pressure readings obtained at
steps 241 and 242, respectively.
[0031] After pressure adjustments are made and the actual pressure
readings obtained at step 240, the algorithm 150 checks for alarm
conditions at step 250. At step 251, leak conditions, which are
readily identified by analyzing the readings from pressure sensors
109 and 116, are identified. If a leak condition is detected at
step 251, the algorithm 150 waits three minutes before flagging the
leak alarm and alerting the user at step 230 during the next pass
through main loop 270. At step 252, a full canister condition is
checked, again easily identified by analyzing the readings from
pressure sensors 109 and 116. If a full canister condition is
detected at step 252, the algorithm 150 waits one minute before
flagging the full canister alarm and alerting the user at step 230
during the next pass through main loop 270. At step 253, the
readings from pressure sensors 109 and 116 are examined to
determine if any internal errors exist. An internal error would
occur if one pressure sensor indicated a pressure reading, for
example, 30 mmHg higher or lower than the other sensor. Again, if
the internal error condition is detected at step 253, the algorithm
150 waits two minutes before flagging the internal error alarm and
alerting the user at step 230 during the next pass through main
loop 270.
[0032] After completion of steps 220, 230, 240 and 250, algorithm
150 will reset the watchdog timer at step 260. The watchdog timer
is provided as a safety feature in the event of an unanticipated
software glitch and is incorporated within embedded microprocessor
102. In the event control algorithm 150 "locks up", main loop 270
would no longer function. When main loop 270 ceases to function,
the hardware watchdog timer would not be reset at step 260 and
would therefore timeout. Once the watchdog timer has timed-out, it
will automatically reset embedded microprocessor 102 and algorithm
150 will re-initialize all variables and parameters at step 210.
Subsequent to the re-initialization, algorithm 150 would again
sequentially execute the modules as described above via main loop
270.
[0033] Referring now particularly to FIG. 3, an example of a linear
control circuit associated with vacuum pump(s) 105 and 107 includes
a control input 301, which is a digital signal provided by
microcontroller 101. Digital control input 301 is associated with
the second-mode described above. When digital control input 301 is
in its low or off state, diode 304 becomes forward biased and
subsequently discharges capacitor 303. After a short period of
time, the voltage across capacitor 303 trends towards zero and the
capacitor is substantially fully discharged. When digital control
input 301 is in its high or on state, diode 304 becomes reverse
biased and is effectively removed from the circuit. In this case,
with said second-mode activated, resistor 302, which is in series
with capacitor 303, will begin to charge capacitor 303 at a rate
determined by the values of both components and proportional to
1/R*C. After approximately 1/R*C seconds have elapsed, capacitor
303 becomes fully charged and no additional current will flow
through resistor 302. The voltage across capacitor 303 will be
approximately equal to the magnitude of the digital control input
301 voltage. The junction of resistor 302 and capacitor 303 is
connected to the base terminal of an NPN bi-junction transistor
305. Transistor 305 can be, for example, a TIP-32C. Transistor 305
is configured as an emitter follower and in this arrangement will
provide current amplification. The positive terminal of vacuum
pump(s) 105 and 107 is connected to the emitter terminal of
transistor 305 while the collector terminal of transistor 305 is
connected directly to the 12-volt power supply 307. An additional
capacitor 306 is provided to prevent unwanted transients on the
power supply caused by the inductive loading of vacuum pump(s) 105
and 107. The negative terminal of vacuum pump(s) 105 and 107 and
the negative terminal of capacitor 303 are connected to the common
ground reference point 308.
[0034] When the digital control input 301 transitions from its
low-to-high state, the voltage across capacitor 303 begins to
ramp-up slowly until reaching a maximum 1/R*C seconds later.
Because of the configuration of transistor 305, the voltage rise at
the emitter terminal will mirror the voltage rise at the base
terminal, thus the voltage supplied to vacuum pump(s) 105 and 107
will also slowly ramp-up until reaching a maximum 1/R*C seconds
later. As the voltage supplied to the pump(s) increases, the
pump(s) will operate faster and thus produce more outflow and
increased vacuum. Since the time constant is selectable by choosing
appropriate values for resistor 302 and capacitor 303, the rate at
which the pumps begin to increase speed can be pre-selected and can
permit operation at a slower and quieter speed for an extended
period of time. As the pump(s) 105 and 107 begin to increase their
outflow, vacuum in the system 100 is increased. This increase is
measured by algorithm 150, which subsequently changes the state of
digital control input 301 in response thereto. As described in
detail above, once target pressure has been re-established, the
pump(s) 105 and 107 will be shut off. As the digital control input
301 transitions from its high-to-low state after target pressure is
met, diode 304 rapidly discharges capacitor 303 as described
earlier, and the voltage supplied to pump(s) 105 and 107 is
effectively removed turning the pump(s) off.
[0035] Referring now particularly to FIG. 4, an example of a Pulse
Width Modulation (PWM) control circuit 400 associated with vacuum
pump(s) 105 and 107 includes an astable multivibrator circuit 401
configured with a duty-cycle that can be varied from approximately
10 to 90 percent. Multivibrator circuit 401 can be, for example, an
LM555, and is referred to further herein as "Timer" 401. A 12-volt
power supply 417 provides electrical power to timer 401 and vacuum
pump(s) 105 and 107. Capacitor 414 is connected between the power
supply 417 and the common ground point 414. Capacitor 414 functions
to remove transients from the power supply 417 due to inductive
loading produced by the operation of pump(s) 105 and 107. In some
embodiments of the invention, vacuum pump(s) 105 and 107 have three
terminals--a positive and negative terminal for power, and a third
terminal 416 that is the PWM control input. The positive terminal
of pump(s) 105 and 107 connects to the power supply 417. The
negative terminal connects to the drain lead of a MOSFET 402, such
as, for example, an IRF510, commonly available and sold under the
trademark International Rectifier.RTM.. The source lead of MOSFET
402 connects to the common ground point 414. MOSFET 402 switches
the power on and off to pump(s) 105 and 107 in response to a
control input 412. The signal from control input 412 is provided by
microcontroller 101 and acts in conjunction with mode-select signal
411. A resistor 413 is connected between the gate of MOSFET 402 and
common ground point 414 and provides ground reference for the gate
of MOSFET 402 and drive impedance for control input 412.
[0036] Timer 401 has several peripheral components that control the
frequency of operation and the duty-cycle of the output waveform.
Capacitor 408 stabilizes an internal voltage reference and keeps
the output frequency constant. Diodes 405 and 406 charge and
discharge capacitor 407 through resistors 403 and 404. Resistor 404
and capacitor 407 determine the output frequency while variable
resistor 403 determines the duty-cycle and can be adjusted from 10
to 90 percent. Typically the output frequency would be between 10
kilohertz and 20 kilohertz to minimize switching noise as these
frequencies are above the nominal range of human hearing. The
output of timer 401 is used as the PWM input 416 and varies the
motor speed of pump(s) 105 and 107 in proportion to duty-cycle. A
high duty-cycle causes the pump motor to run faster and produce
greater outflow while a low duty-cycle causes the pump motor to run
slower and quieter with an associated reduction in outflow.
[0037] A digital-mode signal from mode select 411 indicating the
second mode, which enables selection of said first-mode or said
second-mode, is provided to capacitor 407 through diode 409. When
the mode-select signal from mode select 411 transitions from a high
to low state, diode 409 is forward biased and rapidly discharges
capacitor 407. When capacitor 407 is in its discharged state, the
PWM signal 416 generated by timer 401 is forced high. A constant,
high PWM is equivalent to a 100% duty-cycle and thus pump(s) 105
and 107 run at maximum in this configuration. As mode-select signal
from mode select 411 transitions from a low to high state, diode
409 is reverse biased and therefore effectively removed from the
circuit. Timer 401 then operates in an astable mode producing a
reduced duty-cycle PWM signal 416. Resistor 410 is connected
between mode select input 411 and common ground point 414 to
provide drive impedance for microcontroller 101.
[0038] When control algorithm 150 determines that the first-mode
(draw-down) is required such as when the system is initializing and
drawing-down the dressing, mode select signal from mode select 411
will be in a low state while control-input signal from control
input 412 will be in a high state. This configuration will cause
vacuum pump(s) 105 and 107 to produce the greatest amount of
outflow. Likewise when control algorithm 150 determines that said
second-mode (maintenance) is required such as when the measured
therapeutic vacuum level dips below the predetermined low-limit,
mode-select signal from mode select 411 will be in a high state
while control-input signal from control input 412 will be in a high
state. This configuration will cause vacuum pump(s) 105 and 107 to
operate at a slower speed producing reduced outflow and reduced
unwanted mechanical noise while simultaneously restoring
therapeutic vacuum to the target level. If control-input signal
from control input 412 is in a low state, the pump(s) are disabled
and do not operate at all. This acts as a safety feature in the
event of a component failure that causes pump(s) 105 and 107 to
latch in an on-state.
[0039] Referring now particularly to FIG. 5A, another embodiment of
a portable system 500 for providing therapeutic wound irrigation
and vacuum drainage is illustrated. System 500 includes a
self-contained plastic housing 501 configured to be worn around the
waist or carried in a pouch over the shoulder for patients who are
ambulatory, and hung from the footboard or headboard of a bed for
patients who are non-ambulatory. A membrane keypad and display 504
is provided to enable the adjustment of therapeutic parameters and
to turn the unit on and off. Depressing membrane switch 505 will
turn the power to system 500 on while depressing membrane switch
506 will turn the power off. Membrane switch 509 adjusts the target
therapeutic pressure up and likewise membrane switch 510 adjusts
the target therapeutic pressure down. In some embodiments of the
invention, system 500 has three pressure settings LOW, MEDIUM and
HIGH which generally correspond to, for example, 70 mmHg, 120 mmHg
and 150 mmHg, respectively. Although these three pressure settings
are provided by way of example, they are not intended to be
limiting because other pressures can be utilized for wound-type
specific applications. Membrane LEDs LOW 522, MEDIUM 523 and HIGH
524, indicate the current target therapeutic setting of the unit.
LED 507 indicates a leak alarm and LED 508 indicates a
full-canister alarm. When either alarm condition is detected, these
LEDs will light in conjunction with an audible chime. Housing 501
incorporates a compartment 502 that is configured in such a way as
to receive and store a standard IV bag 503. IV bag 503 may contain
an aqueous topical wound treatment fluid that is utilized by system
500 to provide continuous irrigation. In some embodiments, the
wound treatment fluid can be introduced directly into compartment
502. Additionally, the IV bag 503 can be externally coupled to the
device. As shown in FIG. 5B, a belt clip 514 is provided for
attaching to a patient's belt and an optional waist strap or
shoulder strap is provided for patient's who do not wear belts.
[0040] As shown in FIG. 5C, an exudate collection canister 511
comprises a vacuum- sealing means 517 and associated hydrophobic
filter 520 (not shown), vacuum sensor port 518 and associated
hydrophobic filter 519 (not shown), frosted translucent body 521,
clear graduated measurement window 522, locking means 523 and
multilumen tubing 512. Collection canister 511 typically has a
volume less than 1000 ml to prevent accidental exsanguination of a
patient. Vacuum sealing means 517 mates with a corresponding
sealing means 516 that is incorporated in housing 501. In addition,
locking means 523 has corresponding mating components within said
housing. Hydrophobic filters 519 and 520 can be, for example, those
sold under the trademark GoreTex.RTM. and are ensured the contents
of canister 511 do not inadvertently ingress housing 501 and
subsequently cause contamination of the therapy device 500. Vacuum
sensor port 518 enables microcontroller 101 to measure the pressure
within the canister 511 as a proxy for the therapeutic vacuum
pressure under the dressing 131. Multilumen tubing 512 provides one
conduit for the irrigation fluid to travel to dressing 131 and
another conduit for the vacuum drainage. Thus, IV bag 503, tubing
512, dressing 131 and canister 511 provide a closed fluid pathway.
In this embodiment, canister 511 would be single-use disposable and
may be filled with a gelling substance to enable the contents to
solidify prior to disposal. Gelling agents are available, for
example, under the trademark Isolyzer.RTM..
[0041] As shown in FIG. 5A, at the termination of tubing 512, a
self-adhesive dressing connector 515 is provided for attaching the
tubing to drape 132 with substantially air-tight seal. Dressing
connector 515 can have an annular pressure-sensitive adhesive ring
with a release liner that is removed prior to application. In
actual use, a small hole 530 can be cut in drape 132 and dressing
connector 515 would be positioned in alignment with said hole. This
enables irrigation fluid to both enter and leave the dressing
through a single port. In an alternative embodiment, tube 512
bifurcates at the terminus and connects to two dressing connectors
515 which allow the irrigation port to be physically separated from
the vacuum drainage port thus forcing irrigation fluid to flow
though the entire length of the dressing if it is so desired.
[0042] Referring now to FIG. 6, and according to a further
embodiment of the invention, a dressing system 600 for providing
therapeutic wound irrigation and vacuum drainage is illustrated.
Dressing system 600 includes a sterile porous substrate 131, which
can be fabricated from polyurethane foam, polyvinyl alcohol foam,
gauze, felt or other suitable material; a semi-permeable adhesive
cover 132 such as that sold under the trademark Avery Denison.RTM.;
a single lumen drainage tube 122 for the application of vacuum and
removal of fluids from the woundsite; and a pliable fluid vessel
601 situated between the semi-permeable cover 132 and the porous
substrate 131. Fluid vessel 601 comprises a self-sealing needle
port 603 situated on the superior aspect of the vessel and a
regulated drip port 602 situated on the inferior aspect of the
vessel. Needle port 603, permits the introduction of a hypodermic
needle 604 for the administration of aqueous topical wound
treatment fluids. These aqueous topical fluids can include
antibiotics such as Bacitracin or Sulfamide-Acetate; physiologic
bleach such as Chlorpactin or Dakins solution; and antiseptics such
as Lavasept or Octenisept. Regulated drip port 602 permits fluid
within vessel 601 to egress slowly and continuously into porous
substrate 131 whereupon the therapeutic benefits can be imparted to
the woundsite. Single-lumen drainage tube 122 provides enough
vacuum to keep the dressing 600 at sub-atmospheric pressure and to
remove fluids, which include the irrigation fluid and wound
exudate. The advantage of dressing system 600 is the incorporation
into the dressing of vessel 601 thus eliminating the need for an
external fluid vessel and associated tubing and connectors making
the dressing more user friendly for patient and clinician
alike.
[0043] In normal clinical use, dressing 600 is applied to the wound
site by first cutting porous substrate 131 to fit the margins of
the wound. Next, semi-permeable drape 132 with integrated (and
empty) fluid vessel 601 is attached positioning drip port 602
central to the porous substrate 131. Once the drape 132 is properly
sealed around the periwound, a properly prepared hypodermic needle
604 can be inserted in self-sealing needle port 603, and fluid
vessel 601 subsequently can fill with the desired aqueous topical
wound treatment solution.
[0044] Referring now particularly to FIG. 7, and according to
another embodiment of the invention, a dressing system 700 for
therapeutic wound irrigation and vacuum drainage is illustrated.
The system 700 includes a sterile porous substrate 131, which can
be fabricated from polyurethane foam, polyvinyl alcohol foam,
gauze, felt or other suitable material; a semi-permeable adhesive
cover 132 such as that sold under the trademark Avery Denison.RTM.;
a single lumen drainage tube 122 for the application of vacuum and
removal of fluids from the woundsite; and a pliable fluid vessel
601 situated outside and superior to said semi-permeable cover 132.
Fluid vessel 601 comprises a self-sealing needle port 603 situated
on the superior aspect of the vessel and a regulated drip port 602
situated on the inferior aspect of the vessel. In addition, an
annular adhesive ring is provided on the inferior aspect of vessel
601 surrounding regulated drip port 602 for subsequent attachment
to drape 132. Needle port 603 permits the introduction of a
hypodermic needle 604 for the administration of aqueous topical
wound treatment fluids. These aqueous topical fluids can include
antibiotics such as Bacitracin or Sulfamide-Acetate; physiologic
bleach such as Chlorpactin or Dakins solution; and antiseptics such
as Lavasept or Octenisept. Regulated drip port 602 permits fluid
within vessel 601 to egress slowly and continuously into porous
substrate 131 through a hole in drape 132 whereupon the therapeutic
benefits can be imparted to the woundsite. Single-lumen drainage
tube 122 provides enough vacuum to keep the dressing 600 at
sub-atmospheric pressure and to remove fluids which include the
irrigation fluid and wound exudate.
[0045] In normal clinical use, dressing 700 is applied to the wound
site by first cutting porous substrate 131 to fit the margins of
the wound. Next, semi-permeable drape 132 is applied over the
woundsite covering the substrate 131 well into the periwound area.
A hole approximately 1/4'' diameter is made in drape 132 central to
porous substrate 131. Lastly, fluid vessel 601 is attached by
adhesive annular ring 605 with drip port 602 aligned with the hole
previously cut in drape 132. Once the fluid vessel 601 is properly
sealed to the drape 132, a properly prepared hypodermic needle 604
is inserted in self-sealing needle port 603 and fluid vessel 601
subsequently filled with the desired aqueous topical wound
treatment solution.
[0046] Referring now particularly to FIG. 8, an embodiment of an
application-specific dressing 800 of the invention is illustrated.
The dressing 800 includes a sterile porous substrate 131, which can
be fabricated from polyurethane foam, polyvinyl alcohol foam,
gauze, felt or other suitable material; a semi-permeable adhesive
cover 132 such as that sold under the trademark Avery Denison.RTM.;
a single lumen drainage tube 122 for the application of vacuum and
removal of fluids from the woundsite; single lumen irrigation tube
125 to facilitate the application of aqueous topical wound fluids
to a wound bed 801; and a perforated woven cloth impregnated with
metallic silver 810 and bonded to porous substrate 131, for
providing an antibiotic action within the wound. Alternatively, and
as depicted in FIG. 8, an integrated dressing connector 515 can be
used with multi-lumen tubing 512 permitting the wound irrigation
and vacuum drainage system to fluidically communicate with dressing
800.
[0047] Antibiotic silver layer 810 is fenestrated to permit the
unimpeded removal of fluids from the wound bed 801 through the
substrate 131 and subsequently through vacuum drainage tubing 122
or 512. In addition, fenestrations in layer 810 permit the even
distribution of sub-atmospheric pressure across the wound bed 801
and permit granular tissue formation. Use of silver in a wound as
part of a wound dressing is available to the clinician under the
trademark(s) Acticoat.TM. and Silvadene.TM. and others. Silver can
be utilized specifically for burns, stemotomy, radiated fistulas,
traumas, and open fractures. Silver is utilized in treating
multiple resistant staph aureus (MRSA), preventing odor, reducing
incidence of infection and to promote general healing. This
embodiment combines the use of silver with wound irrigation and
vacuum drainage to provide therapy to the specific wound types
identified hereinabove. Antibiotic silver layer 810 can be made of
a silver coated woven nylon such as that commercially available
under the trademark SilverIon.RTM. from Argentum Medical. The
material can be fabricated from woven nylon coated with 99.9% pure
metallic silver utilizing a proprietary autocatalytic electroless
chemical (reduction-oxidation) plating technology. Alternatively, a
non-woven material such as ActiCoat.RTM. Foam from Smith and
Nephew, uses two rayon/polyester non-woven inner cores laminated
between three layers of High Density Polyethylene (HDPE) Mesh. This
material, like the SilverIon.RTM. material, can also be fenestrated
and used with dressing 800. The antibiotic layer 810 is bonded to
porous substrate 131 using a number of available techniques
including: in-mold binding, adhesives (such as methyl
methacrylate--based bonding agents), and RF or Ultrasonic
welding.
[0048] Dressing 800 is applied to the wound as described in detail
hereinabove. Because of the potential chemical interactions between
the various materials used in the construction of dressing 800,
attention can be paid to the types of aqueous topical wound fluids
used to ensure compatibility.
[0049] Referring now particularly to FIG. 9, another embodiment of
an application-specific dressing 900 is illustrated. The dressing
900 includes a sterile porous substrate 910, which can be
fabricated from polyurethane foam, polyvinyl alcohol foam, gauze,
felt or other suitable material; a semi-permeable adhesive cover
132 such as that sold under the trademark Avery Denison.RTM.; a
single-lumen drainage tube 122 for the application of vacuum and
removal of fluids from the woundsite; single-lumen irrigation tube
125 to facilitate the application of aqueous topical wound fluids
to a wound bed 801; and a sterile porous layer of biodegradable
material 910 bonded to porous substrate 920, for providing an
inducement to healing within the wound. Biodegradable layer 910 is
placed substantially within the wound site and is in intimate
contact with wound bed 801. Biodegradable layer 910 can be made
from myriad materials such as polylactide-co-glycolic acid (PLGA).
Alternatively, and as depicted in FIG. 9, an integrated dressing
connector 515 can be used with multi-lumen tubing 512 permitting
the wound irrigation and vacuum drainage system to fluidically
communicate with dressing 900.
[0050] Biodegradable layer 910 is porous with similar mechanical
characteristics to substrate 920 to permit the unimpeded removal of
fluids from the wound bed 801 through the substrate 920 and
subsequently through vacuum drainage tubing 122 or 512. In
addition, porosity in layer 910 permits the even distribution of
sub-atmospheric pressure across the wound bed 801 and encourages
granular tissue formation into layer 910. Biodegradable layer 910
is bonded to substrate 920 in such a way that it will readily
release from substrate 920 when the dressing is removed from the
wound so that the biodegradable layer 910 remains in place and
provides a matrix through which tissue growth can occur. The
adhesives for removably bonding layers 910 and 920 include, for
example, cured silicones, hydrogels and/or acrylics. The thickness
of layer 910 can be selected such that ingrowth, which can be as
much as 1 mm per day for a typical wound, will not entirely
infiltrate layer 910 and invade the removable substrate 920.
Alternatively, biodegradable layer 910 can be made up of a matrix
of beads adhered together with the same kinds of releasable bonding
agents discussed in detail above.
[0051] Dressing 900 is suited for wound types that have large
defects or voids, which require rapid filling of tissue to provide
a foundation for re-epithelialization in the final stages of
healing. These application-specific wounds include necrotizing
fasciitis, trauma, and iatrogenic wounds such as would occur with
certain oncological procedures. In addition to addressing soft
tissue repairs, dressing 900 can be configured to heal large bone
defects such as those that result from surgical treatment of
osteocarcinoma, and trauma where significant bone loss occurs. For
these types of wounds, biodegradable layer 910 would be made of a
rigid material that would serve as a matrix to encourage osteoblast
invasion and bone growth into the defect. As described above, the
material that makes up layer 910 would remain in the wound after
the dressing is removed.
[0052] Dressing 900 can be applied as described above in the
previous embodiments; the only significant difference being that
during dressing changes, the biodegradable portion, layer 910,
would remain in the wound. With a conventional dressing change,
typically all the dressing material and debris would be removed to
prevent possibility of foreign body reaction and infection. Here,
subsequent dressing would be applied over the previous dressing's
biodegradable layer 910 facilitating tissue grown therein. Once a
suitable foundation of granular tissue has formed in the wound, the
clinician would discontinue use of the biodegradable dressing
substituting instead one of the other dressing materials and
configurations disclosed hereinabove until the wound was completely
healed.
[0053] Referring now particularly to FIG. 10, an embodiment of an
application-specific dressing 1000 is illustrated. The dressing
1000 includes a sterile porous substrate 1030, which can be
fabricated from polyurethane foam, polyvinyl alcohol foam, gauze,
felt or other suitable material; a semi-permeable adhesive cover
132 such as that sold under the trademark Avery Denison.RTM.; a
single-lumen drainage tube 122 for the application of vacuum and
removal of fluids from the woundsite; single-lumen irrigation tube
125 to facilitate the application of aqueous topical wound fluids
to a wound bed 801; a sterile porous layer of biocompatible
material 1020 releasably bonded to porous substrate 1030; and an
autologous graft layer 1010 integrated with biocompatible material
1020 for stimulating a healing response in a wound. Biocompatible
layer 1020 and autologous graft layer 1010 are placed substantially
within the wound site with autologous graft layer 1010 in intimate
contact with wound bed 801. Alternatively, and as depicted in FIG.
10, an integrated dressing connector 515 can be used with
multi-lumen tubing 512 permitting the wound irrigation and vacuum
drainage system to fluidically communicate with dressing 1000.
[0054] Biocompatible layer 1020 can be an acellular dermal matrix
manufactured from donated human skin tissue, which is available
under the trademark AlloDerm.RTM. from LifeCell Inc. This dermal
matrix has been processed to remove all the cells that lead to
tissue rejection while retaining the original biological framework.
Cells taken from the patient or other molecules can subsequently be
seeded into this matrix forming layer 1010. These cells or
molecules can include but are not limited to: fibroblasts, platelet
derived growth factor (PDGF), Transforming Growth Factor Alpha
(TGF-.alpha.), Transforming Growth Factor Beta (TGF-.beta.) and
other cytokines. PDGF is a polypeptide hormone derived from
platelets, which stimulate fibroblasts to migrate and lay down
collagen and fibronectin thereby initiating wound repair. If
targeted cells are taken from the patient and seeded into
biocompatible layer 1020 forming layer 1010, the body will not
reject them. In addition to seeding the inferior aspect of layer
1020 with the above described autologous cells or molecules, the
superior aspect of layer 1020 can be seeded with live dermal cells
taken from the patient using a mesh graft or micrografting
technique. The configuration of two graft layers 1010 enclosing a
biocompatible layer 1020 permits intrinsic tissue regeneration in
such a way as to minimize the formation of scar tissue and maintain
original structure.
[0055] Dressing 1000 is designed for wound types that require
reconstruction where the newly regenerated tissue has cellular
structure similar to the original tissue. These
application-specific wounds include surgical dehiscence, burns, and
diabetic ulcers.
[0056] In normal clinical use, the dressing 1000 would be prepared
on a patient-by-patient basis first by harvesting the requisite
cells from donor sites followed by processing (when necessary to
derive bioactive components) then seeding the cells or cytokines
into the biocompatible layer 1020. Special care and handling can be
used in the preparation of dressing 1000 to promote preservation of
the bioactive components and maintenance of the sterility of the
dressing. Once the dressing has been properly configured for the
patient, it is applied as described in detail hereinabove. When
dressing changes occur, biocompatible layer 1020 and autologous
graft layer 1010 will remain in the wound much like the
biodegradable dressing 900 also described in detail above.
[0057] The above described embodiments are set forth by way of
example and are not limiting. It will be readily apparent that
obvious modifications, derivations and variations can be made to
the embodiments. For example, the vacuum pump(s) 105 and 107
described hereinabove as either a diaphragm or piston-type could
also be one of a syringe based system, bellows, or even an
oscillating linear pump. Similarly, the vacuum control algorithm
150 described in detail above as multi-modal could be one of many
other algorithms well known to anyone of ordinary skill in the art.
Likewise, use of PLGA as a biodegradable substance for a component
of dressing 900 could be one of many different types of
biodegradable materials commonly used for implantable medical
devices. Accordingly, the claims appended hereto should be read in
their full scope including any such modifications, derivations and
variations.
* * * * *