U.S. patent number 3,577,837 [Application Number 04/725,423] was granted by the patent office on 1971-05-11 for subdermal tendon implant.
Invention is credited to Karl F. Bader, Jr..
United States Patent |
3,577,837 |
Bader, Jr. |
May 11, 1971 |
SUBDERMAL TENDON IMPLANT
Abstract
A subdermal tendon implant for use in repairing and
reconstructing tendons which is compatible with the human cellular
structure and includes the process of making the implant. The
subdermal implant is resistant to degeneration and substantially
eliminates adhesions allowing full range of motion after healing
and includes in its structure a flexible sheeting of chemically
inert material sculptured to a desired size and shape and means for
anchoring the implant to prevent it from moving axially along the
tendon.
Inventors: |
Bader, Jr.; Karl F. (Chicago,
IL) |
Family
ID: |
24914495 |
Appl.
No.: |
04/725,423 |
Filed: |
April 30, 1968 |
Current U.S.
Class: |
623/13.15;
623/21.15 |
Current CPC
Class: |
A61F
2/08 (20130101); A61B 2090/0816 (20160201); A61F
2002/4243 (20130101); A61B 2090/0815 (20160201) |
Current International
Class: |
A61F
2/08 (20060101); A61B 19/00 (20060101); A61F
2/42 (20060101); A61f 001/24 () |
Field of
Search: |
;3/1 ;128/334,1(Silicone
Digest)/ |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
"Artificial Skin," by C. W. Hall et al., Transactions American
Society For Artificial Internal Organs, Vol. XII, June 10, 1966,
pages 340--343, copy available in Group 335. .
"The Use of a Silastic Rod as an Adjunct to Flexor Tendon
Grafting," by F. V. Nicolle, The Bulletin of the Dow Corning Center
For Aid to Medical Research, Vol. 8, No. 3, July 1966. 128-Silicone
digest..
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Frinks; Ronald L.
Claims
I claim:
1. A subdermal tendon implant for use in tendon surgery
including:
an elongated member having a smooth, nonwetting inferior surface
and a smooth, nonwetting superior surface, said elongated member
adapted to be positioned between a viable, constantly moving,
damaged tendon and the surrounding body tissue, and being made from
a flexible, substantially inert material that is compatible with
human cellular structure;
a mesh material bonded to only a portion of the inferior surface of
the elongated member, said mesh material adapted to contact
substantially immovable body tissue with the remaining smooth,
nonwetting inferior surface adapted to contact the damaged tendon;
and
suture means for anchoring the implant to the substantially
immovable body tissue to prevent it from moving axially along the
constantly moving, damaged tendon during the early stages of
healing.
2. The structure of claim 1 further characterized in that the
elongated member is made from a reinforced, medical-grade silicon
elastomer.
3. The structure of claim 1 further characterized in that the mesh
material is made from a polyester netting adapted to cause
fibroblastic infiltration through the mesh material securing the
subdermal tendon implant to the substantially immovable body tissue
by periosteal attachment.
4. The structure of claim 1 further characterized in that the
elongated member is sculptured to form at each end a shackle
portion linked together by a central portion, said mesh material
being bonded only to the inferior surface of the shackle end
portions.
5. The process of making a subdermal tendon implant from a flexible
sheeting of substantially inert, nonreactive material having a
smooth exterior surface, the process including the steps of:
sculpturing the flexible sheeting to a desired size and shape;
bonding a mesh material to at least a portion of one surface of the
flexible sheeting;
positioning the flexible sheeting with the bonded mesh material
subcutaneously between a damaged tendon and the surrounding body
tissue so that a portion of the smooth exterior surface of the
sheeting material rests against the damaged tendon and the portion
of the surface containing the mesh material rests against
substantially immovable body tissue; and
fixedly securing the flexible sheeting with the bonded mesh
material to the substantially immovable body tissue to anchor the
subdermal tendon implant for rapid fibrous fixation.
6. The process as set forth in claim 5 further including the
initial step of sculpturing the flexible sheeting to form an
elongated member.
7. The process as set forth in claim 5 further including the
initial step of sculpturing the flexible sheeting to form at each
end a shackle portion linked together by a central portion.
Description
SUMMARY OF THE INVENTION
This invention relates to improvements in tendon surgery and more
particularly, to improvements in a method and apparatus for
repairing and reconstructing tendons.
Accordingly, a primary object of this invention is an improved
subdermal tendon implant which is compatible with the surrounding
body tissue.
A further object is an improved method and structure which
substantially eliminates adhesions between the tendon and
surrounding tissues preventing subsequential restrictive
fibrosis.
Another object is an implant which is chemically inert and
demonstrates a very low order of reactivity eliminating any
incapacitating foreign body reactions.
Another object is a novel means for anchoring the subdermal implant
to substantially immovable tissue to prevent it from moving axially
along the tendon.
Another object is a subdermal implant which keeps the tendon
perfectly positioned under normal tension preventing lateral
displacement of the tendon.
Another object is an improved structure which causes no restriction
in movement or deformity allowing essentially full range of motion
after healing.
Another object is an underlay and pulley which do not cause
infection or extrusion and are resistant to absorption, hardening
and degeneration.
Another object is an implant having nonwetting surfaces which
minimize sticking or encrustation allowing the implant to act like
a membrane permitting the tendon to move freely across its
surface.
Another object is an improved method of constructing a subdermal
implant which may be quickly positioned during the operative stage
and is tough and durable after the operative stage.
Another object is a tendon implant which is adaptable to a variety
of clinical situations including tendolysis, primary repairs, and
secondary reconstruction and grafts.
Other objects and advantages will be apparent from the ensuing
specification and drawings for this invention.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention is illustrated by the accompanying drawings
wherein:
FIG. 1 is a perspective view with portions removed showing a
subdermal underlay in position;
FIG. 2 is an enlarged end sectional view of the underlay shown in
FIG. 1;
FIG. 3 is a perspective view with portions removed showing a
subdermal pulley in position;
FIG. 4 is an enlarged end sectional view of the pulley shown in
FIG. 3;
FIG. 5 is a perspective view with portions removed showing both a
subdermal underlay and pulley in position;
FIG. 6 is a top view of a subdermal underlay;
FIG. 7 shows a diagrammatic view of the method of constructing an
underlay;
FIG. 8 shows a top view of a pulley with portions removed for
clarity; and
FIG. 9 shows a mesh material used in constructing a subdermal
pulley.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
In tendon surgery the problem of subsequential restrictive fibrosis
due to adhesion is omnipresent and frequently severely limiting in
clinical results. With this problem in mind, coupled with the
knowledge that healing and restitution of tendons occurs almost
solely from the surrounding tissue, research was begun. After
extensive testing and obtaining data on various tendon accessories
the subdermal tendon implant 10 disclosed in this application was
developed. Then numerous laboratory experiments were conducted
using the subdermal tendon implant with canine preparations and
ultimately with specific clinical applications. The results were
extremely favorable with both groups experiencing virtually no
adhesions or fibrosis retaining essentially full range of motion.
In addition no infections or extrusions developed during the
postoperative period.
FIGS. 1 through 5 show the subdermal tendon implant 10 as it is
used in tendon surgery on a finger 12. FIGS. 6 through 9 disclose
the implant in more detail and in particular show the process of
making the implant. The subdermal tendon implant 10 basically
includes a flexible sheeting 14 of chemically inert material
sculptured to a desired size and shape with a mesh or netting 16
bonded to a surface of the sheeting material.
FIGS. 1 and 2 show an operative use of a subdermal tendon implant
sculptured to form an underlay 18 taking the shape of an elongated
member. The underlay preferably has a mesh or netting 16 bonded to
an inferior surface 30 of the sheeting 14. The sheeting is
approximately 0.020 inch thick and may be reinforced to provide
added strength and prevent stretch. The underlay 18 may be
fabricated or trimmed to a width of approximately 1.0 cm. and has
lengths ranging from about 1.0 to 2.5 cms.
The underlay 18 is positioned under areas of tendon exploration or
repair to eliminate adhesions and later anchorage. As shown in
FIGS. 1 and 2 the surface containing the mesh or netting 16 is
placed inferiorly against substantially immovable tissues 20 such
as a bone or joint capsule. The mesh or netting material causes
fibroblastic infiltration to occur thereby securing the implant 10
in place with periosteal attachment. This is extremely important as
it allows the tendon to move across the underlay without causing
displacement. It is also important to note that this leaves the
nonreactive superior surface 22 of the sheeting material opposite
the explored or repaired tendon 24.
FIGS. 3 and 4 show an operative use of the subdermal tendon implant
10 sculptured to the size and shape of a pulley 26. The pulley is
also an elongated member having shackle end portions 28 linked
together by a central portion. The pulley is sutured into place
over the tendon 24 with the mesh or netting 16 bonded to the
inferior surface of the shackle ends 28 as best shown in FIGS. 8
and 9. As is true with the underlay 18, the mesh material of the
pulley causes fibroblastic infiltration to occur thereby securing
the implant to adjacent body tissues.
The pulley 26 is fabricated from the same sheeting material as the
underlay 18, however, the thickness of the material is normally
less than that of the underlay and is about 0.007 inch. The lengths
of the pulley 26 range from about 1.0 to 1.5 cms.
The pulley 26 is devised to aid tendon placement and balance
keeping the tendon perfectly positioned under normal tension. In
addition it should be noted that the portion of the pulley 26
touching the tendon 24 is nonreactive sheeting material keeping the
tendon free of fibrosis or adhesion for the distance of excursion
under the pulley.
FIG. 5 shows the operative use of both an underlay 18 and pulley 26
on a finger 12. It should be pointed out that the underlay and
pulley may be used together as shown in FIG. 5 or may be used
separately as shown in FIGS. 1 through 4. In addition the
chemically inert surface of the sheeting material is always
adjacent the tendon 24 with the surface containing the mesh
material adjacent body tissues 20 such as the bones shown in FIG.
5.
FIGS. 6 through 9 disclose the subdermal tendon implant 10 in more
detail. In particular FIG. 6 shows a top view of the inferior
surface 30 of an underlay 18 with the mesh or netting 16 bonded to
the flexible sheeting.
The sheeting 14 is preferably made from a chemically inert material
which is compatible with the human cellular structure. In addition
it is preferable that the sheeting 14 have nonwetting surfaces
which minimize sticking or encrustation. Further the material
should be resistent to absorption, hardening and degeneration and
as previously mentioned contains the quality of nonadherence to
tissue. A flexible silicone elastomer manufactured by Dow Corning
sold under the trademark Silastic has been found to substantially
meet the above-mentioned qualifications. In addition other
medical-grade silicone elastomers, or materials similar to
Silastic, or equivalents thereof have been found as satisfactory
material for the sheeting.
As previously mentioned the sheeting 14 is preferably reinforced
with a polyester material or similar synthetic fiber to eliminate
stretch and permit suture attachment.
FIG. 7 shows in detail the process of making a subdermal tendon
implant 10. The sheeting 14 is fabricated or sculptured to the
desired size and shape and the mesh 16 is bonded to a surface of
the sheeting by an adhesive 32. The adhesive is preferably a
medical adhesive such as silicone adhesive. When this is completed
the implant is ready to be placed subcutaneously with the smooth,
nonreactive superior surface 22 of the sheeting adjacent the
repaired or explored tendon and the inferior surface 30 containing
the mesh material adjacent body tissues for rapid fixation.
FIG. 8 shows a pulley 26 with mesh 16 secured to the inferior
surface of one of the shackle ends 28. The mesh 16 to be secured to
the other shackle end 28 is shown in FIG. 9 and may be made from
polyester netting or similar synthetic fiber. As mentioned
previously the polyester netting causes fibroblastic infiltration
through the mesh 16 thereby securing the implant to adjacent
tissues.
The use, operation and function of this invention are as
follows:
After constructing this invention the subdermal tendon implant 10
is ready for use in tendon surgery. The nonreactive sheeting
surface 22 is positioned opposite the explored or repaired tendon
while the mesh surface 30 is placed inferiorly against adjacent
tissues for rapid fixation. In particular, the subdermal pulley 26
is sutured into place over the tendon 24 as shown in FIGS. 3, 4 and
5 while the subdermal underlay 18 is placed under the tendon 24 and
sutured into place as shown in FIGS. 1 and 2. It is important to
note that the subdermal tendon implant will be firmly attached via
the bonded mesh 16 by the third postoperative week.
The subdermal implant 10 provides a medical device which is adapted
to keep the tendons perfectly positioned and free to fibrosis or
adhesions. In addition the implants do not cause infections or
extrusions while permitting the patient to retain essentially full
range of motion after the operation.
In addition to being safe and free from incapacitating foreign body
reaction the subdermal implant may be quickly positioned during the
operation with results that are more reliable than previous
experiences with autogenous fascia or connective tissues. Further
the invention described in this application may be utilized for a
wide variety of difficult clinical situations, including
tendolysis, primary repairs and secondary reconstruction or
grafts.
* * * * *