U.S. patent number 3,648,705 [Application Number 05/055,530] was granted by the patent office on 1972-03-14 for retention bar means for surgical incision closure.
Invention is credited to Banning G. Lary.
United States Patent |
3,648,705 |
Lary |
March 14, 1972 |
RETENTION BAR MEANS FOR SURGICAL INCISION CLOSURE
Abstract
For use in retaining a surgical incision against inadvertent
rupture or disruption, a pair of retention bar elements which
provides reinforcing means for the retention thread loops of an
incision closure and provides means for reducing flesh tearing and
necrosis at the thread loop penetrations of the skin and body
tissue. The pair of retention bar elements are adapted to be
located parallel and on opposite sides of the line of incision of a
surgical wound and preferably are formed of pliable tear resistant
material, such as extruded polyvinyl plastic material. A preferred
form is generally of a figure of eight configuration as seen in
transverse section so that each retention bar element includes
parallel dual tubular portions connected by a thin web portion. In
use of the retention bar elements of the invention, retention
thread loops pass through the web portions of the pair of bars,
extend transversely over the incision, and encircle the
confrontingly extending tubular inner portions respectively of the
retention bar elements, the bar providing purchase so that the
forces uniting the loops and holding the incision are oriented away
from the flesh surface and do not tear it, but rather the tearing
forces are transferred to the bars, and the pliability of the
material yields so as to conform to the flesh surface and
distribute the load of the retention loops as the contour of the
flesh surface changes during the healing process as swelling occurs
and then diminishes.
Inventors: |
Lary; Banning G. (Miami,
FL) |
Family
ID: |
21998465 |
Appl.
No.: |
05/055,530 |
Filed: |
July 16, 1970 |
Current U.S.
Class: |
606/233 |
Current CPC
Class: |
A61B
17/0466 (20130101) |
Current International
Class: |
A61B
17/04 (20060101); A61b 017/04 () |
Field of
Search: |
;128/334R,335 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
What is claimed is:
1. For use in a surgical incision wound closure procedure wherein
retention thread loop sutures are applied transversely of the
incision area as a precautionary measure for preventing wound
disruption, with a portion of the loop being embedded in the flesh
beneath the incision line and a portion above the line and spanning
the incision,
retention bar means for reinforcing the retention thread loops
developed in closing the incision comprising,
a pair of separate elongate retention bar elements of flexible,
pliable, rubbery material resistant to slicing forces and adapted
for placement in parallel relation longitudinally extending
respectively on opposite sides of the wound incision,
each of said elements being of a companionate length to overlay
opposite sides of said incision line in spaced relation
thereto,
each bar element being generally of a configuration in cross
section having an upper and a lower nonadhesive surface with said
lower surface being configured in cross section so that when the
element is in normal unstressed condition, a portion of the lower
surface contacts the surface of the underlying flesh and the
remainder of the lower surface is above the flesh,
the pair of retention bar elements each including a stitch
receiving portion extending longitudinally of the bar element for
passage therethrough at spaced portions the suture loops along the
element and with opposite sides of the loops being opposingly
arranged, with loop portions transversely spanning the flesh
surface in a network of tie threads, and each of the bar elements
including a relatively thick portion to constrain forces drawing
the suture loops tautly to be applied generally outwardly of the
flesh surface to resist tearing of the flesh and to transfer
slicing forces to the element and resist tearing of the flesh,
said elements being deformable in cross section and longitudinally
flexible to conform to and yield in response to various stages of
swelling as the healing process takes place.
2. The device as set forth in claim 1 wherein said lower surface of
each retention bar element is arcuate in transverse extension and
defines a fair curve.
3. The device as set forth in claim 2 wherein the portion of the
lower surface to contact the flesh surface is continuous along the
length of each of the bar elements.
4. The device as set forth in claim 3 wherein the lower portion of
each bar element comprises a pair of spaced rib surfaces with each
of the rib surfaces having a central zone extending along the lower
surface to contact the flesh and with a portion of the lower
surface lying between the rib surfaces when said bar element is in
a normal unstressed condition.
5. The device as set forth in claim 1 wherein the relatively thick
portion of said retention bar is provided with a through recess
extending coincident to the length thereof, weakening the cross
sectional area of the element and rendering it yieldable to forces
of compression.
6. The device as set forth in claim 1 wherein guide line means
extending longitudinally of each bar element is provided to
designate the stitch receiving portion.
7. The device as set forth in claim 1 including a longitudinally
extending plate extending outwardly of the stitch receiving portion
and adapted to overlay the zone of contact of the lower portion of
the lower surface of each bar element when applied in an unstressed
condition in parallel relation of an incision line.
8. The improvement as set forth in claim 7 wherein said plate
extends outwardly in flange form of the relatively thick portion of
the retention element.
9. The device as set forth in claim 1 wherein the configuration of
the retention element defines a figure of eight area in cross
section, with the central zone defining said stitch receiving
portion and with either of the flanking portions thereof being
adapted for use as the relatively thick portion for causing
purchase advantage.
10. The device as set forth in claim 1 wherein the exterior
surfaces of the retention bar elements are defined in part by a
longitudinally extending recess for orientating the stitch
receiving portion during use of the elements.
Description
BACKGROUND OF THE INVENTION
Field of the Invention
This invention relates to surgical incision closure retention
suture means generally and more particularly relates to retention
bar elements for use in operating procedures for preventing
elongation or eroding of skin and tissue at the thread loop
penetrations and is designed to increase the effectiveness of
retention loop sutures.
Description of the Prior Art
Although the use of heavy thread retention stitches or retention
loop sutures have long been recognized as a principal means for
safeguarding an incision against inadvertent disruption, the prior
art techniques which use retention sutures have had certain
undesirable effects resulting in use: since the retention loop must
be drawn tautly across the incision and maintained in such
condition for effectiveness, there is often a tendency of the
thread loop to elongate or erode into the skin and tissue at the
thread loop penetrations of the incision injuring it and resulting
in skin necrosis and causing objectionable scar tissue of the wound
after healing. Various devices have heretofore been employed to
prevent such occurences and include the use of gauze padding,
buttons, segments of rubber tubing, and plastic bridges. Such
devices have as a principal purpose, to lift the retention suture
thread loops away from the skin surface and to reinforce or
distribute the cutting pressure of the thread loops over a wider
area of the skin tissue at the suture perforations. While the use
of gauze padding, buttons, and other such devices have been helpful
in many applications in reducing the disadvantages referred to
above generally, serious problems have remained. Also, as healing
of the incision wound initiates in a normal process, it tends to
swell being more apt to be damaged in this condition and the
application of certain of the prior art retention loop reinforcing
devices may hold the retention suture thread in a continuously taut
and unyielding manner which further aggravates the tissue tearing
tendency of the retention suture prior art ligation and does not
provide structure which yields to adjust to such swelling as
healing takes place, with the swelling gradually diminishing.
The retention bar means of the instant invention obviates many of
the above-mentioned objectionable features noted in the use of the
retention suture reinforcing devices of buttons, gauze padding, or
the like, and provides an effective means for reducing the tissue
cutting tendency of retention thread sutures by providing an
effective means for spreading the thread pulling pressure over a
wider area of the skin adjacent the thread loop penetrations; and,
additionally, is easily applied. Also the use of the retention bar
means of the invention reduces substantially the formation of
objectionable scar tissue surrounding a healed wound, improving the
cosmetics of the field or area of the operation and confining it,
by reason of the fact that the improved retention bar elements of
this invention permits the retention loops at their penetration in
opposed relation with the flesh of the skin to be closer together.
The retention bar means firmly retains the incision wound against
disruption and yet permits yielding movement to accommodate normal
swelling and permits controlled ligation of the wound during normal
body movements of a patient or when undue stress is placed on the
incision by coughing, sneezing, or other such occurences. The
retention bar structure of the instant invention and its procedure
of use, also admits of ready inspection or attendance to a surgical
incision and effective postoperative procedure.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is an environmental view of the retention bar means of the
instant invention in conjunction with a series of retention loop
elements in a retention suture development closing an incision;
FIG. 2 is a perspective view of a preferred configuration of a
retention bar element;
FIGS 3, 4, 5, 6 and 7 are alternative constructions of retention
bar elements.
DESCRIPTION OF THE PREFERRED EMBODIMENT
The retention bar means of the instant invention is generally
designated by numeral 12 in FIG. 1 and is shown and described in
conjunction with a series of retention suture loop elements R
providing postoperative retention means for a typical abdominal
incision I. Generally, the procedure and particular configuration
of the retention thread suture means of the drawing do not
constitute a part of the invention; however, for illustrative
purposes, the general method of suturing an incision is performed
by placing incision sutures such as S1, S2, S3, in the manner
shown. The retention bar elements of the present invention are
designated by the numerals 14 and 14' and are used in reinforcing
the series of retention thread sutures or loops.
Each of the retention bar elements 14 and 14' of the pair are
preferably of like transverse design and companionate length and
may be formed by severing a single length of retention bar stock
material. For this reason, the following specific description of a
preferred configuration of the left retention bar element 14 will
suffice as to a description of the right retention bar element,
which is also characteristic of the other embodiments which will
also be discussed hereinafter.
The retention bar 14 is preferably formed of polyvinyl extruded
plastic material of resilient or cushioning character. The
polyvinyl material preferably is of a firm resilient constituency
permitting resilient lateral deformation and longitudinal biaxial
flexure of the bar. This illustrated retention bar 14 FIG. 2, is of
a generally symmetrical figure eight transverse section and
preferably includes parallel dual-arranged inner and outer rib
portions 16 and 18 and a web portion 20 integrally connecting the
rib portions in parallel longitudinally extending disposition. The
inner and outer rib portions 16 and 18 of the retention bar element
14 preferably are respectively of tubular thin-wall ellipsoidal
form and with the lateral axes of the element through the web being
adapted to overlay the field in spaced relation above it when in a
normal unstressed condition with the pair of elements aligned and
on opposite sides of the incision line. The retention bar element
14 optionally may be provided with a series of thread apertures 26
uniformly intermittently arranged in spaced relation along the
length of the web 20 of the retention bar. The thread apertures 26
may be formed during manufacture of the retention bar or
optionally, the thread apertures may be formed during surgical
procedure by the needle means used to form the retention thread
ligation or network.
The retention bar elements 14 and 14' may be applied in a surgical
procedure in the following manner: Prior to the closing of the
incision, the several retention thread lengths are embeddedly
placed transversely in the wound area and with the opposite free
ends of the retention threads anchored as in conventional manner by
hemostat and towel means. The several series of incision stitches
S1, S2, S3 are applied to close the incision openings respectively
of the several layers L1, L2, L3 of the abdomen wall structure. The
pair of retention bar elements 14, and 14' are then located
parallel and each respectively on opposite sides of the line of
incision; the loose end portions respectively of the retention
sutures R are passed upwardly through the web apertures 26 or by
perforating the web portions respectively by the needle means of
the retention sutures (the arrow 28 in FIG. 1 illustrates this step
of the procedure).
The adjacent loose ends R1, R2 of each pair of retention sutures
are tied together along the respective web portions 20, 20' ,
forming respectively the longitudinal ties T, T' (this step is
indicated by arrow 30 in FIG. 1). At this state, an elongate
padding of gauze material (not shown) may be placed over the
incision and between the parallel retention bars. The double strand
segments RR of each adjacent pair of retention sutures, are brought
together and tied, forming the double strand retention ties RR
(this step is indicated by arrow 32). The wound surface is now
closed and with the several double strand cross sutures RR each
being tied and tautly spanning the tubular inner rib portions 16,
16' of the pair of retention bars (indicated by arrow 34). To the
extent that the area around the wound excessively swells, and at
the first dressing change the transverse retention sutures RR may
be cut to accommodate the swelling beyond that which is relatively
normal. At this stage, the retention bar elements remain in
position along the opposite side of the incision line being
fastened to the flesh by the suture loop segments R passing
transversely and being embedded in the flesh beneath the incision
line and by virtue of the longitudinally spaced portions of the
loops T and T' which are above the flesh surface and secured along
the web portions 20 and 20' of the retention bars. The wound is
held in a firm but relaxed disposition, and the gauze material may
be removed and the wound attended to. After a period of 4 to 10
days, the pair of retention bars may be removed by clipping the
retention sutures R underneath a respective one of the retention
bars; clipping the thread from underneath one bar permits removal
of that bar, and then the opposite bar may be lifted and removed,
thereby withdrawing the series of embedded suture thread segments
from the wound area.
While the embodiment of FIG. 2 illustrates a preferred
configuration with each bar element being characterized by dual or
parallel zones 56 and 58 for flesh contact, other configurations
are suitable, it being pointed out, however, that the lower or
flesh confronting surface generally designated by the numeral 66 is
elevated as at 62, 64, 66, 68 and 70 by reason of the curvature of
the lower surface, it is thus seen that the united ends of the
loops passed beneath the incision are arranged such that the zone
of contact with the flesh is somewhat adjustable as the curved
surface of the zone gently nests over the flesh along opposite
sides of the wound and does not bite into or present sharp edges so
that as swelling occurs injury is not caused to it. Also, opposing
united ends of the spaced loops embedded in the flesh when
connected by the retention portions RR are oriented so that forces
drawing the tied ends T and T' together are constrained by reason
of the purchase obtained by the bar elements to forces at the skin
surface and that the tendency of such forces to tear the flesh is
transferred to the retention bar elements by reason of the
configuration of them. The zone of contact is of an area which
changes as swelling occurs in the field, that is, the pliable
material of the bar elements as seen in cross section flexes
downwardly to increase the zone of contact. Also, the axial length
of the retention bar elements tends to conform to the surface of
the flesh as swelling occurs and diminishes during the healing
process, providing retention bar elements which while maintaining a
purchase to resist tearing and consequent scarring, simultaneously
yield to healing forces conforming to the changing contour of the
flesh surface. It will be noted that as swelling occurs the zone of
contact is increased, in the embodiment of FIGS. 2 and 3
particularly, and by so doing distributes the load over a wider
area without significant effect on the purchase obtained by reason
of the configuration of the retention bar element. Therefore, by
reason of this invention, the field subjected to scarring may be
reduced since the retention bar elements permit the retention
sutures to be more closely spaced to the incision line causing a
reduction in the field and consequently a reduction of the area
which is cosmetically affected as well as improving the cosmetic
appearance of it by reason of reducing the tear force effect on the
flesh itself.
Referring to FIG. 3, an alternative embodiment is shown which
comprises a pair of retention elements, each of which are similar
and therefore only that designated by numeral 75 will be referred
to in this paragraph. It includes a body 77 which is tubular and
preferably of uniform cross section and generally ellipsoidal in
form. It is provided with a longitudinally extending flange 79
which extends outwardly from the major axis of the tubular body 77
and which is adapted to receive the opposite ends of the retention
loops referred to above along the region of juncture 81 between the
flange and the body. This configuration is oriented in the manner
indicated in FIG. 3 with respect to the incision line which is
designated by the letter I. It is thus seen that by reason of the
passage of the opposite end portions of the loops R through the
region 81, a purchase is obtained at each thread loop by reason of
the curvature of the upper surface 83 of the bar elements.
Referring to FIGS. 4 and 5, the retention bar elements are shown on
opposite sides of an incision line again designated by the numeral
I and are, in the case of FIG. 4, of generally circular section,
while in the case of FIG. 5, are of generally elliptical section,
the elements of FIG. 4 being designated generally by the numeral 86
and the elements of FIG. 5 being generally designated by the
numeral 88. These elements are provided on opposite sides of the
length of the incision and receive the ends of the loops R passing
therethrough. While the embodiments of FIGS. 4 and 5 are tubular,
that is provided with an extending column therethrough as at 89 and
90 respectively, in certain embodiments not shown, the same may be
of solid configuration. By reason of the foregoing, it is seen that
there is provided, in the embodiments shown in FIGS. 4 and 5, a
thin walled deformable retention bar element which is adapted to
yield to the forces of swelling and thread tautness in installation
so as to present a lower surface having a zone of contact 92 and 94
to distribute the load while at the same time being of a sufficient
height to cause a purchase or force orienting to resist tearing and
transfer the thread forces to the retention element body. Also, the
bar elements, configured as in FIGS. 4 and 5, are yieldable to
vertical forces caused by swelling, and also by reason of the
pliability of the material of which they are constructed, vary in
contour along the axial length when installed, in response to
swelling so as to uniformly distribute the thread pulling forces.
The bar elements 86 and 88 each may be provided with a plurality of
intermittently spaced thread apertures along the length thereof,
corresponding in form and function with the thread apertures 26 in
the embodiment of FIG. 1. While the bar elements 86 and 88 of the
embodiments of FIGS. 4 and 5 are not as preferred as that of FIG.
2, by reason of the fact that there is an unfavorable contour
presented to the flesh skin to accommodate swelling, the bar
elements 86 and 88 each provide a zone of contact and force
distribution and orienting means which is yieldable and in a sense
floatable on the flesh surface in response to the adjustment
required as swelling and healing processes occur. The utilization,
however, of a retention bar element of dual-tube form, as shown in
FIG. 2, is preferred since the orientation of such retention bar is
fool-proof, which is not the case with respect to the retention bar
embodiment of FIG. 3, the use of which requires the flanged portion
79 to be arranged outboard of the tubular body 77 and with respect
to the incision line.
Referring to FIG. 6, there is shown a pair of spaced retention bar
elements 100 and 102 which are aligned parallel to an incision line
I and which are generally of the same tear resistant pliable
material, in strip form and of a sufficient thickness 114 so as to
provide purchase for the purposes described above while at the same
time being yieldable to conform to the flesh surface. In the
embodiment of FIG. 6, it is preferred that the longitudinal medial
length of the oppositely oriented main surfaces 104 and 106 be
recessed, defining longitudinal grooves 108 and 110 and a
relatively thin web area 112 to accommodate passage of a needle
used in the development of the sutures. In use, the thickness 114
of the retention elements 100 and 102, between the upper and lower
surfaces 104 and 106, is such as to provide purchase in that the
elongate symmetrical mass 116 on the inboard sides of the elements
is sufficient to distribute the load along the opposite sides of
the wound. In this embodiment, the longitudinally extending corner
edges 118 preferably are somewhat rounded so as not to present
sharp surfaces, and by reason of the cushioning material of
construction, do not chaffe the skin surface.
The retention means described above provide a pair of elongate
companionate retention bar elements adapted to be placed on the
opposite sides of an incision with each of the elements being of a
pliable tear resistant material, which are flexible with respect to
the longitudinal axis and deformable with respect to the cross
sectional areas. Each retention bar element preferably is formed to
transparent surgical quality polyvinyl chloride, and extruded with
a thin web or flange portion through which a needle is adapted to
be passed and which is therefore penetratable by the same, and
includes a purchase causing portion, compressible in cross
sectional area, and which is of a height between the flesh abutting
surface and the outer surface sufficient to cause a purchase effect
orienting the retention sutures outwardly of the incision area.
Also, each retention element is deformable to conform to the
varying contour of the surface of the flesh and to follow the
contour thereof as the healing process takes place, and in a sense
to float to a degree generally conforming thereto.
In a preferred embodiment, the stitch receiving portion or plate of
the elements is in the order of between 20 and 60 thousandths of an
inch thick and in any event is sufficient to resist the tearing or
slicing forces of the suture threads passing through the stitch
receiving portion. The air columns of the hollow bar elements shown
may be bounded by walls of varying thickness to achieve the results
and purposes set forth herein and to define a stitch receiving
portion and a purchase causing portion; and preferably the elements
are all of flexible pliable tear resistant plastic material and of
uniform cross section throughout their lengths. A thin recess or
guide line designated by the numeral 115 in FIG. 4 and 117 in FIG.
5 may be provided to designate the stitch receiving portion in
contradistinction to the purchase causing portion, this being
achieved in FIGS. 2 and 6 by the longitudinally extending recesses
formed in the exterior surface of the bar elements, and as by the
crotch of the angle between the stitch plate or flange 79 and the
body 77 of the element shown in FIG. 3. Additionally, color coding
may be provided to designate various retention element lengths for
selection of them from suitable storage facilities or to indicate
the orientation of the stitch plate or the stitch receiving portion
of the elements. The embodiment of FIG. 7, provided with the cite
line 115' may also be used as an alternative embodiment.
* * * * *