U.S. patent number 3,663,965 [Application Number 05/044,166] was granted by the patent office on 1972-05-23 for bacteria-resistant percutaneous conduit device.
Invention is credited to Culp, Gordon W., Henry L. Lee, Jr., David E. Ocumpaugh.
United States Patent |
3,663,965 |
Lee, Jr. , et al. |
May 23, 1972 |
BACTERIA-RESISTANT PERCUTANEOUS CONDUIT DEVICE
Abstract
A percutaneous device for facilitating passage of wires, tubes,
and other electrical or fluid conductors through the skin of an
animal, in a manner such that the wires, tubes, or other conductors
are immobilized with respect to the skin and a fluid and bacterial
seal is obtained. The device comprises a generally cylindrical,
elongated percutaneous conduit element having a central passageway
therethrough and a subcutaneous fenestrated flange disposed in
generally surrounding relationship to the conduit element. The
subcutaneous flange is provided with a series of holes suitably
spaced and sized to facilitate growth of tissue therethrough. The
conduit element and the flange are contoured to facilitate the
proliferation of the external epidermis down along the outer
surfaces of the conduit, out, over and under the surfaces of the
subcutaneous flange, through the holes in the flange, and up the
passageway in the conduit element. Thus, the epidermis provides, in
effect, an exteriorization of the flange and a sphincter around the
passageway to immobilize wires, tubes and other electrical or fluid
conductors extending through the passageway.
Inventors: |
Lee, Jr.; Henry L. (San Marino,
CA), Culp, Gordon W. (North Hollywood, CA), Ocumpaugh;
David E. (Santa Monica, CA) |
Family
ID: |
21930858 |
Appl.
No.: |
05/044,166 |
Filed: |
June 8, 1970 |
Current U.S.
Class: |
623/23.64;
604/175 |
Current CPC
Class: |
A61M
39/0247 (20130101); A61M 2039/0261 (20130101); A61M
2039/0285 (20130101) |
Current International
Class: |
A61M
1/00 (20060101); A61f 001/00 (); A61m 025/00 () |
Field of
Search: |
;128/348-351,214R,1R,2R
;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Merrill et al. Trans. Amer. Soc. Artific. Inter. Orgs. Vol. VIII,
pp. 252-255, 1962 .
Ore et al. Surgery, Vol. 52, No. 2, August, 1962 pp.
385-390.
|
Primary Examiner: Truluck; Dalton L.
Claims
We claim:
1. A percutaneous conduit device for facilitating passage of
information, energy or material to or from the interior of an
animal while preventing substantial ingress of bacteria and egress
of body fluids, said device comprising:
an elongated, generally cylindrical percutaneous conduit element
having a central passageway therethrough; and
a subcutaneous fenestrated flange mounted on the conduit element,
in surrounding relationship to said passageway, the holes being
dispersed throughout the flange area, being generally circular and
having diameters approximately equal to the thickness of the flange
and being spaced equidistant along a series of equally angularly
spaced involute spirals;
the junction between the outer surfaces of said conduit element and
said flange being rounded to provide a smoothly contoured fillet
radius to facilitate and guide the proliferation of the external
epidermis of an animal in which said device has been implanted in a
direction down along the conduit, out, over and under the flange,
through the fenestrations in the flange, and up to said passageway
whereby said epidermis provides an exteriorization of the flange
and a sphincter around said passageway.
2. A percutaneous device as set forth in claim 1 wherein the total
open area of the holes is approximately equal to the remaining area
of the flange.
3. A percutaneous device as set forth in claim 1 wherein the
lateral edges of the holes and of the flange are rounded.
4. A percutaneous device as set forth in claim 1 wherein said
conduit element and said flange are integral.
5. A percutaneous device as set forth in claim 1 wherein is
included an external flange disposed at the opposite end of the
conduit element from said subcutaneous flange.
Description
The invention described herein was made in the course of work under
a grant or award from the Department of Health, Education and
Welfare.
BACKGROUND OF THE INVENTION:
1. Field of the Invention
The present invention relates to percutaneous conduit devices and
particularly to percutaneous connectors adapted to provide repeated
access to internal regions of the body to facilitate such
operations, for example, as hemodialysis.
2. Description of the Prior Art
The prior art is replete with examples of percutaneous devices. In
particular, percutaneous devices have been utilized to provide
artificial corneal implants. Examples of these devices are
illustrated in U.S. Pat. Nos. 2,714,221 and 3,458,870. These
devices, of course, are not conduit devices.
Prior art percutaneous conduit devices are exemplified in U.S. Pat.
Nos. 3,447,161; 3,452,366; and 3,461,869. These devices provide,
for example, access for pressure and electrical connections for
heart pump systems and access to blood vessels for procedures such
as peritoneal dialysis, lymph dialysis, and hemodialysis.
The prior art devices commonly have failed to provide adequate
sealing from the standpoint of preventing ingress of bacteria and
egress of body fluids through and around the percutaneous device.
Of course, inadequate sealing presents the potential problem of
sinus tract infection from the skin surface downward along the
cannulae into the blood, itself, causing septicemia. Such
infections, in addition to complicating medical management,
necessitate repositioning of the cannulae thereby presenting
increased surgical difficulties as the supply of suitable vessels
is progressively diminished.
Prior art devices also have been noted for their relatively short
life expectancy resulting from trauma applied to vascular walls by
movement of the cannulae tips positioned within them. The
traumatized vessel walls are active sites for the formation of
blood clots and phlebitis, and with time, such complications will
also require repositioning of shunts and the like.
The most severe problem encountered in the use of prior art
percutaneous devices has been the failure of such devices to resist
extrusion from the body. Typically, this phenomena has been
encountered because the geometrical configuration of prior art
devices has been inadequate to properly anchor the devices within
the epidermal epithelium.
SUMMARY OF THE INVENTION
The object of the present invention is to avoid the shortcomings of
the prior art, and in particular, those which have been discussed
above. Primarily, this result has been accomplished by providing a
percutaneous device having a configuration suitable for being
securely anchored within the epidermal epithelium while maintaining
a seal adequate to prevent ingress of bacteria and egress of body
fluids and without causing severe trauma to tissues adjacent to the
device.
According to the present invention, there is provided a
percutaneous conduit device for facilitating passage of
information, energy or material to or from the interior of an
animal while preventing substantial ingress of bacteria and egress
of body fluids. The percutaneous device of this invention comprises
an elongated, generally cylindrical percutaneous conduit element
having a central passageway therethrough. The device further
comprises a subcutaneous fenestrated flange mounted on the conduit
element, in surrounding relationship to the passageway. The
fenestrations or holes in the flange are spaced and sized to
facilitate growth of skin tissue therethrough. The outer surfaces
of the conduit element and the flange are contoured to facilitate
and guide the proliferation of the external epidermis of an animal
in which said device has been implanted in a direction down along
the conduit, out, over and under the flange, through the
fenestrations in the flange, and up to said passageway for
immobilizing a tube, wire or other electrical or fluid conductor
extending through the passageway.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a percutaneous conduit device
constructed in accordance with the concepts and principles of the
instant invention;
FIG. 2 is a cross-sectional view of the device in position in the
skin after surgical implantation; and
FIG. 3 is a top plan view of a preferred embodiment of the device
illustrating the manner in which the holes in the fenestrated
flange are arranged to achieve a constant ratio of open area to
total flange area.
DESCRIPTION OF THE PREFERRED EMBODIMENT
The device described herein allows the passage of wires and tubes
through the skin of a living animal while precluding egress of body
fluids and ingress of bacteria through and around the device.
The puncture sealing skin conduit device may comprise a plurality
of component parts which may be constructed individually and later
assembled. Conversely, the device may comprise an integral assembly
or a plurality of subassemblies. A preferred form of the device,
wherein the components are integral, is shown in FIG. 1.
In FIG. 2, it can be seen that the device has a subcutaneous flange
1 implantable beneath the skin of an animal. Flange 1 is contiguous
with the internal portion 2a of a percutaneous conduit 2.
Percutaneous conduit 2 also has a central portion 2b disposed to be
located in the subcutaneous tissue and to extend therethrough, and
an external portion 2c adapted to be disposed outside the skin of
the animal. The device may also include an extracutaneous flange 3
contiguous with external portion 2c of percutaneous conduit 2.
A connecting element 4 is provided for carrying information, energy
and/or material to or from the interior of the animal. For this
purpose, connecting element 4 extends through conduit 2 as
illustrated. Passage of body fluids from within the animal to its
exterior and passage of bacteria from the exterior to the interior
of the animal, by way of the path between the exterior surface of
the connecting element 4 and the interior surface of the conduit 2,
is prevented by compression of the conduit 2 around the connecting
element 4, and/or by the application of a sealing adhesive 5 at the
junction of the connecting element 4 and the extracutaneous flange
3.
Subcutaneous flange 1 is fenestrated to present a plurality of
circular holes 6 therethrough. Holes 6 preferably have transversely
rounded edges 6a as can best be seen in FIG. 2. The peripheral edge
7 of subcutaneous flange 1 is also preferably rounded with a radius
equal to approximately one half of the thickness of the
subcutaneous flange 1. The junction 8 between percutaneous conduit
2 and subcutaneous flange 1 is also preferably rounded to provide a
smoothly contoured fillet radius at junction 8.
FIG. 2 illustrates a cross section of the puncture sealing skin
conduit as it appears in the skin after surgical implantation. The
epidermal epithelium (stratum corneum to stratum germinatinum 9),
has been surgically punctured or otherwise modified to implant the
device. Because of the novel configuration of the device of this
invention, the epidermal epithelium heals by growing inwardly along
the exterior cylindrical surface of conduit 2, then along the
rounded surface of junction 8 between percutaneous conduit 2 and
subcutaneous flange 1, thereafter through the holes 6 in
subcutaneous flange 1 nearest the conduit 2, and finally along the
lower surface 1a of subcutaneous flange 1 until connecting element
4 is completely surrounded thereby. Note that the epithelium, in
effect, forms a sphincter 11 around element 4 to substantially
immobilize the latter against movement internally of the host. The
epithelium 9 proliferates across both the upper 1b and lower 1a
planar surfaces of subcutaneous flange 1 simultaneously with the
proliferation of the same through the holes 6 closest to conduit 2.
The final stage of growth of the epithelium 9 occurs when the
remaining holes 6 in flange 1 are filled and peripheral edge 7 of
subcutaneous flange 1 is surrounded by epithelium 9.
Fabrication of the devices of this invention may be effected by
machining separate parts or the entire device from larger fragments
of the desired materials. If the parts are fabricated separately,
the component parts may be assembled using heat, adhesive, with or
without heat, screw threads or deformable fasteners. As an
alternative method, the assembly can be accomplished by molding one
of the components of the device in a mold in which the other
components have been previously, and by design, positioned, such
that when the molded component achieves the desired physical
properties during the molding process, the molded component and the
previously positioned components in the mold become a single
assembly and unit.
The percutaneous conduit 2 may or may not be fabricated as a
separate component from the extracutaneous flange 3 and/or the
subcutaneous flange 1. The extracutaneous flange 3 and subcutaneous
flange 1 may be cast, molded, or machined as separate components
and then assembled to the other component or components of the
assembled device.
The subcutaneous flange 1 may preferably be fabricated by cutting a
disk from a sheet of the desired material, and then forming the
holes 6 therein by punching, shear-punching, drilling, trephining,
piercing or otherwise machining. The holes 6 in the subcutaneous
flange 1 may alternatively be formed as the flange 1 is molded,
pressed, extruded, or otherwise formed or deformed, using starting
materials in gaseous, liquid or solid form, into the desired
configuration, by dies, molds, forming tools, cores, patterns, or
templates.
The arrangement of the holes 6 in the subcutaneous flange 1 is
preferably such that the average open area of the holes 6 per unit
area of flange 1 is substantially constant throughout the area of
flange 1. As an acceptable alternative, the average open area of
the holes 6 per unit area of flange 1 may vary uniformly radially
outward from percutaneous conduit 2 to peripheral edge 7 of
subcutaneous flange 1. Fabrication of subcutaneous flange 1 with
the average open area of the holes 6 per unit area of flange 1
being maintained substantially constant throughout the entire area
of flange 1 from the edge of the annular row of holes 6 closest to
the percutaneous conduit 2, to peripheral edge 7 of flange 1, may
be accomplished, for example, by using a rack and pinion jig in
which the pitch diameter of the pinion is made equal to the center
circle diameter of the annular, inner rows of holes 6. In this
operation, the pitch of the teeth of the pinion gear should be
equal to the center-to-center distance of two adjacent holes 6 of
the annular inner rows of holes 6 and the hole locating device (in
the case of a mold, template, or pattern) or hole forming device
(in the case of drilled, punched, trephined, or otherwise formed
hole by the process of removing or deforming the material of the
flange), is held stationary while the pinion gear, upon which the
flange 1 is positioned, is moving along the rack, thereby causing
simultaneous translation and rotation of the flange 1, relative to
the hole forming or locating device. The resulting layout of holes
is illustrated in FIG. 3.
The geometry of this method is such that the locus of hole forming
or locating device positions is an involute spiral which has a base
circle equal in diameter to the diameter of the center circle of
the annular inner row of holes 6. This geometry therefore requires,
when the holes 6 are spaced equidistant along each of the equally
spaced involute spiral arms, that the average open area of holes 6
per unit area of flange 1 be constant, since each equally spaced
involute spiral arm is everywhere parallel to the adjacent arm.
This is true at all locations along the arm from the base circle,
where all arms are parallel to a radius of the base circle, to
infinity, where all arms are perpendicular to an infinitely
extended radius of the base circle. In other words, since the
spiral arms are equally spaced, and the holes 6 are equally spaced
along each arm, then the average open area of holes 6 per unit area
of flange 1 is constant. This an analogous to wrapping an equally
spaced rectilinear array of holes around an axis and distorting the
inner-hole topology rather than distorting the topology of the
space including the holes.
Holes 6, having rounded edges at both upper and lower planar
surfaces of subcutaneous flange 1, invoke less irritation to the
subcutaneous tissues than would holes having sharp edges.
Fabrication of holes having rounded edges may be accomplished by
deforming the edges of holes 6 during or after the forming of each
hole 6, by removing material comprising the edges of each hole 6 by
cutting or scraping, or by molding or forming the holes 6 in a mold
or with a die that has provisions for preventing the formation of
holes with sharp edges. It has been found that earliest maturation
of connective tissue in holes 6 occurs when the diameter of each
hole 6 is made approximately equal to the thickness of subcutaneous
flange 1.
Devices embodying the concepts of this invention may be fabricated
from a variety of materials matching the physical characteristics
of each device to any one of a variety of applications. The
materials found best suited for device fabrication are TFE Teflon
(R), silicone rubber, polypropylene, polyurethane, epoxy, and
various forms of pyrolyzed carbon. Materials with higher elastic
moduli may preferably be used for the subcutaneous flange 1 where
the device is to be implanted at a location on the animal where the
mobility of the skin is minimal. On the other hand, where the
mobility of the skin is high, materials having a lower elastic
moduli are preferred for the subcutaneous flange 1 so that erosion
of tissues adjacent to the edge 7 of the subcutaneous flange 1 is
minimized by the higher compliance of the latter.
After the device has been implanted, final growth and cessation of
the healing process will be characterized by the complete coverage
of all of the subcutaneous and percutaneous surfaces of the device
with epithelium. Also, in the absence of severe mechanical trauma,
the appearance of the tissues adjacent to the device will return to
normal, when examined by standard histological techniques, that is
by: (a) excision of the device and adjacent skin; (b) sectioning
with a microtome; (c) slide preparation; (d) staining with suitable
preferential coloring stains; and finally (e) examination of the
slides through a microscope.
The epithelium, having covered all subcutaneous and percutaneous
surfaces of the device, completely isolates subcutaneous tissues
from the foreign material of the device itself and thereby reduces
foreign body reactions by the subcutaneous tissues.
In the absence of severe mechanical trauma, the rounded, smooth
contour of the surface of the device at the junction 8 between the
percutaneous conduit 2 and the subcutaneous flange 1, being
completely covered by the epithelium, provides a long, tortuous,
labyrinth type path through which bacteria are required to pass
before entering the subcutaneous regions. Thus, such bacteria will
be subjected to the naturally occurring bacteriostatic and
bacteriacidal agents of the epithelium to thereby minimize the
possibility that a multiplying colony of bacteria will be
established in the subcutaneous tissues adjacent to the device.
The growth of subcutaneous connective tissue through the holes 6 in
subcutaneous flange 1, during the latter stages of the healing
process, results in the firm enmeshing of the device in the tissue.
Accordingly, the device and the adjacent tissues are capable of
resisting considerable mechanical force without dislodging the
device or otherwise disrupting the adjacent tissues.
The holes 6 in the subcutaneous flange 1 permit free passage of
normal body electrolytes and fluids, thereby providing for
nutrition of subcutaneous tissues 10 lying between the surface of
the skin and the upper surface 1b of the subcutaneous flange 1.
These holes 6 also facilitate proper removal of waste products of
skin metabolism from tissues 10.
The percutaneous conduit 2 of this invention provides for the
passage of connecting element(s), such as 4, from the interior of
an animal to its exterior while precluding entrance of bacteria
into the animal and passage of fluids from within the animal to its
exterior.
Mechanical forces applied to the connecting element 4 are
transferred through the percutaneous conduit 2 to the subcutaneous
flange 1. Thus, such forces are distributed to the epithelial and
subcutaneous connective tissues lying in the holes 6 of the
subcutaneous flange 1 to thereby minimize the deletorious effects
of the mechanical forces on the tissues adjacent to the junction of
the skin and the percutaneous conduit 2. This minimizes the
possibility that the tissues will be disrupted sufficiently to
cause distension of the tissues with the consequent allowance of
entrance of bacteria or escape of body fluids.
The extracutaneous flange 3 is disposed to prevent the epithelium 9
of the skin from proliferating such that the exterior portion of
the device becomes covered, when, during the initial healing of the
skin puncture, the skin adjacent to the percutaneous conduit 2 is
swollen because of edema due to subclinical infection, post
operative mechanical trauma, surgical trauma, or other causes.
Manifestly, such swelling could elevate the epithelial layer 9 to a
position above the device and, in the absence of the extracutaneous
flange 3, a path would be provided along which epithelial
proliferation could occur with great rapidity. This would interfere
with proper epithelial proliferation in the desired downward
direction along the exterior cyclindrical surfaces of the
subcutaneous portions 2a and 2b of the percutaneous conduit 2.
The characteristics discussed above will be achieved with the
puncture sealing skin conduit in the living animal if proper
surgical and clinical techniques are utilized. These techniques
include, inter alia, the following:
A. Implantation of the device using adequate surgical technique and
sterile implements;
B. Implantation of the device using sharp and well controlled
cutting instruments so that trauma to the skin of the animal is
minimized;
C. Isolation of the device and adjacent tissues from interior and
exterior mechanical, chemical, and bacteriological trauma until the
aforementioned functional characteristics are observed to have
occurred; and
D. Protection of the device and adjacent tissues from mechanical,
chemical, and bacteriological trauma even after the aforementioned
functional characteristics have been fully developed if the level
of such trauma is as great as or greater than that which can be
sustained without damage by the normal, intact skin.
The bacteria-resistant percutaneous conduit device of this
invention may be used whenever it is desirous to pass electric,
hydraulic, thermal, or pneumatic energy through the skin of a
living organism, or to gain, for any other reason, access to the
organism, without the escape of material from within the organism,
or invasion of the organism by foreign matter, be it either animate
or inanimate.
The device is usable as a container and conduit for single and
multi-conductor electrical, pneumatic, hydraulic, optical or
thermal circuit connectors. Such connectors may be positioned in
the device before or after fabrication, or before or after surgical
implantation of the device in the animal. Alternately, the device
may have a removable plug, appropriately designed for the necessary
bacterial and fluid seal, so that periodic access to the interior
of the organism is possible without disrupting the tissues adjacent
to the device, or without resorting to additional surgical trauma
to the organism to achieve said access. Visual access may be
attained through the use of a device having a suitable window
fabricated therein as an integral part of the assembly or as a
replacement of the previously mentioned plug.
Specifically, providing access for powering a heart assist device
or a total mechanical heart replacement, or for the leads of a
pacemaker are among the specific uses of the device. As a
circulatory access device the percutaneous conduit device is useful
for the admission and exit of blood cannulae to allow the
connection of the circulatory system to an artifical kidney or an
artificial lung or both. Access to the peritoneal cavity may be
provided by the percutaneous conduit device for the periodic
administration of the peritoneal dialysis. The percutaneous conduit
may also be used for the exteriorization of brain electrodes, nerve
electrodes, blood pressure, flow, pH, pCO.sub.2, pO.sub.2, and
temperature transducers, which may be used to provide information
for the control systems of various external adnexa or prosthetic
organs.
* * * * *