U.S. patent number 3,664,345 [Application Number 05/052,449] was granted by the patent office on 1972-05-23 for surgical buttons.
Invention is credited to Clyde Harwell Dabbs, Hugh G. Neil.
United States Patent |
3,664,345 |
Dabbs , et al. |
May 23, 1972 |
SURGICAL BUTTONS
Abstract
A surgical button for retaining a suture after passing through
the skin on one side of an abdominal or other wound. The button
comprises a non-metallic disc made of nylon or other suitable
plastic material which has an axial orifice therethrough for
passage of the suture and which axial passage or orifice is
intersected by a radial orifice extending diametrically
therethrough to receive a locking pin which engages the suture in a
wedging action to hold it tightly in the disc. The button also
comprises a pad of soft, spongy material, such as sponge rubber,
secured to one face of the disc with a covering of cloth or fabric
which lies against the skin and prevents irritation or maceration.
No tying of the suture is involved. It is held in place by the
wedging action of the disc.
Inventors: |
Dabbs; Clyde Harwell
(Knoxville, TN), Neil; Hugh G. (Knoxville, TN) |
Family
ID: |
21977680 |
Appl.
No.: |
05/052,449 |
Filed: |
July 6, 1970 |
Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B
17/0401 (20130101); A61B 2017/0414 (20130101); A61B
2017/045 (20130101); A61B 2017/0404 (20130101) |
Current International
Class: |
A61B
17/04 (20060101); A61b 017/04 () |
Field of
Search: |
;128/334R,334C,335,335.5,339 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
We claim:
1. A surgical button comprising a disc having an axial opening
therethrough for passage of a suture, said disc having a radial
opening extending from the periphery inward and intersecting said
axial opening, and a pin inserted into the radial opening in
position for wedging relation with the suture.
2. A surgical button according to claim 1, wherein the pin has a
tapered end at the axial opening for wedging the suture.
3. A surgical button according to claim 1, wherein the disc is
relatively thick and flat and is formed of non-metallic
material.
4. A surgical button comprising a disc having an axial opening
therethrough for passage of a suture, said disc having a radial
opening extending from the periphery inward and intersecting said
axial opening, a pin inserted into the radial opening in position
for wedging relation with the suture, said button including a thick
pad of cushioning material on one side of the disc, and a strip of
fabric covering the side of the pad opposite from the disc to be
disposed between the cushion pad and the skin.
5. A surgical button comprising a relatively flat non-metallic disc
having an axial opening therethrough for passage of a suture
through the disc, said disc having a second opening extending
diametrically therethrough intersecting the axial opening, a pin
inserted in the second opening for wedging the suture in the axial
opening, a pad of cushion material secured to one face of the disc,
and a fabric material covering the outer face of the pad opposite
from the disc to be disposed against the skin.
6. A surgical button according to claim 5, wherein the pin has a
tapered end for wedging the suture in place.
7. A surgical button according to claim 5, wherein the pad and
fabric covering are of greater area than the disc.
8. A method of securing a suture in place after passage from the
skin of a patient, comprising passing the suture through a
perforated disc, and inserting a pin radially through the disc in
wedging relation with the suture.
9. A surgical button comprising a relatively flat disc, a pad of
cushion material secured to one face of the disc, a sheet of fabric
extending over the opposite face of the pad from the disc and
substantially throughout said opposite face to lie in contact with
the skin and to protect the skin from the cushion material, said
pad and sheet of fabric being in position for passage of a suture
therethrough from the skin to the disc, and means for securing the
suture to the disc.
10. A surgical button according to claim 9, wherein the disc is
non-metallic and the fabric sheet covers the entire area of the
face of the pad to which said sheet is secured.
Description
SUMMARY OF THE INVENTION
This invention relates to improvements in surgical buttons used for
holding sutures for abdominal and other wounds without damage to
the skin even when left in place over several weeks.
Since the dawn of medicine, surgeons have sought to improve the
methodology and technics of wound closure. The ancient enemy of the
healing tissue is tension. Tension on the tissues at the line of
closure poses an ever present threat of mechanical disruption of
the wound itself. Moreover, tension interferes with the healing
process per se, by increasing edema, and interference with the
blood supply to the parts caught between the sutures.
Historically, various technics have been used to place retention
sutures in wounds, designed to relieve the tension on the primary
line of closure. Abdominal wounds (laparotomy incisions) have
constituted the chief use of retention sutures because wound
dehiscence (wound rupture) here results in evisceration, a
physiologic catastrophe.
Heretofore, there has been no satisfactory, and easily applicable
method of accomplishing the desired objective, that is, to take the
tension off the primary closure. The conventional method of using
retention sutures consists of placing large strong sutures of silk,
wire, monofilament nylon, etc. through all layers of the abdominal
wall except the peritoneium (inner lining) and then pulling tightly
and tying, usually over some sort of cloth or rubber padding.
Often a section of small rubber tubing (catheter) is used to
protect the skin. Since wounds require three weeks to attain their
maximal tensile strength of healing, it is necessary to leave all
retention sutures in for approximately this long, if they are to
serve any useful function. The forces exerted by tying a loop, as
is conventionally done, inevitably produce necrosis (death) of
living tissues subjected to the constant strong linear pressure
along a very narrow area (the width of the contacting (inner) side
of the wire or material). This is a well recognized phenomenon, and
discourages the widespread use of retention sutures. The cutting in
of the sutures is oftentimes extremely painful to the patient and
the resulting scars are unsightly. Even more important, from a
functional standpoint, the more necrosis that occurs, the looser
the loop becomes so that, by the end of three weeks (the critical
period) the retention sutures are so loose that they offer no
protection from dehiscence whatsoever.
Buttons and frames have been used down through the years in order
to change the direction of forces ad still relieve the tension on
the primary wound. A commercially available button, known as the
Davy button, has been available for several years and is easier to
apply that clothing buttons. While it is true that the use of
external fixation via buttons improves the situation by eliminating
the cutting action resulting from a tightly tied loop, buttons have
not gained widespread acceptance. One reason that buttons are not
more widely used is that the edge of the button digs in to the skin
and, over a period of three weeks, produces pressure necrosis
around one or more of the buttons.
The defects of the commercially available buttons are as
follows:
1. The thin metal edge predisposes to pressure necrosis of the
skin.
2. The absence of padding on the surface next to the skin results
in pressure necrosis.
3. Gripping of the retention suture by crushing the metal nipple
requires a special tool as part of the sterile operating room
equipment.
4. The hardness of the metal precludes performing this maneuver
with any of the surgical clamps ordinarily available.
5. Gripping of the suture so that it is held securely requires
practice by the surgeon before it can be done properly, and
consistently. If not crushed just right the suture pulls out.
6. The protruding nipple from the outer side of the button
interferes with wearing of abdominal supports and clothing
post-operatively by reason of the fact that it protrudes
approximately three-eighths inch above the surface.
7. The crushed metal nipple presents an irregular, jagged
projection which snags on clothing, dressing, etc.
One object of this invention is to obviate the objections to the
buttons used heretofore and to improve the construction thereof and
the method of holding in place sutures after passage from abdominal
or other wounds.
Another object of the invention is to eliminate the tying of
sutures to buttons and to provide for secure connection
therebetween by a wedging action.
Still another object of the invention is to eliminate skin necrosis
by contact of the button or a pad thereon with the surface of the
skin.
In carrying out these objects, we have provided a surgical button
comprising a disc of suitable non-metallic material, such as nylon.
This disc has an opening extending axially therethrough for passage
of the suture and a diametrically extending or radial opening which
intersects the axial opening and receives a pin that extends into
wedging relation, clamping the suture against a side of the axial
opening, thereby retaining it securely in the disc. The face of the
disc toward the skin is provided with a suitable cushion material
or pad thereon, preferably larger in diameter than the diameter of
the disc and which is covered with a layer of fabric or cloth which
lies in contact with the skin between the latter and the pad.
Padded buttons and discs have been used in approximately two
hundred cases, with an average of six buttons per case. This
constitutes an experience in observing approximately twelve hundred
padded discs or buttons in patients. Since the adoption of the
bottom-faced rubber pads, there have been no instances of skin
necrosis.
BRIEF DESCRIPTION OF DRAWINGS
One embodiment of the invention is illustrated in the accompanying
drawings, in which:
FIG. 1 is a perspective view, diagrammatically illustrating an
incised abdominal wall and showing the application of the buttons
for holding sutures in place;
FIG. 2 is a vertical section through the abdominal section,
substantially on the line 2--2 in FIG. 1;
FIG. 3 is a cross section through the surgical button, illustrating
the clamping of a suture therein; and
FIG. 4 is a disassembled perspective view, showing the parts of the
surgical button.
The surgical button is designated generally at 1 and comprises a
disc 2 of suitable, preferably non-metallic material. This disc may
be made by cutting a section from a nylon rod of a suitable
diameter, such, for example, as three-eighths inch or three-fourths
inch, according to the size of surgical button desired. The
thickness of the button should be sufficient to hold firmly as, for
example, one-eighth inch or three-sixteenths inch.
A small hole, indicated at 3, is drilled through the center of the
disc to allow passage of a surgical needle therethrough and to
receive the suture. A radial or diametrical opening or passage 4
extends transversely through the disc 2 intersecting the axial
opening 3. A pin 5 of a diameter substantially to fit the radial
passage 4 is inserted therethrough and preferably has a pointed or
wedge-shaped end 6 thereon to squeeze the suture laterally in the
axial opening 3. The pin 5 is shorter than the diameter of the disc
and serves to wedge the suture in place in the axial opening 3. The
pin 5 may be formed of nylon or stainless steel or other suitable
material.
The surgical button 1 also includes a pad 7 formed preferably from
latex foam rubber of a thickness suitable for effective cushioning
action. A thickness of one-eighth inch or one-fourth inch has been
found suitable for the purpose. This pad is secured to one face of
the disc 2 by a waterproof adhesive so that it is effectively
secured. The pad 7 may be of a diameter or area larger than the
disc 2 to distribute the force over a large area and to allow use
of a smaller size disc. The face of the pad 7 opposite from the
disc 2 is covered with a sheet of cotton webbing or fabric,
illustrated at 8 in FIG. 4. This sheet 8 is secured to the pad 7 by
a suitable adhesive.
The regular or large size disc is designed for use in laparotomy
wounds and wounds involving large heavy tissues or flaps and the
like. The small size disc is for smaller skin flaps such as radical
neck flaps, thyroidectomy flaps, face flaps in plastic surgery, and
incisions where no great stress is applied to the primary wound
post-operatively. The regular size is designed to be used with
large, strong retention sutures of the magnitude of No. 2 material.
The small size, on the other hand, is designed for use with sutures
of smaller size, e.g. No. 00 monofilament nylon. The discs are
identical except for the differences in the dimensions.
The invention is illustrated in FIGS. 1 and 2 as applied to an
abdominal section, generally indicated at 9, made up of a series of
layers of muscular tissue and skin within which an incision 10 has
been made. The sides of the incision 10 are closed by sutures 11 at
suitable or desired points. The main suture material secured by the
buttons is indicated at 12.
THE PROCEDURE FOR LAPAROTOMY WOUND CLOSURE IS AS FOLLOWS:
The retention sutures 12 may be placed before any of the layers are
closed, after the peritoneum is closed, or after the musculofacial
layer is closed, depending on the personal preference of the
surgeon. In any event, it is considered important that the
retention sutures not pass through into the peritoneal cavity. A
free loop of suture inside the peritoneal cavity may occasionally
be the source of intestinal obstruction. Whichever method is
preferred, the technic of anchoring the retention sutures is
similar. First, pass the needle containing the desired suture
material 12 from the external surface of the disc 2 (the unpadded
side) down through the central hole 3 through the foam rubber pad
7. Pull the suture 12 through, leaving a short section of the
suture protruding from the external (nylon) surface, as shown in
FIG. 1. Grasp the free end with a hemostat to keep under slight
tension while the suture 12 is impacted by pushing the pin 5
through the horizontal hold 4 with a Kocher clamp until the pin 5
is flush with the edge of the disc 2. Test the grip on the suture
manually, to make sure that it is held firmly. Then pass the needle
through all layers of the abdominal wall, except the peritoneum. In
other words, passing the suture from the (patient's) left hand side
of a vertical abdominal wound, the needle (and suture) would pass
through, successively, skin, subcutaneous tissue, musculofacial
layer including transversalis fascia, then through the right hand
side, musculofacial layers, subcutaneous tissue and skin.
The opposite (right hand) disc is then transfixed by passing the
needle up through the foam rubber pad 7, through the center hole 3.
A hemostat is placed on the suture 12, one or two inches above the
disc and the suture cut. The same procedure is repeated at desired
intervals until two, three, four or more pairs of retention sutures
have been placed, depending on the length of the wound, the degree
of protection desired and the personal preference of the surgeon.
After all the sutures have been placed, the primary wound closure
is completed according to the preference of the surgeon.
The tension sutures 12 are then completed one at a time as follows:
The first is tightened by picking up the free end of the suture 12
and pulling it through the central hole 3 of the right hand disc 2
until the desired tension is achieved, keeping in mind that the
tension will become greater when the anesthetic agent has worn
off.
While the resiliency of the pads will protect the skin
post-operatively from necrosis, even with considerable abdominal
distention, the degree of distension which may occur is
unpredictable. For this reason, it is the practice to adjust the
degree of tension so that the skin is depressed only slightly. The
remaining (right hand) disc is now depressed into the skin to a
similar degree and the suture fastened by squeezing the pin 5 into
place. The excess suture is cut off, leaving a few millimeters
protruding (FIG. 1). Care should be taken to place the sutures far
enough from the skin edge 10 so as not to interfere with skin
closure; 1 to 11/2 inches will usually suffice.
A similar technic can be used quite effectively on any surgical
wound in which the incision is made through the skin. It is
particularly useful in dissections involving flaps such as
mastectomy wounds, radical neck dissections, thyroidectomies,
rotated flaps to plastic surgery, and the like.
No special after-care is required. The stay sutures are left in
place a minimum of 3 weeks (the time required of attaining maximal
tensile strength in a cleanly healing wound). Skin sutures may be
removed anytime after the first day. No dressing is required over
or under the discs. The patient may bathe or shower as desired. An
occasional patient may react to the suture material and develop
irritation around the suture tract. In the majority, however, there
is no reaction at all even after three weeks by reason of the
protection of the cotton layer 8. The sutures are easily remove
when desired. One side is lifted up enough to insert the point of a
scissors between the skin and the disc and the suture clipped. The
other disc with the remainder of the suture attached is then
withdrawn.
We are convinced that the widespread use of this device will solve
the ancient problem of retention sutures in closing abdominal
wounds. Its use in a wide variety of other types of surgical wounds
adds a new dimension to wound healing. Relieving of the distracting
forces at the primary line of closure results in greatly improved
patient comfort and cosmesis.
While a preferred embodiment of the invention is illustrated and
described, it is recognized that variations and changes may be made
therein without departing from the invention.
* * * * *