U.S. patent number 3,698,395 [Application Number 05/123,559] was granted by the patent office on 1972-10-17 for surgical closure.
Invention is credited to Harrith M. Hasson.
United States Patent |
3,698,395 |
Hasson |
October 17, 1972 |
SURGICAL CLOSURE
Abstract
A sutureless closure device for use in surgery which is both an
operative drape and a post-operative skin dressing. A flexible
sheet having a pressure sensitive adhesive undersurface is adapted
for placement on the skin over the area to be cut. The sheet is
differentiated into two opposing dressing portions which remain on
the skin as a post-operative dressing and which define a narrow
median strip that acts as a surgical drape and can be removed at
the end of the operation. One of the dressing portions of the sheet
carries, on its upper surface, means for engagement with the
opposite dressing portion whereby the engagement means can be
connected to bridge the incision thereby forming a connected
closure.
Inventors: |
Hasson; Harrith M. (Chicago,
IL) |
Family
ID: |
22409378 |
Appl.
No.: |
05/123,559 |
Filed: |
March 12, 1971 |
Current U.S.
Class: |
606/218;
602/58 |
Current CPC
Class: |
A61B
46/00 (20160201); A61B 17/085 (20130101) |
Current International
Class: |
A61B
19/00 (20060101); A61B 19/08 (20060101); A61B
17/03 (20060101); A61B 17/08 (20060101); A61b
017/04 () |
Field of
Search: |
;128/155,156,168-171,334R,335,335.5 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
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994,197 |
|
Aug 1951 |
|
FR |
|
349,371 |
|
Nov 1960 |
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CH |
|
Other References
Annals of Surgery, September 1960, pp. 54-55A.
|
Primary Examiner: Truluck; Dalton L.
Claims
What is claimed is:
1. A closure device for surgical use, which comprises: a flexible
sheet having a pressure sensitive adhesive undersurface; an
intermediate portion defined by two opposing side portions and
being adapted for placement on the skin directly over the area to
be cut; one of said side portions carrying, on its upper surface,
means for engagement with the other side portion, whereby an
incision through said intermediate portion can be made and
thereafter closed with said engagement means bridging said incision
to form a connected closure; and means for enabling simple removal
of said intermediate portion from said side portions.
2. A device as described in claim 1, wherein said intermediate
portion is formed of a plastic surgical drape material.
3. A device as described in claim 1, wherein said side portions are
formed of a surgical dressing material.
4. A device as described in claim 2, wherein said side portions are
formed of a surgical dressing material.
5. A device as described in claim 1, wherein said engagement means
comprise a first engagement member connected to one of said side
portions and a second engagement member connected to the other side
portion, and an external fastening member for bridging the incision
to connect said first and second engagement portions.
6. A device as described in claim 5, wherein said first and second
engagement members comprise Velcro strips and said external
fastening member comprises a member carrying Velcro material on its
opposing ends.
7. A device as described in claim 5, wherein said first and second
engagement members comprise hooks and said external fastening
member comprises thread means for connecting the hooks on opposing
side portions.
8. A device as described in claim 1, wherein said engagement means
comprise Velcro material connected to said side portions.
9. A device as described in claim 1, wherein said engagement means
comprise pressure sensitive tape means fastened to said one side
portion, said tape means being of a length to span the intermediate
portion and connect to said other side portion; and removable strip
means covering the adhesive area of said tabs.
10. A device as described in claim 1, wherein said engagement means
include laterally spaced means for permitting lateral adjustability
of the closure engagement.
11. A device as described in claim 2, wherein said intermediate
portion is light transmissive and has a printed guide line
thereon.
12. A device as described in claim 1, in which said engagement
means comprise a plurality of beaded tie fasteners connected to
said one portion and means connected to said other side portion
defining apertures for receiving said beaded tie fasteners.
13. A device as described in claim 12, wherein said apertures open
to the outside of said means defining them.
14. A device as described in claim 1, in which said engagement
means comprise a plurality of ties connected to said one side
portion, each of said ties having a stepped upper surface to form a
ratchet, and a plurality of pawls connected to said other side
portion for engagement with said ties, said connected pawls and
ties cooperating to prevent opening movement of said ties with
respect to said pawls.
15. A device as described in claim 14, including thumb-operable
means for releasing said pawls from the steps of said ties, said
ties and pawls being formed of a plastic material.
16. A drape and closure device for surgical use, which comprises: a
flexible sheet having a pressure sensitive adhesive undersurface;
an intermediate portion defined by two opposing side portions and
being adapted for placement on the skin directly over the area to
be cut, said intermediate portion being formed of a plastic
surgical drape material and said side portions being formed of a
surgical dressing material; means for enabling simple removal of
said intermediate portion from said side portions; one of said side
portions carrying, on its upper surface, means for engagement with
the other side portion, said engagement means comprising
alternating Velcro-carrying tabs and adhesive strips, whereby an
incision through said intermediate portion can be made, said
intermediate portion can be removed and said incision can
thereafter be closed with said engagement means bridging said
incision to form a connected closure.
17. A drape and closure device as described in claim 16, in which
said engagement means further comprise adhesive strips located on
the underside of said Velcro-carrying tabs whereby said incision
can be closed by connecting said Velcro tabs and said alternating
adhesive strips, thereafter disconnecting said Velcro tabs and
connecting said adhesive strips underlying said Velcro tabs, and
thereafter reconnecting said Velcro tabs.
18. A device as described in claim 16, in which all of said
adhesive strips and said flexible sheet have a removable protective
liner.
Description
BACKGROUND OF THE INVENTION
This invention relates to a novel surgical closure device which
overcomes many of the obstacles and deficiencies of prior art
sutures and adds the benefit of simultaneously being a surgical
drape as well as a post-surgical dressing.
One very widely used prior art surgical technique is the suture or
clips technique which comprises stitching or applying clips to the
incision in order to close it, and requires subsequent removal of
the stitches or clips. However, the suture or clip technique has
several disadvantages. Often the needle or the clips will go
through a blood vessel causing bleeding. Further, closing the
incision by means of sutures or clips has been found to be very
time consuming. Additionally, the removal of sutures or clips after
several days causes added discomfort, inconvenience and such
sutures or clips normally leave scars.
Another method used to close small wounds is the application of
separate narrow adhesive strips such as STERI-STRIPS, manufactured
by 3 M Company, to opposing skin edges. Such narrow adhesive strips
can only be used on very small wounds because the closure tends to
loosen and come apart with stress. My invention presents an
improvement over the narrow strip method since it provides a
substantially continuous closure for surgical wounds of any length.
Another advantage of my invention is that it employs materials and
methods capable of withstanding high tensions, such as Velcro. This
closure will resist disruption in places such as the abdominal wall
where coughing or sneezing or other expulsive efforts may disrupt
the closure. Additionally, since the engagement adhesive of my
invention or other means of engagement is mounted on a large
adhesive sheet which is in turn in contact with the skin but which
is applied to a prepared area of the skin at the optimum time
(before the incision) thereby providing maximum bondage, the means
of engagement remains free from wetness or oil or grease which
cause the means of engagement in the strip method, for instance, to
loosen and come apart.
It is therefore an object of the present invention to provide a
surgical closure device which obviates the need for applying clips
or sewing incisions closed, thus minimizing scar formation.
It is another object of the present invention to provide a surgical
closure which enables the surgeon to close an incision in a rapid,
effective manner without having to puncture the skin, thereby
removing the possibility of bleeding caused by the closure.
A further object of the present invention is to provide a surgical
drape and dressing closure which is placed on the patient prior to
the incision, which aids the surgeon in providing a straight
incision when desired, and which obviates the need for sutures.
An additional object of the invention is to provide a surgical
closure which does not require the use of sutures and which allows
the surgeon to selectively provide the proper amount of closure
tension on the incision.
A still further object of the invention is to provide a sutureless
surgical closure which includes a sterile surgical drape which
improves aseptic techniques and eliminates the need for less
efficient draping while simultaneously providing a surgical
dressing.
My novel closure therefore combines the advantages of a sterile
surgical draping sutureless closure and a surgical dressing in one
device.
Other objects and advantages will become apparent from the
following description, claims and the illustrations in the
drawing.
BRIEF DESCRIPTION OF THE INVENTION
In accordance with the present invention, there is provided a
closure device for surgical use which comprises a flexible sheet
having a pressure sensitive adhesive undersurface. An intermediate
portion is defined by two opposing side portions of the sheet, and
is adapted for placement on the skin directly over the area to be
cut. One of the side portions of the sheet carries, on its upper
surface, means for engagement with the other side portion, whereby
an incision through the intermediate portion can be made and
thereafter closed with the engagement means bridging the incision
to form a connected closure.
In an illustrative embodiment of the invention, the intermediate
portion is formed of a surgical drape material fastened to opposing
side portions which are formed of surgical dressing material. The
flexible sheet is fastened to the undersurface of a top sheet of
surgical drape material which is applied to the skin with the
flexible sheet. After the incision is made and near the end of the
operation, the top surgical drape is removed, the intermediate
drape portion is torn from the opposing side portions, and the
engagement means are then operated to bridge the incision to form a
connected closure.
In another embodiment of the invention, the closure device includes
a series of hook means carried on the upper surface of each of the
side portions. The hook means are adapted to hold a thread which is
connected to the hook means and tied after an incision is made and
the operation is completed.
A more detailed explanation of the invention is provided in the
following description and claims, and is illustrated in the
accompanying drawing.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a view of one form of a closure device in accordance with
the principles of the present invention;
FIG. 2 is a view of a second form of a closure device in accordance
with the principles of the present invention;
FIG. 3 is a view of a connector for use with the closure device of
FIG. 2;
FIG. 4 is a perspective view of another form of closure device in
accordance with the principles of the present invention;
FIG. 5 is a cross-sectional view thereof, taken along the line 5 --
5 of FIG. 4;
FIG. 6 is a fragmentary elevational view, taken from the left side
of FIG. 4;
FIG. 7 is a top plan view of another form of a closure device in
accordance with the principles of the present invention;
FIG. 8 is a cross-sectional view thereof, taken along the line 8 --
8 of FIG. 7;
FIG. 9 is a top plan view of another form of closure device in
accordance with the principles of the present invention;
FIG. 10 is a top plan view of a further form of a closure device in
accordance with the principles of the present invention;
FIG. 11 is a perspective view of the closure device of FIG. 9,
showing the closure device in position on the skin during an
incision; and
FIG. 12 is a perspective view of the closure device of FIG. 9 after
surgery is completed and the incision is closed by means of the
device.
DETAILED DESCRIPTION OF THE ILLUSTRATIVE EMBODIMENT
The device of FIGS. 1 and 2 comprises a large basic flexible top
sheet 10 preferably formed of surgical drape material such as the
material having the trade mark STERI-DRAPE manufactured by 3M
Company. Sheet 10 has a pressure sensitive adhesive undersurface so
that it can adhere to the skin and for attachment to a flexible
sheet 12 which sheet 12 is more clearly illustrated in FIG. 2.
Flexible sheet 12 and the portions of top sheet 10 which do not
overlie sheet 12 have a pressure sensitive adhesive undersurface
and are adapted for placement on the skin over the area to be cut.
Sheet 12 is differentiated into a first dressing portion 14 and a
second dressing portion 16, which dressing portions define a median
strip 18 formed of a surgical drape material which can be removed
at the end of the operation. The dressing portions comprise a
porous dressing material as is well known in the art. Drape
material 18 is connected to opposing dressing portions 14 and 16 by
perforations so that material 18 can be easily torn and removed (as
indicated in FIG. 2) at the end of the operation.
Dressing portions 14 and 16 carry on their upper surfaces,
respectively, strips 20, 22 of Velcro material. As shown in FIG. 3,
a connection strip 24, having Velcro tabs 25, 26 at its opposing
ends, is used to bridge the area between Velcro strips 20 and 22 in
order to form a connected closure after the incision is made and
the operation is completed.
In the embodiment of FIGS. 4, 5 and 6, a flexible sheet 30, similar
to flexible sheet 12, comprises two opposing side portions 32 and
34 formed of a dressing material and which define an intermediate
tear strip 36 formed of a drape material. The engagement means
comprise a first strip 38, formed of plastic or the like, and
fastened to side portion 32. Strip 38 carries a number of beaded
tie fasteners 40, each of which is preferably formed of plastic and
includes flexible elongated portions 42 defined by beads 44. A
second strip 46 is fastened to side portion 34 and includes a
fastened base 48 having an upright portion 50 which defines equally
spaced grooves 52. Grooves 52 align with respective beaded ties 40
and open upwardly as shown most clearly in FIG. 6. The width of
grooves 52 is less than the diameter of beads 40 but is greater
than the diameter of elongated members 42 so that members 42 can be
inserted into grooves 50 with the beaded tie portion under tension
and release will be prevented by abutment of bead 44 with the walls
of portion 50 defining groove 52.
In the embodiment of FIGS. 7 and 8, flexible sheet 60 comprises
opposing side portions 62 and 64 formed of dressing material, which
opposing side portions define a tear strip 66 formed of drape
material. The attachment means comprise a plastic base 68 to which
is connected a number of ties 70, each of which has a stepped upper
surface 72, as shown most clearly in FIG. 8. Side portion 62 has
affixed thereto a base or pawl strip 73 which carries pawls 74 for
engagement with surface 72 of tie 70. Strip 72, pawls 74 and
integral hinge portions 76 are preferably formed of a plastic
material in an integral, one-piece construction. Pawl 74 has a
distal end 78 which engages the ratchet formed by top surface 72 of
tie 70.
To operate the attachment means of FIGS. 7 - 8, ties 70 are
inserted into recesses 80 defined by pawls 74 and the tie is moved
in the leftward direction (with respect to FIGS. 7 and 8) to apply
tension to the opposing side portions 62 and 64. Tie 70 is
prevented from moving in the rightward direction (with respect to
FIGS. 7 and 8) because of the engagement of distal end 78 with one
of the notches as shown in FIG. 8. If for some reason release of
tension on the tie is desired, pawl 74 can be forced in the
clockwise direction by thumb pressure on portion 82 of the pawl, to
release distal end 78 from engagement with the notch.
In the embodiment of FIG. 9, flexible sheet 90 comprises opposing
side portions 92 and 94 formed of dressing material, which side
portions define intermediate tear strip portion 96 formed of drape
material. The engagement means of the FIG. 9 embodiment comprise
Velcro material and adhesive strip material which connect to form
an effective closure. Referring to FIG. 9, side portion 92 carries
a number of Velcro strips 98 which are in spaced alignment for
cooperation with Velcro tabs 100 carried by strips 102. Each of
strips 102 has positioned thereunder a centrally located adhesive
strip 104 for engagement with portion 105 intermediate a pair of
Velcro material strips 98. Also located intermediate strips 102 are
adhesive strips 106 which adapt to engage a portion of side portion
92 which is free of Velcro material. All of the adhesive strips are
covered with a removable liner so that they will remain sterile in
the manner well-known in the art. Intermediate portion 96 has a
guide line 108 printed thereon which serves as a guide for the
surgeon in providing a straight incision, if such a straight
incision is desired. Guides for curved incisions may be
provided.
In the use of the device of FIG. 9, referring to FIGS. 11 and 12,
it is seen that flexible strip 90 is applied to the skin with
intermediate portion 96 overlying the area to be cut. Prior to such
application, the area of the skin about which an incision is to be
made is cleaned thoroughly and is wiped completely dry. Excessively
oily skin should be cleaned with rubbing alcohol and then dried
thoroughly. In order to render the skin more adhesive, it may be
treated with tincture of benzoin or other such substances which are
well-known in the art, such as Ace Adherent manufactured by
Beckton-Dickinson, or Vi-Drape adhesive manufactured by
Parke-Davis. Flexible sheet 90 is then applied to the skin after
removing the protective liner covering the adhesive undersurface
and pressure is applied to affix it to the skin.
After the operation is completed, intermediate portion 96 is
removed by tearing it as indicated in FIG. 9 and strips 102
carrying Velcro tabs 100 are connected to Velcro material strips
98. Thereafter the protective liners are removed from adhesive
strips 106 which strips are connected to side portion 92.
Thereafter Velcro strips 102 are removed from Velcro strips 98, the
protective liners are removed from adhesive strips 104 and adhesive
strips 104 are connected to portions 105, as shown in FIG. 11.
Thereafter the Velcro strips 102 are reattached to apply the proper
tension to the closure, with the resulting closure having the
appearance as illustrated in FIG. 12.
After a predetermined number of days when the incision is healed to
a predetermined degree, the entire flexible sheet 90 is removed
from the skin. It is seen that there will be no scars from sutures
or clamps.
Flexible sheet 90 could be entirely covered with a surgical drape
material, as in the FIG. 1 embodiment. To this end, the entire
flexible sheet 90 would be attached to the undersurface of a piece
of surgical drape material having an adhesive undersurface and the
entire unit would be placed on the skin with intermediate portion
96 overlying the area to be cut. After the incision is made and the
operation is substantially completed, the top drape material
(reference numeral 10 in the FIG. 1 embodiment) is removed just
prior to removal of intermediate portion 96.
The attachment means could take the form of various types of hooks
which would bridge the intermediate portion in order to close the
incision. Another form of the invention is shown in FIG. 10 which
comprises a flexible sheet 110 similar to sheet 90 and having a
plurality of hooks 112 connected on opposing side portions 114 and
116, which side portions are formed of surgical dressing material
and define removable intermediate portion 118 formed of surgical
drape material. In using the device of FIG. 10, after sheet 110 is
applied to the skin in the same manner as applying sheet 90 with
respect to the FIG. 9 embodiment, the incision is made through the
intermediate portion 118. After the surgical procedure is
completed, the incision is closed by threading the device closed as
indicated by the thread 120 in FIG. 10, similar to the conventional
manner of lacing ice skates, and the thread 120 is tied closed at
122 with the desired amount of tension applied to provide the
desired closure tension on the incision. In the FIG. 10 embodiment,
hooks 112 are formed of a plastic material and are fastened to
sheet 90 by means of tape 124, with the lower part of the hooks
extending underneath the tape and piercing it. However, any
suitable means for fastening hooks 112 to a flexible sheet 110 may
be used.
It is seen that a surgical closure device has been provided which
obviates the need for sewing the incision closed as is very often
required using prior art techniques. It is apparent that by using
the device of the present invention, a very rapid closure procedure
is obtained and after the closure is performed and the device
remains on the skin for several days, the entire device can be
peeled off (in a similar manner as an ordinary bandage) without the
need to remove sutures and without causing the scras which are a
concomitant of prior art stitching techniques.
Although several illustrative embodiments of the invention have
been shown and described, it is to be understood that various
modifications and substitutions may be made by those skilled in the
art without departing from the spirit and scope of the present
invention. For example, the attachment means could comprise various
types of tapes, hooks and other fasteners such as zippers. Of
course, the attachment means must be suitable for sterilization,
but many types of devices which can bridge the intermediate portion
and permit a tension closure on the incision would be suitable and
would be within the scope of the present invention.
* * * * *