U.S. patent number 3,802,438 [Application Number 05/240,185] was granted by the patent office on 1974-04-09 for surgical instrument.
This patent grant is currently assigned to Technibiotics, Inc.. Invention is credited to Sidney Wolvek.
United States Patent |
3,802,438 |
Wolvek |
April 9, 1974 |
SURGICAL INSTRUMENT
Abstract
Method and apparatus for closing an incision in the body of a
patient including forming a suture by passing a loop of wire
through opposite sides of the incision and inserting the end
portions of the wire into and through bores formed in a splice
plate comprising a substantially rectangular member having a pair
of parallel bores formed longitudinally therethrough. The end
portions of the wire are then inserted into an instrument for
applying a controlled tension to said wire comprising a pair of
parallely spaced legs having mechanisms for fixedly holding each
respective wire end portion therein. A rack and pinion arrangement
is activated to increase the distance between the legs thereby
tensioning the wire at a controlled rate. When sufficient closure
of the incision is attained, the splice plate is crimped thereby
splicing the wires therein. The end portions of the wire extending
beyond the splice plate are cut flush with an edge surface of the
splice plate thereby forming a safe suture. An alternate embodiment
includes having the length of suture wire prethreaded on the splice
plate prior to the operation.
Inventors: |
Wolvek; Sidney (Brooklyn,
NY) |
Assignee: |
Technibiotics, Inc. (Brooklyn,
NY)
|
Family
ID: |
22905481 |
Appl.
No.: |
05/240,185 |
Filed: |
March 31, 1972 |
Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B
17/82 (20130101); A61B 17/823 (20130101); A61B
17/04 (20130101); A61B 2017/0496 (20130101); A61B
17/8869 (20130101) |
Current International
Class: |
A61B
17/68 (20060101); A61B 17/88 (20060101); A61B
17/82 (20060101); A61B 17/04 (20060101); A61l
017/00 () |
Field of
Search: |
;128/334,335,335.5,339,33R,20,345,121,124,334C,346,92R,92B,92D
;254/66 ;140/93.4,93.2 ;24/16,272,23W,123W ;339/276 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
204,258 |
|
Nov 1956 |
|
AU |
|
2,013,707 |
|
Apr 1970 |
|
FR |
|
494,960 |
|
Sep 1919 |
|
FR |
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Recla; Henry J.
Attorney, Agent or Firm: Darby & Darby
Claims
What is claimed is:
1. A surgical splice plate for locking two end portions of surgical
suture wire together comprising:
a member formed of a deformable material which is biologically
acceptable to the human body having at least one passage formed
therethrough receivable of said suture wire end portions, said
member having a long dimension greater than 3 millimeters but does
not exceed 9 millimeters,
said splice plate adapted to be implanted within the human body
during the closing of an incision subsequent to a surgical
operation.
2. A splice plate according to claim 1 wherein said biologically
acceptable material is stainless steel.
3. A splice plate according to claim 1 wherein two passages are
formed in the splice plate, each passage receivable of an end
portion of the suture wire.
4. A splice plate according to claim 3 wherein said passages are
generally parallel to each other.
5. A splice plate according to claim 1 wherein an elongate flexible
member is attached to said splice plate at one end having means for
identifying the splice plate attached to the other end.
6. A suture splicing assembly comprising:
a splice plate for locking two end portions of surgical suture wire
together including a member formed of a deformable material which
is biologically acceptable to the human body having a pair of
substantially parallel passages formed therethrough receivable of
said suture wire end portions, said member having a long dimension
which does not exceed 9 millimeters, and
a length of suture wire passing through one of said passages, said
wire having a surgical needle fastened thereto at one end and the
other end folded upon itself, thereby maintaining said wire within
said one of said bores.
7. An assembly as recited in claim 6 wherein said splice plate and
said suture wire are formed of the same material.
8. An assembly as recited in claim 7 wherein said material is
stainless steel.
9. A method for closing an incision in the body of a patient
comprising the steps of:
forming a suture by passing a loop of a wire through openings
formed in tissue of the patient on opposite sides of the
incision;
inserting at least one end portion of said wire through at least
one bore formed in a splice plate of deformable material;
tensioning the end portions of said wire in opposite directions in
a controlled manner;
crimping said splice plate to fix the ends of the wire therein;
and
cutting those portions of wire not within the formed loop flush
with said splice plate.
10. A method as recited in claim 9, wherein both end portions of
said wire are inserted through said at least one bore in opposite
directions.
Description
BACKGROUND OF THE INVENTION
This invention relates to a method and apparatus for use during
surgical operations, and more particularly to a method and
apparatus for closing incisions made in certain bones during
surgery in the chest and other regions.
In the course of surgery in and around the chest cavity area, and
more particularly during heart surgery, an incision is commonly
made in the sternum, or breast bone, in order to gain access to
that portion of the body which is being operated upon. Of course,
subsequent to the completion of the operation the incision must be
closed.
In one method used in the past to accomplish this closure, the
sternum is punctured to form an opening on one side of the incision
with a chisel-ended circular needle, a thin wire brought down and
through this opening and then brought up through a similarly formed
opening in the sternum on the other side of the incision. The
portions of the wire extending outwardly from the sternum are then
manually pulled together to achieve a tight closure of the
incision. In this method the wires are pulled together using a
hemostat or needle holder and when the incision is deemed by the
physician to have been closed sufficiently the wire ends are
spliced by twisting them together. The twisted end is cut leaving
five to seven twists at the closure.
Many difficulties have arisen in the use of the prior art method
described hereinabove. The uncontrolled physical pulling on the
wire by the physician, to obtain sufficient closure of the
incision, has often resulted in one or more of the wires snapping.
Too much tension applied to the wires may also cause the sternum to
be cut involving serious injury to the patient. Further, the
hemostat may slip from the wire with a consequent risk of damage to
both the equipment and the patient. In addition, at the inception
of the wire splicing operation, the twisting of the wire changes
the loading on the suture from a linear (tension) loading to a
shear loading. This reduces the holding power of the wire. Also,
the resulting six or seven twists which remain in the body may
either irritate the periosteum of the sternum or pierce the skin,
only a small layer of which is present over the sternum in this
area, in many cases. The twisted portions of the wire may also
provide an infection path should the loose end pass through the
skin.
SUMMARY OF THE INVENTION
Accordingly, an object of this invention is to provide a new and
improved apparatus for assisting in the closure of incisions made
in bones during surgery.
Another object is the provision of a new and improved incision
closing instrument which controls the amount of tension placed on
the wires during the closing of the incision.
Still another object is to provide a new and improved incision
closing instrument which will safely grasp the wire used for
closing the incision.
A further object is to provide a new and improved wound closing
instrument which maintains the suture in tension at all times.
A still further object of this invention is the provision of a
wound closing instrument which assures the absence of any surplus
wire which might irritate the anatomical region about the chest
cavity or pierce the surrounding skin and to provide a closure
which is more acceptable from a cosmetic point of view.
In accordance with a preferred embodiment of this invention, these
and other objects are achieved by providing an instrument removably
connectable to wire end portions which have been passed through
openings formed in the sides of the bone adjacent the incision and
drawing these ends in a controlled manner to apply tension to the
wire. Prior to fastening the wire end portions to the instrument,
the wire end portions are passed in opposite directions through a
splice plate which, although confining those portions of the wire
contained therein, permits movement of the wire ends through the
plate. After the wire has been tensioned to a sufficient amount to
close the incision, a tool having appropriately formed jaws crimps
the splice plate to hold and fasten the wires contained therein.
The wire end portions extending beyond the splice plate are then
cut off flush with the splice plate edges. In an alternative
embodiment the wire is passed through the splice plate prior to the
operation.
DESCRIPTION OF THE DRAWINGS
A more complete description of the invention and many of the
attendant advantages thereof will be readily appreciated as the
same becomes better understood by reference to the following
detailed description when considered in connection with the
accompanying drawings in which:
FIG. 1 is a plan view of an instrument according to the present
invention;
FIG. 2 is a side view of the instrument shown in FIG. 1;
FIG. 3 is an end view of the splice plate greatly exaggerated in
size according to the present invention;
FIG. 4 is a view of the splice plate of FIG. 3 in section taken
along line 4--4;
FIGS. 5a and 5b are a perspective view and a side view respectively
showing the relative position of the incision and wire suture
according to the present invention;
FIGS. 6a and 6b are a front elevational view and a plan view
respectively of a crimping tool according to the present invention;
and
FIG. 7 is a plan view of an alternate arrangement of the splice
plate and suture according to the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring now to the drawings wherein like reference characters
designate identical or corresponding parts throughout the several
views, and more particularly to FIGS. 1 and 2 thereof, a wound or
incision closing instrument 10 is shown as including a
substantially L-shaped member 12 coupled in a manner described
below to an angularly shaped member 14 so that the two can move
relative to each other. L-shaped member 12 is formed with a first
leg 16 integral with and at right angles to a second longer leg 18.
Leg 16 has a recessed surface 20 formed in its free end which
extends a limited distance and terminates in a knurled vertical
wall 22. A knurled wheel 24 is mounted off center about a pivot 26
so that the wheel 24 acts as a cam upon rotation by grasping and
turning a spoke 24a and defines a passage 25 in cooperation with
wheel 24 which is closable upon rotation of the wheel.
The second, longer leg 18 of member 12 has a straight gear or rack
28 fastened by conventional fasteners 29 within an insert 31 formed
therein which extends along a substantial portion of the leg. It
should be understood that the rack 28 may also be formed integrally
with member 12.
The angular shaped member 14 includes a body portion 30 and a leg
32 formed in a generally L-shaped relationship. The body portion 30
is formed with a channel 34 having a rectangular cross section
through which the rack 28 can pass. A pinion gear 36 (shown in
phantom in FIG. 1) is pivotally mounted to body portion 30
sufficiently close to channel 34 such that a portion thereof
extends therewithin and the teeth of pinion 36 mesh with the teeth
of the rack 28. A spoked wheel 44 is connected to gear 36 to
provide a means for turning the gear. The spokes are used to permit
rotation of gear 36 by one or two fingers of the hand. This makes
it easier to use the instrument during surgery. As should be
apparent, rotation of the pinion gear 36 by turning the spoke wheel
44 will move member 14 relative to member 12.
A rotatable detent wheel 46 is threadedly mounted in body portion
30 of member 14 adjacent channel 34. The detent wheel 46 includes a
lock washer (not shown) positioned directly beneath the wheel and
extending over a portion of leg 18 of L-shaped member 12. Rotation
of wheel 46 downwardly into body portion 30 will cause the lock
washer to bear against the upper surface of leg 18 thereby fixing
the position of L-shaped member 12 with respect to angular shaped
member 14.
Leg 32 of member 14 has a recessed surface 38 formed in the free
end portion thereof and, in a manner like recessed surface 20 in
leg 16, is terminated by a vertical knurled wall 40. A knurled
wheel 42 is mounted off center about a pivot 41, in a manner
similar to wheel 24, so that the wheel can act as a cam, upon
rotation by grasping and rotating attached spoke 42a. A second
closable passage 43 is defined between the wheel 42 and the wall
40.
Referring more particularly to FIG. 1 and FIG. 2, upon assembly of
the instrument 10, it is seen that the passages 25 and 43 are
substantially colinear. Further, the lower faces 48 and 50 of the
L-shaped member 12 and the angular shaped member 14 respectively do
not have any protrusions extending therefrom and are substantially
flat. This enables the physician to lay the instrument on the chest
cavity of the patient during an operation without danger of causing
injury by puncturing or lacerating the body tissue in contact with
the instrument. It is to be understood that the two passages may be
formed in a manner other than as specifically shown. For example,
threaded bores may be formed in the ends of legs 16 and 32 or the
closable passages may be formed on a surface laterally extending
from each leg.
FIGS. 3 and 4 show one embodiment of a splice plate 52 for use with
the present invention, greatly exaggerated in size. Splice plate 52
is a three dimensional body having a rectangular shape and is
formed of a suitable biologically acceptable material, such for
example, as stainless steel. A pair of bores 56 and 58 are
parallely formed adjacent to each other through the long dimension
of plate 52. Typical dimensions of splice plate 52 include about 5
millimeters in the long dimension, about 4 millimeters in width and
about 2.5 millimeters in thickness (FIG. 3). The diameter of bores
56 and 58 are such that the suture wires used to close the incision
or wound can slide through the bores and is typically about 0.94
millimeters. It is to be understood that although the splice plate
is shown as substantially rectangular, other shapes may be utilized
having dimensions of the same order as those described above.
The operation of the instrument can be ascertained by referring to
FIG. 5. The sternum 60 of a patient is shown having an incision 62
formed therein with the periosteum 61 overlying the sternum. As
shown in FIG. 5b, a stainless steel wire suture 64 is passed
through holes formed on either side of the incision in the sternum,
the holes having been previously opened by any suitable instrument.
The end portions 64a, 64b of the sture 64 are then directed through
bores 56 and 58 in splice plate 52 in opposite directions by the
doctor closing the incision.
The doctor next takes the instrument and places the end portions
64a, 64b of suture 64 within passage 25 and the other within
passage 43 in the respective legs 16 and 32 of the instrument 10.
The instrument can be laid flat on the patient's chest at this
time. The wheels 24 and 42 are then rotated by spokes 24a and 42a.
The camming action of the wheels 24 and 42 grab the respective wire
end portions 64a, 64b between walls 22 and 40 and the respective
knurled wheels 24 and 42. The use of the camming action and the
spokes on wheels 24 and 42 in combination with the open passages 25
and 43 is advantageous since it is relatively easy to lay the end
of the suture in the passages between the wheel and its
corresponding knurled wall rather than to thread the suture through
a hole, an operation which would become even more difficult when
working with a bloody suture wire. Further, the cam arrangement
universalizes the instrument for all diameters of suture wire. Also
the use of the spokes on the wheels 24, 42 permits easy turning of
the latter to provide an arrangement for quickly fastening the ends
of the suture to the instrument.
With the detent wheel 46 in a loose position, spoked wheel 44 is
rotated by the doctor in the appropriate direction to cause angular
shaped member 14 to move away from leg 16. This action causes the
loop of wire 64 to tighten. This tightening action is continued
thereby drawing together the sides of the sternum adjacent the
incision. During or just prior to the inception of the incision
closing procedure, the splice plate 52 may be grasped between the
jaws 68 of a crimping tool 66 and held therebetween as the sides of
the sternum are drawn together. The crimping tool 66 may be a
conventional compound pliars tool having identical opposed jaws 68.
Each jaw 68 may be formed having a substantially horizontally
disposed inwardly projecting surface 69 integrally formed with a
bevelled, substantially vertical projection 70 recessed from the
inner edge thereof. The surfaces 69 form a platform for the splice
plate 52 as it is grasped during the wound closing procedure. The
maximum separation of the jaws 68 is preferably fixed so that the
space 71 between the projecting surfaces is smaller than the width
dimension of the splice plate thereby assuring that the splice
plate will not pass therebetween into the non-functional portion of
the jaws but rather will be positioned between the bevelled
projections 70. As the sternum is drawn together, the handles 72 of
crimping tool 66 are squeezed gently so that the projections 70,
although bearing against the sides of the splice plate, will not
deform it. After the sternum is closed, the handles 72 are squeezed
together tightly thereby causing the bevelled projections to move
into and deform the splice plate. The inwardly projecting surfaces
71 serve as a movement limiting device by mutually abutting upon
sufficient inward movement. Thus, the amount of deformation is
limited by the distance that surfaces 69 extend inwardly. The
maximum "pinching" 74 (FIG. 5a) on each side of the splice plate is
preferably about 0.5 millimeters. Finally, the excess of the wire
suture ends 64a, 64b extending through splice plate 52 is sheared
off flush with the edge surface of the plate. Thus, no rough edges
are left which might injure the patient. This process is repeated
between four to six times along the incision until the wound is
completely closed.
A particularly efficient arrangement of the instrument and
associated apparatus includes the splice plate 52 having the length
of suture wire 64 previously passed through one of the bores as
shown in FIG. 7. A surgical needle 80 is provided on one end of the
wire and the other end of the wire is folded back on itself for
about one-eighth inch, thereby maintaining the splice plate along
the length of wire. The surgery proceeds much the same as described
above. However, several advantages are attained using the alternate
configuration of pre-wired splice plate. Openings on either side of
the incision need not be previously formed since the surgical
needle may be used to do so as the suture is formed. Since the
plate has become an intergral part of the easily manipulated suture
wire, the difficulty in handling the small splice plate is greatly
reduced. One of the in-surgery splice plate "hole-finding"
operations is eliminated for the surgeon since the splice plate is
strung onto the suture wire prior to the operation. Further, there
is no longer any need to spend time identifying the plate hole size
(and therefore wire size) since the plate is now predisposed on the
matching suture wire size.
An alternative arrangement of the apparatus includes providing
individual splice plates apart from the suture wires and performing
the threading procedure during the operation. To provide a measure
of caution against inadvertently dropping splice plate 52 into the
chest cavity, a thin thread or wire 76 (FIG. 4), for example of
silk or other inert material, is attached to the splice plate at a
bore 60, formed at one end of plate 52 transverse to bores 56,58.
Thus, if the splice plate were dropped during the operation,
location of the plate and its retrieval are quick and easy. The
attached thread may also be used to preliminarily "tag" the splice
plate indicating the size wire which may be used in the suture.
In cases where splice plate 52 was made extremely small, the
crimping operation was found to be difficult due to the fact that
the splice plate tended to fall into a notch 78 (FIG. 5A) left in
the periosteum after the incision. For this reason, a minimum
length of about 4 millimeters was found to be optimum for the long
dimension of the splice plate. Of course, it is preferable for the
splice plate to be as small as possible and a long dimension of not
more than about 8 millimeters is desirable.
Thus, the surgical instrument described above provides for a
controlled tensioning of the suture by a precise rotation by the
physician of spoked wheel 44. The flat faces 48 and 50 permit
resting the instrument on the body of the patient during the
operation. The use of only one hand of the doctor is necessary to
operate any of the cams or gears contained in the instrument
thereby allowing the physician free use of the other hand. Further,
the danger of exposed rough twisted wire splices irritating or
infecting the surrounding body tissue is obviated by the use of the
splice plate 52 with a subsequent removal of exposed wire end
portions flush therewith.
* * * * *