U.S. patent number 3,825,010 [Application Number 05/353,229] was granted by the patent office on 1974-07-23 for surgical apparatus for closing wounds.
Invention is credited to Bernard McDonald.
United States Patent |
3,825,010 |
McDonald |
July 23, 1974 |
SURGICAL APPARATUS FOR CLOSING WOUNDS
Abstract
There is described apparatus for repairing lacerations or
closing surgical incisions by means of a pair of carrier strips on
which are mounted a plurality of curved stylets that can be
inserted into the tissue on either side of the wound. A combined
applicator, fastener, and bandage is used to grip a strip during
insertion of the stylets into the tissue and then used as a strap
connecting the two strips together to draw the carrier strips
together on either side of the wound, so as to close the wound and
at the same time act as a dressing for covering the wound.
Inventors: |
McDonald; Bernard (Malibu,
CA) |
Family
ID: |
23388254 |
Appl.
No.: |
05/353,229 |
Filed: |
April 23, 1973 |
Current U.S.
Class: |
606/216; 604/173;
604/174; 604/212; 604/272 |
Current CPC
Class: |
A61B
17/08 (20130101) |
Current International
Class: |
A61B
17/03 (20060101); A61B 17/08 (20060101); A61b
017/08 (); A61m 005/32 () |
Field of
Search: |
;128/218,335,337,215,216,221,214A ;24/87,16 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Medbery; Aldrich F.
Attorney, Agent or Firm: Christie, Parker & Hale
Claims
What is claimed is:
1. Apparatus for closing a wound comprising a plurality of curved
stylets, a carrier strip of semi-rigid material, one end of each
stylet being received in and rigidly anchored in the carrier strip,
the anchored ends of the stylets being spaced along and in a single
row lengthwise of the carrier strip, the stylets being parallel to
each other, the carrier strip having a substantially flat surface
on one side, the stylets projecting out of said surface adjacent
one edge of the strip with the stylet projecting in the direction
of the opposite edge of the strip.
2. Apparatus of claim 1 further including releasable attaching
means on the carrier strip on the side opposite said flat surface
by which a band may be attached to the carrier strip.
3. Apparatus of claim 1 wherein the carrier includes a plurality of
integral fingers projecting along one edge and forming an extension
of said surface, the fingers extending in the direction of the
curved stylets.
4. Apparatus of claim 2 in which the carrier is scored in a
direction parallel to and between the planes of the stylets and
between the fingers to permit the carrier to be readily broken off
between adjacent stylets to selectable lengths.
5. Apparatus of claim 1 further including means forming a
compressable chamber on the opposite side of the carrier strip from
said flat surface, the carrier strip forming one wall of the
chamber, at least one stylet having a passage extending the length
of the stylet and communicating with the interior of said
chamber.
6. Apparatus for closing a wound comprising a pair of
tissue-gripping units, each unit including an elongated carrier
strip and a plurality of parallel curved cantilever-supported hooks
having one end anchored in the strip and the other terminating in a
very sharp tapered point, and means for adjustably mounting said
carrier strips means detachably connected to and extending between
the carrier strips for holding the strips in spaced relationship to
each other with the points of the hooks associated with one carrier
strip extending toward the point of the hooks associated with the
other carrier strip said mounting means comprising a strap of
flexible material, and means detachably securing the strap to each
of the strips at selected positions along the length of the straps
to hold the strips in variably spaced parallel relationship to each
other.
7. Apparatus of claim 6 wherein the strap includes two sections at
either end that are relatively rigid joined by a flexible
intermediate section, the strap being foldable in the flexible
section to bring the two end sections together to form a
tweezer-shaped applicator for gripping each of the strips during
insertion of the hooks into the tissue adjacent the wound.
8. Apparatus of claim 7 wherein at least one end section of the
strap is formed with a plurality of equally spaced projecting
fingers, the fingers being spaced to fit into the spaces between
the parallel hooks.
9. Apparatus of claim 7 wherein the end sections of the strap are
separable from the intermediate section.
Description
FIELD OF THE INVENTION
This invention relates to surgical appliances, and more
particularly, is concerned with apparatus for closing a wound and
holding it closed while providing a dressing during healing.
BACKGROUND OF THE PRESENT INVENTION
It is conventional practice to close wounds from a laceration or
surgical incision by using sutures or clamps. Sutures present a
number of problems. They are slow and tedious to apply. They cannot
be adjusted during the healing operation to maintain the desired
tension, particularly if there is any swelling during the healing
operation. Sterilization is a problem particularly on removing the
sutures, since the sutures must be pulled through the tissue,
thereby exposing the tissue to a possible source of contamination.
While various types of clamps or skin clips have been proposed,
such clamps are difficult to apply. Clips usually require some
special tool for applying them, which presents the added problems
of availability, sterilization, and cost.
SUMMARY OF THE INVENTION
The present invention is directed to improved apparatus for closing
and dressing a wound. The invention has the advantage that it is
completely self-contained and can be packaged as a sterilized unit.
It can be adjusted during use to vary the pressure in the region of
the wound without the need for further surgery or anesthesia. The
invention also provides an efficient means of anesthetizing the
area surrounding the wound. The apparatus at the same time acts as
a dressing for covering the wound during the healing process.
In brief, the above advantages are achieved by an arrangement in
which a plurality of curved stylets are supported at one end by a
carrier strip. One such strip is held on either side of the wound
by inserting the associated stylets into the tissue, with the
stylets associated with the two strips curving towards each other.
An elongated strap, hinged at the middle by a flexible intermediate
section is used in tweezer fashion to grip each of the strips,
providing a handle for inserting the stylets into the tissue. The
strap is then secured to the two strips to hold the edges of the
wound together and at the same time to cover the surface of the
wound.
BRIEF DESCRIPTION OF THE DRAWINGS
For a more complete understanding of the invention, reference
should be made to the accompanying drawings, wherein:
FIG. 1 is a plan view of a carrier strip with its associated
stylets;
FIG. 2 is a sectional view taken substantially on the line 2--2 of
FIG. 1;
FIG. 2-A is an edge view of a carrier strip deformed into a slight
arc.
FIG. 3 is a sectional view of a wound showing how the apparatus is
applied;
FIG. 4 is a sectional view of a wound after closure;
FIG. 5 is an enlarged partial sectional view of the area indicated
at 5 in FIG. 4;
FIG. 6 is a plan view of the fastener applicator and fastener
strap;
FIG. 7 is an alternative embodiment of the strap of FIG. 6;
FIG. 8 is a sectional view taken substantially on the line 8--8 of
FIG. 7; and
FIG. 9 is a plan view of an alternative embodiment of the
invention;
FIG. 10 is a further embodiment of the invention.
DETAILED DESCRIPTION
Referring to FIGS. 1 and 2 in detail, the numeral 10 indicates
generally an elongated carrier strip which is preferably molded of
a semi-rigid plastic material. Supported by the strip 10 in
cantilever fashion are a plurality of curved stylets or needles 12
which are preferably fabricated from stainless steel or other
suitable metal having high tensile strength with a very thin
cross-section. One end 14 of each stylet terminates in a very sharp
point, while the other end 16 is formed to provide a flattened
base, which is embedded in the plastic of the carrier strip 10
during the molding operation. The stylets are thus securely
anchored in parallel relationship with the pointed ends 14
extending in the same direction.
The carrier 10 is formed with a plurality of projecting fingers 18
which extend in the same direction as the curved stylets 12. These
fingers provide a greater effective width for the strip while still
retaining some longitudinal flexibility so that the strip may be
contoured to the skin on application. In addition, the carrier may
be scored or molded with a slight indentation, as indicated at 20,
in the top surface of the carrier strip at various spaced points
intermediate the fingers 18 to permit sections of the carrier to be
snapped, providing shorter lengths as required.
Referring to FIGS. 3-6, the manner in which the carrier strip with
its associated stylets are used in closing a wound is shown.
Numeral 22 indicates an open laceration or surgical incision
extending through the epidermis 24, subcutaneous tissue 26 into the
muscle tissue 28. One of the carrier strips 10 is positioned on
either side of the margins of the wound 22, and the curved stylets
12 are caused to puncture the skin and enter into the subcutaneous
tissue. The stylets of the two carrier strips are inserted so that
the stylets curve towards each other on either side of the wound.
When the stylets are fully inserted, the carrier strips lie flush
against the surface of the skin with the fingers 18 projecting
towards each other on either side of the wound. Because the carrier
strip is semi-rigid it can be bent in a curve along its narrow
dimension. As a result the tips of the stylets are displaced from
the normal straight line so as to lie along a curve line. Thus the
tips of the stylets, when initially engaging the surface of the
skin during insertion, enter the skin along a curved line which
follows the curve in the margin of the open wound. As the curved
stylets enter deeper into the tissue, the line of entry of the tips
is forced to become straight when the stylets are fully embedded,
causing the margins of the wound to be forced together. See FIG.
2-A which shows the carrier strip deformed into a slight curve.
Because the carrier strips are quite small, being of the order of a
centimeter in width, including the fingers 18, and being of 21/2 to
5 centimeters in length, typically, an applicator is used to hold
the carrier strip during insertion of the stylets into the tissue.
The applicator, indicated generally at 30, can then be used as a
linking strap and bandage for holding the two inserted carrier
strips in closely spaced relationship to keep the wound closed
during healing. As indicated in FIG. 4, at the same time the strap
provides a dressing which covers the wound, protecting it from dirt
and contamination. The combined applicator and bandage strip is
preferably formed of transparent plastic material in three
contiguous sections, two relatively stiff end sections 32 and 34,
and an intermediate flexible section 36. The end section 32 is
formed with a plurality of indentations 38, as seen in FIG. 6,
which have the same spacing as the stylets 12. The end sections 32
and 34 are made more rigid by integrally formed stiffening ridges
40. The ridges 40 extend between the indentations 38.
When used as an applicator, the ends of the strap 30 are brought
together by folding at the relatively thin intermediate section
36'. As shown in FIG. 3, the folded strap is gripped between the
thumb and fingers of the user and used to clamp the carrier 10 on
opposite sides. The indentations 38 receive the stylets so that the
full width of the strip 10 can be gripped. The inner end surfaces
of the strap 30 may be roughened, as indicated at 42 and 44,
respectively, to provide improved gripping action with the carrier
strip 10.
After the stylets of both carrier strips are fully inserted into
the tissue, the applicator strap is flattened out and secured to
the carrier strips so as to protect the wound while at the same
time holding the edges of the wound together. To hold the strap 30
to the carrier strips 10, the strap may be provided with a
plurality of rows of holes, one row of holes being in the end
section 34, as indicated at 46, and three or more rows of holes
being provided in the end section 32, as indicated at 48, 50 and
52. Each of the carrier strips is provided with a row of projecting
lugs 54 on the top surface of the carrier adjacent the end of the
fingers 18. The row of lugs is adapted to be inserted into a row of
holes in the strap 30, as shown in detail in the enlarged sectional
view of FIG. 5. The lugs 54 are preferably formed with an undercut
margin 56 which helps grip the margin of the associated hole in the
strap sections 32 and 34 when the strap is under tension.
The three separate rows 48, 50 and 52 provide a means for adjusting
the spacing between the two carrier strips when closing the wound.
The arrangement of indentations 38 along one edge of the strap 30
and the reinforcing ridges 40, together with the holes between the
reinforcing ridges, permits the strap to be readily torn edgewise
at any selected one of the indentations 38 to narrow the strap to
the desired width depending upon the size of the wound and the
length of the carrier strips being used. Other means of securing
the strap to the carrier strips may be used, such as Velcro
material, hook and eye, snaps, or the like, which permit adjustment
of the strap length between the carrier strips on either side of
the wound.
FIG. 7 shows an alternative strap arrangement in which a flexible
intermediate section 36', extending between the two relatively
stiff end sections 32' and 34', is made considerably longer than in
the strap of FIG. 6. The rows of holes 46', 48', 50', and 52' are
formed in the flexible intermediate section 36'. After use as an
applicator, the two end sections 32' and 34' may be torn away from
the intermediate section 36', and the intermediate section used
alone as the strap for combining the two carrier strips together
and forming a dressing over the wound.
A further embodiment of the invention is shown in FIGS. 8 aand 9 in
which the curved stylets 60 are made of a very thin, hollow tubing
in the manner of a hypodermic needle. The hollow stylets are
mounted in a carrier strip 62 with the supporting end of the
stylets extending through to the opposite side of the carrier strip
62. The carrier 62 is provided with lugs 64 and adjacent the lugs
are attached small flexible plastic ampoules 65 which can be filled
with anesthetic fluid, the fluid cavity of the ampoule being in
communication with the hollow interim of the stylets. The carrier
can be inserted by an applicator which grips the carrier strip on
the top of the lug 64 so as not to compress the ampoule 65. As the
stylets are gradually embedded in the tissue, the ampoule 65 can be
squeezed, forcing the anesthetic or other fluid out through the
hollow hypodermic tubing of the stylet 60 into the tissue at a rate
to numb the tissue ahead of the stylet tips. As shown in FIG. 8,
the several separate ampoules 65 are provided so that the carrier
strip may be separated between the ampoules without breaking open
the ampoules.
Referring to FIG. 10, there is disclosed a further embodiment of
the invention which comprises a carrier strip 66 in which is
anchored a plurality of stylets 68. The stylets are angular in
shape rather than a continuous curve, which may provide a better
anchor particularly where the surrounding tissue is very soft. The
carrier strip 66 forms one wall of a chamber 70 formed by flexible
corrugated side walls 72 and a top wall 74. The chamber is filled
with anesthetizing fluid which is in communication with a hollow
tube formed by each of the stylets 68. Prior to use, the ends of
the stylets 68 are sealed off by a sealing strip 76 into which the
tips of the stylets are embedded. The sealing strip 76 is removed
when ready for use.
As in the arrangement of FIG. 8, a plurality of separate chambers
70 may be provided along the length of the carrier strip 66
permitting the carrier strip to be separated into shorter lengths
by the user as required. The corrugated walls are formed of a
flexible plastic and constructed to offer enough resistance to
external pressure that the surgeon seizing the strip with the
applicator grip will not, while using the ordinary care and skill
of his craft, inadvertently express the anesthetic fluid
prematurely. However, after inserting the points of the stylets
into the superficial skin, the surgeon exerts an increased force on
the gripper sufficient to initiate a collapse of the chamber to
commence expulsion of the anesthetic fluid into the skin. By
increasing the squeezing pressure as the stylet points advance into
the tissue, the tissue can be anesthetized ahead of the advancing
tips of the stylets, in a manner conventionally used with
hypodermics.
Instead of using an anesthetic fluid, the ampoules or chambers
could be filled with a normal physiologic saline solution. Prior to
use, the strip is refrigerated to reduce the temperature to
approximately 4.degree. to 10.degree. C. This chilled fluid when
injected in the neighborhood of the regional nerve fibers reduces
their temperature and mechanically compresses the fibers, both
factors leading to a reduction or temporary absence of conductivity
so that the zone is temporarily anesthesized. To obtain the desired
effect, a volume of approximately 0.5 milliliters per cubic
centimeter of soft tissue injected produces the desired anesthetic
effect. For example, to close and anesthetize a wound which is 2.5
centimeters in length and 1 centimeter deep requires approximately
3 milliliters of saline administered peripherally a distance of
approximately 1/2 centimeter from the margins of a wound. Stylets
are inserted to a depth approximately equal to the depth of the
wound and the fluid is ejected continuously while the stylets are
being inserted to their maximum penetration. The compression and
reduction of temperature of the nerve fibers produces the
anesthetic effect, which lasts for several minutes.
From the above description, it will be recognized that a non-suture
wound-closure device is provided which is safe and easy to use. No
accessory equipment, such as sterile needle holders, surgical
scissors, bandages, or surgical dressing is required. It may be
packaged in sterilized ready-to use form. The strap material may be
transparent so that progress of wound healing may be observed
without removal of the strap. It may be used for anesthetizing an
area before an incision is made, such as during the removal of a
lesion, and then, without removal from the skin tissue, be used to
close up the wound. Because of the curved shape of the stylet, the
carrier strips remain firmly in place even though the area is not
completely immobilized. The strap can be readily adjusted without
removal of the stylet to relieve pressure during the healing
process or to permit drainage of the wound. The arrangement of the
present invention provides improved blood circulation in the area
of the wound as compared to the usual suturing technique.
While the invention is described as useful in the closing of skin
and other superficial wounds, it will be apparent that it has many
other applications, such as the rapid closure of ruptured organs
within the body where rapid life-saving measures are essential.
* * * * *