U.S. patent number 3,831,608 [Application Number 05/309,466] was granted by the patent office on 1974-08-27 for suture bridges.
This patent grant is currently assigned to Bio-Medicus, Inc.. Invention is credited to Harold D. Kletschka, Edson H. Rafferty.
United States Patent |
3,831,608 |
Kletschka , et al. |
August 27, 1974 |
SUTURE BRIDGES
Abstract
The disclosure is directed to a surgical bridge for supporting
incision sutures under continuous tension. One form of the surgical
bridge comprises an elongated member constructed to bridge the
incision, and which is resiliently flexible under the influence of
suture tension to compensate for swelling of the incision as it
heals. In another form, the bridge includes slotted end guides
which are respectively disposed under elevated suture support
points, which structure precludes cutting or slicing of the
patient's skin by the suture itself upon pressured lateral movement
of the bridge over the skin surface.
Inventors: |
Kletschka; Harold D.
(Minneapolis, MN), Rafferty; Edson H. (Excelsior, MN) |
Assignee: |
Bio-Medicus, Inc. (Minnetonka,
MN)
|
Family
ID: |
23198358 |
Appl.
No.: |
05/309,466 |
Filed: |
November 24, 1972 |
Current U.S.
Class: |
606/233 |
Current CPC
Class: |
A61B
17/0466 (20130101); A61B 2017/0496 (20130101) |
Current International
Class: |
A61B
17/04 (20060101); A61b 017/04 () |
Field of
Search: |
;128/334R,335 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Merchant, Gould, Smith &
Edell
Claims
We claim:
1. A surgical bridge for supporting incision sutures under tension,
comprising:
a. a bridge member having first and second end portions joined by a
connecting portion, the end portions being adapted to engage the
surface of a patient's skin on opposite sides of an incision, and
the connecting portion being constructed to arch and be spaced from
the incision;
b. a pre-cut suture one end of which is secured to the first end
portion of the bridge member;
c. a stud member projecting upwardly from the second end portion
and having a friction notch formed therein for securably receiving
the opposite end of the pre-cut suture;
d. said bridge member being constructed to resiliently flex under
the influence of changing tension within the suture.
2. The device defined in claim 1, wherein the bridge member is
elongated in shape, and each end portion comprises a pair of
longitudinally extending projections defining a slot therebetween
to guidably receive a suture.
3. The device defined in claim 2, wherein the end and connecting
portions are of essentially uniform thickness, and further
comprising a region of increased thickness at the inner suture
supporting end of the slot, said thickened region being rounded to
preclude damage to the suture.
4. The device defined by claim 1, and further comprising a surgical
needle for the pre-cut suture.
5. The device defined by claim 4, wherein said opposite end of the
pre-cut suture is integrally secured to the head of the surgical
needle.
6. The device defined by claim 1, wherein said one end of the
pre-cut suture is integrally formed with said first end
portion.
7. The device defined by claim 1, and further comprising a
resilient pad disposed on the under surface of each end portion in
a skin engaging position.
8. The device defined by claim 1, wherein the bridge member is
formed from absorbable material capable of being assimilated by the
human body.
9. The device defined by claim 1, wherein the bridge member is
formed from non-absorbable material.
10. The device defined by claim 1, wherein the bridge member is
formed from porous material capable of absorbing body fluids and
admitting air to the incision.
11. A surgical bridge for supporting incision sutures under
tension, comprising:
a. a bridge member having end portions joined by a connecting
portion;
b. the end portions being generally flat and adapted to engage the
surface of a patient's skin on opposte sides of an incision;
c. the connecting portion being constructed to bridge the incision
and adapted to receive and support a suture over the incision, and
comprising sides which diverge longitudinally of the bridge and
upwardly from the plane of the respective end portions and a top
section which interconnects the sides, the juncture of the top
section and each of the sides defining an elevated suture support
point which overlies and is spaced from the associated end
portion;
d. each end portion having an opening formed therein below the
associated suture support point and sized to preclude engagement of
said end portion with the suture.
12. The device defined by claim 11, wherein the bridge member is
constructed to resiliently flex under the influence of changing
tension of a suture supported thereby.
13. The device defined by claim 11, wherein the bridge member is
elongated in shape, and each end portion comprises a pair of
longitudinally extending projections, and said opening comprises a
slot defined between said projections.
14. The device defined by claim 11, wherein the connecting portion
is notched at each of said junctures to guidably retain the
suture.
15. A surgical bridge for supporting incision sutures under
tension, comprising:
a. an elongated bridge member having end portions joined by a
connecting portion;
b. the end portions being in part adapted to engage the surface of
a patient's skin on opposite sides of an incision and said
connecting portion being constructed to bridge the incision and
adapted to receive and support a suture over the incision;
c. each end portion comprising a plurality of longitudinally
extending projections at least one of which is adapted to engage
the patient's skin surface, and one of which bends upwardly and
away from the connecting portion in cantilever fashion to form a
suture support member and elongated opening therebelow through
which the suture can pass, the extreme end of each support member
defining an elevated suture support point which overlies and is
spaced from said elongated opening.
16. The device defined by claim 15, wherein each cantilevered
support member is constructed to resiliently flex under the
influence of changing tension within the suture.
17. The device defined by claim 15, wherein each cantilevered
support member has a frictional slot formed therein to receive and
retain the suture.
18. The device defined by claim 15, wherein the bridge member is
resiliently flexible.
Description
The invention relates to surgical bridges for supporting incision
sutures under continuous tension.
Surgical devices of this general type have existed for some time in
a number of different forms. For example, see the devices disclosed
in U.S. Pat. No. 815,264 issued to Joseph E. Chambers on Mar. 13,
1906; U.S. Pat. No. 1,852,098 issued to Alfred W. Anderson on Apr.
5, 1932; and U.S. Pat. No. 3,014,483, which issued on Dec. 26, 1961
to Horace F. McCarthy. With such devices, an incision closing
surgical stitch is formed by inserting the suture through the
incision under the skin with a surgical needle in the known manner,
placing the bridge over the incision relative to the suture,
bringing the suture ends around the respective bridge ends and
tying them at the middle under the requisite tension.
One problem that has accompanied the formation of surgical stitches
with existing devices is cutting or slicing of the patient's skin
by the suture itself as swelling of the incision occurs during the
healing process. Such swelling tends to force the bridge outwardly,
which increases suture tension until the adjacent skin gives way
and is cut or slit. The same end effect is also caused by pressured
movement of the bridge (as by swelling, for example) which carries
the suture laterally with it until the skin gives way. No matter
how they occur, skin cuts or slits are a source of major irritation
to the patient, and they increase the possibility of infection
before the wound has healed completely which can result in the
formation of scars.
Our inventive surgical bridge alleviates the problems of excessive
suture tension and resulting skin cuts through the regulation of
suture tension and suspension of the suture relative to its point
of entry into the skin. More specifically, one form of our suture
bridge comprises an elongated member having skin contacting end
portions joined by a connecting portion constructed to bridge the
incision. The suture pierces the skin adjacent the incision in a
conventional manner, and is then brought around each end of the
bridge and is tied or otherwise secured under proper tension. Of
primary significance is making the bridge flexible so that it will
resiliently and elastically bend under the influence of increasing
suture tension due to swelling of the wound. In so doing, the
bridge compensates and thereby maintains proper tension of the
suture. Also, when the swelling decreases as the wound heals, the
bridge returns to its initial shape and takes up any loosening to
maintain such proper tension.
In another form, our suture bridge comprises a connecting or bridge
portion which elevates the suture support point over a guiding slot
which completely surrounds the point at which the suture enters the
skin. Thus, even though the bridge is moved due to swelling or the
like, the slot precludes engagement of the suture by the bridge
itself, thus precluding the suture from being laterally forced
against the adjacent skin.
Our invention further contemplates the provision of an individual
pre-cut suture and needle for each surgical bridge which may be
integrally formed therewith, to eliminate needless repetition in
taking surgical stitches and to insure maximum convenience and
simplicity to the physician in carrying out his surgical
duties.
Other structural features and advantages of our inventive surgical
bridges will become apparent from the description below in
conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a surgical bridge for supporting
incision sutures under proper tension;
FIG. 2 is a sectional view of the suture bridge and suture in place
over an incision, taken along the line 2--2 of FIG. 1;
FIG. 3 is the sectional view of FIG. 2 with swollen body tissue
surrounding the incision;
FIG. 4 is a perspective view of an alternative form of the
inventive suture bridge;
FIG. 5 is a sectional view of the suture bridge of FIG. 4 over an
incision with a suture in place, taken along the line 5--5 of FIG.
4;
FIG. 6 is another alternative embodiment of the inventive suture
bridge;
FIG. 7 is an enlarged sectional view of the suture bridge of FIG. 6
over an incision with a suture in place, taken along the line 7--7
of FIG. 6;
FIG. 8 is an enlarged perspective view of one end of the suture
bridge of FIG. 6;
FIG. 9 is a perspective view of another alternative embodiment of
the inventive suture bridge;
FIG. 10 is a perspective view of another alternative embodiment of
the inventive suture bridge; and
FIG. 11 is a fragmentary view of the suture bridge of FIG. 10 in
bottom plan.
DESCRIPTION OF THE PREFERRED EMBODIMENT
With initial reference to FIGS. 1 and 2, a suture bridge embodying
the inventive principle is represented generally by the numeral 11.
Bridge 11 is elongated in shape, having end portions 12 joined by a
connecting portion 13 constructed to bridge an incision. Each end
portion 12 includes a pair of projections 14 which define a slot 15
that serves to guide and retain a suture 16. At the inner most
point of the slot 15, bridge 11 includes a thickened region 17
which is rounded to prevent damage to the suture 16.
Connection portion 13 is formed with a gentle curvature in this
embodiment which permits it to arch an incision 18 extending
through a patient's skin 19 and layers 20 and 21 of deeper tissue.
As used herein "incision" is intended to encompass wounds,
lacerations and the like which disrupt normal tissue integrity, as
well as openings made for surgical purposes. Bridge 11 may be made
from any number of materials suitable for surgical accessories of
this type, examples of which are stainless steel, nylon and teflon.
Of primary importance to the construction of bridge 11, whatever
material from which it is made, is its ability to flex under
varying degrees of suture tension, as discussed more fully
below.
FIG. 2 represents formation of a surgical stitch with the use of a
suture bridge 11. With the aid of a surgical needle, suture 16 is
passed through the skin 19 and layers 20 and 21 of tissue as shown,
and the suture ends are brought through the respective slots 15,
over the thickened regions 17 and tied or otherwise secured on top
of the connecting portion 13 under proper tension as shown in FIG.
3.
Under normal circumstances, the tissue surrounding incision 18
undergoes swelling during the healing process. As shown by the
broken line and upward arrows in FIG. 3, this swelling may entirely
fill the bridge space and engage the underside of connecting
portion 13.
With prior art devices, the result of swelling is increased suture
tension, often to the extent that the suture exerts sufficient
pressure on the adjacent skin to cause it to give way and be cut or
torn. The flexibility of suture bridge 11, however, permits it to
resiliently bend in a compensating manner, thereby precluding
suture tension from becoming excessive to the point of damaging the
skin. This significant feature of the suture bridge 11 also works
conversely; i.e., as the swelling of skin surrounding incision 18
decreases, any loosening within the suture is automatically
tightened by resilient flexibility of the bridge 11 so that proper
suture tension is maintained and the surgical stitch continues to
carry out its intended purpose.
With reference to FIGS. 4 and 5, an alternative suture bridge
embodying the inventive principle is represented generally by the
numeral 31. Bridge 31 comprises similar end portions 32 joined by a
connecting portion 33. Each of the end portions 32 is similarly
formed with projections 34 defining a slot 35 which is somewhat
longer relative to the slot 15 of bridge 11. The connecting portion
33 is quite different than that of bridge 11, having sides which
diverge upwardly from the respective end portions 32 and are
interconnected by an essentially flat top section. Each of the
sides of connecting portion 33 is also formed with a notch 36 to
prevent a suture 37 from slipping off.
As described, it will be appreciated that the suture 37 is
supported by the connecting portion 33 at points elevated or spaced
above the skin surface, and that each of the slots 35 extends
inwardly beyond these elevated support points to preclude
engagement of suture 37 by the projections 34. Broadly speaking, it
is the provision of elevated support points coupled with reasonably
constructed end portions which gives rise to the improved structure
and use.
Formation of a surgical stitch to close an incision 38 is
essentially the same; i.e., the suture 37 is introduced through
skin and tissue layers 40 and 41, and its ends are respectively
brought through the slots 35 and tied at the top of connecting
portion 33. Due to the specific construction of connecting portion
33, the suture is suspended between the aforementioned elevated
support point and the skin 39, and is disposed essentially normal
to the skin to reduce the likelihood of skin tears or cuts.
Further, even if swelling of the tissue surrounding incision 38 is
appreciable, suture 37 will not be engaged due to the recessed
construction of end portions 32, and tearing of the skin by reason
of such engagement is precluded.
This improved function occurs whether or not bridge 31 is flexibly
constructed. Preferably, however, bridge 31 is constructed to
resiliently flex under the influence of increased suture tension
due to swelling, and such flexure is represented by the broken
lines and arrows in FIG. 5.
FIGS. 6 and 7 disclose an alternative suture bridge 51 which
preferably is resiliently and flexibly constructed, and also
defines elevated suture support points. More specifically, bridge
51 comprises modified end portions 52 and a connecting portion 53
essentially the same as connection portion 13 of bridge 11. End
portions 52 are similar insofar that they include projections 54
defining elongated slots 55. In the preferred case, each of the
slots 55 is formed by punching out a supporting tab 56 which bends
upwardly and away from the connecting portion 13 in cantilevered
fashion. The extreme end of each tab 56 has a slit 57 formed
therein which is sized to receive and frictionally retain any
portion of a suture 58. It will be appreciated that the tabs 56 and
slits 57 define elevated support points for the suture 58, and that
the slots 55 extend inwardly beyond these support points to
preclude engagement of the suture 58 at its point of entry into the
skin.
Formation of a surgical stitch with the bridge 51 may be in the
manner shown in FIG. 6; i.e., by tying the suture 58 at the top of
connecting portion 53 after bringing the suture ends around and
through slits 57 of tabs 56. Preferably, tabs 56 are constructed to
resiliently flex and bend downwardly with increasing suture tension
as swelling occurs, in the manner described above. Alternatively,
and with reference to FIGS. 7 and 8, suture 58 may simply be
wrapped around the tab 56 and ultimately through slit 57 so that
the surgical stitch is held in place without tying. It will be
apparent that the surgeon may simply release the surgical stitch
for removal or adjustment purposes simply by grasping the free end
of suture 58 and removing it from the tab 56.
FIG. 9 depicts form, the bridge 61 of the inventive type in
conjunction with an individual pre-cut suture 62 and needle 63.
Surgical bridge 61 comprises end portions 64, 65, which are not the
same as in the previous embodiment, and a connecting portion 66
which is essentially the same as that of surgical bridge 11 and 51.
A small aperture is formed through end portion 64 to receive suture
62, which is knotted at one end to prevent its release. End portion
65 conforms with a short recess 67 for guiding and retaining the
opposite end of suture 62 in formation of a surgical stitch, and
further includes a post or stud 68 projecting upwardly from its top
surface. Post 68 has a notch 69 which permits suture 62 to be
frictionally secured simply by winding it around the post 68 and
through notch 69.
In the preferred form th free end of suture 62 is threaded through
the eye of surgical needle 63, and all components are packaged as a
unit for maximum convenience and efficiency to the surgeon.
FIGS. 10 and 11 set forth a surgical bridge similar to the bridge
61 of FIG. 9, and in which like parts are represented by like
numerals with the letter a added. Bridge 61a differs in that one
end of the suture 62a is fused or bonded to the end 64a rather than
the knot-aperture method of securement. It will be appreciated that
suture 62a could be integrally formed with bridge 61a whether made
from the same material, an example of which is nylon, or from a
different material.
The opposite end of suture 62a is fused or integrally secured to
the head of surgical needle 63a so that all components define an
integral unit. This manner of securement of suture 62a to needle
63a is advantageous because it forms a smaller skin opening in the
formation of a stitch, as compared to the opening formed when the
doubled suture 62 at the eye of needle 63 passes through the
skin.
As shown particularly in FIG. 11, bridge 61a is different in one
further respect through its inclusion of a resilient pad 70 on the
under surface of each of the end portions 64a, 65a. In the
preferred embodiment, pads 70 are formed from a layer of sponge,
which offers a better frictional engagement with the skin surface
and also absorbs any secretion from the incision during the healing
process.
It will be apparent that the sutures 62 and 62a may be formed from
absorbable material capable of being assimilated by the body, such
as catgut, or from non-absorbable material, examples of which are
silk and nylon. Similarly, and as suggested above, the several
suture bridges disclosed herein can also be formed from either type
material, whichever is suitable for a specific application and
capable of being constructed in accordance with the inventive
principles set forth above. The suture bridges can also be
constructed from porous or microporous material to themselves serve
as absorbers of body fluids secreted during the healing process,
and to better admit air to the incision and thereby hasten the
healing process.
Althrough our inventive suture bridges are disclosed and described
for use in supporting surgical stitches which secure an incision or
break in a patient's outer layer of tissue or skin, it will be
appreciated that the devices are equally capable of use in securing
deeper layers of tissue and/or structures together.
* * * * *