US 2421193 A
Description (OCR text may contain errors)
May 27, 1947. W l- GARDNER l ZZLQS SURGICAL' DRESSING Filed Aug. 2, 1945 fr 'IIIIIIIIIIOF WIIIIIIIJ' INVENTOR.
f w/L/AM JAMES GARDA/EE Patented May 27, 1947 SURGICAL DRESSING William .lames Gardner, Cleveland Heights, Ohio,
assigner to Cleveland Clinic Foundation, a nonproiit corporation of Ohio Application August 2, 1943, Serial No. 496,982
(Cl.` 12B-335) Claims.
This invention relates to improvements in dressings for wounds or the like and more particularly to an improved elastic dressing which may be stretched over the wound and is adapted to draw the edges of the wound together.
As is well known to those versed in the art, an open wound has a tendency to gape. This has an undesirable effect in that it increases the size of the scar and the length of the time for healing. In the past, various methods have been used fo-r cutting down the gaping. Probably the most common was to wrap the wound member with a bandage. This was undesirable because it did not reduce the gape the desired amount, the bandage came in contact with and adhered to the raw flesh increasing the difficulty of renewing the dressing and the pressure of the bandage constricted the wounded member causing various complications.
Other methods used included sewing, the use of clamps, and sometimes even the sewing of buttons to the skin and the use of rubber bands for traction. These were and are all more or less undesirable because they are not only painful to the patient, but their application is time consuming.
The time element is particularly important at times where a great many dressings must be made as in the case of caring for the wounded in time of war.
By my present invention I have provided an improved form of dressing which may be quickly and easily applied without special instruments and wherein the dressing may be removed or renewed without pain and discomfort to the patient.
It is therefore an object of my invention to provide an improved form of dressing for wounds or the like.
Another object of my invention is to provide a dressing wherein traction may be continuously applied to the sides of the wound over extended periods.
Another object of my invention is to provide an improved means for applying traction to a wound.
Another object of my invention is to provide a dressing where greater traction may be applied.
Another object of my invention is to provide a dressing which does not adhere to the open wound.
Another object of my invention is to provide a dressing which when removed will not reopen the Wound.
Another object of my invention is to provide a dressing which may be applied quickly and easily rto the wound and does not skill for its application.
Another object of my invention is to provide a dressing which may be adapted to wounds of various sizes and shapes.
Still other objects of the invention and the invention itself will become more apparent from the following description of an embodiment thereof which description isillustrated by the accompanying drawings and forms a part of this specification.
Fig. 1 is a view illustrating diagrammatically an open wound;
Fig. 2 is a cross-sectional View of an improved dressing of my invention;
Fig. 3 is a plan View of a section of dressing;
Fig. 4 is a diagrammatic View illustrating the dressing applied to the wound of Fig. 1."
Fig. 5 is a cross-sectional view of another modification of my invention;
Fig. 6 is a plan View of another form of the invention;
Fig. 7 is an enlarged section taken on the line l--l of Fig. 6;
Fig. 8 is an enlarged plan View of a portion of the dressing of Fig. 6; and
Fig. 9 is a sectional View taken on the lines 9 9 of Fig. 8.
Briefly, one aspect of the invention comprises bridging the raw surface of the wound with Aa sheet of rubber tissue of high elasticity which is stretched and secured to the healthy skin on each side of the Wound thus applying traction to the sides of the wound.
More specically, Fig. 1 illustrates a condition where the healthy skin is shown at I and a gaping wound at 2. It should be noted that although the wound may be a simple cut, eXtending down into the flesh, it has a natural tendency to gape more or less as illustrated. Such a wound, if not pulled together, has a tendency to remain open and takes a long time for the flesh to heal and be covered with skin. It is therefore desirable to draw the edges of the wound together causing a progressive narrowing of the wound and greatly increasing the healing rate and resulting in a narrower scar. As previously stated this can be accomplished in several ways, the most common previously used being by stitching through the edges of the wound and drawing the opposite edges together. This was a, disadvantage because it was not only painful but increased the chances of infection. Fur'- thermore, the stitches sometimes pulled out.
In Fig. 2, I have shown a section of my imrequire great proved dressing which in this embodiment comprises a center elastic portion 4 of thin, highly elastic latex rubber, the edges of which are provided with a, non-elastic fabric 5. Preferably the latex is formed so that it impregnates or becomes embedded in the interstices of the fabric to form a secure and non-removable connection therewith. Thus when the latex or rubber is cured it is bonded securely to the fabric. Fig. 3
is a plan view of a portion of the dressing and shows the center elastic portion and the nonelastic margins. A dressing of this character can be made up in rolls with the non-elastic tapes acting as a selvedge. Sections of the desired length may be cut from the rolls to provide dressings of various lengths and the rolls may be constructed of varying widths such as 1", 2", etc.
Although I have specifically mentioned Latex as being useful it is within the purview of my invention to make the elastic portion of any of the Well known synthetic elastic materials -as well as rubber.
In securing the .dressing Vin place, I preferably use ordinary adhesive tape. This .tape is applied to the healthy skin on -one side of the wound with one part of the tape against the skin and the other part overlapping the non-elastic portion 5 of the dressing. In order to increase the eihciency of the hold, I preferably cause the latex or like material to extend only partially through the tapes 5, so the top surface 5a is free from the elastic material, it only extending partially through the tape. I have found, however, that the rubber can extend-entirely through the material at the edge and that as long as the edge material is inelastic a good adherence will be obtained. In this manner` the adhesive tape adheres firmly to the skin and to the inelastic edge of the dressing holding it securely in place. After one side of the dressing is secured on one side of the wound the dressing is stretched, thewound gently closed and the other opposite side of the dressing secured to the healthy skin by another piece of tape in like manner. The dressing thus secured in place is illustrated in Fig. 4 wherein a gaping wound is shown partially closed at 2 and the adhesive tape 6 is secured to the healthy skin l and to the non-elastic portion 5. With the dressing applied in this manner the pulling force of the elasticportion is always in the direction of the arrows 1 tending to close the wound 2, which can be completely closed when the iiesh has not been torn away.
In the case of a wound where the flesh is completely removed, with a dressing of this character the surface is gradualiy drawn together or at least the pull on the skin causes it to grow faster under the dressing.
It should be noted that there is no gauze adjacent the wound. This is Iani-advantage since there is no tendency for the excretions to impregnate the gauze and dryV thus uniting the wounded part to the dressing.
The wound, being pulled together, is made smaller and the raw surface is protected. There is no occasion of trauma such as occurs with a gauze dressing. The elastic portion has no tendency to adhere to the wound and healing medicaments may be kept in contact with the wound until they are absorbed. Since the elastic portion is more or less transparent the condition of the wound may be observed Without removing the dressing. I also contemplate providing openings 'm the elastic portion to permit escape yof pus or the like and in this case the whole wounded member including the dressing of my invention may be wrapped when desired with absorbent material to absorb the excretions and still the material does not come in direct contact with the raw wound.
With a dressing of this type epithelization is speeded and, by narrowing the scar, the necessity cf subsequent plastic procedure is often eliminated. I have also found that the patient is more comfortable both during and between dressings and that the constitutional reaction and flurry of fever which sometimes follows a change of gauze dressings lin extreme shrapnel Wound cases is eliminated.
Furthermore, drainage is enhanced although the quantity of discharge is lessened. Exuberant granulations are cut down without the use of a pressure bandage which has a constrictive effect on the limb.
Although I have shown a, separate adhesive tape for retaining the dressing in place, I also contemplate making the dressing in one piece. In this instance, as shown in Fig. 5, the nonelastic portion 5 may be wider and the elastic portion extend only partially across the nonelastic portion t0 a point as indicated at 8; the remaining marginal portions are provided with adhesive indicated at 9, in the usual manner.
I have also found that in some instances, particularly in cases of plastic surgery, it is desirable to provide far greater traction than is ordinarily contemplated. In this 4case I have sometimes found that with the known adhesives such as ordinary surgical adhesive tape, the tension of the elastic portion may be suiciently great `to pull the adhesive off of the skin. I have therefore .provided an improved means for securing the elastic which provides for greater traction with the skin. This comprises a sheet of thin flexible metal having small spurs or spicules which engage with the superficial cell layers of the skin to anchor the same in place.
In Fig. 6, I have iliustrated one modification thereof wherein the elastic material is shown at 4 and is secured to a sheet of thin metal at i0. 0ne manner of securing the elastic material is to provide a plurality of openings H in the metal and allow the material to cover both surfaces of the metal and extend through the openings il and anchor in the openings as best shown in Fig. 7. Also it is possible to cure the material directly onto the metal. The other portion of the metal at I2 is provided with a plurality of small barbs or .spicules I3; these, as best shown in Figs. 'I to 9 inclusive, are pointed and extend downward at an angle of approximately 45.
In operation the barbs dig into the upper supercial skin and thus adhere tightly over the entire barbed area. Although the barbs also may be suiiicient to hold the metal in place, I also contemplate placing a piece of adhesive tape over the metal and extending it onto the skin to hold the barbs in contact therewith, In this case the tape holds the barbs imbedded and the metal with the barbs takes the tension of the elastic portion.
I also contemplate as a substitution for the barbs the provision of sharp protuberances for substantially the same effect formed by molten metal spraying or electrodeposition. The barbs, however, have the advantage in that they all extend in the proper direction and at the most eflicient angle to best engage with and anchor in the skin.
With the devices of my invention there is substantially no limit to the extent to which the normal skin can be stretched. The dressing is not only useful in the closing of shrapnel and ordinary wounds but can be used to gradually stretch the skin over denuded areas and limit the amount of skin grafting necessary.
Heretofore the full advantages of the ability of the skin to elongate under the inuence of continuous elastic traction have not been realized because a suitable dressing for applying the traction has not been available. With the invention described above a full realization of these advantages may now be attained.
I also contemplate forming the skin engaging portion of the dressing in a manner similar to a wire brush. That is, the wires may be Woven to form a short nap, These wires extend from the body at an angle in much the same manner as the barbs of Fig. 9, and thus engage With the supercial cells of the skin to which traction is then applied. The Wires may be embedded in cloth or a combination of cloth and rubber with the traction portion slightly thicker than the elas tic portion and being rendered inelastic by the wire and/or cloth. Also the wires or barbs may be embedded in a plastic material with the barbs projecting angularly from its surface,
In the case where traction is desired over a large uneven surface the adhesive material made in the manner above described may be cut up into small squares or discs of about one quarter inch in diameter and attached to a flexible backing which allows the traction portion to follow the contours of the skin surface, the exible backing in turn being attached to the elastic body.
Although I have described my invention in some embodiments thereof it will be apparent that numerous and extensive departures may be made therefrom without departing from the spirit or scope of my invention.
1. A dressing comprising a highly elastic web portion, means for attaching said web to the body comprising a terminal portion of thin metal having the elastic web portion secured to one marginal portion thereof and having the other marginal portion provided with a plurality of skin engaging barbs.
2. A dressing comprising an elastic web portion, means for attaching said web to the skin comprising a thin metal terminal portion secured to said elastic and having a roughened surface for engagement with the skin and means for holding said roughened portion in tractional engagement with the skin.
3. A dressing comprising an elastic web portion, means for attaching said web to the skin combining a thin metal terminal portion secured to said elastic and having a roughened surface for engagement with the skin and means for holding said roughened portion in tractional engagement therewith, comprising an adhesive tape for holding the metal against the skin.
4. A surgical dressing for application to a wounded member comprising an intermediate portion formed of elastic material, traction providing terminal portions secured to opposite sides of said elastic portion and formed of thin flexible metal, said metal being provided with sharp pointed members adapted to engage the healthy part of the wounded member and provide traction for the dressing.
5. A dressing comprising an elastic web portion, means for attaching said web to the body comprising oppositely disposed terminal portions of thin metal sheets, each of said sheets formed with a plurality of minute skin engaging barbs extending at an angle therefrom and in the same direction, said barbs adapted to engage with the skin.
WILLIAM JAMES GARDNER.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS