US 3013559 A
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Description (OCR text may contain errors)
Dec. 19, 1961 w. c. THOMAS INSTRUMENT FOR CLOSING FLESH WOUNDS 3 Sheets-Sheet 1 Filed May 6, 1959 INVENTOR ATTORNEY Wed/[ 4y (2, gomo 9 Dec. 19, 1961 w. c. THOMAS 3,013,559
INSTRUMENT FOR CLOSING FLESH wouuns Filed May 6. 1959 3 Sheets-Sheet 2 EEEEET M u///%/% HHRAW. H u
3 Sheets-Sheet 3 INVENTOR ATTORNEY Mm.. (Q m N Dec. 19, 1961 w. c. THOMAS INSTRUMENT FOR CLOSING FLESH WOUNDS Filed May 6. 1959 3,013,559 INSTRUMENT it rfiit CLOSING FLESH WQUNDS Wesley C. Thomas, 1717 Reynolds St, Brunswick, Ga. Filed 6, i959, Ser. No. 811,319 6 Claims. (Cl. 128-646) My invention relates broadly to surgery, and more particularly to the construction of an instrument for closing flesh wounds.
One of the objects of my invention is to provide a. self contained instrument including a magazine feed for suture material which may be readily threaded through the skin of a patient for closing a wound where the suture material is prevented from curling, twisting, t-anglrng, or kinking.
Another object of my invention is to provide an in strument for closing flesh wounds which is threaded to supply successive lengths of suture material for closing the flesh wounds and where the instrument may be readily sterilized by autoclaving while threaded and made ready for immediate use in a clean and sterilized condition such as by boiling or in solutions while completely threaded and ready for use.
Still another object of my invention is to provide an instrument for closing flesh wounds by which stitches may be introduced through the skin on opposite sides of the wound to be closed in a shorter time period and easier and with less trauma than with any other known method.
Still another object of my invention is to provide a construction of instrument for closing flesh wounds by which thread or wire may be introduced through the needle used by the surgeon in closing a flesh wound and thus eliminating the extra trauma caused by enlargement of the needle at the eye and the double strand of the suture material necessary at the eye.
A still further object of my invention is to provide an instrument for closing flesh wounds which employs a hypodermic needle for threading the suture through the skin bordering a flesh wound where the needle may be readily shaped by the surgeon to meet the particular requirements of the contour of the wound and thus facilitate threading of the suture through the flesh bordering the wound.
A still further object of my invention is to provide an instrument for closing flesh wounds which is particularly suitable for threading stainless steel wire through the flesh bordering the wound for effectively closing the wound.
Other and further objects of my invention reside in the construction of an instrument for closing flesh wounds in which the suture may be gripped and advanced through the bore of a hypodermic needle for introduction through the parts of the skin bordering a flesh wound as set forth more fully in the specification hereinafter following by reference to the accompanying drawings in which:
FIG. 1 is a top plan view of the instrument of my invention shown in position for introducing the suture through parts of the skin bordering a flesh wound, part of the instrument being broken away and illustrated in section;
FIG. 2 is a view similar to the view shown in FIG. 1 in which the needle of the instrument for closing flesh wounds has been threaded through parts of the skin bordering the flesh wound and the suture advanced through the needle preparatory for the withdrawal of the needle;
FIG. 3 is a view illustrating the manner in which the needle is withdrawn from the flesh wound leaving the suture threaded through the wound preparatory to the closing of the skin about the parts of the wound;
FIG. 4 is a fragmentary view showing parts of the flesh bordering the flesh wound which is closed by tying the suture about the closed parts of the flesh around the Wound;
FIG. 5 is a side elevational view of the needle of my invention after it has been withdrawn from the skin bordering the flesh wound, leaving the suture threading the parts of the flesh bordering the wound and before cutting the suture from the needle;
FIG. 6 is an enlarged longitudinal sectional view taken through the operating parts of the needle and illustrating particularly the magazine feed for the suture and the manner of gripping the suture for advancement through the needle, the view illustrating part of the magazine, part of the feed tube for the suture, and part of the device for gripping the suture for advancement through the needle in top plan View;
FIG. 7 is a longitudinal sectional view taken through the mechanism of the needle substantially on line 7-7 of FIG. 6;
FIG. 8 is a top plan view of the feed tube for the suture partially broken away and shown in section, the view showing the manner of ripping the suture in the feed tube for advancement through the hypodermic needle;
FIG. 9 is a side elevational View of the feed tube for the suture, the tube being partially broken away and shown in section and illustrating particularly the spring device for gripping the suture in the feed tube;
FIG. 10 is a transverse sectional view taken on line 10-10 of FIG. 7 and illustrating the magazine for supplying the suture through the feed tube and through the hypodermic needle;
H6. 11 is a transverse sectional view taken substantially on line 1111 of FIG. 6;
FIG. 12 is a side elevational view of the instrument of my invention showing the feed means for the suture advanced to its maximum position for moving the suture through the hypodermic needle; FIG. 13 is a plan view of the instrument of my inven tion in the position corresponding to the position illus' trated in FIG. 12;
FIG. 14 is an enlarged plan view with parts shown in section and illustrating the griping device for the suture clamped upon the suture in a position for advancing the suture through the hypodermic needle by movement toward the needle end of the instrument;
FIG. 15 is a view similar to the view illustrated in FIG. 14, but showing the suture advanced toward the needle for movement through the needle;
FIG. 16 is an end View of the gripping device for the suture showing the manner in which the suture is gripped v for movement through the hypodermic needle;
FIG. 17 is a longitudinal sectional view taken through the hypodermic needle through which the suture is advanced;
FIG. 18 is a transverse sectional view through the hypodermic needle taken on line 1813 thereof;
FIG. 19 is atop plan view of the inner slidingcylinder which carries the magazine feed for the suture, the view being partially broken away and illustrated in section;
FIG. 20 is a side elevational view of the inner sliding cylinder shown in FIG. 19, the view being broken away and illustrated in section adjacent one end thereof;
FIG. 21 is a transverse sectional view taken on line 21-21 of FIG. 19;
FIG. 22 is a side elevational view of the outer cylinder employed in the assembly of the instrument of my invention; and
FIG. 23 is a longitudinal sectional view taken through the outer cylinder on line 23-23 of FIG. 22.
My invention is directed to an instrument for suturing flesh wounds which is suitable for use with any suture Patented Dec. 19, 1961 thread or material and more especially for delicate stainless steel wire which is one of the best suture materials use in modern surgery. The instrument employs a hypodermic needle which is readily insertable through parts of the flesh bordering a flesh wound for introducing through the bore thereof the suture which may be drawn through the parts of the flesh as the hypodermic needle l'drawn and then utilized to tie the parts of the flesh ether for facilitating growth of the parts together. The instrument employs only a small number of parts including an outer cylinder having a hub portion which serves to support the hypodermic needle. The outer cylinder serves as a guide for a piston which is attached to an inner sliding cylinder which carries on the remote end thereof a magazine supply for the suturing material. There is a feed tube for the suture material disposed centrally within the inner sliding cylinder which passes through an enlarged bore in the piston in a position adjacent an adjustable gripping device controllable from the outer cylinder. The suture passes through this feed tube and may be gripped by the gripping device and then moved longitudinally in successive steps by manually pushing the gripping device externally of the outer cylinder for advancing the suture through the hypodermic needle coupled through the hub portion with the outer ylinder of the instrument. Various sizes of hypodermic needles may be employed to meet various conditions encountered in surgery and the end of the needle may be readily shaped to pass through the skin bordering wounds of dilierent contours. Various types of suturing materials including delicate stainless steel wire may be supplied from the magazine carried by the inner cylinder and suitable braking may be imposed upon the magazine supply mechanism to prevent a condition of overfeed of the suture.
Referring to the drawings in more detail, reference character 1 designates the outer cylinder of the instrument having a forwardly extending hub portion 2 and a rearwardly disposed manual grip 3 enabling the outer son. The manual grip 3 has an axial bore 4 extending in iethrough which serves as a guide for the inner sliding cylinder 5. The sliding cylinder 5 has a piston 6 on the inner end thereof which is engageable with the inner wall of the outer cylinder 1 and is slidable therein through a lineal distance limited by the length of the slot 7 in the outer cylinder 1 and the abutment with the opposite end thereof shown at 7a and 7b of the set screw 8 having the thumb engaging end 9. The set screw 8 terminates in a pintle it) which serves to engage a spring member 11 secured at one end to the side of the suture feed tube The suture feed tube 12 extends centrally within the inner sliding cylinder 5 and passes through an enlarged slightly oval lineally extending bore 14 in the piston 6. The feed tube 12 is notched at 12 on the end thereof which passes through piston 6, and adjacent the junction of the notched portion of feed tube 12 with the solid cylindrical portion of feed tube 12 I attach the spring 3?. as shown at 15 so that the inwardly turned gripping portion 16 of spring 11 is free to move into and out of the notched portion of the feed tube 12. FIG. 36 illustrates clearly the manner in which spring 11 is provided with an inwardly turned gripping portion 16 which clamps the suture 17 against one side of the inner wall or" the feed tube 12. The movement of the spring 3.1 is controlled by the pintle 10 which bears against spring 11 for gripping the suture when it is desired to advance the suture through the hypodermic needle shown at T3 which is coupled to the hub portion 19 of the outer cylinder 1 through the screw-threaded coupling 20.
The suture, which may be thread or wire, is carried on the reel 21 which is journaled on the screw-threaded member 22 adjacent the end of the inner sliding cylindc 5. The screw-threaded member 22 is insertable through or removable from the end of the inner sliding :nder to be readily maintained in the hand of the cylinder 5 to permit the insertion or removal of reel 21 to insure the replenishment of supply of the suture 17. For this purpose the inner sliding cylinder 5 is slotted on opposite sides thereof at 23 and 24 which allow the entry of the reel 21. The leaf spring 25 is provided on sliding cylinder 5, extending from a connection 26 with inner sliding cylinder 5 to resiliently engage the side flanges of the reel 21 to suitably brake the feed of the suture through the feed tube 12 and the hypodermic needle 18. Thus a continuous feed of successive lengths of the suture is assured without tendency of the reel 21 to overrun a proper feed. The feed tube 12 reciprocates with the inner sliding cylinder 5 under control of the thumb screw 9 as hereinbefore explained. In FIG. 14 I have shown the suture gripped by the spring 11 and about to be advanced an increment distance through the hypodermic needle 18. In FZG. 15 I have shown the suture advanced lineally the length of the slot 7. The thumb screw 9 should be tight against the feed tube 12 all the time during use. Piston 6 is returned with the attached inner sliding cylinder 5 to the initial position depicted in FIG. 14. The thumb screw 9 remains in tightened position gripping the feed tube 12 containing the suture i7 gripped by the spring 11 and an increment length of the suture again advanced through the lineal distance of slot 7 to the position illustrated in FIG. 15.
The 'nstrument is threaded up in the following manner: First, the needle 18 is detached and the suture is threaded through the needle starting at the point and then threaded through the feed tube 12, raising the spring 11, and holding it open so that the grip 16 is ineifective, so that the suture material will pass easily through the tube. Next, the feed tube 12 is passed through the oval shaped bore 14 in piston 6 until the spring 11 shows about /1 outside the hub on which the needle is fitted. Then the needle is assembled onto the hub portion and the wire or other suture material attached to the reel 21 and the suture material wound onto the reel very easily by turning the knob 27 of screw 22, which carries reel 21.
The surgeon uses the needle in the following manner: At the start, the suture should extend about A beyond the end of the needle point of needle 18, while the thumbscrew 9 abuts against the end 7a of slot 7 (FIGS. 2, 3, 6, 7, and 15). Then the thumbscrew 9 is retracted until the suture is entirely within the needle 18. Next, the needle is introduced through the lips of the incision to be closed as represented in FIG. 1, where the lips of the incision are indicated at 23 and 29. The needle 18 is moved to the position shown in FIG. 2 and, after the needle emerges from the second side, the thumbscrew 9, which occupies the position shown in FIG. 1 at the time of passage of the needle 18 through the lips 28 and 29, is now advanced to the position shown in FIG. 2, so that the suture 17 is pushed through the hollow end of the needle. The suture is grasped as it is pushed through the needle point and then pulled through to provide a sufficient length to make the stitch as indicated in FIG. 2, and then the needle withdrawn as represented in FIG. 3 and the suture cut when a sur'licient length of suture has been left in the lips or" the flesh bordering the wound and in a position where only /4" of the suture protrudes from the eedle point. The wound is now bound by knotting the suture around the lips 23 and 29 as indicated in FIG. 4 where the suture is tied at 30. In FIG. 5 I have shown the manner in which the needle 18 is withdrawn from the lips 28 and 29, leaving the suture 17 in the lips, at which time sufiicient suture material may be withdrawn from reel 21 by drawing the instrument away from the wound and holding the extreme left-hand end of the suture as shown in FIG. 5. While the straight needle may be used for most surface work, curved needles are useful for work in cavities such as the mouth and throat. For use in the throat a long adapted and a much longer feed tube must be used between the hub and the needle.
The instrument of my invention is best suited to putting in what surgeons term as interrupted sutures, i.e., each stitch is put in, out and tied before the next is started. This is the stitch most commonly usedin all fields of surgery. However,'the instrument can be used to considerable advantage for putting in mattress stitches or continuous stitches. In putting in these stitches, the first part is put in as herein described for interrupted stitches and the next and remaining operation is accomplished by putting each part in without cutting the suture. This leaves an open loop on one side of the incision for each stitch after the first. In the case of mattress stitches, the free end of the loop is pulled through to the proper side and tied; in the case of continuous stitches the loop is either opened or another suture put through all of the loops and the suture is tightened upon all of the loops. In cases of little stitch tension, the opened loop will hold.
In order to protect the instrument, I find it advisable, after the instrument is threaded up, to place a knot in the suture to prevent the inadvertent turning of the reel 21 by knob 27 to a position where the suture disappears into the barrel of the instrument. After the knot is cut oif, the needle is ready for use or disassembly, i.e., needle 18 may be removed from the hub portion 2, the set screw 9 may be removed from piston 6, and the manual grip 3 unscrewed from the screwthreaded end 31 of the outer cylinder 1, and the piston and the inner sliding cylinder 5 removed for cleaning and repair. To facilitate cleaning I provide slots 32 and 33 in the hub portion 2 through which the instrument may be flushed out. When reassembling the instrument, as hereinbefore explained, it will be noted that the set screw 9 performs two functions, i.e., the pintle 10 holds the spring 11 in position and the feed tube 12 is also maintained in position with respect to piston 6.
While I have described my invention in certain preferred embodiments, I realize that modifications may be made, and I desire it to be understood that no limitations upon my invention are intended other than may be imposed by the scope of the appended claims.
What I claim as new and desire to secure by Letters Patent of the United States is as follows:
1. An instrument for suturing flesh wounds comprising an outer cylinder having a bore, a piston slidable within said bore of the outer cylinder and having an axial passage, an inner cylinder secured to said piston and slidably engaging the outer cylinder and adapted to reciprocate with said piston relative to the outer cylinder, a suture magazine carried by said inner cylinder and movable therewith, a feed tube extending axially through said passage of the piston and within the inner cylinder and being movable with said piston, a tubular needle carried by the leading end of the outer cylinder and having a bore substantially aligned with the axis of the feed tube, the suture from said magazine being engageable through said feed tube and through said tubular needle, resilient means securedto the feed tube and engageable with the suture to clamp the suture to feed tube and slidable over the suture when the feed tube is moved in one direction, and reciprocatory means engaging said feed tube and connected with said piston and operable to shift said suture forwardly toward said tubular needle, the outer cylinder having a slot receiving said reciprocatory means and limiting the movement of the latter in opposite directions longitudinally of the outer cylinder.
2. An instrument for cuturing flesh wounds comprisa tubular needle secured to said hub and adapted to be, thrust through the flesh adjacent said wound, a pistonv v mounted for reciprocation within the outer cylinder and having an axial passage substantially aligned with the bore of the tubular needle, an inner tubular member connected with said piston and extending within the outer cylinder and slidably engaging the latter for reciprocation relation thereto with said piston, a suture magazine mounted upon said inner tubular member for reciprocation therewith, an elongated feed tube extending through said axial passage of the piston and within the inner tubular member and substantially aligned with the bore of the tubular needle and adapted to receive and guide the suture from said suture magazine to said tubular needle, a resilient gripping element carried by said feed tube and having a part engaging said suture and clamping the same to said feed tube, whereby the suture is feedable forwardly with the feed tube toward the tubular needle, and means connected with said piston and feed tube and projecting exteriorly of the outer cylinder and operable to reciprocate said piston and feed'tube and having guided engagement with the outer cylinder.
3. The invention as defined by claim 2, and wherein said suture magazine is a spool journaled upon said inner tubular member for rotation and having the suture wound thereon.
4. The invention as defined by claim 2, and wherein said resilient gripping element is a leaf spring secured to one side of the feed tube and including a leading transverse extension engageable with said suture to clamp the latter to a leading portion of said feed tube.
5. An instrument for closing flesh wounds comprising an outer cylinder having a longitudinal slot in its side wall, a piston mounted for reciprocation within the outer cylinder and having an axial passage, a feed tube extending through said axial passage, a suture gripping elementcarried by said feed tube adapted to engage the suture and clamp the same to the feed tube so that the suture may be fed forwardly by the feed tube when the latter is shifted in one direction, a radial set screw carried by said piston and engaging slidably through said slot of the outer cylinder and clampingly engaging the feed tube and operable to reciprocate the piston and feed tube as a unit, a tubular needle carried by the forward end of the outer cylinder in substantial alignment with said feed tube to receive the suture therefrom, and suture magazine means carried by said piston for reciprocation there with and extending near one end of said feed tube remote from the tubular needle.
6. An instrument for closing flesh wounds according to claim 5, and wherein the inner end of said set screw engages said suture gripping element carried by the feed tube to adjustably tension the same.
References Cited in the file of this patent UNITED STATES PATENTS 373,372 King Nov. 15, 1887 1,464,897 Atkinson Aug. 14, 1923 2,808,055 Thayer Oct. 1, 1957 FOREIGN PATENTS 772,134 France Aug. 13, 1934 1,069,680 France Feb. 17, 1954