US 3014483 A
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Dec. 26, 1961 Filed Oct. 26, 1959 H. F. MCCARTHY 3,014,483
SURGICAL BRIDGE FOR SUPPORTING SUTURES 2 Sheets-Sheet l HORACE FRANK MCCARTHY INVENTOR.
ATTORNEYS Dec. 26, 1961 H. F. MCCARTHY 3, 4
SURGICAL BRIDGE FOR SUPPORTING SUTURES Filed Oct. 26, 1959 2 Sheets-Sheet 2 HORACE FRANK MCCARTHY INVENTOR.
TTORNEYS Uni: SE
' 3,014,483 SURGICAL BRIDGE FOR SUPPORTING SUES Horace Frank McCarthy, North Andover, Mass, assignor to Avco Corporation, Cincinnati, Ghio, a corporation of Delaware Filed Oct. 26, 1959, Ser. No. 848,576 6 Claims. (Cl. 128-334) The present invention relates to a surgical appliance and more specifically to a surgical bridge for use in supporting transverse sutures employed in abdominal and thoracic surgery.
In the course of major surgery, as in performing a hysterectomy, it is necessary to cut through major muscle structures, such as the rectus abdominis muscles. At the completion of suchsurgery transverse tension (stay) sutures are applied to hold the severed muscles in juxtaposition to promote healing. conventionally, the sutures are applied in a figure-of-eight configuration in which the lower loop of the figure surrounds the adjacent portions of the severed muscles and the upper loop is completed outside of the patients body. The sutures necessarily must be drawn tightly since they are relied upon to oppose major strains on the muscle structure incidental to movement of the patient. As a result, the sutures have a tendency to cut the tissue surrounding the places where they emerge from the skin. Infection, necrosis of the skin, and severe wound scars are common after-effects.
Through use of the present invention, it is possible to avoid such drawbacks. Briefly, the invention comprises a unitary bridge having a pair of spaced ears joined by an arch. In use, the bridge is placed transverse of the incision to be healed, with the ears of the bridge positioned adjacent the points where the suture emerges from the skin. Slots are formed in the ears to accommodate the suture, and a groove is provided in the arch to support the suture in spaced relationship above the incision. The slots in the ears are selectively positioned and formed to re'duce the criticality with which the sutures must be applied to the patient. Since the bridge generously clears the incision site, removel of stitches or clips along the incision is facilitated. Inspection of the incision is simplified. Further, the bridge constitutes a protective support for hospital clothing and bed covers, holding them away from the incision site, and can be used to support drainage tubes.
In view of the foregoing it will be understood that an important object of the present invention is to provide an improved surgical suture bridge. A further object of the invention is to provide a bridge for supporting a tension suture and minimizing its tendency to cut tissue through which it passes.
It is also an object of the invention to provide a bridge which has inherent lateral stability with little or no tendency to tip under the tension load of a suture.
Another object of the invention is to provide a bridge that distributes the suture load over a relatively large area of the patients body thereby promoting comfort.
A further object of the invention is to provide a bridge having slots for accommodating a suture which may easily be applied by the surgeon without concern for the precise point at which the suture emerges from the skin.
The novel features that I consider characteristic of my invention are set forth in the appended claims; the invention, itself, however, both as to its organization and manner of use, together with additional objects and advantages thereof, will best be understood from the following description of a specific embodiment when read in conjunction with the accompanying drawings, in which:
FIGURE 1 is a full size top plan view of a suture bridge embodying the present invention;
FIGURE 2 is a side elevational view of the bridge shown in FIGURE 1; FIGURE 3 is an enlarged longitudinal sectional view taken on plane 33 of FIGURE 1;
FIGURE 4 is a cross sectional view through one ear of the bridge taken on plane 4 -4 of FIGURE 2;
FIGURE 5 is a cross sectional view through the arch of the bridge taken on plane 5--5 of FIGURE 2;
FIGURE 6 is a cross sectional view, drawn to a reduced scale, showing the bridge in use; and
FIGURE 7 illustrates some of the undesirable conditions that are avoided by use of the present bridge.
Turning attention first to the construction of the bridge shown in FIGURES 1 and 2, it will be noted that it includes a pair of spaced, substantially co-planar ears 1 and 2, joined by an intermediate integral arch 3. As well illustrated by FIGURES 1 and 4, the ears are generally circular in plan view and have a width substantially greater than that of the arch. For reasons that will become apparent shortly, the bottom sides of the ears 4 and 5 are convex whereas the top surfaces 6 and 7 are generally planar. 7 5
Each ear defines a slot extending from its outer end towards the arch. Thus, slot 8 is formed in ear land slot 9 in ear 2, the two slots being in alignment with each other and a groove 10 formed in the arch by ridges 11 and 12. The ridges and groove are well illustrated in the cross sectional view of FIGURES- A transverse notch 13 is also provided at the center of the arch to accommodate the suture where it is knotted, as will be described.
The configuration of the bridge at the nexus of the arch and ears is important. By definition the nexus is an interconnection or link. Specifically, the nexus is the region of the suture bridge interconnecting or linking the arch to an ear. In FIGURE 3, the nexus between the ear and the arch 3 is delineated by the lines 40 and 41. It will be noted that the nexus curves upwardly from the ear 1 to the arch 3. As illustrated by FIGURE 3, groove 10 communicates with slots 8 and 9, and at their juncture the material of the arch is rounded to a smooth contour, as at 14. The end of each slot is also smoothly contoured, as at 15 as shown in FIGURE 1. Thus both slot and groove, as well as notch 13, are defined by smooth contours presenting no sharp edges that might cut the suture.
The material from which the bridge is made is a matter of choice. the bridge integrally from methyl methacrylates which may be chemically sterilized, as by zephiran chloride or cry-oxide. If made from polypropylene, the bridge may be sterilized either chemically or in an autoclave. Both of these materials are non-toxic, non-irritating and of low absorption.
Further details of the bridge are best understood with reference to its use. Turning attention to FIGURE 6, there is shown a bridge, generally designated 20, transversely spanning an incision 21. The incision is shown as penetrating through the various layers of the skin and the rectus abdominus muscle 22. A figure-of-eight suture 23, of black silk thread, is shown looped around portions of the muscle and the bridge. Preferably the suture is installed as a loop under hoop tension, tightly holding the severed muscle structure in juxtaposition to promote healing. The suture extends from the lower loop, through the skin layers, emerging at 24 and 25 and passing through the slots 8 and 9 of the bridge and the groove 10 to a central position on the arch. After being drawn tight, it is knotted, as at 26. The transverse notch 13 accommodates the knot, holding it cen- It has been found convenient to mold tral and making it simpler to tie. Further, the notch also facilitates severance of the suture when it is to be removed.
As illustrated by both FIGURES 3 and 6, the lower convex faces of the ears distribute the load, resulting from the tension of the suture, over a relatively large skin area. This is important to the comfort of the patient since the suture normally must remain as applied for a period of several days. The broad extent of the ears also imparts lateralstability to the bridge and prevents it from tipping over under the load of the suture imposedon the arch.
It is desirable to fashion the slots 8 and 9 so that they extend fully across the ears to their nexus with the arch. In this way, the undesirable conditions shown in FIGURE 7 may be avoided. Directing attention to that figure, there is shown a bridge having an ear 31 with a slot 32 which only extends about halfway across the ear. A suture 34 is shown emerging from the skin at 35, passing along the bottom of the car at 36 and above the arch at 37. A bridge constructed in this man ner is unsatisfactory for several reasons. It is important to note that the ear actually covers the point at which the suture emerges from the skin forming a focal point for infection that cannot be cleaned. Further, the ear of the bridge may press the suture against the skin, making the patient uncomfortable. In addition, the horizontal run of the suture permits movement of the bridge relative to the incision. This is not only unsatisfactory from thestandpoint of secure support of the suture but also may result in chafing of the skin as the patient moves about.
The criticality with which the point of emergence of the suture from the skin must be located is also of vital importance. In the bridge of FIGURE 7, the suture must emerge. within a very narrow region Y. If the point of emergence is to the right of this region, the undesirable conditions, already described, will result. If the point of emergence is to the left of Y, such as at 38, the suture shown in dash lines will have a large horizontal force component tending to tear the tissue and largely defeating the very purpose for using the bridge.
These difiiculties are avoided by use of the present bridge. As' shown in FIGURE 3, the slot 8 of the ear 1 extends to the nexus of the arch and. ear. The point of emergence of the suture is much less critical and may fall within the region X without adverse efiect. Regardless of: where the point of emergence is within this region, it will be fully exposed and not physically covcredv by the bridge. Further, under no circumstances will the suture be pinched between the bridge and the patients skin. Of great importance is the fact that the suture, in passing from the point of emergence to the region 14- of the arch, will be sufiiciently close to vertical that no large horizontal component of force will exist to tear the tissue next to thesuture.
Other benefits of the bridge may now be considered. It will be noted in FIGURE 6 that the bridge spans the incision with ample clearance. This clearance not only accommodates surgical dressings but also simplifies their application and removal. Free fiow of air around the dressing and incision is also assured. Likewise, application and removal of stitches may be accomplished without interference from the bridge. The bridge also forms a support for hospital clothing and bed covers and keeps them well clear of the incision. In special cases, when drain tubes must be used, thesemay readily be anchored by being taped to the bridge.
It will be noted that the bridge, when applied as illustrated in FIGURE 6, is stable and not subject to movement in any direction. The upper loop of the suture is readily accommodated by groove 10 which prevents it from becoming dislodged. All of the edges against which the suture bears, or in contact with the patient, are well rounded.
Through use of the present bridge, infections and necrosis of the skin are avoided. Use of the bridge assures that a patient, when recovered from his operation, will not be disfigured by wound scars; during the period of his recovery, he is assured a maximum of comfort.
From the foregoing description of the invention it will be readily apparent that an improved surgical bridge, having important benefits to the patient, is made available to the medical profession.
Having described a preferred embodiment of my invention, I claim:
1. A surgical bridge for use in supporting a tension suture for closing a patients incision comprising a pair of spaced horizontally extending co-planar ears integrally joined to an upwardly extending intermediate: arch, said ears being of greater lateral extent than said arch, each of said ears defining an elongated slot aligned with said arch and extending through said ear to the nexus of said car and said arch.
2. A bridge as defined in claim 1. inwhich the bottom of each of said cars is convex for comfortably distributing the load of the suture to the patient.
3. A bridge as defined in claim 1 in which said arch is formed to define a longitudinal groove in communication with the slots of said ears and a transverse notch in the center of said arch in communication with the groove.
4. A unitary surgical suture bridge comprising a pair of generally circular horizontally extending co-planar ears, and an upwardly extending raised arch, said ears being. integrally joined to the ends of said arch, each ear defining an opening extending through said ear to its nexus with said arch through which the suture may pass, said arch defining a longitudinal groove in communication with said openings for confining thev suture.
5. A unitary surgical bridge for supporting a suture comprising horizontally extending co-planar load supporting means, an upwardly extending arched member interconnecting said load supporting means, said load sup-- porting means being of greater lateral extent than said arched member, said means defining openings through said load supporting means and upwardly through their nexus with said arched member through which the suture may pass, and means on said arched member for confining the suture.
6. A unitary surgical bridge for use in supporting a tension suture applied to a patient to close his incision comprising a pair of generally circular, spaced, horizontally extending co-planar cars; a continuously upwardly extending curved arch integrally joined to said ears and extending therebetween; said ears being of greater lateral extent than said arch and each of said ears defining an open ended elongated slot in alignment with said arch and extending through the ear and upwardly through the nexus of said ear and said arch; said arch defining a longitudinal groove in communication with the slots of said ears and a transverse notch in the center of said arch in communication with the groove whereby the bridge may be applied to the patient with its slots corresponding to the points of emergence of the suture from the patient and the suture may be passed through the slots and along the groove of said arch and be joined at the transverse notch.
References Cited in the file of this patent UNITED STATES PATENTS 815,264 Chambers Mar. 13, 1906