US 3190289 A
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June 22, 1965 D. PATIENCE SURGICAL SPONGE Filed Feb. 5, 1963 2 Sheets-Sheet. 1
/ V INVENTOR.
June 22, 1965 D. PATIENCE 3,190,289
SURGICAL SPONGE Filed Feb. 5, less 2 Sheets-$heet 2 INVENTOR 6i Jami! Jail-8w United States Patent 3,190,289 SURGICAL SPONGE Donald Patience, Westmont, 111., assignor to The Kendall Company, Boston, Mass., a corporation of Massachusetts Filed Fair. 5, 1963, Ser. No. 26,333 2 Claims. (Cl. 128-296) This invention is concerned with surgical sponges specifically those sponges which are made from especially treated tobacco or cheese cloth of cotton, rayon or mixtures of the two to give it a pronounced three-dimensional structure as contrasted to the substantially planar structure of ordinary gauze.
Surgical sponges have a variety of uses which dictate the desirable characteristics which ideal sponges of this type should have. Such sponges should have a pronounced cushioning effect when used to cover wounds, burns, bruises and abrasions. In addition, they should be soft and conformable so as to have minimum traumatic effect on injured tissue and upon the forming repair tissue buds. Such sponges should permit the wound to be constantialy aerated yet they should inhibit the entrance of invading bacteria. It is axiomatic, of course, that surgical sponges be capable of absorbing wound exudates but the ideal sponge must not only have a high capacity, it should in addition not become easily saturated in the wound area thus inviting bacterial invasion, reducing its cushioning effect and preventing the drying process which is essential to rapid healing.
In operative surgery, the need for non-traumatic soft, conformable, absorbent sponges is even more critical. The application of brushing or rubbing forces across healthy subcutaneous tissue must be kept at an absolute minimum, not only as to theamount of force but also as to the area and duration of its application. Ideally, a sponge for operative surgery should be so conformable that sponging of wound fluids, even in cavities and crevices, may be accomplished by a dabbing motion rather than a brushing or rubbing motion. It is obvious, therefore, that an ideal sponge must be very conformable in order to reduce the force necessary to achieve complete tamponage and must have a high total absorption in order to avoid repeated sponge replacement.
Surprisingly, although ordinary gauze has been used for surgical sponges for a great many years and is still considered by most surgeons to be the best woven mate rial for such purposes, I have discovered it is not the optimum woven material for use in surgical sponges. I have found that treated open mesh tobacco cloth or cheese cloth, a form of which has been on the market for many years and which is described in the Secrist Patent No. 2,081,370, makes a surgical sponge which surpasses those made from ordinary gauze in most, if not all, of the desirable characteristics which such sponges should have.
FIGURE 1 is a plan view of a single sheet of typical open mesh cloth from which the sponges of this invention are made.
FIGURE 2 is an enlarged edge of the typical open mesh cloth of FIGURE 1.
FIGURE 3 is a plan view of a typical sponge of this invention showing the folding steps from a triple thickness of open mesh treated fabric.
FIGURE 4 is a different form of sponge made in accordance with the invention folded from the corners to produce a central zone of increased thickness and other zones of lesser thicknesses.
FIGURE 5 is another form of sponge made in accordance with the invention.
' FIGURE 6 illustrates the bridging tendency of ordi- ,i%,289 Patented June 22, 1965 "ice 2 nary gauze when placed on a corrugated surface and exposed to pressure.
FIGURE 7 illustrates the comparative conformability of the sponges of this invention when placed on the corrugated surface of FIGURE 6 and exposed to the same pressure as the gauze of FIGURE 6.
The preferred open mesh cloth for the products of this invention may be made of 20s to 60s yarn size with range of 30s to 40s being preferred. The twist multiple (turns per inch over square root of yarn number) of the yarn may range from 3 to 7 with the warp yarn preferably having a slightly higher twist multiple than the filler yarns. I prefer that the warp yarn have a twist multiple in the range of 4.25 to 5.0 with the filler yarns having a twist multiple of about 4. The thread count may vary from about 8 x 8 mesh to about 18 x 12 mesh with the optimum about 14 x 8 mesh before treatment. It has been found that to make this material operative for surgical sponges, it must be subjected to standard bleaching procedures and cotton must additionally be subjected to standard boiling procedures for surgical gauze or equivalent thereof.
As indicated in the patent above referred to, ordinary bleached tobacco cloth or cheese cloth as above described may be immersed in a water bath, preferably a hot bath, and while it is immersed or saturated it is strongly agitated causing at least the warp threads to assume sinuous or tortuous formations while the fabric shrinks and becomes thick and bulky. The bulkiness, and the configurations which the warp and weft threads assume, is set in the drying process. These configurations of the threads of the fabric are retained in the dried fabric and persist to a substantial extent even when the fabric, in sponge form, is wetted again as with exudate from a wound. It is possible, by the method explained in the above patent, to get a fabric in which the number of e bends is very great and such a fabric is satisfactory for the sponges of this invention, although it is preferred to stop the processing just short of the formation of e bends.
Although the method of the above patent has been used successfully in producing fabrics useful in the practice of this invention, it is obvious that a very similar material can be produced by other methods which distort the threads of an open mesh fabric from their usually rectangular pattern while the threads are wet and plastic and then dry them in their distorted configurations.
Referring once more to the drawings:
In FIGURE 1, the fabric 10 consists of warpwise threads =11 and weftwise threads 12. When the warp threads have a somewhat greater twist multiple, they tend to become somewhat more sinuous than the weft threads.
In FIGURE 2, two warpwise threads 11 of the fabric 10 are shown in their sinuous configurations while several weftwise threads 12 are shown in cross section.
In FIGURE 3, the sponge 20 is folded from the rectangle WXYZ which is a 3 to 6 ply fold fabric generally similar .to that illustrated in FIGURE 1 with cut edges 21 and 22 and side edges 23 and 24. The side edges preferably comprise one or more folded edges on one side and one or more folded edges and a selvage edge on the other side. But the side edges may have selvage edges in addition to folds on both sides. Alternatively a margin of a cut side edge may be folded in at either or both sides to form folded side edges. In FIGURE 3, the cut edges 21 and 22 are folded in as indicated by the arrows to give folded edges 25 and 26. The corners of the edges 21 and 22 are drawn away from the edges 23 and 24 in the folding process either by folding the corner or pleating the turned over portion. Then the shortened rectangle is folded transversely again to superimpose folds 26 and 25 and create fold 2-7. The thus formed rectangle is then folded again to superimpose fold 27 over folds 25 and 26.
-n FIGURE 4, the sponge 30, a type now popularly known as a fluif, is formed from the rectangle EFGH which is a 6 ply fold of fabric generally similar to that illustrated in FIGURE 1 with theedges 31 and 32 being.
folded edges and the abutting edges 33 and 34being'cut edges-and 36 being a selvage edge. The intermediate ply 35 has either a cut ed e Or a selvage edge adjacent to folded edge F6. The further folds 37 and 38 are made preferably at 45 to the lines GH and EF respectively and so that the folds GH and EF abut at the centerline SIM. Further folds 69 and 40 are then successively made, preferably so that these folds are parallel and so that the sponge sides at corners 41 and 42 form at least slightly obtuse angles The fold-s 38 and 40 and 37'and 39 are shownno't meeting to form a corner but the respectively adjacent sides may almost meet to form a substantially rectangular sponge if desired. In the sponge illustrated,
areas a abut along the lines PN and KQ, but the edges H'N and FL on one side and KP and O'Q on the other side may 'be separated by folding the corners H and F less deeply. The areas at in this sponge are 6 ply, the areas c are 12 ply, the areas b are 18 ply and the areas a are 24 ply. Th e sponge, therefore, has anarea of increased plies and hence increased cushioning, absorption, etc. from the corner 41 to the corner 42 in the area normally covering the wound. Furthermore, the thinner areas c which are 12 ply may be used for the taping areas. Ob-, vious ly, the gradations in thickness permit orientation of the sponge to obtain selective cushioning, absorbency and the like in selected areas. I i V f In FIGURE 5, the sponge 50 is forrined by folding a single ply of fabric generally similar-to fthat' illustrated in FIGURE 1 from the rectangular sheet RSTU having cut edges 51, 52,53 and 54. The Side edges 53 and 54 are then folded in as indicated to form-foldedv side edges 55 and 56 respectively. The ends including edges 51 and 52 are then'foldedso that the latter abut preferably centrally as indicated;v however, the location of the fab lt ment is not important. The folded end edges 64-and '59 are superimposed in the next endfold forming the fold 63. The sponge at this stage has four plies except at the folded side edges 55 and 56. The sponge may next be foldedto superimpos e side edges "55 and 56 producing an 8 ply sponge or preferably, as depicted, each side may be folded at a point one third of the transverse distance so that 'one side overlies the other thus producing 'a 12' ply sponge except in the areas where the folded edges 55 and 56 occur.
In FIGURE 6, a thickness of 12 plies of ordinary .gauze 60 made from cotton warp yarns-size 30s and. cotton filler yarns size 40s and having a thread'count of 20 x 12 mesh is shown placed on a corrugated metal sheet 61. The corrugations of the sheet 61 measure approximately 4 crevices and cavities with a minimum of force was discussed in the initial pages of the application.
As an illustration of the absorbability of the sponges of this invention ten sponges of 12 plies each of material similar to' that used in preparing the illustration of FIGURE 7 and averaging. in weight 2.9 grams each were prepared. Similarly, sponges of 12 plies each'of gauze material similar to that used in preparing 'FIGURE 6 and I averaging 2.4'gramseach were prepared. The absorbency 1 inch from crest to crest. A flat metal square plate 1'4 x 8 count, the fabric 70 was bulked in the treatment to weigh approximately the same per unit area as the 20 X 12 mesh gauze of FIGURE '6. The stack of bulked plies-70 was placed on the corrugatedusheetfil of FIGURE 6 and subjected to the weight of the. sameplate 62. The .conformability of the fabric is shown to be considerably greater than that of gauze 60 by the pone tration thereof partway into the valleys of the corrugated sheet. The importance in surgergy of the penetration into was measured by the Surgical Absorbency Test for Absorbent Cellulose in accordance withFederal Specification LC'166A, Sec.' 4.3.3'. The sponges were allowed .to sink and remain in waterfor 5 seconds and were then lifted from the water on a mesh platform and drained for 10 seconds (at which time the drainage was very much reduced) and weighed. The net' average weight of the sponges of this invention plus the water after draining for 10 seconds was 47.0 grams of which 44.1 grams was water. Thus i or 415.2 grams per gram of sponge represents the water retention coeflicient. In a similar test the 10 ordinary gauze sponges plus water weighed an average of 32.9 grams each ofwhich 30.5 was water. The comparative water retention coefficient of the ordinary gauze sponges was I e I 30.5 e
or grams per gramsof sponge. The experiment was repeated with stacks of .12 plies each of-the two-matcrials instead of sponges. On this test, the stacks made of thetreated tobacco cloth used in the products of th invention averaged 40.1 grams of which 3 7.'4 was water and 2.7 was fabric indicating a comparative water retentio'n coefficient of or 13.9 -grams per gram of fabric. Similarly, the ordinary gauze material stacks averaged 61.5 grams of which 29 grams was water and 2.5" grams was fabric. Ordinary gauze stacks, therefore, had a comparative water retentioncoefficient of or 11.6 grams per gram offabric. The difference between the Water retention coefiicients in each pair of tests is comparable (2.3 and 2.5) even though the absolute values are higher with the paired sponge tests. Sponges generally havehigher coetficients due to the slightly. difierent spacing of the plies when sponges are made "by folding the fabric. 1, v v v V I ,The enhanced resiliency and cushioning effect of the sponges of this 'invention'can be illustrated by using stacks .of 120 plies. ofth'e fabrics used in preparing the illustrations or FIGURES 6 and 7. This eliminates the effect of folding whichhas some influence on the resiliency and would varywith everytype of sponge. The results obtained by using stacked plies rather than folded sponges of this. invention; actually show an increase of resiliency but er a lower order for the bulky fabric-over the'ordinary gauze. I r e e A In the stack which simulates 10 sponges of 12 plies each 5 without. folding, 'the'plies air-e14" X 4" each and weigh approrrimately the same whether of gau ze orof the; treated open mesh: fabr c used in the products of this invention.
A Plexiglas, 4' x 4" square is' placed .on top of each stack and the stack height is' measured as weights are added.
Withordinary gauze no furher compression was obtained beyond 50% reduction from, the; original heightof 1% lnches at grams per square inch, while with the stack of open mesh fabricsimila'r to that'illustrated in FIGURE 1, grams per square inch did not exhaust the compressibility although the fabric was compressed to 38.1% of its original height of 2% inches.
The fact that a 4 x 4 inch sponge of this invention is thicker (with the same weight and cross sectional area) than an ordinary gauze sponge when made of the same yarns means that the sponges of this invention have greater aerating ability and hence permit the wound to remain in drier condition. It also means that the interstices of the sponges of this invention (due to their three-dimensional characters) are larger and hence are able to take up more viscous exudates without clogging.
One might think the sponges of this invention with larger interstices would spot through more easily but surprisingly the reverse is true. When a drop of colored liquid accurately deposited from a hypodermic syringe is placed on a stack of the open mesh fabric of which the sponges of this invention are made, it penetrates usually through only 3 layers with an average of 3.2 layers, whereas the same amount of liquid when placed on a stack of ordinary gauze penetrates through at least 4 layers but more often through 5 to give an average of 4.9 layers. This shows that the sponges of this invention are more efficient in distributing wound fluids layerwise than are ordinary gauze sponges and are thus more efficient in utilizing the absorptive capacity of the sponge before the top layer is wetted. This is important because a sponge with a dry outer surface tends to inhibit passage of bacteria. On the other hand, the passage of bacteria is expedited by the moist thoroughfare which results when the sponge has been spotted through by wound exudate. Similarly, this dry outer layer prevents staining of mate rials contacting the sponge. Another over-all effect of this efficient layer-wise distribution of exudate is the prolongation of the useful life of the dressing.
In addition, the sponges of this invention have the softness and feel of wind-blown washed cotton fabrics as contrasted to the lace curtain stiffness of ordinary gauze sponges.
The sponges of this invention are most effective when they consist of at least eight plies over the Wound area. The preferred number of plies, however, is 12. With fluffs it is desirable to have a centrally located zone which may be much thicker than 12 plies, however, and it may be desirable to have thinner peripheral areas not required for absorption for tape application which are of 6 plies or less. Because one of the principal uses of the sponges of this invention is in surgery, it is desirable that a radiopaque or X-ray detectable material be associated with such sponges when they are so used.
The sponges of this invention have another advantage over gauze sponges in that the three-dimensional character of the fabric after treatment causes the sponge surfaces to cling together making it possible to make rounded folded edges and thicker folded edges. Ordinary gauze must actually have its folded edges creased or pressed to prevent unfolding. Creasing and pressing makes the edges of ordinary gauze sponges harsh and almost abrasive in character whereas the rounded folds of the sponges of this invention are soft and conformable.
1. A surgical sponge free of exposed cut edges formed substantially of woven fabric comprising a bleached multilayered uncreased folded structure formed of bulked, open-mesh woven fabric, the threads of said fabric being distorted into sinuous and tortuous configurations emphasizing the three-dimensional character of said fabric when compared to the substantially planar character of ordinary surgical gauze, and constituting means whereby said fabric is bulked, said sponge having a weight per unit volume less than that of surgical gauze sponges formed of substantially planar gauze and having the same weight per unit area, said sponge being formed from a lengthwisefolded, three to six ply length of said bulked open-mesh woven fabric folded from both ends so that the end edges are in abutting to closely adjacent relationship to form a rectangular blank, said sponge comprising the central portion and inwardly folded opposite corner portions of said blank, the first folded pair of opposite corner portions of said blank having side edges in abutting to closely adjacent relations hip centrally of said sponge, the second folded pair of opposite corner portions of said blank partially overlying the first folded corner portions and partially overlapping each other centrally of said sponge thus forming a sponge with four major and two minor side edges, areas of said sponge having greater thickness extending along the line from the two opposite sponge corners at the junction of two major side edges and Which include folded edges made by folding adjacent corners of the blank inwardly, the four remaining sponge corners each being at the junction of a minor side edge and a major side edge where the folded corner portions of the blank do not overlap.
2. A surgical sponge free of exposed cut edges formed substantially of Woven fabric comprising a bleached multilayered uncreased folded structure formed of bulked, open-mesh woven fabric, the threads of said fabric being distorted into sinuous and tortuous configurations emphasizing the three-dimensional character of said fabric when compared to the substantially planar character of ordinary surgical gauze, and constituting means whereby said fabric is bulked, said sponge having a Weight per unit volume less than that of surgical gauge sponges formed of substantially planar gauze and having the same weight per unit area, said sponge being formed from a lengthwisefolded, three to six ply length of said bulked open-mesh woven fabric folded from both ends so that the end edges are in abutting to closely adjacent relationship to form a rectangular blank, said sponge comprising the central portion and inwardly folded opposite corner portions of said blank, the first folded pair of opposite corner portins of said blank having side edges in abutting to closely adjacent relationship centrally of said sponge, the second folded pair of opposite corner portions of said blank partially overlying the first folded corner portions and partially overlapping each other centrally of said sponge thus forming areas of said sponge having greater thickness extending along the line from the two opposite sponge corners which include folded edges made by folding adjacent corners of the blank inwardly.
References Cited by the Examiner UNITED STATES PATENTS 2,081,370 5/37 SeCriSt 139-391 2,168,286 8/39 Eustis et a1 128-156 X 2,453,705 11/ 48 Gallagher 128-156 2,698,270 12/54 Mesek 128-156 2,802,464 8/57 Baron 128--156 2,823,444 2/58 Davies et al l28156 2,928,389 3/60 Ganz et al 128296 RECHARD A. GAUDET, Primary Examiner.
.lORDAN FRANKLIN, Examiner.