US 3541591 A
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Description (OCR text may contain errors)
Nov. 17, 1970 H. J. HOEGERMAN METHOD AND APPARATUS FOR CLOSING WOUNDS I 2 Sheets-Sheet 1 Filed April 26, 1968 INVENTOR Ala/er L/ //0EE/1/41/ H. J. HOEGERMAN METHOD AND APPARATUS FOR CLOSING WOUNDS Nov. 17, 1970 2 Sheets-Sheet 2 Filed April 26, 1968 United States Patent US. Cl. 128-335 Claims ABSTRACT OF THE DISCLOSURE A footplate has a slot extending from an edge towards its center. A wound-closing suture is disposed in the slot for subsequent closure of the slot and the clamping of the suture firmly in place. An alternate embodiment provides a pair of footplates connected together by a slotted neck. The neck is capable of being severed from each footplate while simultaneously clamping the sutures to the footplates. A suture is first anchored in a footplate and then passed through body tissue to the other side of the wound. The suture is drawn sufficiently tight to snugly abut the footplate against the skin. A second footplate is engaged with the suture on the opposite side of the wound, the wound closed, and the suture clamped in the second footplate.
BACKGROUND OF THE INVENTION This invention relates to a wound-closing apparatus and method. More particularly, the invention relates to an apparatus and method in which a suture is anchored in wound-closing, force-distributing footplates placed on either side of the wound.
In the closing of wounds and surgical incisions, it has been a long-standing practice to use only suture threads to approximate adjacent edges of skin and underlying body tissue. The suture is passed through body tissue across the incision and then brought above the skin on the opposite side of the incision. The ends of the suture are tied after each stitch. The tying operation is critical because the force exerted by the suture on the surrounding body tissue must not be excessive but must be sufiicient to close the Wound or incision.
This classical method of closing incisions and wounds subjects body tissue to high pressures because the surface area of con-tact between the skin and the suture material is very small. The high pressure is incident to the tension required to approximate incision and wound edges. The high pressure often causes a patients skin to indent, produces cross hatc scarring, and leads to the suture cutting through the wound edges. A patients discomfort is obviously adversely affected by such suture-caused tissue damage. Moreover, the tight sutures cause considerable pain when the wound swells from, for example, edema.
Conventionally sutured wounds and incisions often suffer from inadequate closure because of their nature and inadequate bearing tissue. In addition, wound and incision edges between sutures often gap because of unsupported tissue. This gapping and possible cutting require greater healing time than would be necesary with uniform approximation without tissue damage. The probability of infection also increases with the number of stitches used.
Patient discomfort suffers from the classical suture method of closing wounds and incisions because of the time required in surgery. The surgeon is required to place several knots in each suture and then cutoff their free ends. Therefore, the duration of anesthesia and surgical assault is compounded by this technique.
Improvements have, therefore, been proposed to obviate the problems of suture pressure, patient discomfort, surgery time and inadequate wound closure. One such proposal is disclosed in US. Pat. 2,199,025. The patentee provides slotted discs and a layer of soft material between each disc and the skin through which the suture is passed. The pressure from the suture is distributed over a relatively wide area to obtain a better pressure distribution at the wound edges and to reduce tearing of skin and body tissue adjacent the suture. The ends of the suture are hand-tied to the discs.
Notwithstanding the seeming efficacy of the patentees approach, it is not entirely satisfactory because of the large number of individual suture ties which must be hand-made by a surgeon.
SUMMARY OF THE INVENTION The present invention provides a surgical device and method for closing incisions and wounds. Wound closure is effected without the necessity of a surgeon tying knots in the suture thread employed.
In one form, the present invention contemplates a surgical device having a footplate with a hole for receiving the suture thread. Means are provided for permanently clamping the suture thread in the footplate by closing the hole onto the thread. The hole may be in the form of a slot which extends from a lateral periphery of the footplate inwardly to a terminus within the plate. The slot provides an easy means'for threading the suture thread onto the footplate. The slot also provides a convenient means for clamping the thread in the footplate.
One preferred means for clamping the suture thread within the footplate contemplates the forming of a footplate of a malleable material and plastically deforming the footplate to close the slot onto the suture thread. Other means for clamping the suture thread in the footplate is provided by a male latching element and a mating female latching recess. Upon closing the slot, the male latching element locks in the female latching recess to clamp the suture thread within the slot. The male latching element may be disposed to overhang the opening of the slot. In this instance, the mating female recess is disposed below the slot opposite the male latching element. Upon forcing the slot closed, the male latching element deflects over an end of the footplate into locking engagement with the female recess.
One aspect of the method of the present invention employs a surgical device just described. A suture thread is clamped in a first footplate by closing a slot onto the suture thread. The free end of the suture thread is then passed through body tissue from a first side of the Wound to a second side of the wound such that the first footplate is drawn against the skin adjacent the wound and the free end of the suture extends through the skin on the second side of the wound. The wound edges are then approximated by applying a wound closure fo-rce through a second footplate. While the wound closure force is maintained, the free end of the suture thread is clamped to the second footplate by closing its slot onto the free end of the suture thread. Slot closure may be accomplished either by plastically deforming the footplate material or through a male latching element locking in a mating female recess.
The presently preferred form of the present invention increases the rate at which the wound may be closed over the surgical device method just described. This form of the invention contemplates a pair of footplates integrally connected through a connecting neck, such that the footplates are in spaced relationship on either side of the neck. The footplates and neck preferably have a continuous slot for receiving the suture thread. The suture thread may be clamped by closing the slot onto the thread. Slot closure may be accomplished by plastically deforming the material onto the suture thread or through a male and female latch.
The present invention also contemplates a method of utilizing the double footplates and a connecting neck. A
single footplate is attached to a suture thread. The free end of the suture thread is passed through a patients body tissue from a first to a second side of the wound such that the first footplate is drawn against the skin on the first side of the wound and the suture extends through the skin on the second side of the wound. The free end of the suture thread on the second side of the wound is then engaged with the integral footplates and connecting neck. Engagement may be provided through a continuous slot extending through the footplates and connecting neck and the placing of the free end of the suture in the slot. The wound edges are then approximated by applying a wound closure force through the single footplate and the integral footplates. The free end of the suture thread is then clamped in the skin abutting footplate of the integral footplates and the connecting neck is severed in a manner which effects a resultant free end of the suture thread being clamped in the remaining free footplate. Clamping may be effected by closing the slot in the connecting neck onto the suture thread such that the suture thread is firmly attached to both footplates when the connecting neck is severed. The slot may be closed onto the suture thread by plastically deforming the connecting neck or by locking a male latching element in a mating female latching recess. The resultant free portion of the suture thread is then clamped to a footplate for the beginning of a second stitch. The process is repeated until the wound, or incision, is closed.
The method and apparatus in the present invention provides a medically sound wound and incision closure. It avoids tissue tearing, contamination, undesirable scarring and patient discomfort, all of which are associated with the classical method of suturing wounds and incisions. The footplates provide a relatively large area through which the wound closing force is distributed to abutting skin. By avoiding the tying of the suture thread with each stitch, the time required to close wounds and incisions is materially reduced. These advantages are especially evident with the preferred form of the present invention which employs a connecting neck between two spaced-apart footplates. With the simultaneous severing of the connecting neck and the clamping of the suture thread in the footplates, the requirement of clamping a suture thread in a single footplate with each application is avoided.
These and other features, aspects and advantages of the present invention will become more apparent from the following description, appended claims and drawings.
BRIEF DESCRIPTION OF THE FIGURES FIG. 1 is a perspective view of a footplate constructed 1 in accordance with the present invention and shows, in phantom, the position of the footplate prior to its closure on a suture thread;
FIG. 2 is a perspective view of an alternate embodiment of the present invention showing an alternate mode of closing a footplate on a suture thread;
FIG. 3 is a perspective view of an integral, double footplate construction joined by a connecting neck;
FIG. 4 is a perspective view of one of the footplates shown in FIG. 3 severed from its associated footplate with a suture thread clamped in the connecting neck;
FIG. 5 is a perspective view, similar to FIG. 4, showing an alternate embodiment of the construction shown in FIG. 3;
FIG. 6 is a schematic plan view of the wound closed with the apparatus and in accordance with the method of the present invention; and
FIG. 7 is a perspective, schematic view which also shows the closing of a wound with the apparatus and method of the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 illustrates one preferred construction of a footplate in accordance with the present invention. The footplate is shown in general by reference numeral 10. Footplate 10 is formed of a plastically deformable, malleable material. The footplate is generally rectangular in shape and has a slot 12 extending from a frontal face 14 inwardly to its terminus within the footplate. Slot 12 is Wedge-shaped, as shown in phantom, before the closure of the footplate on a suture thread. The wedge is sized for the accommodation of a suture thread 16. The footplate includes cooperating, projecting portions 18 and 20 above and below slot 12. These projecting portions define the slot. A base 22 joins projecting portions 18 and 20. Each of the lateral sides of the footplate is relatively large in area to provide a large pressure distribution area against the patients skin.
In use, suture thread 16 is inserted in slot 12 and projecting portions 18 and 20 collapsed to close on the suture thread. The suture thread is then clamped in footplate 10. Complete collapse of slot 12 is, of course, not necessary to effectively clamp suture thread 16. The free end of the suture thread is then passed from one side of a wound, through the proximate body tissue, and up through the skin on the other side of the wound until footplate 10 abuts the patients skin. The suture extending from the exit side of the wound is anchored in a similar footplate while the wound edges are approximated.
FIG. 2 illustrates an alternate embodiment 30 of a footplate. This embodiment provides a positive mechanical lock to close the footplate on a suture thread without elastically deforming the footplate. As in the previously described embodiment, footplate 30 has a wedge-shaped slot 32 for receiving a suture thread 34. Complementing projecting portions 36 and 38 extend from base 40 and define wedge-shaped slot 32. A male latching element 42 depends below the outer end of projecting portion 36. This male latching element includes a transverse, inwardly directed flange 44 which extends the breadth of slot 32. Projecting element 38 has a face 46 at its outer end. A mating female latching recess 48 is provided in this face. Suture thread 34 is clamped in footplate 30 when projecting portions 36 and 38 are forced together. Upon forcing the projecting portions together, transverse flange 44 will deflect over the upper portion of face 46 and into locking engagement with recess 48. Suture thread 34 is then firmly clamped in footplate 30.
Referring to FIGS. 3 and 4, a footplate assembly 52 is illustrated. The assembly includes a pair of aligned, laterally spaced footplates 54 and 56. These footplates are very similar in construction to footplate 10 which was previously described. The footplates are joined by an elongated connecting neck 58. A wedge-shaped slot is provided in footplate 56 for receiving a suture thread 62. A similar slot 64 is provided in footplate 54 for the same purpose. A slot 66 is provided in neck 58 for suture thread 62. Slots 60, 64 and 66 are in register in order that suture thread 62 may be received in them and passed completely through assembly 52. Neck 58 is in the form of a plastically deformable V-shaped channel. Slot 66 is defined by flanges 70 of this channel.
In use, footplate assembly 52 is placed over suture thread 62 such that the thread is received in slots 60, 64 and 66. A suitable tool is employed to simultaneously sever an intermediate section of neck 58 and forceably move flanges 70 towards each other. Upon such movement of flanges 70, the severed ends of suture thread 62 are firmly clamped in the plastically deformed channel. This is seen in FIG. 4.
FIG. 4 illustrates suture thread 62 clamped firmly in the collapsed flanges 70 of channel 58. The suture thread passes through slot 64 of footplate 54 for a subsequent suturing of a wound. It is preferred that after the simultaneous clamping and severing of suture thread 62 and channel 58, that the channel not extend above the inner face of footplate 54 to any appreciable extent in order to minimize interference with dressing. It is also contemplated that the simultaneous severing and clamping of channel 58 will plastically force the projecting portions of the spaced-apart footplates together while severing channel 58 flush with the inner surface of the footplates. This would avoid any protrusion of the severed channel from the footplates.
FIG. illustrates a construction of the footplate assembly similar to that illustrated in FIGS. 3 and 4. The complementary footplate illustrated in FIG. 3 is not shown. A footplate 80, similar to footplates 54 and 56, has a wedge-shaped slot 82 defined by projecting portions 84 and 86 of the footplate. A connecting neck 88 depends laterally inward from its integral connection with projecting portions 84 and 86 of footplate 80. Connecting neck 88 has a wedge-shaped slot or recess 90 defined by flanges 92 and 94. A suture thread 96 may be received by slot 90 and slot 82 for its clamping. Channel 88 has a posi tively acting lock to effect this clamping function. Flange 92 has a downwardly depending male latching element 98 at its free end. Latching element 98 includes an inwardly extending transverse flange 100. Flange 94 has a complementary recess 102 for accepting male latching element 98. The provision of a recess allows a flush lock. Male latching element 98 is capable of deflecting outwardly over the end of flange 94 into its mating locking engagement in recess 102.
The closing of channel 88 may be effected in one of two ways. Initially, flange 92 may be made free from footplate 80. In this case, flange 92 is closed upon suture thread 96 and locked by locking element 98 engaging the end of flange 94 in recess 102. Alternately, channel 88 may be made integral with footplate 80. In this instance, the clamping of flange 92 on flange 94 carries with it projecting portions 84 and 86 to not only close slot 90, but slot 82 of the foot plate.
With reference to FIGS. 6 and 7, the method of the present invention will now be described. A surgical incision 110 in a patients skin 112 is closed in one of two ways.
The first of these methods is illustrated in FIG. 6. A footplate, such as footplate 10, is deformed to clamp a suture thread 16. The clamped suture thread is then passed through the patients body tissue across incision 110 and brought through the skin on the other side of the incision. A second of the footplates is then passed over the free end of suture thread 16 and pressed against the patients skin. The incision is then approximated by applying a slight tension on suture thread 16 while the second footplate is held against the skin. The second footplate 10 is then plastically deformed to clamp the free end of the suture thread to it while the wound closure force is maintained. The resulting free end of the suture is then severed and the first of a series of stitches effected. This process is repeated until the incision 110 is closed.
FIG. 7 illustrates the use of a footplate assembly such as is shown in FIG. 3. A suture is passed into slots 60, 64 and66 of a footplate assembly 52. The suture is then clamped firmly in these slots while connecting neck 58 is severed. The resulting footplates, 54 and 56, and clamped sutures are similar to that shown in FIG. 4. The free end of the suture thread is then passed through the patients body tissue from one side of the incision 110 to the other side of the incision by needle 114 where it is brought out through the skin for the attachment of a second footplate. The captive footplate, shown by reference numeral 54, is brought firmly against the skin adjacent the edge of incision 110. A second of the footplate assemblies 52 is then attached to suture thread 62 while a wound closing force is applied through first footplate 54 and the edges of the incision approximated. This is done by passing suture 62 into slots 60, 64 and 66 of a second footplate assembly 52 and then applying a wound closing force through first footplate 54, the suture thread and footplate 56 of the second assembly. Second footplate 56 of the second assembly is then severed from its complementary footplate 54. A stitch has been effected and suture thread 62 is attached to a new first footplate 54 for the neXt wound-closing stitch.
The present invention has been described with reference to certain preferred embodiments. The spirit and scope of the appended claims should not, however, necessarily be limited to the foregoing description.
What is claimed is:
1. surgical device for closing incisions or wounds comprising:
(a) a first footplate having a suture thread receiving slot extending from the lateral periphery of the footplate inwardly to a terminus within the plate;
(b)1a second footplate identical with the first footp ate;
(c) a severable connecting neck between the footplates and integrally joining them, the connecting neck having a slot in register with the slots of the footplates which opens in the same direction as the footplate slots and terminates within the neck; and
(d) means for permanently clamping the suture thread to each of the footplates while the connecting neck is being severed and without tying the suture thread.
2. The surgical device claimed in claim 1 including the suture thread, the suture thread being received in the slots of the footplates and the connecting neck.
3. The surgical device claimed in claim 1 wherein the suture thread clamping means is provided by malleable material about the slots of the footplates, the connecting neck upon severing being operable to close the slots in the footplates by plastically deforming the malleable material about the slots of the footplates.
4. The surgical device claimed in claim 1 wherein the suture thread clamping means is provided by the connecting neck, the connecting neck being deformable to clamp the suture thread.
5. The surgical device claimed in claim 1 wherein the suture thread clamping means is provided by the connecting neck, the connecting neck having a male latching element integral with one side thereof and a female latching recess on the other side thereof, the male latching element being operable to lock in the female latching recess to clamp the suture thread upon forcing the sides of the connecting neck together.
6. A method of suturing a wound or the like having a first and a second side, through the use of a suture thread and first and second footplates, each footplate having a slot extending from a lateral surface thereof to an inward terminus, a male latching element and a mating female latching recess on either side of the slot, comprising the steps of:
(a) clamping the suture thread in the first footplate by closing its slot onto the suture thread and locking its male latching element in its female latching recess;
(b) passing a free end of the suture thread through body tissue from the first to the second side of the wound such that the first footplate is drawn against the skin on the first side of the wound and the free end of the suture extends through the skin on the second side of the wound;
(c) approximating the wound edges by applying a wound closure force with the first and second footplates and the suture thread; and
(d) clamping the free end of the suture thread in the second footplate by closing its slot onto the free end of the suture thread and locking its male latching element in its female latching recess while the wound closure force is maintained.
7. A method for suturing a wound or the like having a first and second side comprising the steps of:
(a) attaching a suture thread to a first footplate;
(b) passing the free end of the suture thread through body tissue from the first to the second side of the wound such that the first footplate is drawn against the skin on the first side of the wound and the suture extends through the skin on the second side of the wound;
(c) engaging the free end of the suture thread with second and third footplates, the second and third footplates being integrally connected through a connecting neck;
(d) approximating the wound edges by applying a wound closure force with the first and second footplates through the suture thread;
(e) clamping the free end of the suture thread to the second and third footplates; and simultaneously (f) severing the connecting neck such that the resultant free end of the suture thread remains clamped to the third footplate.
8. The method claimed in claim 7 wherein:
(a) a slot is provided in the second footplate, the third footplate and the connecting neck;
(b) the engaging step includes placing the free end of the suture thread in the slot; and
(c) the clamping step includes closing the slot in the connecting neck onto the suture thread.
9. The method claimed in claim 8 wherein the clamping step includes plastically deforming the connecting neck onto the suture thread.
10. The method claimed in claim 8 wherein the clamping step includes locking a male latching element on one side of the connecting neck into a mating female latching recess on the other side of the latching element.
References Cited UNITED STATES PATENTS Anderson 128-335 Davidson 128335 Conn 128335 Payton 128346 Brown 128346 X Kariher et a1. 128346 Czorny et al 128214.4
FOREIGN PATENTS France.
US. Cl. X.R.