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Publication numberUS3625220 A
Publication typeGrant
Publication dateDec 7, 1971
Filing dateOct 7, 1969
Priority dateOct 7, 1969
Publication numberUS 3625220 A, US 3625220A, US-A-3625220, US3625220 A, US3625220A
InventorsEngelsher Harvey J
Original AssigneeHorizon Ind Ltd
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Extendible suture guard
US 3625220 A
Abstract  available in
Previous page
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Claims  available in
Description  (OCR text may contain errors)

United States Patent [72] Inventor Harvey J. Engelsher Yonkers, N.Y. [21] Appl. No. 864,353 [22] Filed Oct. 7, 1969 [45] Patented Dec. 7, 1971 [73] Assignee Horizon Industries, Ltd.

Bronx, N.Y.

[54] EXTENDIBLE SUTURE GUARD 9 Claims, 7 Drawing Figs.

[52] U.S. C1 128/335, 128/3355, 285/303 [51] Int.C1 ..A6lb 17/04 [50] Field of Search 128/334, 335, 335.5, 336, 337, 339; 285/298, 302, 303; 24/ 129 D [56] References Cited UNITED STATES PATENTS 709,367 9/1902 Simpson 128/334 1,833,040 11/1931 Rader a 285/302 Primary Examiner-Dalton L. Truluck Attorney-Irving Seidman ABSTRACT: A retention suture guard is formed of a pair of semirigid inner and outer tubes arranged in telescoping relationship. Locking means between the tubes permit their relative axial movement in one direction to lengthen the device incremcntally as desired, while providing substantial resistance to relative axial movement in the opposite direction. in practice, the ends ofa suture extend through exit points in the skin on opposite sides ofa wound, with one end ofthe suture being threaded through the central bore of the suture guard. The tubes of the guard are then telescopically extended to have a total length equal to the distance between said exit points, and the suture ends are tied. The guard thus provides a generally flat support surface across the wound, and establishes fixed lateral points through which the suture 's tension is applied.

PATENTED DEE 719m SHEET 1 0F 2 Fig.3



INVIL'N'I'UR. HARVEY J. E LSHER sx'rsnmsts surunls GUARD This invention relates to a method and device for improving the surgical procedure using retention sutures to maintain the closure of incisions and wounds and to aid their healing. Retention sutures are used particularly to urge and hold together the adjacent sides of an opening, and further to align the cor responding layers of skin, fat, fascia, muscle and peritoneum of the two joined sides, and to maintain these layers in the immediate area of the closure in a generally relaxed state.

Unfortunately certain layers, particularly deeper layers, sometimes fail to join and heal properly, or they may become separated as in certain postoperative situations resulting in dihiscence, eventration, and hernia, or even total wound disruption or evisceration as occurs in some laparotomies and abdominal closures. In using retention sutures, other common and undesirable complications often occur particularly to the tissue adjacent the closure; these complications include ischemia, necrosis, infection, and postoperative scarring.

A variety of retention suture configurations and corresponding techniques for inserting sutures have been developed, each an attempt to provide better support for the closure to thus aid and hasten proper healing. Common examples of sutures are the through-and-through type, which circumscribes all the layers of the closure, and the figure-of-eight type, its lower loop encompassing only selected deeper layers such as the fascial, muscle and peritoneum layers, while its upper loop encompasses fat and skin layers. In each case there is an exposed upper loop portion of the suture extending out of exit points in the skin in the vicinity of the closure.

Employed with these common figure-of-eight and throughand-through suture configurations, are devices generally designated suture guards or bolsters used to reduce or distribute the suture's downward pressure that bears upon, irritates, and scars the skin adjacent to the closure at exit points. One of the commonly used guards is a single piece of flexible tubing which extends generally between exit points and across the closure, and through which the exposed loop portion of the suture is threaded. Because of their flexibility, such tubular guards will bend to fit the varying stitch lengths; however, such bending bows the guards to conform to upward rippling and inflammation of the skin about the closure. Consequently the immediate closure area is unsatisfactorily supported, while the skin near the exit points is subjected to excessive pressure from the ends of the suture guards.

Alternatively, rigid tubes or flat splints are used to guide the exposed portions of the sutures, with the expectation that the devices flat surfaces traversing the closures would distribute the pressure and counteract any upward distention of the closure. Difficulties arise, however, because often the distance between exit points of a suture is either longer or shorter than the length of the standard suture guard selected by the surgeon. When a suture which extends through a guard of improper length is tightened, the ends of the suture will be forced to take an angular position at the exit points of the skin, rather than extending normally through the skin surface. Since it is an objective that the retention suture substitute for and approximate the wound marginal pressure existing prior to incision, any exit angle of the suture ends different from normal is undesirable, as there will result high-stress areas in tissue adjacent the exit points with subsequent irritation and scarring of the tissue. During each surgical closure, the many sutures often vary in size both by design and by necessity. If the rigid suture guards selected are of uniform size, many will not match the various long and short stitches; and if different size guards are selected, impractical trial and error sizing would be required to obtain proper fits.

A third type of suture guard subject to many of the drawbacks discussed above, is the spring bar which maintains appropriate tension in the suture during the postoperative period. This is especially useful in active children where the tissues and sutures often receive substantial stress and pressure; however, imperfect matching of the lengths of sutures and spring bars results in undesirable angles and excessive pressure of the suture at the exit points.

While it is generally accepted that suture guards should be used with retention sutures, the surgeons and writers on this subject tend to disagree on the theories by which the various guards operate or should operate. As discussed above, the techniques and devices employed have numerous inherent difficulties, this being continually evidenced by the undesirable effects still occurring in the use of all types of known suture guards.

SUMMARY OF THE INVENTION The new retention suture guard of the present invention is fonned of inner and outer tubular members disposed in telescoping relationship with a locking means between the two members. An overall axial .length of the guard is established by these members, this length being extendible by their telescoping movement, and the locking means is formed of first and second locking parts on the outer and inner members respectively. These parts are releasably engaged to each other, thereby permitting incremental lengthening of the device during telescoping movement of the members in one direction, with the resulting length of the guard being greater than that of either tube alone. Relative axial movement of the members in the opposite direction is resisted by the locking engagement, so that the selected length of the guard may be maintained despite any compressive pressure tending to push the inner tube back into the outer tube. In one preferred embodiment the locking means comprises a plurality of axially spaced teeth or circular ridges on one tube and a corresponding tooth on the other tube, the tubes being axially movable only when sufiicient force is applied to cause their respective engaging teeth to deflect enough to permit passage of one with respect to the others.

In practice two ends of a retention suture extend from exit points spaced from the incision, and one of these ends is threaded through the lumen of the guard; however, before typing these ends together, the new guard is telescopically extended to the desired and optional length. With this invention each suture guard is individually adjusted until its length is substantially equal to the distance between the exit points of the corresponding suture. The guard thus establishes fixed points through which the suture ends extend generally normal to the skin, with a resulting lateral force applied that approximates the wound margins preincision lateral pressure for urging together the adjacent sides of a wound. This is a significant improvement over prior suture guards formed of flexible tubes which simply bend to conform to the spacing of the exit points with a concentration of pressure applied downward against the skin at these points, rather than generally parallel to the skin to close all layers of the incision as can now be accomplished. With respect to the rigid one-piece suture guards of the prior art, the new invention is also greatly superior. These new guards have the desirable characteristics provided by stiffness for distributing downward pressure, while being adjustable to fit every suture, in contrast to many one-piece guards of improper length, which were either used improperly or discarded as part of a trial and error procedure. Once the new suture guard is extended to the desired length, its locking means prevents any shortening of the device by telescopic movement of the tubular members in the opposite direction, but permits further lengthening at a later time if desired.

Actual use of these extendible guards of the present invention with retention sutures has demonstrated remarkable improvements in the speed and quality of healing and a reduction of complications. In specific comparative cases both known one-piece tubular rubber guards and the new extendible guards were used with different sutures on each closure. The results clearly established that in the tissue associated with the new suture guards, there was significantly less incidence of erythema, necrosis and infection; and where erythema occurred at all in this tissue, it was evidenced only at a much later date. Thus, the new guard is highly beneficial for faster and more satisfactory healing of closures requiring retention sutures, and it substantially eliminates many of the common and deleterious postoperative effects.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a fragmentary sectional view showing an incision or wound.

FIG. 2 is a similar view showing a flexible single-piece tubular suture guard.

FIG. 3 is a similar view showing a rigid single-piece splint suture guard.

FIG. 4 is a similar view showing the new extendible suture guard of this invention.

FIG. 5 is an exploded view of the new suture guard shown in section.

FIG. 6 is an elevation view in section of the new suture guard assembled an unextended.

FIG. 7 is a similar view, except that the new suture guard is extended.

DESCRIPTION OF THE PREFERRED EMBODIMENT FIG. 1 shows in cross section a typical incision or wound and a retention suture which might be used in combination with the extendible suture guard of the present invention. The layers of tissue exposed in this incision comprise skin 10 and 10a, fat 11 and 11a, fascia l2 and 12a, muscle 13 and 13a, fascia I2 and 12a, and peritoneum l4 and 14a. In closing such an incision the new suture guard is instrumental in making it possible for all the corresponding layers 10 and 10a, 11 and Ila, and so forth to be properly aligned and maintained together. How the preferred embodiment of this invention functions is best demonstrated by first considering the illustrations of two prior art suture guards having characteristics which are specifically improved upon by the new guard.

FIG. 2 shows a closure which is defective, because the lower layers of fascia 12, muscle 13, and peritoneum 14 have failed to join despite the close junction and healing of the upper layers of skin 10 and fat 11, this being the type of situation with a dangerous possibility of hernia or even total wound disruption. In this figure a through-and-through suture 15 defining a single loop has been used along with a suture guard 16 formed of a single flexible tube, which has become bowed resulting in excessive downward pressure on exit points 17, and insufiicient lateral pressure for the deeper layers.

In FIG. 3 a rigid, one-piece suture guard 18 is longer than the space 18 between the exit points I7, such that the ends of the suture 19 are forced to take an angular rather than normal orientation upon leaving the skin I0. While tension may be maintained in the suture, the layers within loop 20 will have inadequate lateral support for proper closure of the incision.

In FIG. 4 an extendible suture guard 21 of the present invention is shown with a sewn suture 22. It should be noted that parts 21a and 2lb have been telescopically extended until the guards overall length is substantially equal to the space 18' between the exit points 17. At these points the end portions of suture 22a extend generally normal to the skin, the ends of the guard establishing fixed points of lateral support, and also preventing the suture parts 22b from bearing against, irritating and scarring the skin area in the vicinity of the exit points.

A slight bowing of the extendible guard may occur which raises the center part thereof from contacting the actual closure 23, which then heals with further reduced direct pressure and scarring. Downward pressure applied by the guard is generally distributed along its length, such that excessive pressure near the exit points is avoided.

The construction of the new guard is disclosed in detail in FIGS. 5, 6 and 7, FIG. 5 showing the two component parts, FIG. 6 showing the parts assembled prior to use, and FIG. 7 showing the parts telescopically extended. Both the outer tube 24 and the inner tube 25 are made from a semirigid plastic, such as polyethylene. Of numerous practical sizes of this guard, the dimensions of one embodiment are given by way of example only: length variable between 2 and 3 inches with extension, outside diameter about five-sixteenths inch, and wall thickness of the tubes about three-sixtyfourths inch. Circular ribs 26 are disposed along the entire length of the inside wall of tube 24, while there are only a few corresponding ribs 27 on inner tube 25. As shown in the cross-sectional view of FIGS. 5-7, the ribs of tubes 24 and 25 define teeth pointing in opposite directions. It should be obvious that in the assembled state shown in FIGS. 6 and 7, the engagement of teeth 26 and 27 permits tube 25 to be moved only toward the right, and to be moved incrementally by spaces equal to the axial length of each tooth. During this relative movement of tube 25 toward the right, there must be at least some resilient deflection of the teeth however, the configuration of these engaged teeth will substantially preclude relative movement of the tube 25 toward the left, i.e., to telescopically shorten the guard, without very great and unlikely force.

In the embodiment shown in FIG. 6, the inner tube is slightly longer than the outer tube, such that the exposed end 25a can be gripped and pulled for the telescopic extension. Where the teeth 26 and 27 are substantially identical, the tips of teeth 26 will provide a bearing surface to support the outer surface 25b during its telescopic movement. It is further desirable to have finger-gripping means 28, 29 at one end of each tube; this is provided by a circular indentation, roughening, embossing or other convenient technique.

In variations of the embodiments shown, the outer tube could be the longer of the two tubes, or the inner tube could be the one to have teeth along its full length. Also many other forms of locking means would be feasible, including a hook element extending from the outside of the outer tube toward its bore, for engagement with teeth on the inner tube. The two tubes could even be engaged by mutual screw threads. Another optional feature is the rounded edges 30 on both tubes which might help avoid irritating the skin contacted. It should also be realized that the extendible suture guard of this invention does not necessarily require tubular members, and could comprise other forms of components or extendible material.

What is claimed is:

l. A suture guard device comprising:

a. an outer tubular member,

b. an inner tubular member movable disposed within the outer member in telescoping relationship, the device having an overall axial length defined by the two members, this length being extendible by said telescoping movement, and

c. locking means formed of first and second locking parts on said outer and inner members respectively, these parts being releasable engaged to each other to permit incremental lengthening of the device during telescoping movement of said members in one direction, said engagement resisting telescoping movement in the other direction for shortening the device.

2. A suture guard as defined in claim I wherein said inner member has length at least slightly greater than that of the outer member.

3. A suture guard as defined in claim I wherein one of said locking parts comprises a plurality of axially spaced elements defining incremental axial positions, and the other locking part comprises at least one cooperatively engaging element, at least one of said locking parts being sufficiently flexible to deflect for permitting said releasable engagement of said elements during said incremental lengthening of the device.

4. A suture guard device as defined in claim 3 wherein said first locking part comprises a plurality of circular ridges along the length of the inner surface of the outer member and extending inwardly, and the second locking part comprises at least one circular ridge on the outer surface of the inner member.

5. A suture guard device as defined in claim 4 wherein said ridges define teeth in axial cross section of the locking parts, the teeth in one of the parts pointing generally toward a first end of said part to facilitate movement of the other part toward said first end.

6. A suture guard device as defined in claim 1 further comprising gripping means on the end of the inner member which is extendible out of the outer member and on the opposite end of the outer member.

7. A suture guard device as defined in claim 1 wherein each tubular member and its corresponding locking part comprise an integral piece of molded plastic.

8. A suture guard device as defined in claim 7 wherein said integral pieces are polyethylene, the members having length of about 2 inches, outside diameter of about one-fourth inch and three-sixteenths respectively, and wall thickness of about onethirtysecond inch each.

9. A suture guard device as defined in claim I and including a bore therethrough, in combination with a retention suture inserted about and urging together adjacent parts of a closure, the external portion of the suture extending from spaced exit points in said adjacent parts and through said bore of the device, the tubular members of the device being telescopically extended such that the overall length of the device is substantially equal to the space between said exit points.

Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US709367 *Nov 29, 1901Sep 16, 1902Richard H SimpsonSurgical instrument.
US1833040 *Sep 23, 1929Nov 24, 1931Mueller Brass CoAdjustable extension for sprinkler systems
US1852098 *Apr 22, 1931Apr 5, 1932Anderson Alfred WSuture supporting and attaching plate
Non-Patent Citations
1 *Dennis et al. Surg. Forum 1953, pp. 601 607 128 334 R
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US3845772 *Sep 17, 1973Nov 5, 1974D SmithRetention suture device and method
US4092739 *Aug 29, 1977Jun 6, 1978Clemens Richard PMethod of replacing hair
US4950285 *Nov 27, 1989Aug 21, 1990Wilk Peter JSuture device
US5123913 *May 17, 1990Jun 23, 1992Wilk Peter JSuture device
US5263973 *Aug 24, 1992Nov 23, 1993Cook Melvin SSurgical stapling method
US5366480 *Dec 15, 1992Nov 22, 1994American Cyanamid CompanySynthetic elastomeric buttressing pledget
US5464426 *Mar 7, 1994Nov 7, 1995Bonutti; Peter M.Method of closing discontinuity in tissue
US5496348 *May 19, 1995Mar 5, 1996Bonutti; Peter M.Suture anchor
US5507775 *Jan 21, 1994Apr 16, 1996Progressive Surgical Products Inc.Tissue expansion and approximation device
US5522846 *Mar 10, 1995Jun 4, 1996Bonutti; Peter M.Suture anchor
US5527343 *Nov 23, 1994Jun 18, 1996Bonutti; Peter M.Suture anchor
US5534012 *May 26, 1995Jul 9, 1996Bonutti; Peter M.Method and apparatus for anchoring a suture
US5549630 *Aug 17, 1994Aug 27, 1996Bonutti; Peter M.Method and apparatus for anchoring a suture
US5549631 *May 22, 1995Aug 27, 1996Bonutti; Peter M.Method of closing discontinuity in tissue
US5569305 *May 26, 1995Oct 29, 1996Bonutti; Peter M.Apparatus for anchoring a suture
US5571175 *Jun 7, 1995Nov 5, 1996St. Jude Medical, Inc.Suture guard for prosthetic heart valve
US5584862 *May 26, 1995Dec 17, 1996Bonutti; Peter M.Method and apparatus for anchoring a suture
US5618310 *Jul 27, 1994Apr 8, 1997Progressive Surgical Products, Inc.Tissue, expansion and approximation device
US5643295 *Jan 25, 1995Jul 1, 1997Yoon; InbaeMethods and apparatus for suturing tissue
US5649940 *May 3, 1996Jul 22, 1997Innovasive Devices, Inc.Suture tensioning device
US5665109 *Dec 29, 1994Sep 9, 1997Yoon; InbaeMethods and apparatus for suturing tissue
US5690655 *Jan 9, 1997Nov 25, 1997Innovasive Devices, Inc.Suture tensioning device
US5843178 *Jun 20, 1996Dec 1, 1998St. Jude Medical, Inc.Suture guard for annuloplasty ring
US5843179 *Oct 21, 1996Dec 1, 1998St. Jude Medical, Inc.Suture guard for prosthetic heart valve
US5902319 *Sep 25, 1997May 11, 1999Daley; Robert J.Bioabsorbable staples
US5984933 *Jul 29, 1997Nov 16, 1999Yoon; InbaeApparatus for suturing tissue
US6090131 *Dec 4, 1998Jul 18, 2000Daley; Robert J.Bioabsorbable staples
US6120526 *Jan 29, 1999Sep 19, 2000Daley; Robert J.Delivery devices for bioabsorbable staples
US6319280Aug 3, 1999Nov 20, 2001St. Jude Medical, Inc.Prosthetic ring holder
US6485504 *Jun 22, 2000Nov 26, 2002James A. MagovernHard or soft tissue closure
US6500195Jun 1, 2001Dec 31, 2002Peter M. BonuttiMethod and apparatus for anchoring a suture
US8007515Mar 22, 2007Aug 30, 2011Coroneo, Inc.Suture retention device
US8377096Jul 8, 2011Feb 19, 2013Coroneo, Inc.Suture retention device
US8496657Aug 29, 2008Jul 30, 2013P Tech, Llc.Methods for utilizing vibratory energy to weld, stake and/or remove implants
US8617185Feb 13, 2008Dec 31, 2013P Tech, Llc.Fixation device
US8747439Jul 10, 2006Jun 10, 2014P Tech, LlcMethod of using ultrasonic vibration to secure body tissue with fastening element
US8808329Apr 3, 2012Aug 19, 2014Bonutti Skeletal Innovations LlcApparatus and method for securing a portion of a body
US8814902Jul 31, 2006Aug 26, 2014Bonutti Skeletal Innovations LlcMethod of securing body tissue
US8845687Sep 17, 2013Sep 30, 2014Bonutti Skeletal Innovations LlcAnchor for securing a suture
US8845699Mar 6, 2012Sep 30, 2014Bonutti Skeletal Innovations LlcMethod of securing tissue
US8936628 *Aug 17, 2010Jan 20, 2015Kls-Martin, L.P.Suture-retaining sternal clamp assembly
US9060767Mar 2, 2009Jun 23, 2015P Tech, LlcTissue fastener and methods for using same
US9067362Oct 31, 2007Jun 30, 2015P Tech, LlcMethod of using ultrasonic vibration to secure body tissue with fastening element
US9089323Feb 21, 2006Jul 28, 2015P Tech, LlcDevice and method for securing body tissue
US9138222Feb 17, 2004Sep 22, 2015P Tech, LlcMethod and device for securing body tissue
US9149281Jun 7, 2013Oct 6, 2015P Tech, LlcRobotic system for engaging a fastener with body tissue
US9155544Mar 20, 2002Oct 13, 2015P Tech, LlcRobotic systems and methods
US9173647Feb 21, 2006Nov 3, 2015P Tech, LlcTissue fixation system
US9173650May 31, 2011Nov 3, 2015P Tech, LlcMethods and devices for trauma welding
US9192395May 7, 2013Nov 24, 2015P Tech, LlcRobotic fastening system
US9220503Aug 11, 2010Dec 29, 2015The Trustees Of The University Of PennsylvaniaSurgical device for conjuctival tissue closure
US9226828Sep 20, 2013Jan 5, 2016P Tech, LlcDevices and methods for stabilizing tissue and implants
US9271741Aug 8, 2013Mar 1, 2016P Tech, LlcRobotic ultrasonic energy system
US9271766Nov 11, 2013Mar 1, 2016P Tech, LlcDevices and methods for stabilizing tissue and implants
US9271779Aug 13, 2013Mar 1, 2016P Tech, LlcMethods of using a robotic spine system
US9402668Dec 4, 2013Aug 2, 2016P Tech, LlcTissue fixation system and method
US9421005Feb 6, 2007Aug 23, 2016P Tech, LlcMethods and devices for intracorporeal bonding of implants with thermal energy
US9439642Feb 24, 2010Sep 13, 2016P Tech, LlcMethods and devices for utilizing bondable materials
US9463012Oct 5, 2005Oct 11, 2016P Tech, LlcApparatus for guiding and positioning an implant
US9486227Jul 25, 2013Nov 8, 2016P Tech, LlcRobotic retractor system
US9545268Mar 12, 2014Jan 17, 2017P Tech, LlcDevices and methods for stabilizing tissue and implants
US9579129Mar 11, 2014Feb 28, 2017P Tech, LlcDevices and methods for stabilizing tissue and implants
US9585725Jun 21, 2013Mar 7, 2017P Tech, LlcRobotic arthroplasty system
US20030139776 *Feb 13, 2003Jul 24, 2003Anthony PaolittoSuture retention device
US20060241695Jul 10, 2006Oct 26, 2006Bonutti Peter MMethod of using ultrasonic vibration to secure body tissue with fastening element
US20070179511 *Mar 22, 2007Aug 2, 2007Coroneo, Inc.Suture retention device
US20080039845 *Feb 6, 2007Feb 14, 2008Bonutti Peter MMethods and devices for intracorporeal bonding of implants with thermal energy
US20080114399 *Oct 31, 2007May 15, 2008Bonutti Peter MMethod of securing body tissue
US20110040307 *Aug 11, 2010Feb 17, 2011The Trustees Of The University Of PennsylvaniaSurgical device for conjuctival tissue closure
US20110054547 *Aug 17, 2010Mar 3, 2011Charles AndersonSuture-retaining sternal clamp assembly
USRE36974 *Mar 2, 1998Nov 28, 2000Bonutti; Peter M.Suture anchor
DE3146634A1 *Nov 25, 1981Jun 1, 1983Aesculap Werke AgElement set for osteosynthesis
EP0535802A1 *Aug 28, 1992Apr 7, 1993Melvin S. CookImproved surgical stapling method
U.S. Classification606/233, 285/303
International ClassificationA61B17/04, A61B17/03
Cooperative ClassificationA61B17/0466
European ClassificationA61B17/04B