US 3633582 A
A device to facilitate consistent and accurate placement of sutures for closing a wound or incision comprises clamping means having a closed position for clamping the edge portion of the tissue of an open wound or incision. An elongated guide plate is fixed to the clamping means and has an operative position extending generally parallel to the edge of said wound or incision when said clamping means is in said closed position. Locating means, for example notches in the edge of the guide plate, are utilized to locate the placement of sutures in predetermined positions for closing said wound or incision.
Description (OCR text may contain errors)
United States Patent Primary Examiner Dalton L. Truluck AttorneyEdward F. Levy ABSTRACT: A device to facilitate consistent and accurate placement of sutures for closing a wound or incision comprises clamping means having a closed position for clamping the edge portion of the tissue of an open wound or incision. An elongated guide plate is fixed to the clamping means and has an operative position extending generally parallel to the edge of said wound or incision when said clamping means is in said closed position. Locating means, for example notches in the edge of the guide plate, are utilized to locate the placement of sutures in predetermined positions for closing said wound or incision.
PATENTEU JAM 1 I972 SHEET 1 BF 2 INVENTOR. CHARLES STEINMAN BY v ATTORNEY PATENTED JAM 1 I972 SHEET 2 BF 2 /0 m y e 76 i f 5 F929 F .8
INVENTOR. CHARLES STElNMAM ATTORNEY SUTURE PLACEMENT GUIDE DEVICE BACKGROUND OF THE INVENTION The present invention relates to a suture placement guide device which is designed to assist surgeons in the proper placements of surgical sutures in the closing of abdominal or other wounds or incisions.
In certain types of abdominal wound closures, multiple sutures must be placed at a predetermined distance in from the edge of the wound and must be spaced at predetermined, laterally spaced intervals along the longitudinal extent of the wound or incision on either side of the latter. After several or all of the sutures are placed, they are tied to close the wound or incision. Heretofore, surgeons have placed these sutures through all or part of the thickness of the abdominal wall and in placing such sutures have had to judge the distance from the edge of the wound or incision and the lateral spacing between successive sutures. At times the distances and spacing would fall short of ideal, causing bulging of the tissues between sutures and other irregularities in the closure.
In using certain types of surgical wound closure devices, for example the surgical suture and sling device disclosed in my copending application Ser. No. 580,464 filed Sept. 19, 1966, now U.S. Pat. No. 3,496,940 issued Feb. 24, I970, accurate placement of the sutures is imperative.
The device in the aforesaid copending application includes a flexible strip of material having spaced flexible filaments at each longitudinal edge. The strip is placed inside a wound or incision and the filaments are stitched through the tissue bordering the wound and secured together above the wound to serve as sutures. The strip underlies the wound and acts as a supporting splint therefor. In using this device, accurate placement of sutures is important so that when the sutures are properly placed and finally tied, the hidden sling part of the suture is properly drawn into place with adequate tension and spacing in all directions of the wound in relation to the sutures and sling.
Accordingly, an object of the present invention is to provide a suture placement guide device which is adapted to be used for consistently and accurately locating the placement of sutures in predetermined positions for closing a wound or incision.
Another object is to facilitate the placement of sutures a predetermined distance from the edge of the wound or incision and at predetermined, spaced intervals along the longitudinal extent of the wound or incision.
A further object is to provide means for clamping a suture placement guide device at the edge portion of an open wound or incision to thereby dispose in said open wound or incision a guide plate having locating means thereon, whereby said latter means are utilized to locate the placement of sutures in predetermined positions for closing the wound or incision.
Additional objects and advantages of the invention will become apparent during the course of the following specification where taken in connection with the accompanying drawings.
SUMMARY OF THE INVENTION A suture placement guide device comprises a clamping means having a closed position for clamping the edge portion of the tissue of an open wound or incision. An elongated guide plate fixed to said clamping means has an operative position extending generally parallel to the edge of said wound or incision when said clamping means is in said closed position. The guide plate is adapted to be disposed in a desired position and held there by the clamping means so that locating means on said guide plate may be utilized to locate the placement of sutures in predetermined positions for closing said wound or in- ClSlOl'l.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a plan view of a suture placement guide device constructed according to one embodiment of the invention wherein the device is shown as it appears after it has been inserted in an incision or wound and has been slide underneath the end of the incision or wound, the position of the inserted guide plate shown in broken lines.
FIG. 2 is a sectional view taken along line 2-2 of FIG. I and showing the suture placement guide device clamped in position in the open incision or wound and showing sutures after the latter have pierced the skin.
FIG. 3 is a plan view of two suture placement guide devices having their longitudinal ends linked to one another to provide a double length guide.
FIG. 4 is a front elevational view of the suture placement guide shown in FIGS. 1 and 2.
FIG. 5 is an end elevational view of the suture placement guide looking from the right hand side of FIG. 4.
FIG. 6 is a partial end elevational view of the device looking from the left-hand side of FIG. 4.
FIG. 7 is a plan view of the device looking from the top of FIG. 4.
FIG. 8 is a partial enlarged section taken along line 8-8 of FIG. 3, showing the linkage between the two devices.
FIG. 9 is a sectional view similar to FIG. 8 but showing the ends of the two suture placement devices in the process of being linked to one another.
DETAILED DESCRIPTION Referring in detail to the drawings, there is shown in FIGS. 1, 2 and 4 a preferred form of a suture placement guide device 10 made in accordance with the present invention. The device 10 comprises a pair of clawlike forceps l2 and 14 each formed of a respective pair of elongated elements 16, 18 and 20, 22 suitably pivoted to one another at 24 and 26, respectively. The pivotal element 16 of forceps 12 and the pivotal element 22 of forceps 14 are respectively secured, e.g. by welding or the like as indicated at 28, to a connecting plate 32 which is integrally joined at an obtuse angle to a guide plate 34. As will hereinafter be explained, the guide plate 34 is provided with a plurality of needle locating means in the form of spaced notches 35 equally spaced along one longitudinal edge to accurately locate the placement of the sutures.
The forceps l2 and 14 are substantially identical and, accordingly, only the forceps 14 will be described in detail. As can best be seen in FIG. 5 the forceps elements 20 and 22 are provided with lateral projections 36 and 38 respectively, each having serrations 39 which are adapted to engage one another thereby to define locking means for locking the forceps 14 in a desired pivotal position. Suitable handle means in the form of finger-receiving, closed loops 40, 42 are provided on the forceps elements 20, 22 respectively to facilitate manual opening and closing thereof.
As will hereinafter be explained, the forceps 12, I4 are adapted to clamp the tissue adjacent an incision or wound and to this end, clamping means are provided at the ends of the forceps. In the illustrated embodiment, the clamping means on forceps 14 comprises three spaced lateral projections 44, 45, 46 in the form of curved, pointed claws or teeth on the elongated forceps element 20, which projections are adapted to mesh with three similar opposed lateral projections 47, 48, 49 on the forceps element 22, whereby the opposed, lateral projections 44 to 49 cooperate to clamp the tissue adjacent an incision as shown in FIG. 2.
From the above description, it will be apparent that the forceps 14 may be manually opened to separate the opposing clamp projections 44 to 49 for receiving a section of tissue, therebetween, and thereafter manually closed to pierce and clamp the interposed tissue. Once the forceps 14 are closed to the desired position, e.g. the position shown in FIG. 2, the locking means 36, 38 will lock the forceps 14 in the desired clamping position. The forceps 12 function in a similar manner.
The suture placement guide device 10 heretofore described is adapted to be used to assist surgeons in the proper placement of surgical sutures in the closing of a wound and, as shown in the illustrated embodiment, is particularly adaptable for use in applying the sutures of the surgical suture and sling device disclosed in my copending US. Pat. No. 3,496,940 issued Feb. 24, I970. As shown in the attached drawings and as more fully described in the aforesaid patent, the aforementioned suture and sling device 52 comprises a central elongated strip 54 made of a soft, flexible material and provided with a plurality of evenly spaced filaments 56 which extend from one longitudinal edge of the strip 54 and a corresponding number of filaments 58 aligned with the respective filaments 56 and extending from the opposite longitudinal edge of the strip 54. The free end of each of the filaments 56 and 58 terminates in a rigid curved needle 60 having an edged cutting point 62 for piercing body tissue. The strip 54 may be made in varying widths and assorted lengths or in standard lengths sufficiently long to enable sections to be cut to suitable size at the time of surgery.
FIGS. I and 2 show, by way of example, a portion of the abdomen A of the human body having an elongated incision 64 in the front abdominal wall. The strip 54 is shown in its inserted position, with the integral rows of filaments 56 and S8 piercing the abdominal wall. In closing the incision 64, the suture and sling device is first located outside of the body cavity and the filaments at one side thereof are first sewn through one side of the incision, using the suture placement guide device 10 to determine the needle placement, as will be presently described. In FIG. I, the filaments 58 at the righthand edge of the incision 64 have already been placed, and the suture placement guide device 10 is shown clamped to the left-hand side of the incision, where it has located the sutures 56.
In using the suture placement guide device 10, the latter is grasped by the forceps handles 40, 42 to insert the guide plate 34 into the open cavity and to locate it underneath the abdominal wall at one edge of the incision. To begin the suturing at one side of the incision, the guide plate 34 is initially placed within the abdominal cavity and then shifted toward one end of the incision, for example to the position shown in FIG. 1 wherein the lateral extension of the guide plate 34, that is the portion 66 of guide plate 34 which projects beyond the forceps I4, is located beyond the top end 68 of the incision 64.
The forceps 14 are manipulated so that the clamping teeth 44-49 are positioned a selective distance inwardly from the edge of the incision 64, for example, a distance of threeeighths inches, and thereafter closed to clamp the abdominal wall as shown in FIG. 2. Subsequently, the second forceps 12 is positioned the same distance inwardly from the edge of the incision 64 and closed as aforesaid. This maintains the guide plate 34 parallel to the edge of the incision. Once the device 10 has been clamped into position, the notches 35 on the guide plate will be located to dispose the notches 35 in the position corresponding to the desired placement of the sutures. In this regard, the notches 35 on the guide plate 34 are spaced apart by a distance equal to the spacing between the filaments 56 on the strip 54 of the sling device 52.
With the device 10 clamped in position, the filaments S6 at one side of the sling device are threaded through the abdominal wall from the interior of the abdominal cavity by utilizing the curved needles 60, the placement of each threaded filament being determined by the location of the notches 35. It will be apparent, therefore, that the position of the notches 35 determine the lateral spacing of the sutures and also the spacing of the sutures from the edge of the incision. It will be observed, particularly in FIG. 2, that the surgeon using the guide device 10 will be able to readily observe the clamp teeth 44 to 49, particularly the clamp teeth 44 to 46, which are external of the tissue, and position the guide plate 34 so that the notches 35 thereon will be located at a desired distance from the edge 70 of the incision. Thus the surgeon will be able to accurately and consistently control the depth and lateral spacing of the sutures. This is in contrast to known practices in which the surgeon must visually judge the lateral spacing of sutures, as well as the distance of the suture placements from the edge of the incision.
It will be appreciated that in the use of a suture and sling device such as the device 52 shown in FIGS. 1 and 2, the incision is closed by tightening and tying matching pairs of filaments S6 and 58 across the top of the incision. This draws the sling strip 54 firmly against the under surface of the tissue so that it underlies and supports the closed edges of the incision. If the sutures are placed at varying distances from the edges of the incisions, or if they are spaced at different distances from each other, the closed incision may bulge or become deformed, or the internal sling strip may crumple or become inaccurately positioned.
As previously mentioned, the guide plate 34 may be initially placed centrally within the abdominal cavity and subsequently shifted laterally to the broken line position of FIG. 1 to dispose the guide plate extension 66 beyond the end 68 of the incision 64. Thus the guide device 10 permits accurate placement of the filaments beyond the end 68 of the incision 64 by utilizing the notches 35 in said lateral extension 66. For this purpose, the guide plate 34 is first disposed at an angle relative to the longitudinal extend of the incision 64, and the forceps 14 are employed to clamp an edge portion of the abdominal wall as previously explained. Thereafter, while the forceps 14 are still clamped, the guide device I6 may be manually shifted by the surgeon to substantially longitudinally align the guide plate 34 with the longitudinal extent of the incision 64, the abdominal wall, of course, being sufficiently pliable to permit such movement. The forceps 12 is then employed to clamp the edge portion of the abdominal wall in the desired location. With the clamping means on both forceps 12, 14 positioned as aforesaid, notches 35 on the guide plate 34 will be in the proper position to commence threading of the filaments, starting with the end notch 35 positioned beyond the end 68 of the incision 64.
Depending on the length of the incision, two or more of the guide devices 10 may be linked together in tandem to form a continuous, elongated guide extending the length of the incision. To this end, the longitudinal ends of the guide plate 34 are provided with linking means which consist of a tongue and groove. Thus, each end of the guide plates 34 has a pair of short terminal flanges 72 and 74 substantially perpendicular to the general plane of the guide plate 34. The flange 72 has an opening 76 therein whereas the other flange 74 is shorter and is in the form of a solid tab.
In order to join and link the two guide devices 10 and I0 shown in FIGS. 3, 8 and 9, the guide plates of the two devices are disposed as shown in FIG. 9 whereby the opening 76 in flange 72 is aligned to receive the flange 74. Once the tab 74 is inserted through the opening 76, the two guide plates are moved into longitudinal alignment with one another as appears in FIGS. 3 and 8 whereby the two devices will be linked in tandem. The distance between the last notch 35 and the longitudinal end of the guide plate 34 is equal to one half the distance between two spaced notches so that when the two guide plates are linked as aforesaid, the distance between the two end notches will be equal to the distance between all the other notches, thereby providing a continuous placement guide for the sutures.
After the guide device or linked devices are used to place the suture filaments at one side of the incision, in the manner explained above, the device or devices are removed and secured to the other side of the incision where they are used to place the filaments at the other side of the sling through the opposed side portion of the incision. After the filaments at both sides of the incision are placed, the guide device or devices are removed and the matching pairs of filaments are tightened and tied. After knotting, the excess lengths of filaments and the terminal needles are cut away. The strip 12 underlying the incision will be held firmly by the tightly secured filaments and the strip will act as a sling underlying the closed edges of the incision, and reinforcing the closure.
While preferred embodiments of the invention have been shown and described herein, it will be obvious that numerous omissions, changes, and additions may be made in such embodiments without departing from the scope of the invention.
What is claimed is:
l. A suture placement guide device comprising clamping means having a closed position for clamping the edge portion of the tissue of an open wound or incision, an elongated guide plate fixed to said clamping means and having an operative position extending generally parallel to the edge of said wound or incision when said clamping means is in said closed position, and locating means on said guide plate to direct the placement of sutures in predetermined positions for closing said wound or incision, said clamping means comprising a pair of forceps each having a pair of pivotal elements, and an interconnecting plate fixed to one element of each pair of forceps, said guide plate being joined to said interconnecting plate at an obtuse angle.
2. A suture placement guide device according to claim 1 wherein said locating means comprises a plurality of spaced notches in one longitudinal edge of said guide plate.
3. A suture placement guide device according to claim 2 wherein said notches are V-shaped and are equally spaced along the edge of the guide plate.
4. A suture placement guide device according to claim 1 wherein said forceps have a plurality of opposed intermeshing projections at the ends of said forceps elements for grasping and clamping said edge portion of tissue.
5. A suture placement guide device according to claim 4 further comprising locking means on said forceps for locking the latter in said closed position.
6. A suture placement guide device according to claim 1 wherein said guide plate has an end portion extending beyond said forceps and defining a lateral extension adapted to be shifted within an abdominal cavity or the like beyond the end of said wound or incision to facilitate placement of sutures beyond the end of said wound or incision.
7. A suture placement guide device according to claim 1 further comprising linking means at the longitudinal ends of said guide plate for linking two like guide plates in longitudinal alignment.
8. A suture placement guide device according to claim 7 wherein said linking means comprises a perpendicular flange at each longitudinal end of said guide plate, one of said flanges having an opening defining a groove, said other flange defining a tab whereby the tab of one guide plate is adapted to be received in the groove of another guide plate to link the two guide plates in tandem.
9. A suture placement guide device according to claim 1 wherein said pivotal elements of said forceps have opposed intermeshing clamping projections on the ends of said elements, said clamping projections being disposed generally perpendicular to the longitudinal axis of the respective pivotal element from which said clamping projections extend, said guide plate being disposed beyond the longitudinal end of said pivotal elements and spaced from said clamping projections, said guide plate further being disposed at an acute angle relative to said clamping projections, thereby adapting said guide plate to be placed underneath the edge portion of the tissue of an open wound or incision as said clamping means are placed in said closed position.