TISSUE APPROXIMATION DEVICE
A tissue approximation device comprising two elongate arms, an attachment means to secure the elongate arms to each other, adhesive pads on at least a portion of the elongate arms to anchor the tissue approximation device to the skin, and a locking means to lock the elongate arms in place relative to each other.
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This application is a divisional of U.S. application Ser. No. 10/674,653, filed on Sep. 30, 2003, the contents of which are hereby incorporated by reference in their entirety.
BACKGROUNDThe present invention is directed to a tissue approximation device that is capable of maintaining approximation of a wound without substantial eversion of the edge surfaces of the wound and without requiring the physician or health care attendant to manually secure the device.
Prior art tissue approximation devices have been described. For example, U.S. Pat. No. 6,042,599 discloses a tissue approximation forceps that is particularly useful in approximating edge surfaces of a wound where liquid topical adhesive is to be used. The forceps described in this reference comprise two leg members having grip members with grip surfaces that lie in a common plane. The grip surfaces are described as a plurality of parallel longitudinally extending, generally, V-shapes projections or sharp projections. This reference discloses that when the handle of the forceps is squeezed together, the grip members move towards one another in the same plane, in a direction generally parallel to the skin tissue, while the grip surfaces engage the skin tissue on opposite sides of the wound, such that the opposite edges of the wound are moved together without everting the edge surfaces. Specifically, the projections on the grip surfaces are urged into and against the skin tissue to approximate the wound and frictionally hold the engaged skin tissue. The reference also discloses a ratchet type-locking arm on the handle that fits the other handle member when the forceps are in the closed position. However, a problem associated with this tissue approximation forceps is that the physician must apply a force perpendicular to the skin tissue to maintain contact between the gripping surfaces and the skin tissue, in order to maintain approximation of the wound. Therefore, this device will not free-up the physician's hand.
Accordingly, it is desirable to have a tissue approximation device that is capable of maintaining approximation of a wound without substantial eversion of the edge surfaces of the wound during application and curing of a topical skin closure adhesive on a wound, without requiring the physician or health care attendant to manually secure the device.
SUMMARYDescribed herein is a tissue approximation device that is capable of maintaining approximation of a wound without substantial eversion of the edge surfaces of the wound during application of a topical skin adhesive, an adhesive film or skin staples to close a wound, without requiring the physician or health care attendant to manually secure the approximation device. In particular, described herein is a tissue approximation device comprising two elongate arms, an attachment means to secure the two elongate arms to each other, adhesive pads to anchor the tissue approximation device to the skin, and a locking means to lock the two elongate arms in place relative to each other.
In one embodiment, the elongate arms may each have a handle and a tong, such as in a pair of parallel forceps. An adhesive pad is on the distal end of each of the tongs, which may be located on the distal ends of the elongate arms of the parallel forceps. Further, the attachment means may be a pair of slidable bosses, while the locking means may be a ratchet mechanism on the forceps.
In another embodiment, an adhesive pad is on the distal end of each of the tongs, which are located on the distal ends of a pair of forceps. Further, the attachment means may be a yoke on the forceps, while the locking means may be a ratchet mechanism on the forceps.
The adhesive pads in either of these embodiments may be of several forms. For example, the adhesive pad may be fixedly attached to the distal end of each of the tongs. The adhesive pad may have a first adhering surface and a second surface having a socket mechanism that communicates with a ball on the distal end of each of the tongs, and the adhesive pad is optionally rotatable around the ball. Alternatively, the second surface of the adhesive pad may have a ball and the distal end of each of the tongs may have a socket mechanism. Alternatively, the adhesive pads may have a first adhering surface and a second surface having female receiving mechanism that communicates with a male protrusion on the distal end of each of the tongs; or the adhesive pad may have a first adhering surface and a second surface having a male protruding mechanism that communicates with a female receiving mechanism on the distal end of each of the tongs.
The tissue approximation device of the present invention approximates a wound without substantially everting the edge surfaces of the wound during application of a topical skin adhesive, an adhesive film or skin staples to close a wound.
The tissue approximation device may be made of any shape to accommodate the adhesive pad described below. In general, the device may have a pair of elongate arms that are interconnected and substantially similar to each other, each may have a handle and a tong, the tong portion being located on the distal end of the elongate arm. The attachment means of the tissue approximation device hold the pair of elongate arms in a position relative to each other. As an example, the tissue approximation device may be either the parallel forceps as shown in
As discussed above, the tissue approximation device may be a pair of forceps where the tongs accommodate the adhesive pad. The adhesive pad may be pre-assembled, or may be fixedly attached to or detachable from the distal end of each of the tongs. The adhesive pads may have a first adhering surface and a second surface having a socket mechanism that communicates with a ball on the distal end of each of the tongs, and the adhesive pad is optionally rotatable around the ball (
The adhesive pads are specifically designed such that the adhering surface has high shear resistance to hold the skin tissue adjacent to the approximating wound and low peel resistance for easy removal from the skin tissue after the topical wound adhesive has cured. The adhesive surface may be formed from one or more adhesive materials selected from the group consisting of polymeric acrylics, polyisobutylene, polyurethane, polymeric silicone and copolymers of these materials. The thickness of the adhesive may be about 0.0015 to about 0.005 inches and may be applied directly to the adhesive pad or to both sides of a polyethylene foam substrate having a total thickness of between about 0.025 inches and 0.075 inches, which in turn is attached to the adhesive pad. The preferred adhesive has a peel strength between about 50 and 150 oz/in when tested according to PSTC Method #1 Mod./180°.
Additionally, the tissue approximation device has locking means to lock the two elongate arms described above in a fixed position relative to each other. For example, the locking means may be a ratchet mechanism having a ratchet catch and a ratchet arm with a plurality of ratchet teeth, as shown in
In the embodiment shown in
Referring to
Elongate arms 212 and 214 are on the same plane and movably connected to each other for example by bosses 215 and 219 as shown in
Ratcheting mechanism 224 shown in
As shown in
In the embodiment shown in
The tongs and adhesive pads interface may be designed to pivot multi directionally by means of a ball and socket mechanism shown in
As shown in
As shown in
The tissue approximation device described in
Referring now to
As an example, the tissue approximation device may be used in the following manner as depicted in
While the present invention has been described and illustrated by reference to particular forms, those of ordinary skill in the art will appreciate that the invention lends itself to variations not necessarily illustrated herein. For this reason, then, reference should be made solely to the appended claims for purposes of determining the true scope of the present invention.
Claims
1. A tissue approximation device comprising two elongate arms, an attachment means to secure the elongate arms to each other at one or more locations, adhesive pads movably connected on the ends of the elongate arms to anchor the tissue approximation device to the skin, and a locking means to lock the elongate arms in place relative to each other, wherein (i) the adhesive pads are spaced apart from the one or more locations of the attachment means in the direction of the elongate arms, and (ii) the tissue approximation device has an open and a closed position, and when in the closed position, the adhesive pads are parallel and non-contiguous to each other, where the adhesive pad has a first adhering surface and a second surface rotatably coupled to the distal end of each of the elongate arms by a ball and socket connector, wherein the second surface has one of a socket and a ball that communicates with the other one of a ball and a socket on the distal end of each of the elongate arms, and the adhesive pad is rotatable around the ball about at least two axes, wherein the elongate arms form parallel forceps, the attachment means is a pair of slidable bosses, and the locking means is a ratchet mechanism on the forceps.
2. The tissue approximation device of claim 1, where the distance between the elongate arms is adjustable by means of a ratchet mechanism.
3. A tissue approximation device comprising two elongate arms, an attachment means to secure the elongate arms to each other at one or more locations, adhesive pads movably connected on the ends of the elongate arms to anchor the tissue approximation device to the skin, and a locking means to lock the elongate arms in place relative to each other, wherein (i) the adhesive pads are spaced apart from the one or more locations of the attachment means in the direction of the elongate arms, and (ii) the tissue approximation device has an open and a closed position, and when in the closed position, the adhesive pads are parallel and non-contiguous to each other, where the adhesive pad has a first adhering surface having a center line and a connector formed of one of a male protruding mechanism and a female receiving mechanism, wherein the connector is formed on an edge of the adhesive pad offset from the center line and slidingly engages the other of a male protruding mechanism and a female receiving mechanism disposed on the distal end of each of the elongate arms, wherein each adhesive pad is rotatable about the distal end of the elongate arm to which it is connected.
4. The tissue approximation device of claim 3, where the elongate arms form a pair of forceps, the attachment means is a yoke on the forceps, and the locking means is a ratchet mechanism on the forceps.
5. The tissue approximation device of claim 4, where the distance between the elongate arms is adjustable by means of the ratchet mechanism.
6. The tissue approximation device of claim 3, wherein the connector of the adhesive pad is a male protruding mechanism formed as a rod and the distal end of the elongate arm is a female receiving mechanism formed as a sleeve.
7. The tissue approximation device of claim 3, wherein the connector of the adhesive pad is a female receiving mechanism formed as a sleeve and the distal end of the elongate arm is a male protruding mechanism formed as a rod.
8. A tissue approximation device for application to a skin surface adjacent to a wound, comprising:
- a pair of arms, each arm having a longitudinal axis and opposed ends, wherein one end includes a handle and the other end includes a tong with a connector;
- an attachment mechanism coupled to each arm that movably couples the arms to each other so that a distance between each tong is selectively variable;
- an adhesive pad removably coupled to the connector of each tong, wherein each adhesive pad has an adhesive surface that extends in a plane generally parallel to the longitudinal axis of the respective tong, the adhesive surface having a high shear resistance for holding the skin surface and a low peel resistance for removal from the skin surface, and wherein the connectors support the adhesive pads to be positionable in a common plane on opposed sides of the wound and conform to the skin surface adjacent to the wound; and
- a locking mechanism coupled to each arm to selectively lock the pair of arms in a fixed position relative to each other, wherein the connector is a pivotal connector that connects one edge of the adhesive pad to the tong to pivot about the longitudinal axis of the respective arm wherein the pivotal connector is one of a rod and a sleeve and the adhesive pad includes the other of the rod and the sleeve, wherein the rod and the sleeve are slidably coupled together in a press fit manner.
9. The tissue approximation device of claim 8, wherein the arms are connected in a scissors configuration.
10. The tissue approximation device of claim 8, wherein the adhesive pad includes serrations that provide flexibility to the adhesive surface.
11. The tissue approximation device of claim 8, wherein the locking mechanism includes a ratchet.
12. The tissue approximation device of claim 8, wherein the arms are made of a resilient material.
13. A tissue approximation device for application to a skin surface adjacent to a wound, comprising:
- a pair of arms, each arm having a longitudinal axis and opposed ends, wherein one end includes a handle and the other end includes a tong with a connector;
- an attachment mechanism coupled to each arm that movably couples the arms to each other so that a distance between each tong is selectively variable;
- an adhesive pad removably coupled to the connector of each tong, wherein each adhesive pad has an adhesive surface that extends in a plane generally parallel to the longitudinal axis of the respective tong, the adhesive surface having a high shear resistance for holding the skin surface and a low peel resistance for removal from the skin surface, and wherein the connectors support the adhesive pads to be positionable in a common plane on opposed sides of the wound and conform to the skin surface adjacent to the wound; and
- a locking mechanism coupled to each arm to selectively lock the pair of arms in a fixed position relative to each other, wherein the connector is a rotatable connector that connects the adhesive pad to the tong to pivot at least about the longitudinal axis and an axis substantially perpendicular to the longitudinal axis and the rotatable connector is one of a ball and a socket and the adhesive pad includes the other of the ball and the socket, wherein the ball and socket are snap fit together in an interference fit.
14. The tissue approximation device of claim 13, wherein the arms are connected in a parallel configuration.
15. The tissue approximation device of claim 13, wherein the attachment mechanism includes at least one pair of slidable bosses coupled between the arms.
16. The tissue approximation device of claim 13, further comprising a spring disposed between the arms to bias the arms with respect to each other.
17. A method for closing a wound in the surface of a patient's skin, comprising the steps of
- (1) providing a tissue approximation device comprising two elongate arms, an attachment means to secure the elongate arms to each other at one or more locations, and a locking means to lock the elongate arms in place relative to each other, wherein providing the tissue approximation device includes connecting an adhesive pad to an end of each elongate arm and adjusting a position of each pad relative to the skin surface, wherein (i) the adhesive pads are spaced apart from the one or more locations of the attachment means in the direction of the elongate arms, and (ii) the tissue approximation device has an open and a closed position, and when in the closed position, the adhesive pads are parallel and non-contiguous to each other;
- (2) positioning the adhesive pads to skin on opposed sides of a wound;
- (3) approximating the wound by actuating the tissue approximation device in a direction to move the adhesive pads towards each other in a common plane that is generally parallel to the skin tissue;
- (4) engaging the locking means to assure that the edges of the wound do not move;
- (5) applying a topical skin closure adhesive to the wound; and
- (6) removing the adhesive pads from the skin surface.
18. The method of claim 17, wherein the elongate arms of the tissue approximation device form parallel forceps, the attachment means including a pair of slidable bosses, and the locking means including a ratchet mechanism on the forceps.
19. The method of claim 18, wherein the distance between the elongate arms of the tissue approximation device is adjustable by means of a ratchet mechanism.
20. The method of claim 17, wherein the elongate arms of the tissue approximation device form a pair of forceps, the attachment means is a yoke on the forceps, and the locking means is a ratchet mechanism on the forceps.
21. The method of claim 20, wherein the distance between the elongate arms of the tissue approximation device is adjustable by means of a ratchet mechanism.
22. The method of claim 18, wherein the adhesive pad has a first adhering surface and a second surface having a socket mechanism that communicates with a ball on the distal end of each of the elongate arms, and the adhesive pad is optionally rotatable around the ball.
23. The method of claim 20, wherein the adhesive pad has a first adhering surface and a second surface having a socket mechanism that communicates with a ball on the distal end of each of the elongate arms, and the adhesive pad is optionally rotatable around the ball.
24. The method of claim 18, wherein the adhesive pad has a first adhering surface and a second surface having a ball that communicates with a socket mechanism on the distal end of each of the elongate arms.
25. The method of claim 20, wherein the adhesive pad has a first adhering surface and a second surface having a ball that communicates with a socket mechanism on the distal end of each of the elongate arms.
26. The method of claim 18, wherein the adhesive pad has a first adhering surface and a second surface having female receiving mechanism that communicates with a male protrusion on the distal end of each of the elongate arms.
27. The method of claim 20, wherein the adhesive pad has a first adhering surface and a second surface having female receiving mechanism that communicates with a male protrusion on the distal end of each of the elongate arms.
28. The method of claim 18, wherein the adhesive pad has a first adhering surface and a second surface having a male protruding mechanism that communicates with a female receiving mechanism on the distal end of each of the elongate arms.
29. The method of claim 20, wherein the adhesive pad has a first adhering surface and a second surface having a male protruding mechanism that communicates with a female receiving mechanism on the distal end of each of the elongate arms.
30. The method of claim 18, wherein the distal end of each of the elongate arms has a passageway therein such that the adhesive pad communicates with said passageway.
31. The method of claim 20, where the distal end of each of the elongate arms has a passageway therein such that the adhesive pad communicates with said passageway.
32. The method of claim 18, where the adhesive pad has a passageway therein such that the distal end of each of the elongate arms is within said passageway.
33. The method of claim 20, where the adhesive pad has a passageway therein such that the distal end of each of the elongate arms is within said passageway.
34. The method of claim 17, where the attachment means and the locking means are the same.
35. The method of claim 34, where the adhesive pads are located on at least a portion of each of the elongate arms.
Type: Application
Filed: Mar 15, 2013
Publication Date: Aug 22, 2013
Applicant: ETHICON, INC. (Somerville, NJ)
Inventor: Ethicon, Inc.
Application Number: 13/843,229
International Classification: A61B 17/28 (20060101); A61B 17/00 (20060101);