Circumferential medical closure device and method
View Patent ↗A flexible medical closure screen device for a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed. The use of same for eliminating or reducing the formation of subcutaneous voids or pockets, which can potentially form hematoma and seroma effects, is also disclosed. Alternative embodiments of the invention have circumferential configurations for approximating and closing separated tissue portions such as tendons, nerves and blood vessels. Tissue closure methods include the steps of circumferentially applying a screen to separated tissue portions and penetrating the tissue portions with prongs.
1. A tubular, circumferential medical closure device for closing a separation between first and second tissue portions, which device includes:
a flexible screen having opposite first and second open ends, a longitudinal axis extending between said ends, multiple strands extending generally parallel to the longitudinal axis along substantially the entire length of said device between said screen ends;
said strands being adapted for forming a circumferential configuration;
each said strand including first, smooth face and a second, convex face presenting a semi-circular or semi-elliptical cross-sectional configuration of said strand; and
each said strand also including multiple prongs positioned in spaced relation along substantially the entire length of said device intermediate said screen ends, at least some of said prongs being located intermediate said screen ends, said prongs projecting from the convex face of said strand and adapted for penetrating tissue.
2. The device according to claim 1 , which includes:
said prongs having multiple orientations with respect to said strands.
3. The device according to claim 1 , which includes:
an externally-applied vacuum dressing connected to said screen; and
a negative pressure source connected to said dressing.
4. The device according to claim 1 , which includes:
prongs oriented both inwardly and outwardly with respect to said screen;
said device being adapted to receive a first elongated tissue portion therein with said inwardly-oriented prongs engaging same; and
said device being adapted to be received in a second elongated tissue portion with said outwardly-oriented prongs engaging same.
5. The device according to claim 1 wherein each said strand includes:
primary and secondary lines positioned in generally parallel, juxtaposed sliding relation with respect to each other;
multiple prongs mounted on said primary line; and
said prongs being adapted for engagement by said secondary line whereby said prongs can be reoriented by sliding said lines relative to each other.
6. The device according to claim 1 , which includes:
a passage extending between and open at said ends; and
said prongs comprising first and second sets of teeth adjacent to and oriented inwardly from said first and second ends respectively, said prongs projecting into said passage.
7. A method of circumferentially closing a separation between first and second tissue portions, which method comprises the steps of:
providing a generally tubular flexible screen with opposite first and second open ends and a longitudinal axis extending between said screen ends;
providing said screen with multiple strands extending generally parallel to the longitudinal axis along substantially the entire length of said screen between said screen ends;
each said strand including a first, smooth face and a second, convex face presenting a semi-cirular or semi-elliptical configuration of said strand;
approximating said first and second tissue portions;
configuring and positioning said screen circumferentially with respect to said tissue portions;
providing each said strand with multiple prongs positioned in spaced relation along substantially the entire length of said device intermediate said screen ends; and
penetrating said first and second tissue portions with said prongs.
8. The method according to claim 7 , which includes the additional steps of:
wrapping said screen around said approximated tissue portions;
trimming or overlapping excess screen material;
releasing said tissue portions;
placing said screen in tension; and
fastening said screen in a tubular configuration either receiving or received by said tissue portions, or both.
9. The method according to claim 7 , which includes the additional steps of:
preforming said screen in a tubular configuration; and
inserting one or both of said tissue portions into said screen and/or inserting said screen into one or both of said tissue portions.
10. The method according to claim 7 , which includes the additional steps of:
stabilizing and compressing the tissue portions and the device with an externally-applied vacuum dressing to maintain the embedded prong position against increasing distraction load on the prongs and to improve the efficiency of the system.
11. The method according to claim 7 , which includes the additional steps of:
providing each said strand with generally parallel, adjacent primary and auxiliary lines;
connecting said prongs to said primary lines;
sliding said primary and auxiliary lines relative to each other;
engaging said prongs with said auxiliary lines; and
reorienting said prongs relative to said primary lines.
12. A tubular, circumferential medical closure device for closing a separation between first and second tissue portions, which device includes:
a flexible screen having opposite first and second open ends, a longitudinal axis extending between said ends and multiple strands extending generally parallel to the longitudinal axis along substantially the entire length of said device between said device ends:
said strands being adapted for forming a generally tubular, circumferential configuration;
each said strand including a first, smooth face and a second, convex face presenting a semi-circular or semi-elliptical cross-sectional configuration of said strand;
each said strand including multiple prongs positioned in spaced relation along substantially the entire length of said device intermediate said device ends, at least some of said prongs being located intermediate said device ends;
an externally-applied vacuum dressing connected to said screen; and
a negative pressure source connected to said dressing.