ELECTROSURGICAL SYSTEM AND METHOD FOR TREATING CHRONIC WOUND TISSUE

• US 20090209958A1
• Filed: 04/27/2009
• Published: 08/20/2009
• Est. Priority Date: 01/06/2006
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Davison, Terry S., Warne, Brian, Kwende, Martin
• Granted Patent: US 8,876,746 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 2018/00452 Skin
• CPC Class Codes: A61B 2018/1213 creating an arc
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2218/007 Aspiration

Abstract

An electrosurgical method for treating chronic wound tissue, comprising: positioning an active electrode in close proximity to the chronic wound, the active electrode being disposed on a distal end of an electrosurgical shaft; applying a high-frequency voltage potential difference across the active electrode and a return electrode sufficient to develop a high electric field intensity associated with a vapor layer proximate the active electrode and in close proximity to the wound tissue; and stimulating an expression of at least one healing mediator.

Claims

1. An electrosurgical method of treating a chronic wound tissue comprising:

positioning an active electrode in proximity to the chronic wound tissue; and

applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to develop a high electric field intensity associated with a vapor layer proximate the active electrode, wherein the high electric field intensity stimulates an expression of at least one healing mediator within the chronic wound tissue.

2. The method of claim 1, further comprising ionizing the vapor layer such that a plasma is generated.

3. The method of claim 2, wherein the plasma is generated from an electrically conductive fluid delivered proximate the active electrode, the electrically conductive fluid comprising a conductive bridge between the active and return electrodes.

4. The method of claim 1, further comprising removing at least a portion of the chronic wound tissue via molecular dissociation.

5. The method of claim 1, further comprising inducing blood flow to at least a portion of the chronic wound tissue.

6. The method of claim 1, wherein the at least one healing mediator comprises growth factors.

7. The method of claim 1, wherein the at least one healing mediator comprises heat shock proteins.

8. The method of claim 1, wherein the at least one healing mediator comprises cytokines.

9. The method of claim 1, wherein the chronic wound tissue comprises a skin ulcer.

10. The method of claim 1, wherein the chronic wound tissue comprises a surgical wound.

11. The method of claim 1, wherein the chronic wound tissue comprises a trauma wound.

12. The method of claim 1, wherein the chronic wound tissue comprises a burn wound.

13. The method of claim 1, wherein the chronic wound tissue comprises radiated tissue.

14. The method of claim 1, wherein the chronic wound tissue comprises infected tissue associated with a weakened immune system.

15. The method of claim 1, wherein the chronic wound tissue comprises an amputation wound.

16. The method of claim 1, further comprising inducing a non-fatal cell stress in the chronic wound tissue.

17. An electrosurgical method of treating a chronic wound tissue comprising:

positioning an active electrode in proximity to the chronic wound tissue;

delivering an electrically conductive fluid proximate the active electrode; and

applying a high frequency voltage between the active electrode and a return electrode in the presence of the electrically conductive liquid sufficient to generate an ionized vapor layer at the active electrode, wherein the ionized vapor layer alters an inflammatory response in the chronic wound tissue and sterilizes at least a portion of the chronic wound tissue.

18. The method of claim 17, wherein altering the inflammatory response comprises stimulating an expression of interleukin (IL)-8.

19. The method of claim 17, further comprising applying the ionized vapor layer to modify the chronic wound tissue, wherein modifying the chronic wound tissue further comprises debriding at least a portion of the chronic wound tissue and a chronic wound tissue border.

20. The method of claim 19, further comprising removing tissue to a controlled depth to form a bleeding wound bed.

21. The method of claim 19, further comprising removing tissue to a controlled depth to form a modified chronic wound tissue surface having a substantially non-necrotic tissue surface.

22. The method of claim 19, further comprising removing necrotic tissue in the chronic wound tissue and in the vicinity of the chronic wound tissue.

23. The method of claim 19, further comprising removing debris in the chronic wound tissue and in the vicinity of the chronic wound tissue.

24. The method of claim 19, further comprising removing pathogens in the chronic wound tissue and in the vicinity of the chronic wound tissue.

25. The method of claim 19, further comprising removing biofilm in the chronic wound tissue and in the vicinity of the chronic wound tissue.

26. The method of claim 19, further comprising removing bacteria in the chronic wound tissue and in the vicinity of the chronic wound tissue.

27. An electrosurgical method of treating a chronic wound tissue comprising:

positioning an active electrode in proximity to the chronic wound tissue;

positioning a return electrode in the presence of the chronic wound tissue, the return electrode proximally spaced away from the active electrode; and

applying a high frequency voltage between the active electrode and the return electrode, wherein the high frequency voltage is sufficient to perforate the chronic wound tissue and at least a portion of a tissue adjacent to the chronic wound tissue via molecular dissociation to induce an expression of at least one healing mediator.

28. The method of claim 27, further comprising:

delivering an electrically conductive fluid proximate the active electrode;

wherein the high frequency voltage is sufficient to vaporize and ionize the electrically conductive fluid such that a plasma is formed; and

applying the plasma to the chronic wound tissue to perforate the chronic wound tissue.

29. The method of claim 27, further comprising inducing blood flow to the chronic wound tissue.

30. The method of claim 28, wherein the electrically conductive fluid comprises a conductive bridge between the active and return electrodes.

31. The method of claim 27, further comprising contacting the chronic wound tissue with the active electrode.

32. The method of claim 28, further comprising directing the plasma to intermittently contact the chronic wound tissue for about 0.5 seconds on each instance.

33. The method of claim 27, wherein perforating the chronic wound tissue comprises forming perforations at about 1 to 2 mm apart in the chronic wound tissue and in the vicinity of the chronic wound tissue.

34. The method of claim 27, wherein perforating the chronic wound tissue comprises forming perforations up to about 3 mm deep in the chronic wound tissue and in the vicinity of the chronic wound tissue.

35. The method of claim 27, wherein perforating the chronic wound tissue is performed by applying the high frequency voltage to the active electrode having a pointed tip.

36. An electrosurgical method of treating a chronic wound tissue comprising:

positioning an active electrode in proximity to the chronic wound tissue;

positioning a return electrode in the presence of the chronic wound tissue, the return electrode proximally spaced away from the active electrode; and

applying a high frequency voltage between the active electrode and the return electrode, wherein the high frequency voltage is sufficient to debride at least a portion of the chronic wound tissue and at least a portion of a tissue adjacent to the chronic wound tissue via molecular dissociation to induce an expression of at least one healing mediator.

37. The method of claim 36, further comprising:

delivering an electrically conductive fluid proximate the active electrode;

wherein the high frequency voltage is sufficient to vaporize and ionize the electrically conductive fluid such that a plasma is formed; and

applying the plasma to the chronic wound tissue to debride the chronic wound tissue.

38. The method of claim 36, further comprising inducing blood flow to the chronic wound tissue.

39. The method of claim 36, further comprising coagulating the chronic wound tissue.

40. The method of claim 36, wherein the step of debriding comprises removing tissue to a controlled depth to form a bleeding wound bed.

41. The method of claim 36, wherein the step of debriding comprises removing tissue to a controlled depth to form a modified chronic wound tissue surface having a substantially non-necrotic tissue surface.

42. The method of claim 36, wherein positioning the active electrode comprises translating the active electrode axially and radially over the chronic wound tissue and in the vicinity of the chronic wound tissue.

43. The method of claim 36, wherein debriding the chronic wound tissue is performed by applying the high frequency voltage to the active electrode comprising a wire electrode.

44. The method of claim 36, wherein debriding the chronic wound tissue is performed by applying the high frequency voltage to the active electrode comprising a screen electrode.

45. An electrosurgical method of treating a chronic wound tissue comprising:

positioning an active electrode in proximity to the chronic wound tissue, the chronic wound tissue comprising a wound bed having a surface layer;

positioning a return electrode in the presence of the chronic wound tissue, the return electrode proximally spaced away from the active electrode;

applying a high frequency voltage between the active electrode and the return electrode, wherein the surface layer is perforated and the wound bed is debrided to stimulate the chronic wound tissue; and

applying the high frequency voltage to a border tissue portion adjacent to the wound bed to remove the border tissue portion via molecular dissociation and to stimulate the tissue surrounding the wound bed.

46. The method of claim 45, wherein stimulating the chronic wound tissue comprises inducing an expression of at least one healing mediator.

47. The method of claim 45, wherein debriding the wound bed further comprises inducing blood flow to the wound bed.

48. The method of claim 45, further comprising removing necrotic tissue in the chronic wound tissue and in the vicinity of the chronic wound tissue.

49. The method of claim 45, further comprising removing debris in the chronic wound tissue and in the vicinity of the chronic wound tissue.

50. The method of claim 45, further comprising removing pathogens in the chronic wound tissue and in the vicinity of the chronic wound tissue.

51. The method of claim 45, further comprising removing biofilm in the chronic wound tissue and in the vicinity of the chronic wound tissue.

52. The method of claim 45, further comprising removing bacteria in the chronic wound tissue and in the vicinity of the chronic wound tissue.

53. The method of claim 45, wherein the high frequency voltage is sufficient to develop a high electric field intensity associated with a vapor layer, and wherein the vapor layer sterilizes at least a portion of the wound bed.

54. The method of claim 45, further comprising bridging gaps in a vascular structure between the wound bed and the border tissue portion.

55. The method of claim 45, further comprising removing barriers to epithelial cell migration between the tissue surrounding the wound bed and the wound bed.

56. The method of claim 45, further comprising applying the high frequency voltage to stimulate a tissue structure underlying the wound bed.

57. An electrosurgical method of preventatively treating a pre-lesioned wound tissue comprising:

positioning an active electrode in close proximity to the wound tissue, the active electrode disposed on a distal end of a shaft and spaced distally from a return electrode; and

applying a high frequency voltage between the active electrode and the return electrode, the voltage sufficient to develop a high electric field intensity associated with a vapor layer proximate the active electrode and in close proximity to the wound tissue such that a portion of the wound tissue is perforated, wherein perforating the portion of the wound tissue stimulates an expression of at least one healing mediator within the wound tissue and tissue in the vicinity of the wound tissue.

58. The method of claim 57, further comprising:

delivering an electrically conductive fluid proximate the active electrode;

wherein the high frequency voltage is sufficient to vaporize and ionize the electrically conductive fluid such that a plasma is formed; and

applying the plasma to the chronic wound tissue to perforate the chronic wound tissue.

59. The method of claim 58, further comprising directing the plasma to intermittently contact the chronic wound tissue for about 0.5 seconds on each instance.

60. The method of claim 57, wherein perforating the chronic wound tissue comprises forming perforations at about 1 to 2 mm apart in the chronic wound tissue and in the vicinity of the chronic wound tissue.

61. The method of claim 57, wherein perforating the chronic wound tissue comprises forming perforations up to about 3 mm deep in the chronic wound tissue and in the vicinity of the chronic wound tissue.

62. The method of claim 57, wherein stimulating the pre-lesioned wound tissue further comprises increasing nerve stimulation in the pre-lesioned wound tissue and in the vicinity of the pre-lesioned wound tissue.

63. The method of claim 57, wherein stimulating the pre-lesioned wound tissue further comprises restoring sensation in the tissue proximate the pre-lesioned wound tissue.

64. An electrosurgical method of treating a break in skin tissue comprising:

positioning a distal end of an electrosurgical instrument in close proximity to the break, the instrument further comprising an active electrode and a return electrode spaced proximally from the active electrode;

applying a high frequency voltage between the active and return electrodes, wherein a high electric field intensity associated with a vapor layer develops in close proximity to the break;

removing at least a portion of a tissue surrounding the break via molecular dissociation, wherein the step of removing induces blood flow to the tissue surrounding the break; and

stimulating the tissue surrounding the break, wherein stimulating the tissue surrounding the break comprises altering an expression of at least one healing mediator in the tissue.

65. The method of claim 64, further comprising:

delivering an electrically conductive fluid proximate the active electrode,

wherein the high electric field intensity is sufficient to vaporize and ionize the electrically conductive fluid and generates a plasma.

66. The method of claim 64, wherein removing at least a portion of the tissue surrounding the break further comprises debriding tissue to a controlled depth to form a modified tissue surface having a substantially non-necrotic tissue surface.

67. The method of claim 64, wherein the break in skin tissue comprises a chronic wound tissue.