Sternal closure device
First Claim
1. A method of surgically reapproximating a sternal bone which has been divided into two or more segments, comprising the following steps:
- a. providing a surgical needle and a radially compressible suture strand which is firmly coupled to the needle, wherein the needle has a size and shape suitable for positioning the suture strand around a sternal bone that has been divided into two or more sections, and wherein the thickness of the suture strand is greater than the thickness of the needle;
b. inserting the needle through tissue surrounding the sternal bone, thereby creating a needle track through said tissue;
c. emplacing the radially compressible suture strand in the needle track in a manner that (1) forms a loop around the sternal bone which has been divided, and (2) causes the radially compressible suture strand to exert gentle pressure against surrounding tissue, to minimize bleeding;
d. forming a plurality of such loops around the sternal bone; and
,e. securing the loops at a level of tension suitable for maintaining closure and healing of the sternal bone segments.
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Abstract
A surgical device and method are disclosed for closing the sternum following a median sternotomy. Instead of using stainless steel wire or a flat steel band, a strand of thin flexible suture material is used which is compressible in its radial dimension (either because of a hollow tubular shape, or due to solid material properties), while remaining strong and inelastic in its longitudinal dimension. The longitudinal strength may be maintained by using selected plastics, or by using nylon fibers or other materials for reinforcement. When not compressed, the strand has a diameter slightly larger than the diameter of the needle used to place the strand in position around the sternal halves, between the ribs. After insertion, the expandable suture material will provide gentle pressure against the surrounding tissue to minimize bleeding in the needle track. The soft suture material will also help cushion, distribute, and minimize the stresses and damage inflicted on the sternum or ribs during postoperative ambulation. A fastener device which provides additional advantages is also disclosed.
399 Citations
16 Claims
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1. A method of surgically reapproximating a sternal bone which has been divided into two or more segments, comprising the following steps:
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a. providing a surgical needle and a radially compressible suture strand which is firmly coupled to the needle, wherein the needle has a size and shape suitable for positioning the suture strand around a sternal bone that has been divided into two or more sections, and wherein the thickness of the suture strand is greater than the thickness of the needle; b. inserting the needle through tissue surrounding the sternal bone, thereby creating a needle track through said tissue; c. emplacing the radially compressible suture strand in the needle track in a manner that (1) forms a loop around the sternal bone which has been divided, and (2) causes the radially compressible suture strand to exert gentle pressure against surrounding tissue, to minimize bleeding; d. forming a plurality of such loops around the sternal bone; and
,e. securing the loops at a level of tension suitable for maintaining closure and healing of the sternal bone segments. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A method of closing the sternum following a thoracic surgical operation which involves cutting the sternal bone into two or more divided segments, comprising the following steps:
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a. using a needle having a first thickness to draw a suture strand having a second thickness into position around the divided segments of the sternal bone, wherein the needle creates a needle track through peristernal tissue, and wherein the suture strand occupies the needle track after passage of the needle; and
,b. securing the suture strand in a manner which forms a secure loop which encircles the divided segments of the sternal bone, wherein the suture strand is made of a flexible radially compressible material having a thickness larger than the thickness of the needle, wherein the radial compressibility is sufficient to allow the suture strand to exert gentle pressure on tissue which encloses the needle track, thereby allowing the suture strand to help reduce bleeding generated by such tissue. - View Dependent Claims (8, 9, 10, 11)
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12. An article of manufacture useful for surgical closure of sternal bone segments following a median sternotomy, comprising:
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(a) at least one strand of suture material suitable for securing closure of surgically-divided sternal bone segments without damaging the sternal bone segments during post-operative ambulation, wherein the suture strand has a diameter of at least about 2 mm and is made of a longitudinally-inelastic flexible material which will not stretch significantly in the longitudinal direction but which is radially compressible and which will attempt to expand radially after compression, thereby allowing the suture material, after emplacement in a needle track created by a needle having a diameter smaller than the suture strand, to provide gentle pressure against tissue surrounding the needle track, to minimize bleeding in such tissue; and
,(b) a packaging enclosure which encloses the suture material, and which has been sealed and sterilized, and which maintains sterility of the suture strand. - View Dependent Claims (13, 14, 15, 16)
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Specification