Subcutaneous sinusoidal wound closure utilizing one-way suture

• US 8,777,989 B2
• Filed: 08/04/2010
• Issued: 07/15/2014
• Est. Priority Date: 06/29/2001
• Status: Expired due to Fees

• Current Assignee: Ethicon Incorporated (Johnson & Johnson), Ethicon, LLC (Johnson & Johnson)
• Original Assignee: Ethicon Incorporated (Johnson & Johnson)
• Inventors: Leung, Jeffrey C., Megaro, Matthew A., Ruff, Gregory, Kaplan, Andrew
• Primary Examiner(s): McDermott, Corrine M
• Assistant Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US12/850,336
• Publication Number:
  US 20100318124A1
• Time in Patent Office: 1,441 Days
• Field of Search: 606/144, 606/228, 606/232
• US Class Current: 606/228
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/1146 of tendons
• CPC Class Codes: A61B 2017/00575 for closure at remote site, e.g. closing atrial septum defects
• CPC Class Codes: A61B 2017/0061 Implements located only on one side of the opening
• CPC Class Codes: A61B 2017/00632 Occluding a cavity, i.e. closing a blind opening
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/00792 Plastic surgery
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end
• CPC Class Codes: A61B 2017/06171 helically or spirally coiled for needles A61B2017/06076
• CPC Class Codes: A61B 2017/06176 with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/1135 End-to-side connections, e.g. T- or Y-connections Y-shaped blood vessel prostheses A61F2002/065

Abstract

Subcutaneous sinusoidal wound-closure techniques use one-way sutures. The one-way sutures have tissue-grasping surface features which allow passage of the suture in one direction through tissue, but not in the opposite direction. In closing a wound, the one-way suture is deployed along a curvilinear path which passes alternately through subcutaneous tissue on opposed sides of the wound. The wound-closure techniques allow approximation of the sides of the wound without knots, avoid loop stitching and reduce scarring.

Claims

1. A method for closing an open wound in a skin surface of a subject, the wound having a first side and a second side, each of the first and second sides comprising a wound face and a wound edge, the wound edge located between the wound face and adjacent skin surface, the method comprising:

(a) receiving a wound-closure device including a suture having a first suture section, a first needle secured to the first suture section and a first plurality of barbs projecting from the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in a direction of the first needle and resist movement in an opposite direction;

(b) deploying the first suture section along a continuous sinusoidal path which crosses the wound from a wound face on the first side to a wound face on the second side of the wound and then back from the second side to the first side of the wound; and

(c) approximating the wound face on the first side of the wound to the wound face on the second side of the wound.

2. The method of claim 1, wherein step (b) comprises deploying the first suture section along a continuous sinusoidal path which repeatedly crosses the wound from the first side to the second side of the wound and then back from the second side to the first side of the wound.

3. The method of claim 2, wherein step (b) comprises deploying the first suture section along a continuous sinusoidal path which repeatedly crosses the wound from the first side to the second side of the wound and then back from the second side to the first side of the wound as necessary until reaching one end of the wound.

4. The method of claim 3, further comprising:

(d) after reaching said one end of the wound, inserting the first needle into an insertion point on one side of the wound, passing the needle through skin at an exit point displaced from the wound, drawing a remaining part of the first suture section through the skin at the exit point, and cutting off the remaining part of the first suture section.

5. The method of claim 1, wherein step (b) comprises deploying the first suture section along a continuous sinusoidal path which crosses the wound from the first side to the second side of the wound and then back from the second side to the first side of the wound by performing the following steps alternately on the first side of the wound and the second side of the wound:

(b1) inserting the first needle into an entrance point in tissue;

(b2) pushing the first needle along a curved path through the tissue until the first needle extends out of the tissue at an exit point displaced along the wound from the entrance point; and

(b3) gripping the first needle and drawing the first suture section through the tissue leaving a length of the first suture section in the tissue between the entrance point and the exit point.

6. The method of claim 1, wherein:

step (a) comprises receiving a wound-closure device including a suture having a first suture section and a second suture section, a first needle secured to the first suture section and a first plurality of barbs distributed on the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in the direction of the first needle and resist movement in an opposite direction; and

wherein the method further comprises;

(d) securing the second suture section to a tissue of the wound.

7. The method of claim 6, wherein:

step (a) comprises receiving a wound-closure device including a suture having a first suture section and a second suture section, a first needle secured to the first suture section and a first plurality of barbs distributed on the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in the direction of the first needle and resist movement in an opposite direction, a second needle secured to the second suture section and a second plurality of barbs projecting from the second suture section, the second plurality of barbs being adapted to permit movement of the second suture section through tissue in the direction of the second needle and resist movement in an opposite direction; and

step (d) comprises securing the second suture section to a tissue of the wound by deploying the second suture section along a continuous sinusoidal path which crosses the wound from the second side to the first side of the wound and then back from the first side to the second side of the wound.

8. The method of claim 7, wherein step (d) comprises securing the second suture section to tissue by deploying the second suture section along a continuous sinusoidal path which crosses the wound from the second side to the first side of the wound and then back from the first side to the second side of the wound by performing the following steps alternately on the second side of the wound and the first side of the wound:

(d1) inserting the second needle into an entrance point in tissue;

(d2) pushing the second needle along a curved path through the tissue until the first needle extends out of the tissue at an exit point displaced along the wound from the entrance point; and

(d3) gripping the second needle and drawing the second suture section through the tissue leaving a length of the second suture section in the tissue between the entrance point and the exit point.

9. The method of claim 7, wherein step (d) comprises securing the second suture section to tissue by deploying the second suture section along a continuous sinusoidal path which repeatedly crosses the wound from the second side to the first side of the wound and then back from the first side to the second side of the wound as necessary until reaching one end of the wound.

10. The method of claim 1, wherein step (a) comprises receiving a wound-closure device including a suture, made of a glycolide and trimethylene carbonate copolymer having a first suture section, a first needle secured to the first suture section and a first plurality of barbs distributed on the first suture section, the first plurality of barbs being adapted to permit movement of the first suture section through tissue in the direction of the first needle and resist movement in an opposite direction.

11. A method for approximating a first side and a second side of an open wound in a tissue surface, each of the first and second sides comprising a wound face and a wound edge, the wound edge located between the wound face and adjacent tissue surface, the method comprising:

(a) receiving a wound-closure device including a strand of bio-absorbable polymeric suture thread, the strand having a first end and a second end, a needle secured to the first end of the strand, a first strand portion adjacent the first end, a second strand portion adjacent the second end, a plurality of projections distributed on the first strand portion, the plurality of projections being configured to permit movement of the first strand portion body through tissue in the direction of the needle and grasp tissue in an opposite direction;

(b) using the needle to draw the first strand portion along a curvilinear subcutaneous path which passes alternately through the wound face of the first side and the wound face of the second side; and

(c) approximating at least a portion of the wound face on the first side of the wound to the wound face on the second side of the wound.

12. The method of claim 11, wherein step (b) comprises using the needle to draw the first strand portion along a sinusoidal subcutaneous path which passes alternately through tissue of the first side and tissue of the second side.

13. The method of claim 11, wherein step (b) comprises using the needle to draw the first strand portion along a zigzag pattern subcutaneous path which passes alternately through tissue of the first side and tissue of the second side.

14. The method of claim 11, wherein step (b) comprises using the needle to draw the first strand portion along a subcutaneous path which passes alternately through tissue of the first side and tissue of the second side in a continuous stitch pattern.

15. The method of claim 11, further comprising:

(d) securing the second strand portion to tissue adjacent the wound by using a second needle to draw the second strand portion onto a subcutaneous path which passes alternately through tissue of the first side and tissue of the second side.

16. The method of claim 11, further comprising:

(d) securing the second strand portion to tissue adjacent the wound.

17. The method of claim 16, wherein step (d) comprises using the needle to draw the second strand portion onto a subcutaneous path which passes alternately through tissue of the second side and tissue of the first side in a continuous stitch pattern.

18. The method of claim 16, wherein step (d) comprises using the needle to draw the second strand portion along a sinusoidal subcutaneous path which passes alternately through tissue of the second side and tissue of the first side.

19. A method for closing an open wound in a surface of tissue, the wound having a first side and a second side, each of the first and second sides comprising a wound edge that separate a wound face from tissue surface, the method comprising:

(a) receiving a wound-closure device including a suture having a first suture section and a second suture section, a first needle secured to the first suture section and a first plurality of projections distributed on the first suture section, the first plurality of projections being adapted to permit movement of the first suture section through tissue in a direction of the first needle and resist movement in an opposite direction;

(b) securing the second suture section to tissue;

(c) deploying the first suture section along a continuous sinusoidal path which crosses the wound from the wound face on the first side to the wound face on the second side of the wound and then back from the second side to the first side of the wound; and

(d) approximating the wound face on the first side of the wound to the wound face on the second side of the wound.

20. The method of claim 19, wherein step (c) comprises deploying the first suture section along a continuous sinusoidal path which repeatedly crosses the wound from the first side to the second side of the wound and then back from the second side to the first side of the wound as necessary until reaching one end of the wound.