CA3067059A1

CA3067059A1 - Wound closure system and method

Info

Publication number: CA3067059A1
Application number: CA3067059A
Authority: CA
Inventors: Lee Mcdonald; Robert Burke; Joao Baptista De Rezende Neto
Original assignee: Southmedic Inc
Current assignee: Unity Health Toronto
Priority date: 2017-06-13
Filing date: 2018-06-13
Publication date: 2018-12-20
Also published as: CA3190811A1; WO2018227292A1; CA3192102A1

Abstract

There is disclosed a wound management system comprising a belt configured to partially wrap around the body of a patient in the area of a wound; first and second base members configured to contact the patient on opposing sides of the wound; first and second clamp assemblies projecting from upper faces of the base members to grip opposing end regions of the belt, wherein at least one of the clamp assemblies is configured to releasably secure the belt to permit engagement, tensioning and detensioning of the belt relative to the base members; and at least one cord assembly for connecting the base members to each other across the wound. The cord assembly includes a cord, a cord anchor configured to attach a first end of the cord to a first of the base members and a cord retractor on the second of the base members for retracting the cord.

Description

2 WOUND CLOSURE SYSTEM AND METHOD
Field [00oi] The disclosure relates to medical devices, and in particular devices for the management of open wounds such as a post-surgery wound arising from abdominal surgery.
Background [0002] International patent application WO2m6/127256 discloses a device for management of an open abdomen wound. The device comprises a belt which extends partway around a patient, with the two ends of the belt being joined to respective connector members. The connecter members include pads that contact the patient on opposing sides of the wound. The connecters may be cinched together using zip ties or similar retractable cords which join together the opposing pads across the wound. The cords can be retracted to draw the pads together across the opposing edges of the wound, to management treatment of the wound, prevent spreading of the wound margins, and act as a preventive measure against muscle retraction.

[0003] A problem arising in major surgical operations such as abdominal surgery that involves incisions of major abdominal muscle groups, is that such wounds can present difficulties in healing. In particular, normal muscle contractions, patient breathing and other movements tend to cause the wound edges to separate rather than draw together to promote healing. It is desirable to provide devices which counteract this natural tendency.
Summary

[0004] We disclose herein a wound management system comprising:

a belt configured to partially wrap around the body of a patient in the area of a wound;
first and second base members configured to contact the patient on opposing sides of the wound, the base members each comprising a lower face configured for directly or indirectly contacting the patient, and an opposed upper face;
first and second clamp assemblies projecting from the upper faces of the first and second base members respectively to grip opposing end regions of the belt, wherein at least one of the clamp assemblies is configured to releasably secure the belt to permit engagement, tensioning and detensioning of the belt relative to the base members;
at least one cord assembly for connecting the base members to each other across the wound, the cord assembly comprising a cord, a cord anchor configured to attach a first end of the cord to a first of the base members and a cord retractor on the second of the base members for retracting the cord.

[0005] One or both of the clamp assemblies may comprise a rotatable cam member configured to permit free slippage of the belt when the cam member is rotated into a disengaged position and to prevent slippage when the cam member is urged into a closed position by tension on the belt.

[0006] We further disclose herein a method for managing a wound in a patient comprising the steps of:
-positioning first and second base members to contact the patient on opposing sides of the wound, the base members each comprising a lower face configured for directly or indirectly contacting the patient, and an opposed upper face;
securing the base members together across the wound by connecting the base members with at least one cord assembly, the cord assembly comprising a cord, a cord anchor configured to attach a first end of the cord to a first of the base members and a cord retractor on the second of the base members for retracting the cord;
retracting the cord of the at least one cord assembly to provide a selected degree of tension in the cord;
wrapping a belt partially around the body of the patient in the area opposed to the wound, wherein the belt is unsecured from at least one of the base members; and securing the belt to the at least one base member with a clamp assembly wherein the clamp assembly projects from the upper face of the at least one base member to grip an end region of the belt to releasably secure the belt to permit engagement, tensioning and detensioning of the belt relative to the base members.

[0007] In the present specification and claims, directional references such as "horizontal" "upper", "lower" etc. are provided purely for ease of description and are not intended to limit the scope of the invention. Unless otherwise stated, such terms are in reference to the device as placed on a level surface in position or in normal use on a patient, extending across an abdomen wound on the patient's stomach, with the patient lying horizontally on his back facing upwardly. Furthermore, dimensions presented herein, as well as specific materials and the like, are provided merely by way of example.
Brief description of the drawings

[0008] The drawings and description which follow illustrate specific embodiments of the invention herein and are not intended to limit the scope of the present invention. The full scope of the present invention is provided in the present specification, drawings and claims as a whole. Furthermore, persons skilled in the art will understand that references herein to any specific components, features or elements can include their structural and/or functional equivalents.

[0009] Figure 1 is a perspective view of an embodiment of the abdominal closure system, in which the belt is unlocked to permit adjustment.
[oclio] Figure 2 is a perspective view as in figure 1, showing the belt in the locked position against slippage relative to the base members.
[oon] Figure 3 is a perspective view of base member of the system, showing the unlocked position.
[0012] Figure 4 is partial cross-sectional view, in perspective, along line 4-4 of Figure 3 showing components of the system and showing the cord assembly removed to show internal structures.
[0013] Figure 5 is a partial cross-sectional view similar to Figure 4, showing the cord assembly installed.
[0014] Figure 6 is a further cross-sectional perspective view similar to Figure 5, showing the clamp assembly in the fully disengaged position.
[0015] Figure 7 is a side elevation showing of the base member.
[0016] Figure 8 is a perspective view of the device positioned on a patient.
[0017] Figure 9A a shows a portion of the system, consisting of opposing base members which are positioned across a surgical wound of a patient.
[oca8] Figure 9B is a perspective view as in figure 9A, showing retraction of the device across a wound.
[0019] Figure 10 is a side view of a portion of the system, showing the device being retracted across a surgical wound.

[0020] Figure 11 is a side view, showing the device in use on a patient.
[434321] Figure 12 is a sectional view showing the device in use on a patient.
Detailed description [0022] Referring first to Figs. 1 - 7, the present device 1 includes a pair of rigid base members 10 and 12, respectively, which are secured around a patient in the area of a wound, with a combination of a belt 30 and cords 32, described below. Base members 10 and 12 are identical to each other and interchangeable.

Members 10 and 12 comprise rectangular plates which can be fabricated from a rigid moulded or machined plastic such as ABS, Nylon, PVC, acetal and other polymers displaying similar physical properties. Base members 10 and 12 each comprise an upper face 14, an opposing lower face 16, opposing lateral edges 18a and 18b and opposing end edges 20a and 20b. Base members 10 and 12 may be flat or curved to match the curvature of the midriff area of a typical patient. For reference herein, each base member has a longitudinal axis a extending between end edges 20 and a lateral axis b extending between lateral edges 18.
[434323] Typical dimensions for base members 10 and 12 are between 150 and 25omm in length (axis a) and 30-100mm in width (axis b). In one example, the length/width dimensions are about 225 mm x 65mm. A device having these dimensions is intended for use in treating normal adult patients undergoing major abdomen surgery. It will be readily apparent that different dimensions may be provided, depending on the application.
[434324] For reference and convenience of description, device 1 will be described herein with members 10 and 12 located in a horizontal position wherein the upper faces 14 are horizontal and face upwardly. When base members 10 and 12 are secured to a patient for managing a wound, as discussed below, lateral edges 18a of opposing members 10 and 12 face each other across a wound 24.

[0025] Referring to figures 6 and 7, the upper face 14 of base members

10 and 12 has a flat region adjacent to the inner lateral edge 18a (facing the opposing base member across the wound when in use), which is generally horizontal when in use. An outer portion of surface 14, adjacent to outer lateral edge 1813, has a ridge that provides a sloping surface 15.
[0026] The lower faces 16 of members 10 and 12 are slightly curved to provide a trough-shaped, concave surface 23, in which the trough 23 extends along axis a. Lower face 16 has an arcuate cross sectional profile. The curvature of lower face 16 is configured to match the curvature of a typical human abdomen. The thickness of base members 10 and 12 (dimension c, seen in Figure 7) increases from first lateral edge 18a, which faces the opposing base member across the wound when in use, to the second lateral edge 1813, which faces outwardly from the wound. As seen in Figure 7, base members 10 and 12 are generally tapered between lateral edges 18a and b, with the thin portion of the taper being located at the sides of the base members 10 and 12 that face each other across the wound. In use, this provides a generally horizontal upper surface 14 when the device is positioned on a patient.
[0027] Lower faces 16 are further characterized by a ridge 21 adjacent to outer later edge 1813. Ridge 21 defines an inflection line between the concavely-curved region 23 of lower surface 16, and a flat, horizontally-projecting strip 25 that is adjacent to outer edge 1813. Ridge 21 provides additional traction against the patient's skin when the device is tensioned, to assist in drawing together the opposing edges of the wound 90.
[0028] The lower faces 16 of members 10 and 12 are each lined with a pad 28, comprising a soft, elastomeric and somewhat grippy material such as elastomeric silicon, having properties which make it suitable for contacting the patient's skin during a medical procedure. Preferably, pad 28 protrudes slightly beyond the edges 18 and 20 of members 10 and 12, to prevent direct contact between the patient and the rigid plastic material of members 10 and 12.

[0029] A flexible belt 30 is provided to secure base members 10 and 12 to the patient (see Figs. 1 and 2). Belt 30 is configured to wrap partially around the patient to secure members 10 and 12 to the patient, in cooperation with cords described below. As such, the combination of member 10 and 12, belt 30 and cords 32 fully encircle the patient, typically around the midriff region, when device 1 is engaged on a patient. Belt 30 may be tightened or loosened relative to members 10 and 12 to fit the device snugly to the patient. Typically, belt will be adjusted on members lo and 12 whereby members 10 and 12 are positioned on opposing sides of the wound, close to the margins of the wound, with belt 30 providing a snug fit around the patient. The method by which this may be performed is discussed below.
[0030] Bell 30 is fabricated from a flexible material, such as mesh, woven fabric, flexible film or the like. Typical materials include such as spandex, neoprene containing latex rubber and similar fibers. Preferably, belt 30 is stretchable and elastic in at least its elongate dimension. The elasticity of belt 30 permits the device to retain a substantially consistent tension and a snug fit during patient muscle contractions, breathing and other movements by the patient. The degree of elasticity should be provided which provides a sufficiently tight fit to permit the device to accomplish the wound management results discussed below, while at the same time permitting a reasonably consistent tension during normal expansion and contraction of the patient's muscles and abdomen. For example, belt 30 may be configured to provide a maximum of tensile force in the range of 10-20lb5 linear force when secured around an average patient. Bell 30 is configured to wrap partially around a portion of the patient's body (such as the torso) out of contact with the wound area, to secure members 10 and 12 to the patient. At the wound area itself, members 10 and 12 are joined together with a retractable cord assembly 34 comprised of multiple retractable cords 32, as discussed in more detail below. Device 1 in its fully assembled form thus fully encircles the patient's torso. In particular, the patient is encircled with a combination of members 10 and 12, belt 30 and cords 32, as may be seen for example in figure 9.

[0031] At least one of base members 10 and 12, and optionally both of members 10 and 12, includes a clamp assembly 35 to releasably and adjustably secure belt 30 to members 10 and 12. Clamp assembly 35 engages belt 30 to the respective base member 10/12 and also permits belt 30 to be released from base members 10 and 12 and also adjusted in effective length relative to one or both of base members 10 and 12.
[0032] Clamp assembly 35 includes a pair of opposing, spaced apart tabs 36 that project upwardly from the upper faces 14 of base members 10 and 12.
Tabs 36 are aligned with end edges 20 of members 10 and 12. Each of tabs 36 comprises an inwardly-projecting horizontal post 38, whereby the posts 38 on opposing tabs 36 face each other. Posts 38 are co-axial and are aligned with elongate axis a. A releasable belt clamp bar 40 is rotatably journalled on posts 38. Clamp bar 40 is configured to releasably secure belt 30 to respective base members 10 and 12 by gripping belt 30 between clamp bar 30 and a portion of base member 10/12. Clamp bar 40 extends substantially the length of base member 10 or 12 respectively, extending between the opposing end edges 20 thereof. Clamp bar 40 has post-holes (not shown) recessed into its end faces whereby it may rotate freely on posts 38.
[0033] Clamp bar 40 rotates between a first, locked position, seen in Fig.
2, in which belt 30 is gripped between clamp bar 40 and sloping portion 15 of upper surface 14 and thus prevented from slipping, and a second, unlocked position, seen in Figs. 1 and 3, in which clamp bar 40 is spaced from surface and belt 30 can be adjusted or fully released from base member 10/12.
[0034] As seen in Figures 4-6, clamp bar 40 has an eccentric (non-circular) shape in cross section, which provides a cam-like function when rotated between the first and second positions. For this purpose, the axis of rotation of clamp bar 40 is offset from the central axis of the bar. Clamp bar 40 has a generally wing-shaped cross-sectional profile, characterized by a generally flat lower face 41 which is configured to contact the corresponding flat sloping portion 15 of base member 10/12. Clamp bar 40 and associated clamp assembly components are configured whereby lower face 41 of bar 40 is in contact and flush against upper face 14 of base member 10/12. When the respective faces are in contact, belt 30 is gripped between the respective flat surfaces 15 and 41.

Clamp bar 40 further comprises an upper flat face 42, opposed to lower face 41, which slopes upwardly. Upper face 42 is covered with an array of protrusions or other surface which is adapted to grip the belt 30, using a material such as a Velcro TM hook material. This feature permits the free end of belt 30 to be wrapped around bar 40 and further secured to clamp bar 40, as seen in Figures and 2. Lower face 41 of clamp bar 40 has a grip-plate 45 secured thereto, having a serrated edge 54 which engages belt 30 when clamp bar 40 is rotated into the grip position, as described below.
[0035] When clamp bar 40 is rotated into the open position, as seen in Figure 6, a gap 44 is exposed between clamp bar 40 and upper face 14 to permit belt 30 to slide through this gap.
[0036] In use, an end portion of belt 30 is wrapped over clamp bar 40 whereby a portion of belt 30 is engaged to protrusions 43. Clamp bar 40 is then rotated into the closed position by gripping and rotating tabs 36. The cam-like shape of clamp bar 40 tends to urge clamp bar 40 further into the clamped position when belt 30 is retracted, thereby resisting slippage of belt 30 when this is retracted against base members 10 and 12.
[0037] As seen in detail in Figs. 5 and 7, clamp assembly 35 includes locking members 46 that lock clamp bar 40 to the corresponding member 10 or 12 into the locked position. Lock members 46 comprise a pair of opposing L-shaped projections extending from the opposing ends of clamp bar 40. Lock members 46 are attached to clamp bar 40 to rotate with it. Each of lock members comprises a resilient tab 49 aligned with end edges 18, engaged at its proximal end to clamp bar 40. Plates 49 each have a disk-shaped portion at their proximal regions that have a slight depression to accommodate a user's finger, whereby opposing plates 49 may be squeezed together by the user. Plates 49 are configured to provide a suitable degree of resilience whereby the respective lock members may be squeezed together without too much difficulty, but not so easily as to permit inadvertent release during normal use. A flat projection 48 extends downwardly from the disc-shaped portion of plate 49 and is shaped to fit into a corresponding slot 50 within base member 10/12. Slots 50 are located adjacent to end edges 20. Projections 48 are each provided with a laterally-projecting protrusion 52 at its distal end, whereby opposing protrusions 52 project away from each other.
[0038] When clamp bar 40 is rotated towards the locked position, projections 48 of lock members 46 enter into slots 50. As protrusions 52 come into contact with the edges of slots 50, this urges projections 48 to flex towards each other to permit projections 48 to enter into slots 50. Projections 48 can thus snap-lock into slots 50 to lock clamp bar 40 into the locked position.
Lock members 46 may afterwards be squeezed together to release lock members 46 from slot 50, thereby permitting rotation of clamp bars 40 into the undamped position. This in turn disengages belt 30 from clamp assembly 35 to allow adjustment of belt 30 or its release from base member 10 or 12.
[0039] The serrated edge 54 of grip plate 45 serves to grip the belt 30 when in the clamped position. When clamp bar 40 is rotated away from the locked position, serrated edge 54 is out of contact with belt 30, thereby allowing belt 30 to slide through clamp assembly 35.
[0040] Cord assembly 34 will now be described with specific reference to Figs. 3-8.
[0041] Cord assembly 34 comprises multiple cord retractors, consisting of rotatable cord wind-up reels 60 which are independently and rotatably mounted to base plates 10 and 12. Reels 60 may comprise a commercially available take up reel of the type that provides a releasable ratchet mechanism to permit wind-up retraction of cord 32 by rotation of reel 60, and release of cord 60 by pulling upwardly or other manipulation of reel 60. Reels 60 are each mounted to an upwardly-projecting mount 66 on base plates 10 and 12. In the present example, each of base members 10 and 12 is provided with two spaced apart reels 60, each configured to retract an individual one of cords 32. Reels 60 each comprise a spool surface 68 for winding up a corresponding cord, and is capped with a gripper disk 70 to allow the user to rotate the corresponding reel 60.
[0042] Cords 32 may comprise monofilament style, braided and/ or spiral styled constructions, and may be fabricated from a metal or polymer or a combination thereof. Examples include stainless steel, nylon, polyesters, pvc, and other materials.
[0043] Each of cords 32 comprises a free end 72 which is releasably anchored to a respective base member 10/12 with a cleat 74. A corresponding reel 60 is mounted to an opposing base member to retract the opposing end of the cord. Cleat 74 may fixedly or releasably secure free end 72; in the present example, cord 32 is releasably secured. Cleat 74 consists of an upwardly-projecting member, having a vertical slot 76 open to its upper surface and extending laterally. Anchor 74 also has a horizontal slot 78, open to the rear face of cleat 74. The free end of cord 32 is fixed to a flat tab 79, which is configured to fit snugly within horizontal slot 78 to retain cord 32 to cleat 74 in a position in which cord 32 is inserted within vertical slot. The tension applied to cord 32 when device 1 is secured to a patient retains tab 79 within corresponding slot 78.
In this fashion, the free end of cord is securely anchored to one of base members or 12 when in use, with the other end of cord 32 being engaged to reel 60 on the other one of base members 10 or 12.
[0044] In the illustrated embodiment, four cords 32 are provided, each associated with a corresponding wind up reel 60 and cleat 74 for independently anchoring the respective ends of each cord 32. The reels 60 and cleats 74 are staggered, whereby each of members 10 and 12 is provided with two cleats and two reels, arranged an alternating fashion. It will be seen that a different configuration and number of such cords 32 and anchoring cleats may be provided, depending on the overall size of base members 10 and 12 and other considerations.

11 [0045] Device 1 may be provided within a range of dimensions of its components. For example base members 10/12 may be approximately 225 x 65mm in length x width to accommodate a typical adult. In other examples, the base members may be outside of this range in versions scaled to accommodate above or below-average sized persons. The band may be dimensioned to accommodate a range of typical adult circumferences of between 75cm and 150cm but may fall outside of that range in versions scaled to accommodate above or below average sized persons. The cables 32 may be about 45mm in length, which permits a broad range of extension and wind up inside of the reel.
[0046] A method of using device 1 to manage a wound 90 is shown in figures 8-12. Wound 90 may be an abdominal wound, such as a post-surgical wound as shown in figures 9A, 9B and 10, which extends longitudinally (i.e.
head to toe direct) along the midline of the patient's abdomen. Wound 90 is defined by wound margins 92 and 94. Device 1 is normally supplied to the health practitioner with belt 30 disengaged from one or both of base members 10 and

12, and cords 32 disengaged from cleats 74. One end of belt 30 may then be engaged with one of base members 10 and 12. Base members 10 and 12 are then positioned adjacent the margins of the wound, as seen in the figures. In this example, base members 10 and 12 are positioned on the rectus muscles of the abdomen. The tensioning effect of device 1 provides a splinting effect that acts against the naturally occurring wound ¨ spreading effect.
[0047] Typically, lateral edges 18 will be slightly displaced from the exposed edges of wound 90 to prevent the risk of contact of the base members and 12 with the open wound edge. The free (unattached) ends of cords 32 are then anchored to corresponding cleats whereby cords 32 extend across the wound and base members 10 and 12 are prevented from further separation from each other. Cords 32 remain spaced above wound 90 at all times during application, adjustment and use of the device, to avoid contact between wound 90 and cords 32.

[0048] At this point, belt 30 is placed around the patient's body. For example, if wound 90 is on the dorsal midriff (belly) side of the patient, as shown in the figures, belt 30 will be passed around the back (dorsal) midriff of the patient. The free ends of belt 30 are then engaged to the clamp assemblies 35 of the respective base members 10 and 12. Belt 30 is then retracted to provide a snug fit of device 1 to the patient. Figure 7 schematically shows tightening of belt 30 around the patient's midriff, whereby device 1 is snuggly affixed to the patient. As discussed above, the elastic properties of band 30 permits base members 10 and 12 to remain in their original positions without shifting as the patient breathes and other muscle movements.
[0049] Cords 32 are periodically retracted to draw the wound edges together. For example, cord retractions may be performed in a series of discrete retractions performed in a staged fashion 2-3 times daily for several days following surgery, to fully close wound 90. In other examples, discrete retractions of cords 32 are performed hourly, 12X daily, 6x daily, 3x daily, daily or daily. The device may be used for treatment of the patient over a period of 1/2 day, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days or 7 days. The device may secured to the patient for the entire course of treatment. Adjustments of cords 32 may typically be performed as fine adjustments, for example about 5mm of retraction per discrete retraction stage. This may range to a gross adjustment of about loomm. For example, the gross adjustment of cords 32 may be performed during the initial accommodation phase and the magnitude of the adjustments may then decrease over time. Patients are monitored for intra-abdominal pressure and this characteristic would supersede any linear measurement targets, whereby the amount of retraction that is performed, as well as the timing of stages, is adjusted based on patient response as determined by individual monitoring of the patient.
[0050] Retraction of the cords 32 to close a wound 90 is shown schematically in figures 9B and 10. According to one aspect, retraction prevents the loss of domain, in that it engages oblique and a transverse muscles of the abdomen, creating an opposing force to intra- abdominal pressure that would

13 otherwise tend to separate the wound edges thereby preventing healing. When the device is used as described herein, the discrete retractions of the cords delivers gradual traction of the abdominal muscles towards the midline. This action prevents lateralization of the abdominal wall muscles. Furthermore, use of the device 1 as described herein serves to engage oblique and transverse muscles, thereby creating an opposing force against intra-abdominal pressure.
[0051] The description of the device and the accompanying drawings are intended to provide an example of the present invention, and are not intended to limit the scope of the invention in any respect. The full scope of the invention is provided in the present specification as a whole, including the claims.

14

Claims

1. A wound management system comprising:
a belt configured to partially wrap around the body of a patient in the area of a wound;
first and second base members configured to contact the patient on opposing sides of the wound, the base members each comprising a lower face configured for directly or indirectly contacting the patient, and an opposed upper face;
first and second damp assemblies projecting from the upper faces of the first and second base members respectively to grip opposing end regions of the bell, wherein at least one of the damp assemblies is configured to releasably secure the bell to permit engagement, tensioning and detensioning of the belt relative to the base members;
at least one cord assembly for connecting the base members to each other across the wound, the cord assembly comprising a cord, a cord anchor configured to attach a first end of the cord to a first of the base members and a cord retractor on the second of the base members for retracting the cord.

2. The system of claim 1 wherein at least one of said damp assemblies comprises a damp member rotatably mounted to a corresponding one of the base members, the damp member being rotatable between a first position wherein the bell is disengaged from the damp assembly to permit free slippage of the bell relative to the damp assemblies and a second position wherein the belt is gripped by the damp member for restricting slippage of the belt relative to the damp assemblies, wherein the damp member comprises an eccentrically-mounted cam surface configured to urge the damp member into the second position when the bell is engaged and under tension.

3. The system of claim 2 wherein at least one of the damp assemblies comprises a fastener surface for engaging a free end of the belt when engaged by the damp assembly whereby the free end of the belt is partially wrapped around the damp assembly.

4. The system of claim 2 wherein at least one of the clamp members comprises a releasable lock configured to snap-lock the clamp member into the dosed position.

5. The system of claim 4 wherein the lock comprises at least one flexible tab extending from the clamp assembly, configured to fit into a slot within a corresponding one of the base members, the tab comprising a protrusion configured to reversibly lock the tab into the slot.

6. The system of any one of claim 1 to 5 wherein the bell is elastic.

7. The system of any one of claims 1 to 6 wherein the damp assemblies on both of said base members are configured to adjustably engage the belt.

8. The system of any one of claims 1 to 7 wherein said cord retractor comprises a rotatable spool engaged to a releasable ratchet, whereby rotation in a first direction tensions the cord and release of the ratchet permits detensioning of the cord.

9. The system of any one of claims 1 to 8 wherein the cord anchor comprises a cleat configured to releasably engage the cord to a corresponding one of the base members.

10. The system of claim 9 wherein the cord comprises a free end having a cleat-engagement member, and the cleat is configured to releasably retain the cleat engagement member.

11. The system of claim 10 wherein the cleat engagement member comprises a tab and the cleat comprises a slot opening towards a side of the cleat facing away from the opposing one of the base members, configured for engaging the tab.

12. The system of any one of claims 1 to 11 comprising multiple ones of the cord assemblies.

13. The system of claim 12 wherein the multiple ones of the cord assemblies are arranged in an alternating array on the respective base members.

14. A method for managing a wound in a patient comprising the steps of:
-positioning first and second base members to contact the patient on opposing sides of the wound, the base members each comprising a lower face configured for directly or indirectly contacting the patient, and an opposed upper face;
securing the base members together across the wound by connecting the base members with at least one cord assembly, the cord assembly comprising a cord, a cord anchor configured to attach a first end of the cord to a first of the base members and a cord retractor on the second of the base members for retracting the cord;
retracting the cord of the at least one cord assembly to provide a selected degree of tension in the cord;
wrapping a belt partially around the body of the patient in the area opposed to the wound, wherein the bell is unsecured from at least one of the base members; and securing the bell to the at least one base member with a clamp assembly wherein the clamp assembly projects from the upper face of the at least one base member to grip an end region of the belt to releasably secure the bell to permit engagement, tensioning and detensioning of the belt relative to the base members.

15. The method of claim 14 wherein at least one of the base members, cord assemblies, bell and damp assemblies comprise the system of any one of claims to 13.