DE29721532U1 - Wound sheet - Google Patents

Description

A 54 272 u , Applicant:

c-250 AESCULAP AG & CO. KG

4 December 1997 \ At Aesculap Square

78532 Tuttlingen

wound leaf

The invention relates to a wound sheet with a tissue contact surface for retracting tissue parts.

Such wound sheets are used to keep access to surgical sites free by holding back the soft tissue parts located in the area of the access using retractor systems equipped with such wound sheets. The wound sheets can, for example, be designed in the form of wide spatulas. In many cases, these are sufficient to hold back the tissue parts. However, particularly with very soft tissue, the largest possible tissue contact surface is required in order to be able to effectively hold back the tissue parts in the entire surgical area. However, the tissue contact surface of the wound sheets cannot always be increased arbitrarily, because the wound sheets are often introduced into the body through narrow accesses and are therefore limited in their dimensions. In open, minimally invasive surgery in particular, the wound sheet should be able to be inserted into a body cavity through a narrow body opening.

The object of the present invention is to design a generic wound sheet in such a way that, on the one hand, it can be introduced into the body to be treated through narrow accesses and, on the other hand, is suitable for retaining soft tissue parts over a large area.

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This object is achieved according to the invention in a wound sheet of the type mentioned at the outset in that the wound sheet comprises a retaining element that can be moved from an insertion position into a retaining position in order to enlarge the tissue contact surface.

When the wound sheet is inserted into a body opening, the retaining element can be brought into an insertion position in which the wound sheet has only very limited dimensions. After positioning in the surgical area, the retaining element can be moved into a retaining position with an enlarged tissue contact surface. The movable arrangement of the retaining element thus makes it possible to position a wound sheet with small dimensions through a narrow access in the body and then to form a larger tissue contact surface by moving the retaining element into its retaining position, so that even very soft tissue parts, e.g. flexible lung tissue, can be retained over a large area.

In a preferred embodiment, the wound sheet has a base part on which the retaining element is rotatably mounted. This makes it possible to align the retaining element parallel to the base part when the wound sheet is inserted through a narrow access into the body, and after positioning the retaining element can be aligned transversely to the base part by rotating it, so that a considerably enlarged tissue contact surface is obtained.

Alternatively, it can be provided that the retaining element is held slidably on the base part. This

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makes it possible to bring the retaining element into an insertion position that essentially covers the base part when the wound sheet is inserted into the body. The retaining element can then be moved, for example, transversely to the insertion direction of the wound sheet relative to the base part so that it protrudes laterally over the base part and forms an enlarged tissue contact surface.

In a particularly preferred embodiment, the retaining element is held on the base part so that it can be moved as well as rotated. This gives the surgeon the option of either simply rotating the retaining element from its insertion position or additionally moving it relative to the base part in order to increase the tissue contact surface of the wound sheet. By moving and rotating the retaining element, a tissue contact surface with different shapes and sizes can be achieved.

It is advantageous if the retaining element comprises at least one retaining plate. This can have a different shape adapted to the respective application and can be solid-walled or perforated.

In a particularly advantageous embodiment, the retaining element has several retaining plates that can be moved relative to one another. This makes it possible to form a tissue contact surface of different sizes by moving individual retaining plates, depending on the area of application of the wound sheet.

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For example, it can be provided that the retaining element has at least two retaining plates mounted on the base part so that they can rotate about a common axis of rotation. The retaining plates can be arranged offset from one another in the direction of rotation in their retaining position, while in their insertion position they can be aligned parallel to the base part.

It is particularly advantageous if the retaining plates can be subjected to a spring force pointing towards the base part. This makes it possible to brace the retaining plates with the base part under the effect of the spring force, although the surgeon can move them against the effect of the spring force. The spring force thus ensures that the retaining plates do not automatically change the position they have taken.

In a particularly cost-effective embodiment, the retaining plates each have a guide slot, with all of the guide slots being penetrated by a spring-loaded bearing bolt, which applies a spring force to the retaining plates in the direction of the base part. The bearing bolt thus serves to rotatably support the retaining plates, and it also ensures that the retaining plates do not automatically change their retaining position once they have been adopted, by exerting an elastic clamping force on the retaining plates. For this purpose, it can be provided, for example, that the bearing bolt is in its longitudinal direction

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is movably held on the base part and is subjected to a spring force acting in its longitudinal direction by a spring element. The bearing bolt can be T-shaped or mushroom-shaped and its bolt head presses the retaining plates against the base part under the action of the spring element.

It is advantageous if the retaining element comprises a first retaining plate that is rotatably mounted on the base part, on which a second retaining plate is slidably mounted. The tissue contact surface that can be achieved using the two retaining plates can thus be changed both in size and in its orientation relative to the base part of the wound sheet.

In a particularly preferred embodiment, one of the two retaining plates comprises two guide slots, each of which is penetrated by a guide bolt held on the other retaining plate.

In order to ensure that the retaining plates do not automatically change their retaining position once they have been adopted, it can advantageously be provided that the guide bolt is spring-loaded and applies a spring force to the two retaining plates pointing towards the base part, so that they can be clamped to the base part, as already described above.

As already described, the tissue contact area of the wound sheet according to the invention can be increased after positioning in an operation area by

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the retaining element is moved from its insertion position into its retaining position. In a particularly preferred embodiment, the retaining element has at least one coupling part for a manipulation instrument, with the aid of which the retaining element can be moved. The coupling element can, for example, comprise a bore for the engagement of a manipulation instrument, for example a manipulation hook.

Advantageously, the retaining element can have a plurality of through holes, preferably evenly distributed on its surface. Such a design allows a surgeon to easily manipulate the wound sheet in any position of the retaining element in order to enlarge or reduce the tissue contact area.

The following description of a preferred embodiment of the invention serves to explain it in more detail in conjunction with the drawing. They show:

Figure 1: a schematic side view of a

wound sheet according to the invention with a retaining element arranged in its insertion position;

Figure 2: a schematic side view according to

Figure 1, wherein the retaining element assumes a first retaining position;

Figure 3: a schematic side view according to

Figure 1, wherein the retaining element is a

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takes a second restraint position and

Figure 4: a schematic side view according to

Figure 1, wherein the retaining element assumes a third retaining position.

Figure 1 schematically shows a wound sheet, designated overall by the reference number 10, which essentially comprises an elongated base part 12 and a retaining element 14 which is held on the base part 12 in a displaceable and rotatable manner.

The base part 12 has a protruding ball pin 16 at one end, which represents part of a quick-release fastener, with the aid of which the wound sheet 10 can be attached to a known frame (not shown in the drawing) to form a retractor system. For this purpose, several wound sheets can be attached to the frame in a known manner in order to expose a desired surgical area in this way.

The retaining element 14 can be rotated by means of a bearing bolt 18 about a rotation axis aligned transversely to the longitudinal direction of the base part 12 and is held on the base part 12 so that it can be moved transversely to the rotation axis. This makes it possible to align the retaining element 14 parallel to the base part 12 when the wound sheet 10 is inserted into a body through a narrow access opening, as shown in Figure 1. After insertion, the retaining element 14 can be moved relative to the base part 12.

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twisted and moved, e.g. into the retention positions shown in Figures 2, 3 and 4.

As is particularly clear from Figure 2, the retaining element 14 comprises three retaining plates 20, 21, and 22, each of which has through holes 24 evenly distributed over its circumference.

As can be seen in particular from Figure 1, the retaining plates 20, 21 and 22 can be placed on top of one another. The retaining plates 20, 21 and are mounted on the base part 12 by means of the bearing bolt 18, which is held on the base part 12 so that it can move in its longitudinal direction, i.e. in the direction of the axis of rotation of the retaining element 14, and is subjected to a spring force pointing towards the base part 12. The bearing bolt 18 passes through a longitudinal slot 26 or 28 of the retaining plates 21 and 22 and protrudes laterally with its widened bolt head over the long sides of the longitudinal slot 26 in such a way that it clamps the retaining plates 21 and 22 to the base part 12 due to its spring loading. The bearing bolt 18 is guided on a slot 29 of the base part 12 so that it can be moved along the base part 12 together with the retaining plates 20, 21 and 22 mounted on it.

Two spring-loaded guide bolts 30, 32 are held on the middle retaining plate 21 so that they can move in their longitudinal direction, i.e. parallel to the pivot axis of the bearing bolt 18. The guide bolts 30 and 32 each pass through a guide slot 34 or 36 arranged on the retaining plate 20, the

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Longitudinal sides are each covered by a widened bolt head of the guide bolts 30 and 32 in such a way that the guide bolts 30, 32 clamp the retaining plate 20 to the retaining plate 21 due to the spring force acting on them parallel to the pivot axis of the bearing bolt 18.

In the area of the longitudinal slots 26 and 28, the retaining plate 20 has a notch 38, the width of which exceeds the width of the bolt head of the bearing bolt 18.

In order to apply a spring force to the guide pins 30 and 32 as well as the bearing pin 18, spring elements known per se and therefore not shown in the drawing are used, with the help of which it is ensured that the retaining plates 20, 21 and 22 do not automatically change the position they have once assumed.

The mounting of the retaining plates 21 and 22 on the bearing bolt 18 makes it possible to rotate the retaining plates around the bearing bolt 18 from the insertion position shown in Figure 1 into a retaining position. Since the retaining plates 21 and 22 are held on the bearing bolt 18 by means of the longitudinal slots 26 and 28, respectively, the retaining plates can also be moved transversely to the pivot axis defined by the bearing bolt 18. In this case, the retaining plates 21 and 22 can be moved not only relative to the base part 12 but also relative to each other. In addition, the outermost retaining plate 20 facing away from the base part 12 can be moved relative to the retaining plate 21, since this is moved by means of the guide bolts 30 and 32.

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- 10 -

and the guide slots 34 and 36 are slidably held on the retaining plate 21.

For insertion into the body through a narrow body opening, the three retaining plates 20, 21 and 22 are placed on top of one another, as is clear from Figure 1, and aligned parallel to the longitudinal direction of the base part 12. In this insertion position, the wound sheet 10 has only small dimensions. After positioning the wound sheet 10 in the surgical area, the retaining plates 20, 21 and 22 can be rotated and moved relative to the base part 12, as is clear from Figures 2, 3 and 4, so that they form an enlarged tissue contact surface for the wound sheet 10. The manipulation of the retaining plates 20, 21 and 22 can be carried out by the surgeon using a manipulation hook (not shown in the drawing) that can engage in the through holes 24.

After completion of an operation, the retaining plates 20, 21 and 22 are again displaced relative to one another so that they are arranged one above the other and then they are aligned parallel to the base part 12. The wound sheet 10 can then be removed from the operation area without difficulty due to its relatively small dimensions.

Claims (1)

A 54 272 u December 4, 1997 - 11 - PROTECTION CLAIMS 1. Wound sheet with a tissue contact surface for retracting tissue parts, characterized in that the wound sheet (10) comprises a retaining element (14) that can be moved from an insertion position into a retaining position in order to enlarge the tissue contact surface. 2. Wound sheet according to claim 1, characterized in that the wound sheet (10) has a base part (12) on which the retaining element (14) is rotatably mounted. 3. Wound sheet according to claim 1 or 2, characterized in that the wound sheet (10) has a base part (12) on which the retaining element (14) is slidably held. 4. Wound sheet according to one of the preceding claims, characterized in that the retaining element (14) comprises at least one retaining plate (20; 21; 22). 5. Wound sheet according to one of the preceding claims, characterized in that the retaining element (14) has several retaining plates (20, 21, 22) that are movable relative to one another. A 54 272 u December 4, 1997 - 12 - 6. Wound sheet according to one of the preceding claims, characterized in that the retaining element (14) has at least two retaining plates (21, 22) mounted on the base part (12) so as to be rotatable about a common axis of rotation. 7. Wound sheet according to claim 6, characterized in that the retaining plates (21, 22) are subjected to a spring force pointing in the direction of the base part (12). 8. Wound sheet according to claim 6 or 7, characterized in that the retaining plates (21, 22) each have a guide slot (26 or 28), whereby the guide slots (26, 28) are penetrated by a spring-loaded bearing bolt (18) which applies a spring force to the retaining plates (21, 22) pointing in the direction of the base part (12). 9. Wound sheet according to one of the preceding claims, characterized in that the retaining element (14) comprises a first retaining plate (21) which is rotatably mounted on the base part and on which a second retaining plate (20) is slidably held. 10. Wound sheet according to claim 9, characterized in that one of the two retaining plates (20) comprises two guide slots (34, 36), through which a guide bolt (30 or 32) held on the other retaining plate (21) passes. A 54 272 u December 4, 1997 - 13 - 11. Wound sheet according to claim 10, characterized in that the guide bolt (30; 32) is spring-loaded and applies a spring force pointing towards the base part (12) to the two retaining plates (20, 21). 12. Wound sheet according to one of the preceding claims, characterized in that the retaining element (14) has at least one coupling part (24) for a manipulation instrument for manual movement between its insertion position and its retaining position. 13. Wound sheet according to claim 12, characterized in that the coupling part comprises a bore (24) for engagement of the manipulation instrument.