GB2112648A - Set of accessory equipment for surgical suturing, method for preparing suturing material for a surgical suture, and surgical process for closing of a wound - Google Patents

Abstract

The lips of a wound are secured together by thread stitches 2, each end of a thread stitch having secured thereto a clamp or clip 3 having a jagged edge portion adapted to abut an external side of a respective lip of the wound. The clamps are positioned so that the jagged edge portions abut the lips of the wound from opposite sides. This allows the wound to be closed, yet within each lip blood circulation will be facilitated as the lips are free from exertion thereonto by uniform pressure. <IMAGE>

Description

SPECIFICATION Set of accessory equipment for surgical suturing, method for preparing sulturing material for a surgical suture, and surgical process for closing of a wound A surgical device for closing incisions or wounds, in which pressure elements are massive, clamp-like blocks or foot plates having a V-shaped recess for receiving a thread, and having a relatively broad, even support surface for abutting a lip of a wound is known from Hoegerman, U.S. Patent No.

3,541,591. This surgical device for closing incisions or wounds, although permitting rational suture, by the pressure elements being installed pair-wise on a thread, by this thread and a connecting rod between pairs of pressure elements being separated, and by the piece of thread, thus having obtained a free end, being ready to be passed again through the lips of the wound, the other end of the piece of thread carrying the block or foot plate, is physiologically impractable, and unsuitable for the reason that the blocks or foot plates have an even surface abutting the wound. These even abutting surfaces, which abut respective lips of the wound along their entire length, hinder flow of blood through the tissue, and delay the heating process, particularly if any bandage over the wound generates additional pressure.Separation of a connecting rod between pairs of pressure elements directly near the wound is disadvantageous, as when severing such a connecting rod any shavings or burrs may penetrate the wound, the result in infections. Removal of the pressure element or blocks following scarring ing of the wound is made more difficult, as a spreading apart of the blocks is practically impossible, and as the thread held by the blocks or foot plates is accessible only with difficulty, so that it is not easily cut.

SUMMARY OF THE INVENTION It is an object of the present invention to devise a physiologically more favourable shape of the pressure elements or clamps, which permits both a fashioning of the pressure elements or clamps leading to simple and rational handling, both when completing a suture, as well as during removal of the stitches after healing of the wound, and to a simpler manufacture of the clamps, or pressure elements. This object is primarily attained by the clamps or pressure elements abutting a lip of the wound having a jagged, zig-zag or toothed abutting edge or surface. The lip of a wound is supported by clamps of the aforecited type, while ensuring an optimal blood circulation, which aids the healing process considerably, and also leads to a clean and uniform scar formation.

The clamps or pressure elements preferably have edge portions adapted to abut the lip of the wound which are graduated or slanted, for example in the case of two shanks of the clamp, one shank has edge portions which have a wavy surface, are jagged or formed with teeth, and extends beyond the other shank. This permits the clamps, in a preferred version having flat shanks, to hug a portion of the skin adjacent to the lip of the wound, and where the lip of the wound is free from having any uniform pressure exerted thereon.

No problems are therefore caused when a bandage is applied over the wound. Further more, any squeezing of the skin or tissue onto the thread is avoided during clamping of pressure elements or clamps onto the lips of the wound.

Exhaustive experiments have shown that it is not only possible, but advantageous to shape the pressure elements or clamps so that they are relatively thin and, in a preferred version, flat, so that edge portions of each clamp may abut the lips of the wound. The pressure elements or clamps may be manufac tured by stamping the clamps from a sheet of bendable material, and thereafter bending the sheet or strip of material into an approxi mately V-shaped clamp. Each clamp has pre ferably a normally open form and includes shanks, one shank having an opening the other shank including a tongue arranged to pass through the opening so that the clamp may be secured to the thread upon the thread being clamped between the shank, and upon the tongue being passed through the opeing and thereafter bent and pressed onto the one shank.The tongue serves not only to secure the thread to the shank, but also fulfills the function of a stop, when the thread is passed into the still open clamp. The thread can therefore be passed without any effort into the widest opening of the still open clamp, but still maintains a predefined position in the center of the clamp, when the thread is clamped between the shanks abutting a por tion of the tongue. Thus the clamps which eventually surround the lips of the wound with the thread passing therebetween facilitate blood circulation through the lips of the wound, as blood circulation is not impeded by any uniform flat pressure being exerted on both sides of the lips, and thus shutting off the blood circulation. The construction of the clamp assures that threads of various thick messes can be used, without causing any problems.

The simply constructed clamps fabricated from sheets or strips permit a particularly rational handling, as they can preferably be inserted in pairs in their open position into forceps and clamped by means of the forceps onto a thread. Furthermore, the clamps can be removed from the thread by a suitable instrument by spreading the shanks of each clamp apart, which makes it unnecessary to cut the thread. Thus the clamps are particularly suitable to be stored in a clamp dispenser, and to be removed by means of forceps or the like from the clamp dispenser. This permits not only a rational, but a complete hygienic manipulation of the clamps.

As has already been indicated, manufacture of the pressure element or clamps in the form of stamping the clamps from strips or sheets, and thereafter bending them into the required shape is particularly economical. As these clamps can be installed in pairs on a thread, and spaced at a suitable distance from one another, the thread need only be kept between these clamps, which permits a much simpler implementation of the forceps and necessitates a smaller degree of force when the thread is clamped between a clamp, and when the thread is cut.

When it is known to clamp pressure elements made of a sheet or strip to each end of a surgical thread from German Patent No.

382 337, such clamps do not serve to abut the lips or edges of a wound, but need simply be used as end portions of a thread, so as to facilitate the knotting thereof. Nor are these clamps formed in a shape to render them suitable for use as pressure elements. A further disadvantage of the clamps taught in the aforesaid German patent is the fact that the thread must be passed through narrow holes first. A rational handling in the sense of the present invention is therefore not possible.

Other objects of the invention will in part be obvious and will in part appear hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS For a fuller understanding of the nature and objections of the invention, reference should be had to the following detailed description, taken in connection with the accompanying drawings in which: Figure 1 illustrates the suturing procedure; Figure 2 is a large-scale partial cross-section of the completed suture; Figure 3 is a large-scale partial view of the suture in perspective; Figure 4 is a partial perspective view of the forceps according to the invention, with two clamps and the thread; Figure 5 is a partial longitudinal crosssection of the closed forceps according to the invention; Figure 6 is a perspective view of one version of clamp dispenser; Figure 7 is an elevation view, in part section, of the forceps partly inserted into the clamp dispenser; Figure 8 is a perspective view of a magazine housing;; Figure 9 is a perspective view of a clamp guide of the housing; Figure 10 is a perspective view of an end stop for the clamps in the clamp dispenser; Figure 11 is an elevational view of the pincers according to the invention, for separating the clamps from the thread; Figure 12 is a large-scale side view of the pincers about to separate the shanks of a clamp; Figure 13 is a large-scale side view of a wedge or knife of the pincers, after having separated the shanks of a clamp; Figure 14 is an elevation view of another version of forceps according to the invention, and a schematic representation of the suturing procedure; Figure 15 is a cross-section through the locking device of the other version of the forceps; Figure 16 is a side elevation view of a detail of the other version of the forceps;; Figure 17 is a side elevation view of another detail of the other version of the forceps in one operating position; Figure 18 is a side elevation view of the other version of the forceps similar to that of Fig. 17, but in another operating position; Figure 19 is a perspective view of a magazine housing for the clamps; Figure 20 is a perspective view of a first version of a holding device for the magazine, which can be secured to an operating table; Figure 21 is a perspective view of a second version of a holding device for the magazine, which can be secured to an operating table; Figure 22 is a large scale horizontal crosssection of the magazine.

DESCRIPTION OF THE PREFERRED EMBODI MENTS Referring now to the drawings, Fig. 1 shows a wound 1 which is already partially closed in the upper section of the drawing.

The suture consists of individual pieces of a thread 2 carrying pressure elements in the form of a clamp or clip 3 abutting each lip of a wound. As is shown in Fig. 2, an outer shank of each clamp 3 extends laterally beyond an internal shank thereof, which causes optimal contact between the clamps 3 and the lips of the wound, the clamp 3 abutting the skin at a lip of the wound. As can be seen in Fig. 1, and especially in Fig. 3, an outer edge portion of the clamp 3 is jagged, for example ragged, toothed or wavelike, so that the edge portions make only intermittent contact with the lip of the wound, thus meeting the physiological requirement of good blood circulation.

In addition to the generally used thread 2 and a corresponding needle 4 for passing the thread through the lips of the wound, there are provided clamp actuating means, such as a special pair of forceps (shown in Fig. 1) constructed like conventional surgical clamping scissors having a pair of handles, each being formed with a grip and locking means, such as a toothed stop device 5 to hold the forceps in a locked position; the forceps may be manually released from the locked posi tion. The purpose of the forceps is to simultaneously grip two clamps 3 and to firmly secure them to the thread 2 in a tension-proof manner. This will be described in detail below. In addition, the forceps are equipped with cutting means, such as a knife 6 (not shown in Fig. 1 but visible in Fig. 3) operated by means of a lever 7 to cut the thread 2 between the two clamps 3.At the beginning of the suturing procedure, a first clamp 3 is secured to the end of the thread 2 facing away from the needle 4. The thread is then passed by the needle 4 through the lips of the wound in a known manner until the clamp 3 is in the correct position relative to one lip of the wound. The thread 2 is then introduced into the next two open, V-shaped shanks forming another clamp and located in the open forceps according to Fig. 1. The position of the thread 2 in each clamp 3 is determined, according to Fig. 4, by a tongue 8 formed from a lower shank of the clamp, and initially positioned transversely thereto. The forceps are then moved across the stretched thread 2 toward a lip of the wound, until one of the clamps 3 located within the forceps makes contact with the lip of the wound.

During this movement of the forceps toward a lip of the wound, the clamps 3 may already be compressed to such an extend that a sliding movement of the thread therein is just possible. The optimal bearing pressure of the two clamps against the lip of the wound can be determined very sensitively by moving the forceps with the open or half-closed clamps 3 along the stretched thread 2 toward the lip of the wound, until the pair of clamps 3 bear against and abut the lips of the wound with the desired pressure. The forceps are then employed to close the clamps, in that both clamps 3 are secured to the thread 2 with the one in a correct position with respect to one lip of the wound.This completes one stitch of the suture, consisting of a piece of thread 2 and two clamps 3, and a new therad end combined with a clamp 3 is produced by operating the knife 6 by means of the lever 7 against the force of a (non-illustrated) spring, thus cutting the thread between a different pair of clamps 3 in the forceps. The next stitch can then be initiated immediately by passing the needle 4 in the same, or opposite direction through the two lips of the wound until the clamp 3 on the thread 2 makes contact with the lip of the wound. In the meantime, the forceps have been opened and have received another pair of open clamps 3.

This other pair of clamps 3 can then be clamped onto the thread 2, the thread 2 between the clamps 3 cut, and the suture continued. The procedure is repeated as required until the suture is completed and the wound closed. As mentioned above, this suturing method is rational and fast. Since each pair of opposite clamps presses the lips of the wound together uniformly along a certain length, stitches can be applied spaced at relatively large distances from one another.

This not only increases the speed of the procedure, but also provides a favourable structure for healing and formation of a scar of the wound.

Following the description of the essential elements and technique of the suture, essential details of the accessory equipment used will now be described. The thread may be any of the known surgical thread or wires of any material, provided it meets the medical requirement, and is suitable for sufficiently tension-proof application of the clamps 3. The clamps 3 may be knurled, waved, or roughened on the inner surface, as shown in Fig. 4.

Good adhesive properties of the clamps also depends on the selected material. Ductile, non-irritating material, for example pure aluminium, is preferably used. Such clamps have a minimum tendency to open again after being pressed together. The reliability of the clamping action is increased by the fact that the tongue 8 of the lower clamp shank enters an opening 9 of the upper clamp shank when the shank of the clamps are pressed together by the forceps. A suitable shaped recess 10 (Fig. 5) of an upper arm or handle of the forceps causes the tongue 8 to be bent over the upper clamp shank, thus being pressed against the upper shank, as shown in Fig. 3.

The upper arm of the forceps acts as a bending tool for the tongue 8.

The lower arm or handle of the forceps has two flat lateral recesses with a clamp positioning means such as a front stop or indentation 11 for one lower clamp shank each (see Fig.

4). The outer edges of the lower clamp shank are flushed with the lateral surfaces of the lower arm or handle of the forceps, while the edge portions of the upper clamp shank protrude laterally over and beyond the forceps.

This favors a tight contact between the clamp in the forceps and the lip of the wound, and a correct clamping of the clamp into the thread 2 in this position. The two flat recesses for receiving the lower clamp shanks are separated by a flat center rib 12 against which the knife 6 is pressed to cut the thread. The center rib 12 forms with its lateral surfaces 1 2a an end stop for the clamps 3 which makes it possible to press the clamps 3 against the lips of the wound, while the forceps are open. The forceps are equipped with two resilient U-shaped bolts 13 holding the clamps 3 in position in the stops or indentations when the forceps are open (see Fig. 4). The upper arm or handle of the forceps has recesses to accommodate clamp holding means, such as free ends of the Ushaped bolts 1 3.The U-shaped bolts 1 3 represent the ends of spiral springs which are disposed symmetrically about an axis 14 of the forceps. As shown in Fig. 5, there are provided clamp positioning means, such as indentations or stop surfaces 11, which are undercut to provide a good hold for the clamps 3 in the forceps. The knife 6 with its operating lever 7 is also supported along the axis 14 of the forceps in a manner not described in detail.

The gripping portion of the forceps is provided with jaws 15 having knurled inner surfaces to effectively grip the needle 4, which is required to penetrate the lips of the wound.

To achieve an optimal operating speed, it is not only essential to devise a rational suturing procedure as described above, but also to ensure that the forceps are always quickly and safely loaded with new clamps. This is accomplished by clamp loading means, such as a clamp dispensing station (see Figs. 6 through 10). A base 16 is provided with to magazines or clamp storing units 18 inserted in holding means, such as dovetailed grooves 17. These magazines hold stacks of clamps 3. The magazines 18 are held in an operating position by disconnectable detents or locks, and can be easily replaced when the detents or locks are disengaged. Figs. 8 and 9 show how in each magazine 18 a slide bar 19 acts on a spring 20 with spiral-shaped ends so that a stack of clamps 3 is advanced forwardly at a constant force independent of the length of the stack.The outermost clamp 3a of each stack is advanced forwardly on a clamp guide 21 until it reaches clamp restraining means, such as an end stop 22. In this position, the clamp 3a has completely left the housing 1 8a or the external guide of the magazine 18 and can be gripped by the forceps, and withdrawn in a direction transverse to the longitudinal axis of the magazine 18. A covering lug 21a each secures the so advanced clamp 3a on its guide 21 (Figs. 7 and 10). The two magazines 18 shown in Fig. 8 have their end stops 22 operatively juxtaposed, and the clamps 3a are operatively spaced at that distance from one another which is required in the forceps, according to Fig. 4, to accommodate the clamp within the forceps. A flat spring 23 is located below the release point of the clamp 3a.As shown in Fig. 7, two clamps 3 are received by the forceps by inserting the lower arm or handle of the forceps between the stops 22 (seen in Fig. 6) and the spring 23 presses the lower arm or handle of the forceps against the clamps 3a ready to be removed from the magazine 18, so that the lower shank of each clamp 3 engages the indentation or stop surface 11. This inserting movement of the forceps is limitd by a stop pin 24, best seen in Fig. 6. As soon as the forceps have been fully inserted up to the end stop 24, they are withdrawn again, pulling out the clamps 3a through the end of the stops 11, the clamps 3a being additionally held in position within the forceps by the resilient Ushaped bolts 13.The forceps can now be used to once more install two new clamps on the thread 2, while another pair of clamps is advanced into the release position of the loading statin, or clamp dispenser.

To remove the thread pieces and clamps from the healed wound, the thread pieces can be cut on one side between the scarred wound and the clamp with scissors, thus loosening one clamp. The other clamp is used to withdraw the thread piece from the lips of the wound. However, it is advantageous to provide special means, such as a clamp-remover, opening and removing the clamps. Figs.

1 1-13 show such a device, namely pincers 25, and this method of operation. One arm or handle of the pincers 25 is provided with a notch 26 which serves as a support for a provided end of the clamp 3, according to Figs. 12 and 13. The other arm of the pincers 25 is equipped with a knife 27 which can be moved under a beveled front surface of the upper shank and thus spread the shanks apart as shown in Fig. 13. The same arm or handle of the pincers 25 is provided with a stop 29, which limits the penetration depth of its knife 27 between the shanks of the clamp 3 in such a manner that the thread 2 is loosened, but not clamped by the knife 27. When spread apart in this way, the clamp 3 can be withdrawn to the side of the thread, whereupon the opposite clamp can be removed along with the thread piece.The pincers 25 are also equipped with limiting stops 30 and 31, which limit the path of the knife 27, so that it just makes contact with the elongated lower shank of the clamp 3 when the open pincers are applied, this being correctly positioned to make contact with the lower clamp shank while also engaging the upper clamp shank below its beveled front surface 28. At the same time, it becomes impossible to close the pincers with such a force that the upper clamp shank is bent out of shape. Moreover, any risk of the knife 27 engaging a clamp 3 therebelow, and thus damaging the lip of the wound is eliminated.

Various models or implementations of the clamp are possible. The design of the pressure elements of the clamp may be varied, and different materials may be used. The clamp or pressure elements may, for example, by cylindrical or prismatic rods made of non-irritating plastic compatible with the human skin, with means for passing the thread through the tissue, and being flexible enough to allow tension-proof clamping of the thread. The clamps or pressure elements may also consist each of two metal or plastic parts coupled to one another by a snap closure, and suitable for being pressed in a tension-proof manner onto the thread. The aforedescribed forceps or a corresponding tool for applying other pressure elements or clamps onto the thread may be designed for the application of only one pressure element to that thread.A knife or other cutting device on the forceps is not absolutely essential, since the thread can also be cut with scissors. Cutting of the thread may be altogether omitted, but in such a case the clamps or pressure elements should be adequately spaced from one another, so that the thread sections between the clamps or pressure elements can be moved without any tension, when the suture is completed. If forceps of the above-described type, are employed for handling the clamps, and wherein the clamps are spaced close to one another, the knife 6 may be replaced by a device to form a loop in the thread between the clamps, before the clamps are clamped onto the thread.

The jaws of the forceps may be hardened or lined with hard alloy plates to reduce wear due to handling of the clamps, or of the needle.

The clamp dispenser may be equipped with a special support and guide for the forceps in order to facilitate introduction of the forceps in the correct position for picking up the clamps.

Such a design may also include a device controlled by the forceps for inhibiting the advancement of the clamps from the magazines until the forceps are inserted. This would prevent the clamps from being gripped in a wrong position or being lost. The clamps may also be stacked by means of a suitable and physiologically tolerable binding agent, or may be joined only at specific, easily separable locations. The clamp dispenser may also be equipped with only one storage unit or magazine which has feed devices for clamps fed thereto from the left and right sides, respectively, namely on either side of the release point. Such a design may also include a a common spring for feeding both stacks of clamps.

The forceps, shown in an alternate embodiment in Fig. 14 in side elevation view, includes two ring-ended handles which merge with lugs 40, the lugs 40 being each provided with locking teeth 5, so as to lock the forceps in a rest position.

The upper handle of the forceps carries an end stop pin 41, best seen in Fig. 15, with which the lower lug 40 makes contact in order to limit travel beyond the position at which the forceps are completely closed. The forceps are furnished with a thread cutter, or suture cutter, in the form of movable blade 6, best seen in Figs. 16 and 17, and a lever 7 connected thereto. The lever 7 is pivoted on a pin 42 located in the upper handle of the forceps, as best seen in Fig. 14. When the locking teeth 5 are disengaged from one another, the forceps are held in the open position by yieldably resilient means, such as a spring 43, which also holds the cutter in the open, non-cutting position shown in Fig. 14.

When pivoting the cutter in a counterclockwise direction, the blade 6 advances to its (non-illustrated) mating blade in the lower jaw of the forceps, and cooperates therewith to sever the thread or suture 2.

In the vicinity of the cutter, the jaws of the forceps are designed as to permit one clamp 3 to be picked up and held on each side of the forceps. Fig. 22 shows in greater detail how wear-resistant plates 44 and 45 may be in serted in the forceps. A clamp 3 can be held between each pair of these plates, so that the lower and longer shank of the clamp 3 abuts a stop surface 46. The clamp 3 is thus subjected to a slight elastic deformation of its original shape and is thereby firmly held in the open forceps. Each upper plate 45 is provided with a recess 10 which accepts and bends tongues 8, when the forceps are closed.

The gripping end of the forceps include jaws 15, both seen in Figs. 14 and 15, which are also protected by wear-resistant plates 47 and 48, and which grip the needle 4, when stitches are being inserted through the lips of the wound. The suturing procedure itself, however, has already been fully described, and therefore, requires no further detailed explanation. Only such individual phases of the suturing procedure which are applicable to the method of operation of the forceps will be further discussed.

As has already been mentioned, Fig. 14 shows the forceps in the fully opened state or position at which the transfer of the clamp 3 from the magazine takes place. A detailed description of the construction of this maga zine is given further below. Fig. 19 shows pairs of clamps 3 adjacent to one another disposed on respective retaining bars 49, which can also be seen in Fig. 21 and 22. A flat rib in the center of each retaining bar 49 determines the distance separating the clamps 3. It is therefore merely necessary to insert the open forceps through the open front of the storage unit or magazine over two clamps or over the retaining bar 49, in order to grasp a pair of clamps, as shown in Fig. 22.When the forceps are withdrawn, each stop surface takes a clamp along with it, so that the forceps are now loaded with a suitable ar ranged pair of clamps 3 spaced from one another. This is the stage at which, in accor dance with Fig. 14, the portion of thread 2 which has just been threaded through the lip of the wound is moved between the jaws of the forceps, and thus between the fingers of the clamps 3, until it contacts the tongues 8.

The forceps are then closed to a first locking position in accordance with Fig. 16, in which the first pair of teeth of the locking device 5 engage one another. This forceps then remain in this position as a result of the elastic spreading force exerted by the clamps 3 or the force exerted by the spring 43 uring the forceps to remain open. The forceps can now be effortlessly slid along the thread 2 to the lip of the wound. As soon as one clamp 3 is located adjacent to the lip of the wound and abuts it at the correct pressure, the forceps are closed to a second locked position in accordance with Fig. 17, in which the second pair of teeth of the locking device 5 are engaged with one another. The clamps 3 are then already firmly secured to the thread 2.

Upon pressing the handles of the forceps still further together into a third locked position, in accordance with Fig. 18, the lug on the lever 7 is lifted by the lower handle of the forceps. This causes the cutter blade 6 to pivot downwardly, which, in conjunction with its mating blade in the lower jaw, effectively severs the thread 2 between the two clamps 3. Thus, when the final locked position illustrated in Fig. 18 is attained, the thread or suture is completely severed. The result is a new length of thread or suture with a clamp 3 attached to one end thereof, and a needle attached to the other end of the suture or thread. The needle can again be thrust through the lips of the wound.When the clamp 3 secured to the end of the suture 2 has reached the position relative to the lip of the wound illustrated in Fig. 14, the forceps are used to capture two new clamps 3, whereupon the procedure described above is repeated.

As illustrated in Figs. 19 and 21, there are provided clamp dis#pensing means, such as a magazine casing, which includes two plastic shrouds 50 and 51, which are welded or bonded to one another by known methods.

Toward the rear of each shround a groove 52 is provided which extends upwardly to a particular height, and serves for mounting the magazine in a magazine holder. Both shrouds 50 and 51 are open at one end to provide accessibility to the clamps inserted therein.

The flat side of each shroud 50 and 51 has a vertical row of apertures 53 in which flexible retaining tongues 54 are integrally formed with the shrouds. As illustrated in Fig. 21, flexible retaining tongues 54 are furnished with inwardly-facing protruberances, which engage a tooth formed on an outer surface of a clamp 3. The clamp 3 is thus securely held in the magazine. The clamps 3 are located on clamp retaining bars 49 of a magazine insert in the manner already explained with the aid of Fig. 21. The individual retaining bars 49 are connected by vertical insert members 55 which are held between the shrouds 50 and 51 of the magazine casing. When using the forceps to extract a pair of clamps, the flexible retaining tongues 54 are elastically displaced outwardly and thus release the clamps 3.For filling or refilling the magazine, the clamps 3 may be pushed in, so that the flexible retaining tongues 54 are first displaced outwardly and thereafter snap into position behind the teeth of the clamps 3. The forceps can receive the clamp 3 through an entrance in the casing.

The retaining bars 49 of the magazine insert are provided with recesses 59 to accept the tongues 8 of the clamps 3. These recesses are slightly tapered in depth to provide a guide when the clamps 3 are inserted.

Fig. 19 shows that the magazine can be located in holding means, such as a magazine holder, whose side flanges, according to Fig.

21 with their inwardly bent edges 52, engage in the grooves 52 defined in the shrouds 50 and 51 of the magazine, thereby holding the magazine in the desired position. Fig. 19 shows a Z-shaped upper element 56 of the magazine holder threaded onto an L-shaped lower element 57, whose horizontal limb is shaped to act as a leaf spring 57', which permits the magazine holder to be secured to the edge of an operating table 60 or the like.

If so desired, the Z-shaped upper element of the magazine holder can be threaded onto the lower element 58 shown in Fig. 20. A horizontal limb of the lower element 58 is fur nished with a clamping screw 58' which permits the magazine or storing unit to be clamped to the edge of the operating table.

In the preferred version the clamp 3 is made of rust-free steel and includes a thin region in its bent portion whose thickness is smaller than that of the remaining portion of the clamp. The thickness throughout a greater portion of the clamp is about .3 mm, while the thin region has a thickness of about .1 mm. The width of the clamp is between 3 and 4 4 mm, while the length of the upper shank, as shown in Fig. 3, is about 7.7 mm, and the length of the lower shank is about 8.05 mm.

The upper shank may be bent upwardly near its end, and is pointed, and has a cross section thinner than the remaining portion of the clamp. This design facilitates insertion of a wedge or knife 27 of the pincers 25, to spread the shanks of the clamp apart. Each tooth of the teeth at the upper shank has two side edges subtending an angle of about 60 , has a height of about 1 mm, and the teeth are spaced apart, as defined from the beginning of one edge to the beginning of another edge by about 3mm. Within the region of the tongue 8, where the thread 2 shown in Fig. 3 abuts, the shanks may be provided with corru gated surfaces which improved clamping of the thread considerably. The clamp may also be made of aluminium with substantially the same thickness and width, except that the bend then need not be made of a thickness smaller than the thickness of the remaining portion or portions of the clamp.

We wish it to be understood that we do not desire to be limited to the exact details of construction shown and described, for obvious modifications will occur to a person skilled in the art.

Having thus described the invention, what we claim as new and desire to be secured by Letters Patent is as follows:

Claims (46)

1. A surgical device for closing wounds for use in connection with a needle-carrying thread for passing the thread through the lips of the wound.

comprising in combination two clamps arranged to be positioned on, and firmly secured to said thread on opposite sides of the wound, each clamp having a jagged edge portion adapted to abut an external side of a respective lip of the wound, said clamps being positionable on said thread so that said jagged edge portion abuts from opposite sides the lips of the wound, whereby the wound will be closed yet within each lip blood circulation will be facilitated as said lips are free from exertion thereonto by any uniform pressure.

2. A surgical device as claimed in claim 1, wherein said edge portion has a wavy surface.

3. A surgical device as claimed in claim 1, wherein said edge portion is ragged.

4. A surgical device as claimed in claim 1, wherein said edge portion is formed with teeth.

5. The surgical device as claimed in claim 1, wherein each clamp has an outer surface, and wherein parts of said edge portion form predetermined respective angles with one and other.

6. The surgical device as claimed in claim 1, wherein each clamp includes oppositely disposed interconnected shanks arranged to receive and to clamp said thread therebetween, and wherein one shank extends beyond the other shank, and includes said jagged edge portion.

7. The surgical device as claimed in claim 6, wherein said shanks in the closed clamp position abut each other and have near one end thereof a recess, whereby a wedge can be driven into said recess for separating said shanks.

8. The surgical device as claimed in claim 1, wherein each clamp is normally open, operable to receive the thread, and may be closed to be secured to the thread, and further comprising maintaining means for maintaining each clamp closed.

9. The surgical device as claimed in claim 8, wherein each clamp includes two shanks, one shank having an opening, and wherein said maintaining means includes a tongue disposed on the other shank and arranged to pass through said opening as the clamp is closed, said tongue in the closed clamp position being operable to be moved into engagement with said one shank, thereby securing said clamp to said thread.

10. The surgical device as claimed in claim 8, wherein each clamp may be stamped from one piece of a bendable sheet, and thereafter be bent into a substantially Vshaped form.

11. The surgical device as claimed in claim 8 in combination with forceps having handles movable between open and closed positions, and wherein said maintaining means includes a bendable part operable to be bent from an unlocked position to a locked position, wherein it keeps said clamp closed, said forceps being arranged in said open position to receive each clamp in the normally open state thereof, and for bending said maintaining means from said unlocked position to said locked position.

12. The surgical device as claimed in claim 11, wherein said forceps include cutting means for cutting said thread.

13. The surgical device as claimed in claim 11, wherein said forceps include jaws for gripping each clamp, said jaws including end portions adapted to grip the needle.

14. The surgical device as claimed in claim 11, wherein the handles of said forceps are movable along a path between an open position and at least one closed position, and further comprising arresting means for limiting the movement along said path to said closed position.

15. The surgical device as claimed in claim 11, and further comprising cutting means movable between non-operative and operative positions for cutting said thread in said operative position, and yieldably resilient means for urging the handles of said forceps towards said open position, and for urging said cutting means to said non-operative position.

16. The surgical device as claimed in claim 11, wherein said handles of said forceps are movable along a path between an open and at least one closed position, and further comprising locking means operable for locking said forceps in at least said one closed position.

17. The surgical device as claimed in claim 16, wherein each clamp is normally open, is receivable by said forceps in said open state, but may be compressed by said forceps when in said one closed position so that said clamp may still slide along said thread preparatory to securing said clamp in the proper position to said thread.

18. The surgical device as claimed in claim 16, wherein said handles of said forceps are movable along said path to a second more closed position, and wherein said clamp will be compressed by said forceps, when in said second closed position, so as to be secured to said thread.

19. The surgical device as claimed in claim 18, wherein the handles of said forceps are movable along said path to a third closed position, and further comprising cutting means actuated from said handles near said third closed position for cutting said thread in said third closed position.

20. The surgical device as claimed in claim 19, wherein the handles of said forceps are additionally movable between said open position and said second and third closed positions, respectively, and wherein said locking means is additionally operable for locking said forceps in said second and third closed positions, respectively, said forceps being manually releasable from said closed positions.

21. The surgical device as claimed in claim 19, wherein each handle of said forceps is formed with a grip, and further including a lever connected to said cutting means, one of said handles actuating said lever upon the handles of said forceps being moved from said second closed position to said third closed position, thereby cutting said thread.

22. The surgical device as claimed in claim 20, wherein said handles are elastically deformable, and wherein at least one of said handles is elastically deformed when said handles are moved from said second closed position to said third closed position.

23. The surgical device as claimed in claim 11, wherein said forceps are arranged simultaneously to receive two clamps in their open state, and simultaneously to move said two clamps to their closed state, thereby clamping said two clamps simultaneously onto said thread on one side of the wound.

24. The surgical device as claimed in claim 7, in combination with pincers that includes oppositely disposed arms, one arm forming an abutment, the other arm including near an end thereof said wedge, whereby the closed clamp may be opened by the wedge engaging said recess, and force exerted between said arms to move one arm towards the other while the clamp is suspended between said abutment and said wedge of said pincers.

25. The surgical device as claimed in claim 24, wherein the arms of said pincers are movable along a path towards and away from each other, and further comprising stop means for limiting said movement along the path in either direction.

26. The surgical device as claimed in claim 1 in combination with clamp dispensing means for storing clamps in a row, including a base and a clamp dispenser mountable on said base for dispensing at least one clamp at a time, so that forceps adapted to grip said one clamp may remove said one clamp from said clamp dispenser.

27. The surgical device as claimed in claim 1 in combination with clamp dispensing means for storing clamps in a row, including a base and a clamp dispenser mountable on said base for storing clamps and for dispensing at least one clamp at a time, forceps operable to grip said one clamp and thereafter to remove said one clamp from said clamp dispenser, and guide means mounted on said base for guiding said forceps to said one clamp.

28. The surgical device as claimed in claim 27, wherein said forceps include lower and upper jaws, and said guide means include a a leaf spring mounted on said base for guiding said lower jaw into a position below said clamp, and a stop secured to said base for limiting movement of said jaws beyond said base for positioning of said one clamp within said jaws.

29. The surgical device as claimed in claim 27, wherein said dispenser includes a housing provided with an opening, a clamp guide disposed partly within said housing and projecting therebeyond through said opening, and clamp movement restraining means disposed on said clamp guide at a distance corresponding to the width of each clamp for limiting the dispensing of said clamps to one clamp at a time.

30. The surgical device as claimed in claim 27, and further comprising means connected to at least one of said base and retaining means, respectively, for replaceably holding said dispenser.

31. The surgical device as claimed in claim 27, wherein said forceps include two jaws, at least one jaw having an indentation, and further comprising resilient means receivable in the other jaw, whereby a clamp of the dispenser may be received and held in a predefined position between indentation and said resilient means preparatory to removing it from the dispenser.

32. The surgical device as claimed in claim 1 in combination with clamp dispensing means for storing clamps in place, including a casing having an opening, and clamp retaining bars insertable into said casing for storing pairs of clamps thereon, and forceps having jaws arranged to pass through said opening, to receive at least one from a pair of clamps stored on a retaining bar in said clamp dispensing means, and thereafter to remove the received clamp from said clamp dispensing means.

33. The surgical device as claimed in claim 32, wherein said casing has apertures and said edge portion is formed with teeth, and further comprising resilient retaining ton gues at least partially disposed in said casing, and including end portions normally disposed substantially within said casing, but partly passing through said apertures, respectively, each end portion having an abutment releas ably engaging one of said teeth.

34. The surgical device as claimed in claim 32, wherein said casing includes two interconnected covers, an insert member held between said covers, and wherein said clamp retaining bars are connected to said insert member.

35. The surgical device as claimed in claim 32, further comprising holding means securable to a table and arranged releasably to hold said clamp dispensing means.

36. The surgical device as claimed in claim 1, wherein pairs of clamps are adapted to be stored in clamp dispensing means, and each edge portion is formed with teeth, said clamp dispensing means including resilient retaining tongues comprising means releasably to engage a tooth, said teeth being spaced apart from one another at a predetermined spacing, each tongue including an end adapted to enter said spacing to nestle normally between two teeth, but operable to yield releasing said tooth when pushed outwardly.

37. The surgical device as claimed in claim 36, wherein each tooth has a predetermined height, and wherein said spacing exceeds said height by a factor of at last four.

38. The surgical device as claimed in claim 36, wherein each tooth has two edges subtending an angle of about 60 degrees with one another.

39. The surgical device as claimed in claim 36, wherein each clamp can be stamped from a bendable and elongated sheet, and has a certain thickness throughout a major part of the length thereof, a region of said clamp about midway thereof having a thickness smaller than said certain thickness, whereby said clamp may easily be bent from said sheet around said region into a substantially V-shaped form.

40. The surgical device as claimed in claim 36, wherein each clamp has a normally V-shaped form and includes two shanks, one shank having an opening located in a prearranged zone thereof, the other shank including a tongue arranged to pass through said opening and located in a pre-arranged zone of said other shank, whereby, when said thread is located between said zones, and upon said shank being pressed towards one another, said thread is firmly secured between said zones.

41. The surgical device as claimed in claim 39, wherein said sheet is made of stainless steel, and wherein said certain thickness is about 0.3 mm, and said region has a thickness of about 0.1 mm.

42. The surgical device as claimed in claim 36, wherein said clamp may be stamped from a bendable sheet of aluminium having a thickness of about 0.3 mm.

43. In a method of preparing suturing material for closing the lips of a wound with the aid of a needle-carrying thread and of forceps, the steps comprising bending strips of bendable material into substantially V-shaped clamps, thereafter receiving and holding two clamps spaced from one another in said forceps, subsequently clamping said clamps onto said thread by said forceps, thereafter cutting said thread between said clamps while said clamps are still held by said forceps, whereby there is obtained a piece of a thread having one clamp secured thereto at one end of said piece of said thread, the other end of said piece of the thread carrying said needle for threading said piece of thread through the lips of the wound until said clamp abuts one lip of said wound.

44. The method as claimed in claim 43, wherein each clamp has a jagged edge portion, and further comprising the step of positioning said one clamp, so that said jagged edge portion abuts the exterior of said one lip of said wound.

45. A surgical procedure for closing the lips of a wound with the aid of a plurality of clamps and a needle-carrying thread, each clamp having an initially open state, one jagged edge, and another edge, the steps comprising (a) securing seccessive pairs of clamps spaced from one another, respectively, onto said thread so that there are formed pairs of adjoining clamps with said other edges facing each other, (b) cutting said thread between a pair of said clamps so as to obtain a piece of thread having one clamp secured thereto at one end of said piece of thread, the other end of said piece of thread carrying said needle, (c) passing said needle-carrying thread through one portion of said lips of said wound so that said one clamp abuts with its jagged edge one lip, the other end of said piece of thread projecting beyond the other lip, (d) clamping another clamp on the other end of said piece of thread so that said other clamp tightly abuts the other lip with its jagged edge, (e) repeating step (b), repeating step (c) through other portions of said lips of said wound, and repeating step (d) until the wound is substantially closed, whereby within each lip blood circulation will be facilitated as said lips are free from exertion thereonto by any uniform pressure, (f) thereafter, when said wound is at least partially healed, prying open one clamp of a successive pair of clamps, and (g) withdrawing the corresponding piece of thread from said wound, thereby allowing said wound to heal free of any thread remaining therein.

46. A surgical device for closing wounds substantially as hereinbefore described with reference to and as illustrated in the accompanying drawings.