JP2009533204A - Medical occlusion clip system and method - Google Patents

Abstract

A medical occlusion screen device for first and second tissue portions is provided, the device comprising a mesh screen comprising a tubular longitudinal riser, and a longitudinal strand comprising fibers with barbs. And a transverse spacer for joining the risers and the strands in a lattice form. An optional peripheral member partially surrounds the screen and can include a peripheral tube fluidly coupled to a vertical riser to form a tube assembly. Various input / output devices can optionally be connected to the end of the peripheral tube to expel the exfoliation from the irrigation and / or exfoliation according to the method of the present invention. Exfoliation occlusion, irrigation and drainage methods have been disclosed using various combinations of occlusion screens, tubes, sutures, fluid transfer members and gradient force sources. The use of mechanical force on strands with barbs to reposition and secure the exfoliated tissue is disclosed. Also disclosed is the use of mechanical force to remove or reduce deformation of the subcutaneous cavity or sac cavity that can form hematomas and seromas. Further, alternative embodiments of medical occlusion screen mounting systems and methods are disclosed. The device can be manufactured with clips having various configurations, and the method can be performed with clips having various configurations.

Description

  The present invention relates generally to medical closures (including dental, veterinary, etc.) and wound exudate handling instruments, and more particularly to screen closure members for closing tissue detachment such as incisions and wounds, such closure members. Is optionally a bioabsorbable material. The occlusion member can be assembled with a variety of parts selected for its functional properties and material compatibility.

  In the medical field that is widely defined including dentistry, skin incision is usually performed by surgery, reaching to the underlying tissues, organs, joints, skeletal structures and the like. Incision and occlusion techniques are generally an important part of surgery. They tend to occupy the surgical team and other resources related to an important part of many surgical procedures.

  Surgeons generally employ a variety of occlusion techniques that help minimize incisions and reduce postoperative swelling, bleeding, seromas, infections, and other undesirable postoperative side effects. By trying to minimize surgical trauma and scarring on the patient. For example, endoscopic-assisted surgery, microscopic surgery, and computer-enhanced instruments (eg, the DaVinci System available from Intuitive Surgical, Inc. of Sunnyvale, Calif.) Are generally less invasive. ("MIS") surgery and methods are considered and are becoming increasingly popular. Such a reputation is not only due, at least in part, to leaving a minimally sized scar by such a method, but also minimal trauma to the fascia and muscle layers and correspondingly fast. This is by enabling recovery. However, the surgeon must balance such consideration with reaching sufficiently to perform various surgical procedures. A typical surgical procedure includes a cutting or incision stage and an occlusion stage. In recent years, significant progress has been made regarding surgical cutting, incision and formation. Surgical closure methods include sutures, clips, staples and adhesive tape. However, suturing can be time consuming and cumbersome. Furthermore, the combined tissue structure is susceptible to other occlusive methods. MIS often makes it more difficult to close and close the tissue structure to limit access to the detached tissue structure.

  In contrast to MIS, some surgical procedures require long incisions due to their nature. Examples include skin resection surgery such as “lifting” and reduction procedures, tissue strip procedures for defect occlusion, and many obesity treatment procedures. Such extensive defect stitching can be time consuming and cumbersome.

  The “first goal” in surgery (the primary goal of treatment) is to “close” the incision. In tissues that can withstand loads such as bone, fascia and muscle, this requires a significant amount of material as suture material, staples, or plates and screws. In wounds to be “occluded”, the epithelial layer must be sealed. To achieve this, the “load-bearing” regions of the skin and subcutaneous layers (ie, deep skin elastic layer and superficial fascia or adipose tissue fiber layer, respectively) must be kept at least in close proximity. Important considerations include infection control and bleeding management, scar reduction, hematoma, seroma, and elimination of the possibility of forming “dead spaces”. Dead space problems tend to occur with subcutaneous obstruction. A relatively shallow incision can usually be occluded with occlusion methods applied to the surface, such as sutures, staples, glue, and pieces of adhesive tape. However, a deep incision requires not only a skin surface occlusion, but also a time consuming arrangement of muscle layer sutures on the surface to withstand the load. Absorbable sutures are usually used for such purposes and comprise an important class of surgical sutures. Depending on various factors, absorbable sutures typically degrade over days to months. Commercial examples include polycaprone and PDS. RTM. (Polydioxanone) and Vicryl. RTM. (Polyglactin) with a suture, Monocryl. RTM. Monofilament absorbable synthetic sutures, all from Ethicon, Inc. , Of Somerville, N .; Available from J.

  Surgical meshes are usually used to bridge or strengthen surfaces or defects that can withstand loads. Surgical meshes represent another important class of surgical occlusion devices when joined with sutures or fasteners. Applications include reconstruction, hernia repair, and organ repair. In such procedures, a surgical mesh fiber prosthesis is inserted into the patient via either an open surgery or endoscopic (MIS) procedure. A knitted surgical mesh for hernia repair is described by Agarwal et al. Ethicon, Inc. U.S. Pat. No. 6,287,316. Another Ethicon, Inc., U.S. Pat. No. 4,548,202 to Duncan. Discloses a mesh tissue fastener that includes various fastening members with spaced legs for passing through a portion of tissue. Another occlusion procedure is to place an external fastener or fixation device that bridges the wound after placement of a pin or rod through the end of the skin or bone and, more frequently, tightens and stabilizes over long periods of time. Including the incorporation of a worm screw instrument capable of providing angulation or distraction.

  Fluid handling represents another important aspect of both open surgery and minimally invasive surgery. Post-surgery fluid drainage can be performed with various combinations of tubes, sponges, and porous materials configured to collect and drain bodily fluids. The prior art has techniques and methods for assisting discharge. For example, US Pat. No. 4,969,880 by Zamierowski; US Pat. No. 5,100,396; US Pat. No. 5,261,893; US Pat. No. 5,527,293; and US U.S. Patent No. 6,071,267 discloses the use of pressure differentials, i.e., vacuum and positive pressure, to assist in draining fluid from a wound including a surgical incision site. Such pressure differences can be achieved by applying a porous foam material inside or outside the wound, covering the wound with a permeable, semi-permeable, or impermeable membrane and connecting a vacuum source to the wound. Can be generated. Fluid drawn from the patient is collected for disposal. Such fluid control methods have been shown to achieve significant improvements in patient treatment. Another aspect of fluid handling after surgery and elsewhere relates to the application of fluid to the wound site for purposes of irrigation, infection control, pain management, growth factor application, and the like. In addition, wound removal devices are used to assist in treatment and occlusion by providing tissue fixation and immobilization. This can be achieved by both internal discharge of the closed wound and an external vacuum device. Also, tissue fixation can be achieved in the same manner by coverings (stent coverings) to be administered as a bolus, applying a tape, applying an adhesive bandage, and (contacting) casting.

  Conventionally, there are no available medical occlusion screen assemblies with the advantages and aspects of the present invention that include a combination of the present invention and negative pressure wound therapy ("NPWT").

  In one form of implementation according to the present invention, a medical occlusion screen device is provided, the device comprising a tubular vertical riser, fibers with barbs extending between the risers, and lateral spacers. It has a mesh-like screen. An integral or separate suture can be provided. An optional peripheral member may partially surround the screen member and may comprise a peripheral tube that is fluidly coupled to the vertical riser to form a tube assembly. The tube assembly cooperates with the vertical riser to drain fluid from tissue ablation in a drain tube manner and introduce fluid into the tube assembly in a irrigation manner. In one embodiment of the present invention, the tube assembly is fluidly connected to a vacuum source to facilitate drainage. In another embodiment of the present invention, the peripheral tube passes through the surrounding tissue and secures the screen member in place. Fluid transfer members, such as sponges, foams, absorbent meshes, microtubule materials, etc., are optionally placed near or on the extension of the screen, for example to transfer fluid with a vacuum or pump source . Another embodiment of the invention includes a suture that is attached to the screen and configured to secure the screen to tissue detachment.

  An alternative embodiment of a vertical riser is also disclosed, which can provide active fluid transfer using the patient's body as power. Yet another alternative embodiment of the present invention uses the return of a mechanical locking screen during the peel to close the peel. Disclosed occlusion, irrigation and drainage methods using various combinations of occlusion screens, tubes, sutures, fluid transfer members and gradient force sources are disclosed. The occlusion screen according to the present invention uses a mechanical or other force on the screen and the strands with barbs to fix the exfoliated tissue and form the effect of hematoma and seroma. Or remove or reduce the deformation of the sac cavity. A further embodiment according to the invention comprises a clip assembly, which comprises a relatively stiff material with flexible elastic or folding binding fibers forming a composite screen.

1. Introduction and Environment Where appropriate, detailed embodiments of the present invention are disclosed herein; however, the disclosed embodiments are merely examples of the present invention and may be implemented in various forms. Please note that. For this reason, the specific structural and functional details disclosed in this document should not be construed as limiting, but merely as the principles of the claims. It should be construed as a typical principle to suggest one of ordinary skill in the art to make various use of the invention.

  For convenience, certain terms will be used in the following details, without limitation. For example, the words “upwardly”, “downwardly”, “to the right” and “to the left” refer to the direction in the referenced drawing. The words “inside” and “outside” refer to the approaching and leaving directions, respectively, and the geometric center is the part of the description and illustrated. The words “laterally” and “vertically” generally mean left and right and up and down, respectively. These terms include words specifically mentioned, derivatives thereof, and words of similar meaning.

  Referring to the drawings in detail, reference numeral 2 generally indicates a medical occlusion screen device or system embodying the present invention. Without limiting the generality of useful application of the occlusion screen system 2, the primary uses disclosed herein are occlusion, drainage, irrigation and delamination of first and second tissue portions, such as wounds or incisions 4. It is to assist treatment. As shown in FIG. 5 a, the wound 4 opens at the skin 6 and extends therefrom, and reaches the vicinity of the fascia 10 through the deep skin layer 7 and the subcutaneous layer 8. The wound 4 shows end portions 12a, b corresponding to the first and second tissue portions. The occlusion screen device 2 generally comprises a screen 14, a screen peripheral member 16, and an input / output (I / O) subsystem 18.

2. Screen 14
The screen 14 has upper and lower edges 20a, b; first and second ends 22a, b; and first and second surfaces 24a, b. The screen 14 is generally in the form of a grid with a longitudinally hollow perforated tubular riser 26 that cross-couples with a lateral spacer member 28. A plurality of barbed strands 30 are provided between the risers 26. Riser 26, spacer 28 and strand 30 are preferably joined at their respective intersections. As shown in FIG. 3, each strand 30 has fibers 32 with a plurality of sharp barbs 34 extending upward and outward in staggered relation on both sides thereof. Barbs 34 generally project outwardly from screen surfaces 24a, b for purposes described in detail below.

  The screen or mesh 14 material can be either degradable (absorbable) or non-degradable (non-absorbable) and is generally medical for sutures, implantable meshes, and similar medical devices. Can be selected from many commercially available biocompatible products.

  Examples of absorbent materials: lactide homopolymers and copolymers, ε-caprolactone, p-dioxanone, trimethylene carbonate, trimethylene carbonate alkyl derivatives, δ-hydroxyvalerate, 1,4-dioxepan-2-one, 1 , 5-dioxepane-2-one, 6,6-dimethyl-1,4-dioxan-2-one and polymer mixtures thereof including but not limited to aliphatic polyesters. Examples of non-absorbable materials include, but are not limited to: cotton, hemp, silk, polyamide, polyester, fluoropolymer, polyolefin, polyethylene, metal and combinations thereof.

3. Screen peripheral member 16
The optional screen peripheral member 16 comprises, for example, a flexible hollow tube 35 with a plurality of holes 36. As shown in FIG. 1, the tube 35 includes first and second legs 38, 40 that extend generally along the first and second ends 22a, b of the screen, and generally under the screen. And a base leg 41 extending along the edge 20b. The first and second leg portions 38, 40 of the tube terminate in first and second end portions 38a, 40a, respectively. The tube 35 can be secured to the screen 14 by a plurality of coupling portions 42, and the tube 35 can comprise a lateral spacer member 28 and an extension of the strand 30. By providing the melting coupling part 42, the tube 35 can be separated from the remaining part of the closing screen 2 in a relatively short period of time. For example, the meltable material can melt in the patient's body a few days after removing the tube 35.

  Optionally, a portion of tube 35 can be disconnected from screen 14. For example, the screen 14 can be separated along each screen end 22a, b, or the screen 14 can be completely separated from the tube 35. In such a way, the screen 14 and tube 35 can be configured to suit various situations and tissue ablation configurations.

  A longitudinal riser 26 is optionally fluidly coupled to the tube 35 at each T-intersection 44. In such an embodiment, the tube 35 and the longitudinal riser 26 cooperate to provide a manifold for fluid handling, ie, collection or irrigation as indicated by the fluid flow of arrow 45.

4). Input / output (I / O) subsystem 18
The input / output subsystem 18 is configured for the collection and / or irrigation of patient fluids and / or external fluids. As shown in FIG. 1, the input / output subsystem 18 is attached to the first and second leg ends 38a, b of the tube, which in this configuration would be considered the "port" end of the tube 35. The first and second I / O devices 18a and 18b are provided. One or both I / O devices 18a, b are available from Kinetic Concepts, Inc. of NPWT equipment available from San Antonio, Tex, The VAC. . RTM. System. TM. The differential pressure source can be provided. The use and fluid control of such units for wound treatment are described in US Pat. No. 4,969,880 by Zamierowski; US Pat. No. 5,100,396; US Pat. No. 5,261,893. U.S. Pat. No. 5,527,293; U.S. Pat. No. 6,071,267, which are hereby incorporated by reference.

  Alternatively, the tube port ends 38a, b can be connected to various other differential pressure sources and various drainage and irrigation devices. For example, the port end can be cut short subcutaneously and left in the ablation 4 for occlusion by nearby tissue portions 12a, 12b. FIG. 4a shows the cut tube end 38b. The end 38a / 40a of the tube is tied, trimmed, tied (eg, with a suture) or otherwise occluded either above or below the skin 6 (as shown at 48 in FIG. 4b). May be. FIG. 4c shows a luer lock coupling 46 attached to the end 38a / 40a of the tube. In addition, a transfer member comprising a piece of foam or sponge 50 may be coupled to the tube 35 at the end 38a / 40a (FIG. 4d). Examples and embodiments of such foam or sponge materials are disclosed in the same US patent by Zanierowski as described above. A differential pressure source, such as a vacuum source 51, can be connected to the tube end 38a / 40a and the fluid container 66 as shown in FIG. 4e. Clamp 62 is shown in FIG. 4f and closes tube end 38a / 40a. The clamp 62 can be selected from a number of suitable clamps that are commonly used in medical applications.

  The end 38a / 40a of either tube can function as either an inlet port or an outlet port for the system 2. For example, aspiration is possible to draw fluid from the patient through the system 2 through either tube end 38a / 40a. Furthermore, fluid can be drawn in both directions through the system 2 by aspirating the tube ends 38a / 40a alternately or together. For example, suction can be performed simultaneously on both ends 38a / 40a of the tube.

5. Operation and Closure Method FIGS. 5 a-e show the introduction procedure using the system 2 according to the invention. In FIG. 5 a, the occlusion screen 2 is placed in the peel 4 with the tube base 41 placed near the fascial layer 10 at the bottom of the peel (eg, wound or incision) 4. As shown, tissue portions or wound / incision ends 12a, b are spaced apart. The upper edge 20a of the screen protrudes outward from the skin 6. FIG. 5 b shows the tissue peeling edge 12 pushed as indicated by the force of arrow 52. FIG. 5 c shows a peeled end 12 that meets the skin 6 and has a slight gap in the subcutaneous layer 8. The end 12 can be pushed as indicated by the force of the arrow 52. Furthermore, the screen 2 can be held or positioned inside to advance the return to the peeling end 12 as indicated by the force inward or downward of arrow 54a. FIG. 5 d shows the peeled ends 12 a, b substantially closed with respect to the screen 2. When the screen 14 is pulled in the direction of the force toward the outside of the arrow 54b, the net-like barb 34 is set.

  FIG. 5 e shows the peel 4 closed against the closure screen 2, with the tube 35 removed from the screen 14. The tube 35 can be removed by cutting the coupling portion 42 before introduction or by melting the coupling portion 42 after introduction, and then the unsafe tube 35 can be withdrawn.

  FIG. 6a shows barbs 34 compressed by engagement with peel ends 12a, b. The peel end 12 can be closed by hand by pressing with the lateral force of the arrow 52 as shown. With the barb 34, the peeled ends 12a, b can slide upward or outward along the screen 14. Such a process can be repeated until the peel 4 is plugged, as shown in FIG. 6b. The protruding length of the screen 14 can be cut close to the skin 6. In the final configuration (FIGS. 5e and 6b), barbs 34 are embedded in the tissue near the peel ends 12a, b, thereby holding the peel 4 in a closed position. The fluid-transmitting property of the screen 14 makes it easier to draw out the fluid. An outward or upwardly directed force arrow 54b indicates the direction of the force, thereby setting the screen barb 34 in the nearby tissue. Although the screen 14 with the barbs 34 can be set to be fixed in place, as shown in FIG. 6a, the peeling ends 12a and 12b are separated from the screen 14 by releasing the barbs 34 with a lateral force. Note that it remains slidable up. A skin hook 55 can be used to engage the tissue portions 12a, b and pull the tissue portions 12a, b outward as shown in FIG. 6a. A skin hook 55 can facilitate positioning and repositioning the screen 14.

6). Alternative Embodiment of Occlusion Screen System and Method FIGS. 7a-f show an alternative procedure for attaching the occlusion screen 2 in applications that utilize pressure differentials to drain from a wound. As shown in FIG. 7a, the tube 35 passes through the tissue near the wound 4 and exits the skin 6, terminating at the tube end 38a / 40a as described above. FIG. 6 illustrates an additional layer of a suitable biocompatible adhesive 64 that is applied to the first surface 24a of the closure screen to secure the closure screen to the wound first end 12a. FIG. 7b shows the screen 14 extending upward from the skin 6 applied in a similar manner as described above and having wound edges 12a, b.

  The input / output subsystem 18 has a set of additional fluid transfer members with foam or sponge members 56a, b disposed on the skin 6 on either side of the protrusion 14a of the screen 14. ing. The screen 14 is then cut to a level that is generally flush with the upper surfaces of the sponges 56a, b, as shown in FIG. 7c. An optional sponge bridge 58 is placed over the sponge members 56a, b (FIG. 7d). Examples of suitable transfer member materials are described in the above-mentioned Zamierowski patent, and are open cell porous foam materials (eg polyurethane esters (PUE)) selected for hydrophobicity and liquid passage have. Polyvinyl acetate (PVA) material can be used due to its hydrophilicity. A transfer member subassembly 59 formed of sponge members 56a, b and 58 can be connected to a vacuum source, fluid irrigation source, and the like. In addition, transfer member subassemblies 59 can be attached to additional fluid transfer members with various flexible membranes and covers that are semi-permeable or impervious, as indicated for specific exfoliation and wound closure and treatment. Can cover.

  FIG. 7e shows the tube installation tool 120 with a hook 126 having an operating portion 122, a shaft 124 and a sharp or pointed bullet-shaped tip 128. FIG. FIG. 7 f shows the instrument 120 passing the tube 35 through the tissue of the subcutaneous layer 8 and approaching the skin 6. A tip 128 is received at the abutment 134 of the tube 35 by a notch 136 formed in the tube 35. By pressing the instrument 120 strongly, the skin 6 can be tent-shaped as indicated by reference numeral 138, the skin 6 can be incised with a scalpel 140, and the tube 35 is removed from the patient and the Appropriate termination configurations are possible as shown in FIGS. 4a-f.

  FIG. 8 shows an improved embodiment of an occlusion system 202 comprising a pair of screens 14 provided to generally contact end-to-end within the peel 204. A transfer member subassembly 59 is provided on the peel 204 and a membrane drape 205 is provided thereon. The tube 35 passes through the tissue on both sides of the peel 204 (eg, using means and tube placement instrument 120 as described above) and exits the skin 6 on both sides of the transfer member assembly 59. The tube 35 is connected by reference numeral 206. As such, the tube 35 functions as a suture or retainer to secure the closure system 202 to the peel 204. The tube end 38a or 40a can be used for such purposes, so that the other tube ends are in communication with one or more input / output subsystems 18 as described above. .

  The tube 35 can be fixed by an appropriate fastener provided on the skin 6 such as a clip. In addition, the screens 14 can be overlapped, adjacent, slightly or spaced apart and otherwise configured and installed for exfoliation of specific tissues as needed. Furthermore, the screen 14 can be configured to be cut out as necessary.

  FIG. 9 illustrates an improved embodiment of a tube / suture subassembly 220 with a trocar instrument 222 having a proximal end 226 with a pointed distal end 224 and a plurality of annular tops 226a. A flexible tube 228 combines the functions of the screen perimeter member and the suture. The flexible tube 228 terminates in an end 228a configured to be removably attached to the proximal end 226 of the needle so that it is held in place by the top 226a. Tube 228 is optionally coupled to screen 14 as described above and may have perforations 228b for fluid drainage and / or irrigation with input / output subsystem 18 as described above. Tube / suture subassembly 220 is configured to occlude delamination 4 by securing screen 14 in place and passing tube 228 near the tissue. The tube / suture subassembly 220 and screen 14 can be pre-packaged and pre-sterilized for occlusion and treatment of delamination including wounds and incisions.

  FIGS. 10, 11a and 11b show an improved embodiment of an occlusion screen system 302 comprising first and second suture subassemblies 304, 306 comprising screen peripheral members. Suture subassemblies 304 and 306 have curved needles 304a and 306a, respectively, that are swaged and adhesively bonded to opposite ends 304b and 306b of a normal length suture 307. Yes. The suture 307 can be absorbent or non-absorbable. As shown in FIG. 10, the screen closure system 302 can be pre-assembled with a suture 307 removably secured to the periphery of the screen 308. Prior to assembly of the screen 308, the suture 307 can be partially or completely cut or severed. For example, the suture can be fixed only along the lower edge 312 of the screen by separating the suture 307 along the screen ends 310a and 310b.

  In use, the suture sub-assemblies 304, 306 can be provided with pre-assembled instruments that incorporate the necessary parts to secure the peel 4 by facilitating attachment of the suture / screen closure system 302. For example, the screen 308 can be fixed only at the lower part by passing the suture subassemblies 304 and 306 through the tissue part located at the lower part of the peeling 4. Alternatively, suture subassemblies 304, 306 can be passed through nearby tissue and out of the surface of skin 6, and suture subassemblies 304, 306 can be used to occlude delamination 4 with skin 6. The strands 320 with barbs can act on the tissue portions 12a, b as described above to provide a relatively reliable mechanical connection between the tissue portions 12a, b with the screen 308 separated. The suture subassemblies 304, 306 can be used for a variety of purposes in debonding 4, including the attachment and temporary stitching of skin 6, deep skin layer 7, subcutaneous layer 8, and fascia 10. Further, all or a portion of the suture assemblies 304, 306 can be removed, and additional suture subassemblies can be attached or sewn to the screen 308.

  FIG. 11 a shows the screen 308 attached to the suture 307. FIG. 11 b shows the construction of an alternative screen 318 having a hollow tubular longitudinal riser 324 provided between each adjacent longitudinal strand 320, with all risers 324 being separated by spacers 322. Combined and configured to communicate with the strip through the open end 324a and perforation 324b of the riser, as shown by the fluid flow arrow 326. All or a portion of the screen / suture 302 may comprise an absorbent material.

  12, 13a and 13b show an improved embodiment and method of application of a closed screen system 402 having only a screen. A screen or mesh 404 is provided in the peel 4 opposite the first tissue portion 12a, similar to the screen 14 with the strands 30 having barbs as described above. Since the second tissue portion 12b is positioned opposite to the screen 404, the peeling 4 can be closed and fixed by the mechanical action of the screen 404. Sutures, drainage tubes, I / O devices, and wound ends 12 are occluded, drained inside tissue detachment 4, combat infection, pain management, and are described elsewhere in this document Other auxiliary components intended for all other functions related to the present invention can be added to the screen 404. For example, the screen 404 can be secured with a suture at a subcutaneous level 8. A variety of fluid internal coupling devices can be used as desired to be configured to be removed after the fluid internal coupling device has served its original purpose. Also, a transfer member subassembly such as the embodiment of FIG. 7d shown above (FIG. 7d) can be used to discharge from the outside at the dermis level 6. In addition, drain and irrigation tubes can be incorporated side by side with the screen 404 or in the wound 4 near the screen 404. It should be noted that the screen-only version of the present invention can comprise a variety of suitable biocompatible absorbent and non-absorbable materials including the materials described above.

  FIG. 13 a is an enlarged view of the screen 404, specifically showing barbed strands 406 and lateral spacers 408 that are joined together in a grid to form the screen 404. FIG. 13 b shows an alternative embodiment with an improved screen 410 having a longitudinal riser 412 with a hollow tube spaced apart and coupled to a lateral spacer 408. The fluid flows in and out of the vertical riser 412 through the open end 412a and perforation 412b of the riser, as shown by the fluid flow of arrow 420.

  FIGS. 14a to 14g show a screen 404 that is incorporated into and occludes tissue exfoliation 4 using a method according to the present invention. The method shown in FIGS. 14a to 14g is the same as the method shown in FIGS. 5a to 5e and FIGS. 6a and 6b. FIG. 14c represents a down / inward force arrow 54a indicating the direction in which the screen 404 is pushed and guided into the peel.

  FIGS. 15a, b and 16a, b show an improved longitudinal riser 502 comprising tubes 504 that are secured together by a connector 506 and are bundled together. The normal movement of the patient facilitates alternately compressing and expanding the longitudinal risers 502, thus providing a “pump” action to transfer fluid from the wound 4 as shown by the fluid flow at arrow 510. FIGS. 15 a and b show the riser 502 in the extended configuration. Compressing the screen 14 in the longitudinal direction (ie, end to end) compresses the bundled risers 504 into the configuration shown in FIGS. 16a, b, thereby drawing fluid into the gap space 508 and causing the riser 502 to When stretched, it is pumped from there.

  FIG. 17 shows yet another form of longitudinal riser 602 with bundled tubes 604 that define a passage 6060 that is closely bundled to deliver fluid. Pumping for normal patient movement may enhance such fluid transport. A barb 608 projects outward from the tube 604. It should be noted that various other aspects of bundled tubes can be utilized, such as twisted, braided, and the like.

  FIG. 18 illustrates yet another alternative embodiment of a longitudinal riser / peripheral member 702. This member 702 has a form commonly referred to as a “fluted” drain tube and has a passage 704 extending in the longitudinal direction. Such a configuration can be replaced with a peripheral member as described above and can serve to distribute with the wound 4 with an input / output subsystem 18.

  With respect to additional alternative embodiments relating to the longitudinal risers, they may comprise either a monofilament strand having a barb similar to the strand 30 shown in FIG. 3 or a monofilament strand having no barb. Such monofilament longitudinal risers can function as passive drain tubes where fluid flows along the tube. They can extend over the skin 6 and are adjacent to or in contact with transport members formed in various ways with suitable absorbent materials. The embodiment has a gauze bandage and transfer member subassembly as shown at 59 in FIG.

  FIG. 19 shows an alternative embodiment of a strand 802 constructed by twisting and knitting a plurality of individual fibers 804. A barb 805 is formed by each individual fiber 804a terminating at the rounded end 806. The barb 805 generally projects outward from the strand 802 to form an acute angle with respect to its longitudinal axis. They are configured to penetrate the tissue in the exfoliation 4 as described above. In use, barbs 805 are generally oriented in a direction that generally points outside the patient and tissue ablation 4.

  FIG. 20 shows another alternative embodiment of a strand 902 comprising a plurality of twisted and knitted fibers 904. Barbs 905 are formed of individual fibers 904a and have notches 908 and pointed ends 910. Notch 908 and end 910 are configured so that barbs 905 can be easily pulled out of the tissue at the end of the peel and the screen is configured to slide along the end of the peel to reach the proper position. .

  FIG. 21 shows a further improved screen 1002 comprising barbs 1004 formed by cutting individual fibers 1006 into rings and cutting them at a cutting location 1010 spaced inwardly from the respective vertex 1008 of the fiber rings. Indicates. In use, barbs 1004 penetrate slightly into the tissue and are implanted into the tissue. Note that the comfort of the patient is optimized because the fiber 1006 is relatively small in diameter as the microfiber.

  FIG. 22 comprises a barb 1104 formed by cutting individual fibers 1106 into loops and cutting them at locations 1110 inwardly from the respective vertex 1108 of the fiber loops, thereby forming each hook 1112. Another embodiment of the improved screen 1102 is shown. The hook 1112 moves in a manner similar to Velcro, and nearby tissue forms a loop portion of the bond. In use, the hook 1112 penetrates the tissue slightly and is embedded in the tissue. The form of the hook 1112 makes it easier to hold the hook in the tissue near the exfoliation 4, thereby closing the first and second tissue portions 12 a, b that are separated.

  FIG. 23 shows a screen 1202 having a configuration similar to the screen 1002 described above, with additional fiber members or fibers 1204. The additional fibers 1204 make it easier to place the fiber barbs 1206 thereon, which allows the screen 1202 to be oriented in a direction during the delamination and moves in a manner similar to the screen 14 described above. . Barb 1206 is formed by cutting top 1208 at cutting location 1210.

  Similarly, FIG. 24 shows a screen 1302 that includes additional fibers 1304 that engage the fiber loop 1306 and direct the fiber loop 1306 in the right direction as shown in FIG. By pulling outward with respect to the screen 1302 due to the oblique orientation of the fiber loop 1306, the fiber loop 1306 can be easily set in the tissue portions 12 a, b near the exfoliation 4. Further, the screen 1320 can be rearranged as described above. The fiber loop 1306 can be cut at a cutting location 1310 that is inwardly away from the apex 1308 of the fiber loop, thereby forming a hook 1312.

  Note that FIGS. 21-24 disclose a screen with barbs and hooks extending from one side of the screen. The present invention also includes a screen having barbs and hooks extending from both sides.

  An occlusion screen comprising a further improved aspect or embodiment of the present invention is shown in FIGS. 25-30 and generally indicated with reference 1402. FIG. The screen 1402 is flexible in that it engages and approaches nearby tissue portions across the peel by the semi-independent movement of multiple individual clips with links 1440 (FIG. 25b) with each strand 1408 joined together. A high panel 1404 is generally included. As shown in FIG. 25b, each link 1440 has a pair of protrusions 1442 connected in the middle by loops 1444, to which fibers 1446 can be tied or otherwise secured. As described above, the loop 1444 forms a rotation point or a fulcrum with respect to the fiber 1446, so that the link 1440 can be vibrated easily. For example, the relative movement of the screen 1402 and surrounding tissue facilitates the application of a rotational force, as indicated by the rotation arrow 1448. The rotational force rotates the clip 1440 to a tilted position, as shown by the dotted line in FIG. 25b. Such a vibration action can advance the protrusion into the surrounding tissue, thereby strengthening the occlusion. Furthermore, the relative motion of the surrounding tissue can be adjusted by a combination of screen flexibility and protrusion movement. By changing the configuration of the screen 1402 and the clip 1440, the fixation and tissue movement can be variably controlled.

  FIG. 26 and FIG. 27 show an alternative comprising a first protrusion 1410 and a second protrusion 1212 joined by a link body 1413 with the sharp first and second protrusion ends 1414 and 1416 as terminations, respectively. A typical form of link 1406 is shown. A link 1417 with a slightly different more open configuration is shown in FIG. 27a. As shown in FIG. 28, the protrusions 1410, 1412 of the link 1406 extend generally longitudinally outward from the body 1413 with respect to the longitudinal axis 1418 of the strand 1408 and are acutely angled with the longitudinal axis 1418. Form a diagonal. The angular direction of the protrusions 1410 and 1412 provides one direction with respect to the engagement direction in the first direction and the release direction in the opposite direction. Each link 1406 may be integrally formed of a single length of a suitable suture-like material with appropriate memory, flexibility / rigidity and biocompatibility characteristics. A U-shaped loop 1420 is formed between the protrusions 1410 and 1412.

  Also, as shown in FIG. 28, each loop 1420 has a flexible engagement, which can be formed by heat fusion, ultrasonic welding, adhesives or other suitable fastening devices or methods, respectively, from adjacent links 1406. The long projection 1410 is received. For example, the link protrusions 1410 and loops 1420 can be constructed with a tongue-and-groove or snap-on movable interconnect without the need for a physically connecting link 1406.

  In forming the panel 1404, the strands 1408 can be secured by a plurality of diagonal fibers 1422 that extend generally laterally, horizontally, longitudinally, or preferably diagonally relative to the panel 1404. As with the links 1406, 1417 and 1440, the fibers 1422 can comprise bioabsorbable or biocompatible materials. The fibers 1422 are preferably thin with high flexibility. FIG. 29 shows a screen panel 1404 that, in a compressed configuration, pivotally receives a first long protrusion 1410 within each loop 1420 of a nearby link 1406. FIG. 30 shows such a pivoting movement (dotted line) of the link 1406 to accommodate the relative movement of the tissue with respect to both sides of the tissue detachment.

  The screen 1402 has a pre-assembled enclosure assembly 1424 with front and rear backing sheets 1426, 1428, which is provided with a suitable removable adhesive 1429. The backing sheets 1426, 1428 are preferably paper or (relatively thin panels) to retain the flat shape of the occlusion screen 1402 and protect it from sharp projection tips when handled and placed in a patient. Other materials that are relatively hard (compared to 1404) (eg Styrofoam.RTM. Material). The operation piece 1430 at the outer end is attached to the upper end of the peripheral edge 1432 of the panel 1404 (FIG. 25) and is configured to be gripped by hand or instrument, and is easy to handle, align and install.

  An alternative embodiment or aspect of the present invention is shown in FIGS. 31-33 and has an improved clip with a dual loop link 1556. Each link 1556 has first and second protrusions 1560 and 1562 that terminate in first and second ends 1564 and 1566, respectively. Proximal and distal leaps 1570, 1571 are provided near the first and second protrusions 1560, 1562, respectively.

  FIG. 34 shows an improved occlusion screen configuration 1624 using clips 1604 attached to a flexible matrix 1626 with flexible strips 1628 flexibly interconnected in parallel relationship by intersecting strands 1630. Show. Since the strips 1628 can be penetrated by the protrusions 1614 and 1616, all the clips 1604 can be attached to one side of the double-sided blocking screen 1624. Alternatively, clips 1604 can be attached on either side of the strip 1628 of the double-sided closure screen 1624, or any of the strips 1628 such that all protrusions face outward with respect to the single-sided closure screen 1624. A clip 1604 can be attached to the side.

  FIG. 34a shows an alternative clip structure. The clip 1632 has an internal protrusion 1614 and an edge protrusion 1616 having an upper portion extending from one surface and a lower portion extending from the other surface. The clip 1634 has upper protrusions 1614 and 1616 extending from both surfaces, and lower protrusions 1614 and 1616 extending from both surfaces. Each clip 1636 has only one internal protrusion 1614 and edge protrusion 1616 and can extend outwardly from the same surface (as shown) or extend outwardly from both eyes.

  FIG. 35 shows a clip 1632 adjacent to the tissue for detachment. Respective protrusions 1614 and 1616 are buried in the end portions 12a and 12b of the opposing tissue portions. Because the relative movement of the tissue can further secure the protrusions 1614, 1616, the ends 12a, b are pulled together for treatment.

  FIGS. 36 and 37 show an occlusion screen 1602 with another embodiment or embodiment having a plurality of independent clips 1604 on a flexible reticulated substrate 1606. Each clip 1604 has first and second surfaces 1608, 1610 and a peripheral edge 1612. The inner protrusion 1614 is punched out of the clip 1604 to form a clip opening 1615, and the peripheral protrusion 1616 is punched near the peripheral edge 1612 to form a notch 1618. An occlusion screen 1602 is formed by securing the strands 1620 in a cruciform pattern as shown in FIG. The clip protrusions 1614 and 1616 extend from both sides of the screen 1602 for engagement on both sides (as shown) or the clip protrusions 1614 and 1616 for engagement on one side. The clips 1604 can be directed alternately so as to extend from only one side.

  FIG. 38 shows several configurations of clips 1852, 1858, 1864 and 1870, each punched out of a metal sheet or other suitable material and having respective bodies with bases 1854, 1860, 1866 and 1872. The projections 1856, 1862, 1868 and 1874 protrude from 1854, 1860, 1866 and 1872. FIG. 39 shows a further clip configuration 1876 of a knitted screen or mesh structure as described above that is generally flush with the clip base 1880. Each clip 1876 has a pair of protrusions 1882 that project outward from the clip. Clips 1852, 1858, 1864, and 1870 are configured to be attached to such a screen or mesh structure, resulting in a configuration as shown in FIGS.

  FIGS. 44-49 show various wire clip configurations configured to attach to a flexible screen or mesh structure. A clip 1802 with a generally rectangular base 1806 and one protrusion 1806 protruding outward from the base 1806 is shown in FIGS. 45 and 48 show an improved clip 1808 with a generally rectangular base 1810 and protrusions 1812. FIGS. 46 and 49 illustrate another improved clip 1814 with a generally U-shaped base 1816 and a pair of protrusions 1818 projecting outwardly from the base 1816. Bases 1804, 1810 and 1818 are formed by screens or mesh structures and are generally configured to be in place, with protrusions 1806, 1812 and 1818 having a suitable acute angle, such as from about 30 ° to about 45 °. Project outward from them. The protrusion may have a sharp tip as shown.

  FIG. 50 shows a clip 1902 comprising another alternative embodiment clip configuration. 51a to 51c, clip configurations 1902a to c are each provided with four first protrusions 1904 and four second protrusions 1906, respectively, extending from one or both surfaces of the body 1908 of each clip 1902. And can be formed. 52a-c show side views of clip configurations 1902-c. A central elongated hole 1903 is formed in the main body 1908, and a notch 1905 is formed in the periphery of the main body 1908. The central slot 1903 and the notch 1905 are configured to receive the fiber or other flexible material of the closure screen substrate having a plurality of clips 1902 to make the clip 1902 flexible. It can be somewhat fixed in place in the closed screen configuration.

  FIGS. 53 and 53a show another alternative embodiment clip arrangement 1910 with a curved first protrusion 1912 and a linear second protrusion 1914. The curved surface of the first protrusion 1912 makes it easy to pull the separated tissue portions 12a and 12b as indicated by the lateral force arrow 1916 in FIG. 53a. Such lateral forces are measured by Kinetic Concepts, Inc. of San Antonio, Tex. Manufactured by TheV. A. C. . RTM. System. TM. NPWT can be added. The second protuberance 1914 assists in preventing detachment when subjected to a downward force (ie, into the body) as indicated by the force arrow 1917 as indicated by the occlusion screen.

  54 and 55a illustrate another alternative embodiment clip configuration with a curved body 1922. FIG. With this configuration, the dragged first projection 1924 first engages and penetrates the tissue, and then the clip 1920 rotates to embed the leading first projection 1926. The rotation (in the clockwise direction indicated by the rotation arrow 1927) applied to the clip 1920 by the pulling force makes it easier to fix the fixing portion of the tissue 12b.

  FIGS. 55 and 55a show another alternative embodiment clip configuration 1930 with flexible folding projections 1932, 1934 that fold when the clip is between the backing screens 1936a, b. When the backing screens 1936a, b are removed (FIG. 55a), the protrusions 1932, 1934 are configured to protrude outward in the extension direction and penetrate into the tissue 12b.

  Alternative forms of clips 1910, 1920, and 1930 can be formed of a common clip template as shown at 1902 in FIG. 50, and the bendable body and protrusion can be configured to bend in various desired forms. The In addition, clips can be attached to various screen substrates.

  FIG. 56 shows another alternative embodiment clip configuration 1940 with first and second protrusions 1942, 1944 having respective barbs 1942a, 1942b. FIG. 59 shows another alternative embodiment clip configuration 1950 with first and second protrusions 1952, 1954 having respective barbs 1952a, 1952b. FIG. 58 shows another alternative embodiment clip configuration 1960 with quadrilateral first and second protrusions 1962, 1964 having respective trocar-shaped ends 1962a, 1964a. Various other clip, base and protrusion configurations, combinations and orientations can be used with the present invention.

  FIG. 59 illustrates an occlusion clip system 1970 that includes another alternative embodiment of the present invention. The system 1970 includes a screen 1972 that may comprise, for example, any of the clip and screen configurations described above. The screen 1972 is disposed in the tissue exfoliation 4 and the extension 1974 folds over the surface of the skin on one or both sides of the tissue exfoliation 4. Attaching the screen or strip with it helps to support the link or clip in place against downward loads. The screen adhesive or strip does not stick to the wet tissue at the peeled end, but appears to dry the skin surface 6. The screen or strip is placed on the 3M Company of St. Paul, Minn. STERI-STRIP. Similar to the construction of strand reinforcement tapes marketed as RTM, it can be made of a rapidly soluble bioabsorbable material reinforced with slowly melting longitudinal strands. The extension 1974 can be attached to the skin surface 6 with STERI-STRIP or other suitable tape 1976 by folding the extension 1974 over the skin surface 6 and removing or cutting off other clips on the wound 4. it can. Instead of or in addition to tape 1976, surgical staple 1978 can be used to occlude tissue detachment and provide an extension to skin surface 6. The V.A. A. C. . RTM. System. TM. By applying the NPWT source 1980, a lateral occlusion force can be arbitrarily applied to the tissue exfoliation 4 as shown in FIG. A suitable cover 1982 can be applied over the negative pressure source 1980 with the periphery closely contacting the skin.

  FIG. 60 shows the extension of the system measured in units of 1/16 inch and measured in pounds per protrusion using multiple clips similar to the closure screen 1602 as shown in FIG. The load deformation curve showing the relationship with tension is shown. The screen was held between two slices of raw beef steak and a varying (tensile) shear stress was applied as plotted on the Y-axis of the graph of FIG. With the closing screen sandwiched between the beef steak pieces, a compressive force equal to 0.341 pounds per protrusion was applied to the beef steak pieces. Such a compressive force was mechanically applied to prepare a load-deformation curve as shown in FIG. FIG. 61 shows a load-deformation curve when a compressive force is applied that changes to apply a constant tensile force of 0.341 pounds per protrusion. The theoretical point predicted from the load-deformation curve in FIG. A. C. . RTM. System. TM. The vacuum compression of 100 mmHg when applying is shown. FIG. 60 shows that the elongation of the model increases (good relationship) with increasing tensile load. FIG. 61 shows that the compression load and the elongation have an inversely proportional relationship, and the elongation increases as the compression load decreases.

  While specific forms of the invention are illustrated and described herein, it should be noted that the invention is not limited to the specific forms or configurations of the parts described and illustrated.

FIG. 1 is a side view of a medical occlusion screen device embodying the present invention. FIG. 2 is a partially enlarged side view of the circle 2 in FIG. FIG. 3 is a partially enlarged side view taken generally along line 3-3 of FIG. 2, particularly showing a strand with barbs. FIG. 4 shows the end of an alternative peripheral tube: FIG. 4a shows the subcutaneous end; FIG. 4b shows the tied end; FIG. 4c shows the luer lock; FIG. 4e comprises a vacuum source; FIG. 4f comprises a clamped end. FIG. 5a shows a tissue detachment occlusion procedure implementing the method according to the invention. FIG. 5 b shows a tissue detachment occlusion procedure implementing the method according to the invention. FIG. 5c shows a tissue detachment occlusion procedure implementing the method according to the invention. FIG. 5d shows a tissue detachment occlusion procedure implementing the method according to the invention. FIG. 5e shows a procedure for occlusion of tissue ablation implementing the method according to the present invention. FIG. 6a is an enlarged partial cross-sectional view of the occlusion screen during tissue detachment with a skin hook shown in dotted lines for positioning the separated tissue portions along the occlusion screen. FIG. 6b is an enlarged partial cross-sectional view of the occlusion screen during the delamination of the substantially occluded tissue. FIG. 7a shows a tissue detachment occlusion procedure for carrying out the method according to the present invention using a fluid transfer member and tube installation device made of sponge or foam. FIG. 7b shows a tissue detachment occlusion procedure in which the method according to the present invention is carried out using a fluid transfer member made of sponge or foam and a tube setting device. FIG. 7c shows a tissue detachment occlusion procedure in which the method according to the present invention is carried out using a fluid transfer member made of sponge or foam and a tube placement instrument. FIG. 7d shows a tissue detachment occlusion procedure for carrying out the method according to the present invention using a fluid transfer member made of sponge or foam and a tube setting device. FIG. 7e shows a tissue detachment occlusion procedure for carrying out the method according to the present invention using a fluid transfer member made of sponge or foam and a tube placement instrument. FIG. 7f shows a tissue detachment occlusion procedure for carrying out the method according to the present invention using a fluid transfer member and tube installation device made of sponge or foam. FIG. 8 is a cross-sectional view of the occlusion of tissue ablation using a tube to secure the occlusion screen with a fluid transfer subassembly attached to the upper end of the occlusion screen. FIG. 9 shows a needle configured to attach a drain tube and pass the drain tube through tissue. FIG. 10 is a side view of an occlusion screen having a peripheral suture with an alternative embodiment according to the present invention. 11a is a partially enlarged side view of the entire circle 11a in FIG. 10, and FIG. 11b is a partially enlarged side view showing an improved vertical riser. FIG. 12 is a side view of a closed screen having only a screen with an alternative embodiment according to the present invention. FIG. 13a is a partially enlarged side view of the entire circle 13a in FIG. 12, and FIG. 13b is a partially enlarged side view showing an improved vertical riser. FIG. 14a shows a tissue detachment closure procedure using an embodiment of an occlusion screen having only a screen. FIG. 14b shows a tissue detachment closure procedure using an embodiment of an occlusion screen having only a screen. FIG. 14c shows a tissue ablation closure procedure using an embodiment of an occlusion screen having only a screen. FIG. 14d shows a tissue detachment closure procedure using an embodiment of an occlusion screen having only a screen. FIG. 14e shows a procedure for closing tissue ablation using an embodiment of an occlusion screen having only a screen. FIG. 14f shows a tissue detachment closure procedure using an embodiment of an occlusion screen having only a screen. FIG. 14g shows a procedure for closing tissue ablation using an embodiment of an occlusion screen having only a screen. FIG. 15a is a side view of an improved vertical riser with a flexible multi-tube riser that forms a fluid passageway. FIG. 15b is a cross-sectional view taken generally along line 15b-15b of FIG. 15a. FIG. 16a is a partial side view taken generally along line 15b-15b of FIG. 15a. FIG. 16b is a cross-sectional view taken generally along line 16b-16b of FIG. 16a. FIG. 17 is a cross-sectional view of another improved vertical riser structure with risers and barbs bundled in various configurations. FIG. 18 is a cross-sectional view of an improved vertical riser or peripheral member with a flute-like tube. FIG. 19 is a partially enlarged side view of a strand configuration with an improved barb. FIG. 20 is a partially enlarged side view of a strand configuration with another improved barb. FIG. 21 is an enlarged cross-sectional view of a closure screen comprising an alternative embodiment according to the present invention having barbs formed by cutting the ends of looped fibers. FIG. 22 is an enlarged cross-sectional view of a closure screen comprising an alternative embodiment according to the present invention having barbs constructed by cutting looped fibers to form hooks. FIG. 23 is a closure screen comprising yet another alternative embodiment of the present invention having barbs formed by cutting ends of looped fibers lying in a common direction or orientation. FIG. FIG. 24 is a closure screen comprising yet another alternative embodiment of the present invention having barbs formed by cutting looped fibers lying in a common direction or orientation to form a hook. FIG. FIG. 25 is a perspective view of a closure screen comprising a further alternative embodiment or aspect of the present invention, with individual links forming flexible strands. FIG. 25a is a front view of the link of FIG. FIG. 26 is a side view of an alternative configuration link for the closure screen shown in FIG. FIG. 27 is a front view of the link of FIG. 27a is a front view of an alternative configuration link for the closure screen shown in FIG. FIG. 28 is a side view of the strand of FIG. FIG. 29 is a side view showing a state where the strands are contracted. FIG. 30 is an enlarged partial cross-sectional view of a strand approaching an exfoliated tissue portion. FIG. 31 is a side view of a strand link of another alternative embodiment of an occlusion screen system. FIG. 32 is a front view of the link of FIG. FIG. 33 is a partial side view of the strand of FIG. FIG. 34 is a perspective view of another alternative embodiment of an occlusion screen system having individual clips attached to flexible strips. FIG. 34a shows a perspective view of an alternative clip configuration. FIG. 35 is a side view of the clip approaching the end of the opposing tissue portion, taken generally along line 35 of FIG. 34a. FIG. 36 is a perspective view of another alternative embodiment of a closure screen system with individual clips. FIG. 37 is a side view of the individual clip of FIG. 36, taken generally along line 37 of FIG. FIG. 38 shows a perspective view of an alternative securing clip configuration for use with the present invention. FIG. 39 shows another securing clip configuration attached to the mesh. FIG. 40 is a side view of a closure screen having various clip types. FIG. 41 is a side view of an occlusion screen having various clip types. FIG. 42 is a side view of a closure screen having various clip types. FIG. 43 is a side view of a closure screen having various clip types. FIG. 44 is a perspective view of a wire securing clip for use with the present invention. FIG. 45 is a perspective view of a wire securing clip for use with the present invention. FIG. 46 is a perspective view of a wire securing clip for use with the present invention. 47 is a side view of the clip shown in FIGS. 44-46. FIG. 48 is a side view of the clip shown in FIGS. 44-46. FIG. 49 is a side view of the clip shown in FIGS. 44-46. FIG. 50 is a plan view of another alternative embodiment clip configuration. 51a shows an alternative projection orientation for the clip configuration shown in FIG. FIG. 51b shows an alternative projection orientation for the clip configuration shown in FIG. FIG. 51c shows an alternative projection orientation for the clip configuration shown in FIG. 52a is a side view of the clip shown in FIGS. 51a-c. 52b is a side view of the clip shown in FIGS. 51a-c. 52c is a side view of the clip shown in FIGS. 51a-c. FIG. 53 is a side view of another alternative embodiment clip with curved protrusions. FIG. 53a is a side view of the clip shown in FIG. 53, showing access to the detached tissue. FIG. 54 is a side view of another alternative embodiment clip with a curved body. FIG. 54a is a side view of the clip shown in FIG. 54, showing the state secured in tissue. FIG. 55 is a side view of another alternative embodiment of the closure screen showing the clip's protrusions folded substantially flat with respect to the clip body, with the backing material provided on both sides of the closure screen. ing. FIG. 55a is a side view of the occlusion screen shown in FIG. 55 with the clip protrusion extending and secured in one side of the tissue. FIG. 56 shows an alternative embodiment of the protrusion. FIG. 57 shows an alternative embodiment of the protrusion. FIG. 58 shows an alternative embodiment of the protrusion. FIG. 59 shows an alternative embodiment occlusion system with an external fitting and optional negative pressure source. FIG. 60 is a graph showing a load-deformation curve (tensile versus elongation) for a test associated with a screen implementing the invention with multiple clips. FIG. 61 is a graph showing another load-deformation curve (compression force versus elongation) for another test with a screen having a plurality of clips.

Claims (39)

A clip body with a surface,
A protrusion configured to protrude from the surface and penetrate into the tissue,
The tissue occlusion clip, wherein the protrusion has a tissue occlusion configuration.   The clip of claim 1, wherein the tissue occlusion configuration comprises an acute angle defined by a surface of the body and the protrusion.   The clip of claim 1, wherein the tissue occlusion configuration comprises a curved surface of the protrusion. The surface of the clip body comprises a first surface and a second clip body surface;
Since the clip body has a curved surface, the first surface is concave and the second surface is convex;
The clip according to claim 1, wherein the protrusion protrudes from the first concave surface to form an acute angle together with the first concave surface.   The clip according to claim 1, wherein the main body and the protrusion have a length of a linear preformed material. A first protrusion that terminates in a first tip, and a second protrusion that protrudes from the clip body and terminates in a second tip, and has the protrusion.
6. The clip of claim 5, wherein the body forms a receptacle configured to movably attach the clip to another clip. The receiving portion comprises a first receiving portion;
The body forms first and second loops;
A first loop surrounds the first receptacle;
A second receiver is surrounded by the second loop;
The clip according to claim 6, wherein the first loop is configured to be coupled to a second loop of an adjacent clip, so that the clip is connected by a coupling type coupling. The clip body has a substantially planar structure, a peripheral edge portion, and an interior as a whole,
The protrusion includes a first protrusion located at the peripheral edge;
An opening is formed in the interior;
The clip according to claim 1, wherein the second protrusion protrudes outward from the main body near the opening.   9. The clip of claim 8, wherein first and second barbs are located at ends of the first and second protrusions, respectively.   The clip according to claim 8, wherein each of the protrusions has a quadrangular configuration, and ends with a trocar-shaped end. A notch is formed in the peripheral edge of the clip body,
The first protrusion includes a first main protrusion located near the notch and oriented in a first direction relative to the clip body;
The second protrusion comprises a second main protrusion oriented in the first direction;
The first and second protrusions protrude outward from the clip body and are located near the notch and the opening, respectively;
The clip according to claim 8, wherein the second protrusion is directed in a second direction with respect to the clip body.   The clip of claim 1 comprising a bioabsorbable material. A medical occlusion clip system for closing a detachment between a first and second tissue portion comprising:
A plurality of clips each having a protrusion configured to penetrate tissue;
A flexible coupling for flexibly coupling the clip;
A clip system comprising:   14. A flexible material screen comprising a flexible material screen having a plurality of fibers attached to the clip and attached to the clip. Clip system. Each clip has a length of bent wire that forms a respective projection, and
An engagement portion that flexibly couples with another clip to form the flexible coupling portion;
The clip system according to claim 14, comprising: The first set of clips has a protrusion configured to engage the first tissue portion with a first direction;
The clip of claim 13, wherein the second set of clips has a protrusion configured to engage the second tissue portion in a second direction. system. A flexible screen having opposing first and second surfaces;
The protrusions of the first set of clips extend from the first screen surface;
The clip system of claim 16, wherein the protrusions of the second set of clips extend from the second screen surface. The screen has a first portion with a first set of clips attached thereto;
The screen has a second portion with a second set of clips attached thereto;
The clip system of claim 16, wherein the protrusions of each of the first and second sets of clips are oriented in opposite directions to apply tension across the tissue detachment. The clip comprises a coupling part each having a loop;
A plurality of interlocking strands of the joint are interconnected in their respective loops;
14. The clip system of claim 13, wherein the interlocking strands are flexibly interconnected. Each of the clips has first and second loops and first and second protrusions;
A plurality of flexible strands are formed by interconnecting adjacent clips with respective first and second loops connected by interlocking bonds;
The clip system of claim 18, wherein a screen comprises the strands and a plurality of flexible fibers extending across the strands and bonded to the strands. Each of the clips has a clip body provided with a protrusion extending outward from the clip;
The clip system according to claim 17, wherein the clip is flexibly attached to the screen independently. The clip bodies each have an opening;
The clip system of claim 17, wherein the screen comprises a plurality of fibers that pass through openings in the clip body. The screen has a plurality of flexible backing pieces;
A plurality of clips are attached to each of the backing pieces with each clip protrusion extending across the backing piece,
23. The clip system of claim 22, wherein the plurality of fibers of the screen extend between the backing pieces in a generally parallel and spaced relationship and are interconnected with the backing pieces.   Each said clip has the 1st and 2nd surface, and the 1st and 2nd protrusion part each extended from the said 1st and 2nd surface, The Claim 13 characterized by the above-mentioned. The clip system described. Each of the clips has a peripheral portion that generally surrounds the clip body and has a notch;
An opening in the clip body;
An internal protrusion located in a spaced relationship on the inside of the peripheral edge near the opening of the clip body;
A protrusion at the end provided on the peripheral edge of the clip near the notch;
The clip system according to claim 24, comprising: The clip body, each clip having first and second surfaces;
First and second internal protrusions that protrude outwardly in opposite directions from the surfaces of the first and second clip bodies,
Projections of first and second end portions projecting outward in opposite directions from the surfaces of the first and second clip bodies,
26. The clip system according to claim 25, comprising: A negative pressure source,
Means for sending negative pressure connected to the negative pressure source;
Means for fluidly coupling the means for delivering to the tissue detachment;
The clip system according to claim 13, comprising: The negative pressure source comprises a vacuum source;
The means for sending comprises a foam material;
28. The clip system of claim 27, wherein the foam material is disposed in or near the tissue exfoliation. A flexible medical occlusion screen having the clip;
An extension of the screen configured to extend beyond the tissue detachment;
Attachment means configured to attach an extension of the screen to the surface of the skin;
The clip system according to claim 13, comprising: Said attachment means comprising one of the group comprising adhesives, staples and sutures;
A fluid transfer member comprising a hydrophobic foam material configured to attach to an extension of the screen on the surface of the skin;
A covering configured to be disposed on and attached to the surface of the skin on the fluid transfer member;
A negative pressure source fluidly coupled to the fluid transfer member;
30. The clip system of claim 29, comprising: A medical occlusion screen system for closing a detachment between a first and second tissue portion, comprising:
A plurality of clips each having a clip body having first and second surfaces and a peripheral portion of the clip body;
Each of the clips has an internal protrusion punched out of the area of the clip body in a spaced relationship from the peripheral edge, forming an opening in the clip body;
Each of the clips has a protrusion at the end punched out from the area of the clip body near the peripheral edge, forming a notch,
The protrusions extend outward from both sides of each of the clip bodies and face a generally common direction with respect to the clips;
A flexible screen has first and second surfaces, and the screen is attached with the clip having the protrusions facing outward from the first and second surfaces, respectively. Feature screen system. A medical occlusion method for closing a detachment between a first and second tissue portion comprising:
Preparing a plurality of clips each having a protrusion extending from the clip;
Flexibly joining the clips to form a screen panel having first and second portions;
Directing the first set of protrusions in a first direction on a first portion of the screen panel;
Directing the second set of protrusions in a second direction on a second portion of the screen panel;
The first and second directions correspond to relative positions of the first and second tissue portions;
Engaging the first and second tissue portions with the protrusions facing the first and second directions, respectively;
A method characterized by comprising. Providing each of said clips comprising a body having first and second surfaces and a peripheral edge;
Punching first and second protrusions from the first and second surfaces of the clip body, respectively;
Directing the first and second protrusions in a substantially common direction from the surfaces of the first and second clip bodies toward the outer periphery of the clip, respectively,
33. The method of claim 32, further comprising the following step. Providing each said clip with a loop;
Interconnecting respective loops of adjacent clips to form elongated flexible strands;
Attaching the plurality of strands to a flexible screen to form the screen panel;
33. The method of claim 32, further comprising the following step. Preparing a plurality of strands;
Providing a convex surface on the strand;
Notching the convex surface to form the protrusion,
Attaching the strands to a flexible screen to form a screen panel;
35. The method of claim 34, further comprising the step of: Disposing the screen panel between opposing first and second ends of the first and second tissue portions, respectively;
Closing the ends of the first and second tissue portions;
33. The method of claim 32, further comprising the following step. Applying the screen panel over a longitudinal tissue detachment;
Applying tension across the first and second tissue portions;
Bringing the tissue portion closer;
Blocking the tissue detachment;
33. The method of claim 32, further comprising the following step. The tissue detachment is located in one of the group consisting of tendons, blood vessels and nerves;
35. The method of claim 32, wherein the tissue occlusion configuration comprises a bend. Applying the screen panel over a longitudinal tissue detachment;
Applying tension across the first and second tissue portions;
Bringing the tissue portion closer;
Blocking the tissue detachment;
33. The method of claim 32, further comprising the following step.

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