US2327353A - Instrument for suturing - Google Patents

Instrument for suturing Download PDF

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US2327353A
US2327353A US36969240A US2327353A US 2327353 A US2327353 A US 2327353A US 36969240 A US36969240 A US 36969240A US 2327353 A US2327353 A US 2327353A
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needle
shuttle
shaft
instrument
end
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John D Karle
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Singer Co
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Singer Co
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0491Sewing machines for surgery

Description

Aug. 24, 1943. I J. D. KARLE Y 2,327,353

INSTRUMENT FOR SUTURING Filed Dec. 12, 1940 4 Sheets-Sheet 1 JMW ug- 24, 1943- J. D. KARLE 2,327,353

INSTRUMENT FOR SUTURING Filed Dec. l2, 1940 4 Sheets-Sheet 2 u/ )Wm i, Y rfbi/J..

Aug. 24, 1943. 1 D KARLE 2,327,353

INSTRUMENT FOR SUTURING Filed Dec. l2, 1940 4 Sheets-Sheet 5 Imlunulllllllllllllllil Aug. 24, 1943. J. D. KARLE INSTRUMENT FOR SUTIURING Filed Dec. 12, 1940 4'SheetS-Shee' 4 Lum/man y Patented Aug. Z4, 1943 WSTRUMENT FOR SU'EURING John D. Karls, Roselle Park, N. J., assigner to The Singer Manufacturing Company,

Eiizaheth,

N. J., a corporation of New Jersey Appiication December 12, 1946, Serial No. 369,692 38 Claims. y(Cl. Ilz-169) This invention relates to thread-suturing of flesh wounds resulting either from accidental vor surgical causes and it has for a primary object to provide a new and improved method oi suturing and a simple 'and practical instrument for carrying out that method.

Several methods of suturing wounds are known in the art of surgery. Among these, one which has been commonly employed consists in passing through the esh, at opposite sides oi the wound, a curved needle having, in the Vbutt'end thereof, an eye carrying a suitable suture-thread. After the needle has been passed through the flesh that end of the suture which projects from the flesh at the side of the wound at which the needle enters is tied with the portion projecting from the iiesh at the opposite side of the wound, thereby completing the stitch, after which the suture is severed between the wound and the needle.

Tha-t method, which requires a considerable amount of skill, has been both slow and tedious but has been used almost universally for the want of a better method 'and means with which to practice the same. Y

This invention vhas asan object to providea method of suturing wounds which to practice willY not require a great amount of skill; which will be materially faster than that heretofore used; which will be less tedious; which will obvi'ate the necessity of hand manipulation of the suturethread to lock the stitches; in which the various stitches will be connected together; and in which the suture extending from one stitch to the next will overlie the wound and assist in holding the oppo-site marginal portionsthereof in alignment and in contact with each other.

One phase oi the present improved method comprises the' suturing of wounds by means of two threads, one of which is first passed inwardly and thence outwardly through the flesh at opposite sidesv of the wound and the other of which is interlocked with the first to form a locked stitch. By repeating this operation at spaced intervals along the wound, with the threads extending from one stitchto the next, Vthefwound will be closed by a two thread lock-stitch seam.

The beginning end of the seam may be prevented rom loosening or ravelling by the tying together of the two threads before the making of the first stitch. The improved lock-stitch method of suturing wounds alsoprovides for the securing of the finishing end oi the seam against loosening or ravelling by making two stitches through the same or closely adjacent punctures, thereby forming a tying stitch, and severing the threads at a substantial distance from the last stitch.

In one utilization of the proposed method of suturing, the two threads are additionally locked together at the center at the outer .face of the wound and overlie the same thereby to give added strength to the seam and better to hold the opposite marginal portions ci the wound aligned 'and in contact with each other. Y

The means provided for practicing the above described lock-stitch method comprises a handcarried and hand-manipulated instrument which, in its preferred form, includes a support having a handle, a spool of suture-thread carried by said support, a curved eye-pointed suture-carrying needle carried by the vsupport and Aadapted to have the eyed end thereof passed into and out -of the esh at opposite sides of the wound, and

a shuttle mechanism including a suturencarrying bobbin, also carried by the'support and adapted to cooperate with the needle-suture in the formation of lock-stitches. Y

Drawings depicting the improved method of suturing wounds and means for practicing that method have been annexed as a part of this disclosure and in said drawings,

Figs. l, 2, 3, 4 and 5 are perspective views of my improved locl-stitch surgical stitching instrument illustrating its various stages of use when practicing the method of suturing wounds in accordance with the present invention.

Fig. 6 is a plan View ci the instrument shown in Figs. l to 5.

Fig. 7 is a plan view or" a portion of the needle and shuttle supporting shaft showing particularly a shuttle-controlling cam-groove therein.

Fig. 8 is a needlaend elevation of the instrument showing, in full and dotted lines, diierent positions of the shuttle mechanism relative to the cooperating needle.

Fig. 9 is a transverse section on the line Q-S of Fig. 6, showing a shuttle-controlling camgroove and its cooperating follower.

Fig. 1) is a transverse section in the line lii--I D of Fig. 6, illustrating a detent mechanism for re taining the shuttle mechanism in an out-oi`the way position relative to the needle.

Fig. 11 is a vertical section on the line H--H of Fig. 6, showing locking means for the spool carrying a supply of needle-suture.

Fig. 12 is a disassembled perspective view of the principal elements of the supporting and locking means for the needle-suture spool.

Fig. 13 is a horizontal section on the line lB-l 3 of Fig, 8, showing needle-clamping means.

Fig. 14 is a transverse section on the line I l-I of Fig. 6, showing means for supporting the shuttle mechanism on its shaft.

Fig. 15 is an enlarged side elevation, partly in section, of the shuttle mechanism.

Fig. i is an enlarged longitudinal vertical section on the line If-i of Fig. 6.

Fig. 17 is an enlarged horizontal sectional View of a portion of the shuttle mechanism showing, more particularly, means for holding the shuttle against rotary and endwise movement in its holder and for locking the bohbin against rotation in the shuttle.

Fig. 18 is a disassembled perspective view of the shuttle-holder, the shuttle and the bobbin.

Figs. i9 and 2o are views illustrating one im'- proved suturing seam which may be made by the improved suturing instrument.

Fig 26a is a view illustrating one form of tying stitch for tying-oit the finishing end of a suturing seam, e v

Fig. 21 is a view illustrating another improved suturingseam Which may be produced by the instrument and another form of tying stitch for tying on" the finishing end of a suturing seam.

22 is an enlarged transverse section on the line 22-22 of Fig. 2l illustrating the securing action of a tying stitch made at the compl-.etion of a suturing seam.

Figs. 23 and' 24 are perspective views of the front end portion of the improved instrument illustrating the manner in which it is manipulated in making the seam illustrated in Fig. 2l.

Fig. 25 is a perspective Yview of a modied form of suturing instrument adapted for forming individual suturing stitches and also for forming a plurality of connected suturing stitches in the nature of a chain-stitch seam.

Figs 26, 27 and 28 are views liustrating various forms of suturing operations adapted to be performed with the instrument illustrated in Fig, 25.

While this surgical stitching instrument, illustrated inFigs. l to 18 inclusive, has been developed primarily to practice the improved lockstitch method of suturing Wounds, as hereinbefore described, it is believed that the method and the operation of the instrument in performing the saine can best be understood afterhaving first obtained an understanding of' the structural characteristics of the instrument.

The instrument comprises essentially a knurled or otherwise roughened hand; l adapted to be grasped by the hand of the o,erator; a shaft 2 on which the handle is secured; a needle-carrying arm 3 secured to and projecting laterally from the shaft 2; a curved eye-pointed needle fl secured to the arm with the plane of the needle normal to theV longitudinal axis of the shaft; and a shuttle mechanism, designated generally as S, supported from the shaft and adapted to cooperate with the needle the ormation of stitches. The needle, wl i has its center f curvature substantially coc sident with the axis of the shaft, is secured t ie free end ofthe arm 3 by means of a needle-clamp comprising an adjustable clamp one side of the sha .z other side thereof into `co a needle-receiving slot -V of the arm law 5 ca a laterally proiecting pin l which passes through a bore Sa in the arm S into an arerture 3b in which is located a needle-clamp actuating nut 8 threaded on the pin l'. Rotation or" the nut 8 forces the jaw into and out of clamping contact With the with the walls of l in the free end shank of the needle. A screw 3 threaded into the arm S has its head overlying the needle-receiving slot 6 and serves as a locating abutment for the shank la of the needle. A suture-guiding channel ill is formed in the clamp-jaw 5 to direct a suture-thread n from a source of supply to a groove formed in the outer convex portion of the blade of the needle and leading to the needleeye ib in the pointed end thereof.

Fixed to the shaft 2 intermediate its ends, as by means of a collar I Iil secured by screws I Ib, is a spool-carrying arm II formed at its free end as a disk I IC. Secured to the disk is a spoolholding casing l2 adapted to receive and hold a spool IS carrying the needle suture n. The suture is Wound on the spool i3 and extends outwardly through an aperture ila in the casing and thence to the upper end of the suture-guiding channel Ill in the nee le-clamping jaw 5. Slidingly mounted in an aperture lid formed centrally of the disk Ilc is a spool-supporting pin lll having projecting from opposite sides thereof the opposite ends of a cross-pin l5 normally seated in notches Ile formed in one face III of the disk EIC adjacent the aperture IId. The spool i3 is provided with a central bore i311 adapted. to nt upon one end of the pin Il with the inner ange @il of the spool in contact with the face IIf of the disk Iic and adjacent the crosspin I5. A nut il' (Fig. 1l) threaded on one end IQ@ of the pin lf2., contacts with the outer flange H59' of the spool IS and prevents relative axial movement between the spool and the spool-pin Eil. The opposite end of the pin I/l projects through the arm I l and has threaded thereon a cup-nut l@ which receives one end of a compression spring lil surrounding the pin I4 between the nut I8 and the disk IIC. This spring normally urges the pin i4 axially in a direction to cause the cross-pin it to be moved out of contact with the spool I3 and seated in the notches Ile and to force the flange l5 of the spool into contact with the adjacent face I if of the disk II,

Provision is made for locking the spool against rotation except when it is desired to draw suturethread therefrom. This provision comprises a study 29 projecting from the face Ilf of the disk I I and a series of holes I 3b formed in the flange I5 of the spool I3. Under the influence-of the compression spring I9, the flange I6 of the spool is forced into contact with the end of the stud 2l) and therefore a slight rotation of the spool will cause one of the holes I 3b, which substantially correspond in size-and location to the stud, to be aligned with the stud which thereupon will enter the hole and lock the spool against further rotation.

When it is desired to permit rotation of the spool, so that suture-thread may be drawn therefrom, the operator will push downwardly on the nut lil. This will cause the pin I4 to be moved axially, in opposition to the compression spring I9, whereupon the cross-pin I5 will Contact and shift the spool axially and cause the hole I3b to be disengaged from the stud 20 thereby unlocking the spool and permitting it to be rotated. When pressure on the nut I3 is relieved the spool will again be moved into Contact with the stud and the stud 2) will re-engage one of the holes I 3b as above described.

The shuttle mechanism, which cooperates with the needle in the formation of stitches, comprises a shuttle-holder 2l having a trough-like portion 22 carrying a shuttle 23 therein. The shuttle-holder is supported on the shaft 2 for rectilinear and rotative-movement. The shuttleholder includes a sleeve'25 slidingly mounted on the shaft 2 and having a laterally projecting bifurcated arm 26 terminating in a split sleeve 21 which embraces a coreV element 2Ia to which the portion 22 is secured as by a set-screw 2lb (see Fig. 16). A pinch screw 28 connecting the two portions of the split arm 26 causes the sleeve 2 frictionally to grip the core element 24a. A pin 29 projecting laterally from the core element rits between the opposed walls of the split sleeve 21 and positively prevents rotation of the element in the sleeve.

The shuttle 23 is of the straight type and has a pointed end 23a adapted to be projected into a loop of suture-thread thrown out by the needle il. The shuttle is formed with a central bore into which is insertedV a bobbin 3l! carrying a second suture-thread s which, when the shuttle 23 and bobbin 3% are projected through the loop of needle-suture thread n, cooperates therewith in the formation of lock-stitches. To permit the shuttle, and the bobbin carried thereby, to pass completely through the loop of needle-suture,

Jthe shuttle is retained in the trough-like portion- 22 of the shuttle-holder by a latch 3| pivotally mounted on a pin 32 carried by spaced ears i22b which project laterally from the trough-like portion 22. The latch 3l has at its free end, an ofrset portion Sla which loosely fits within a notch 23h formed in the outer surface of the shuttle. There is sufficient clearance between the walls of the notch and the portion Ela of ther-shuttleretaining latch 3l to permit the needle-suture to pass therebetween. The latch 3l" is vnormally maintained in its shuttle-holding position vby means of a locking screw 33 threaded through one of the ears 22b and having a reduced and unthreaded end 33a adapted toV enteran aperture 3th in the latch 3|. it is desired to remove the shuttle from the shuttie-holder, the screw 33 may be unscrewed to withdraw the end 33a from the aperture 31h, and the latch 3l may be swung outwardly about its pivot as shown in Fig. 18.

For a reason hereinafter to be explained, it is desirable that, during the operation of the instrumenty the bobbin 3@ normally be held against rotation so that suture-thread may Ynot be pulled therefrom. This has been attained by forming, in the rear end of the bobbin, a transverse slot tta (similar to a screw-driver slot) and extending thereinto the forward flat and rounded end thin (see Figs. 16 and 1'?) of a translatable but non-rotatable plunger 3G slidingh7 mounted in a bore 2 lc in the core element 2in. At its rearward end the plunger 311 is pivotally connected, at 34h, to a lever 35, fulcrurned at 35 between spaced ears 3l projecting from the core element 2W.V A flat spring 33, secured to extension of the core element by screws til has its free end 38i in pressure contact with the outer rounded surface 35a of the lever 35 and thereby tends to swing the lever countercloclrwise as viewed in Figs. and 16, thereby forcing the plunger 3ft inwardly and holding the forward end a thereof in the slot 39a in the bobbin. Contact of the upper portion of the lever 35 with the rear end of the ccre element 2 la, as shown at a: in Fig. 16, limits the inward movement oi' the plunger 3d. Sufficient clearance is provided between the end Sila of the plunger 3ft and the walls` of the slot 33a in the bobbin to permit the needle suture loop to pass therebetween as the shuttle is projected through that loop.

(See Figs. 15 and 18). WhenY At certain times it is desirable to withdraw the plunger 34 to release the bobbin so that a length of suture-thread may be pulled therefrom. VTo effect such withdrawal of the plunger, the lever 35 has secured thereto a thumb-button 40 by which the lever may be turned about its fulcrum in opposition to the Spring 38.

As hereinbefore stated, the shuttle mechanism is adapted to be rotated about the axis of the shaftv 2 and also to'be moved lengthwise thereof. To facilitate these movements the sleeve 25 has secured thereto by screws dla, a thumb-piece 4I having a rear face 41,5, 'a side face Ilc and a front face 41d, `all later to be referred to.

During a portion of the operation of the instrument, that is while the needle is being passed through the flesh at opposite sides of the wound, the entire shuttle mechanism is maintained in an elevated out-of-the-way position relative to the needle to give a better view of the wound and better access thereto. This position of the shuttle mechanism is shown in Figs. 1 and 2 .and in full lines inA Fig. 8. Detent means is provided for yieldingly holding the shuttle mechanism in its out-of-the-way position. As shown most clearly in Fig. 10 this detent means comprises a plunger 42 Yhaving'aportion '1321L slidingly tted within a transverse bore 42h in the shaft 2 and another portion 420 projecting therefrom and extending through an aperture 2d in the sleeve Ila of the spool-carrying arm Il. A coil-spring 43 fitted within the bore 42h, between the plunger 42 and astop-screw 44, normally forces the plunger outwardly to cause the rounded outer end thereof to enter ,the'lower end of a bore 45ab formed in a bushing 45 fitted within the thumb-piece 4l, thereby to preventrelative rotation between the thumb-piece (and the parts connected therewith) Vrand the shaft 2 An annular head 45t formed on the bushing d5 engages the rounded end 4290i the plunger 42 and serves to depress the plunger prior to the entrance of the end 42' into the bore 558.

' After the needle '4 has been passed through the i flesh the shuttle mechanism is swung downwardly into operative position relative to the needle as shown in Fig. 3.' This is effected by releasing the detent 42 from the thumb-piece 4l andthereafter rotating the thumb-piece, .and the shuttle mechanism connected therewith, about the 'axis of the shaft 2. To effect release of the plunger 42 the thumb-piece M has slidingly fitted therein, in line with the plunger 42, a push-pin L16 which normally rests upon the rounded outer end of the plunger. A transverse pin el, securedin the thumb-piece and passing through the bushing 45 and a notch te formed in the side of the pushpin, holds the push-pin in place and permits endwise movement thereof. At its ,outer end the push-pin has secured thereto a thumb-button 48 by means of which the pin may be depressed to release the detent.

To the end that the shuttle mechanism will be given the proper movements rotatively about the shaft 2 and lengthwise thereof to cause the shuttle properly to cooperate with the needle to form stitches, these movements'of the shuttle mechanism are controlled by a continuous camgroove 49 formed in the outer periphery of the shaft (see Figs. 6, l and 9) and a cooperating follower 50, carried by the thumb-piece 4 l, which tracks the cam-groove. This follower preferably is formed as the lower reduced end of a springplunger 5l slidingly iittedwithin a thimble 52 tion 49e,

secured within the thumb-piece 4|. A coil-spring 53, surrounding the reduced upper end of the plunger 5| and interposed between a shoulder lnon vthe plunger and the closed upper end of the thimble, serves-to urge the follower 5B against the bottom of the groove 49, thereby 'to produce a slightly frictional Aresistance between the shaft and the shuttle `mechanism mounted thereon. This slight frictional lresistance `enables the operator to have better control'of the shuttle lmechanism during the operation of the instrument.

The kshuttle-directing cam-groove 49 consists of a plurality of portions each of which guides or controls the vmovement of the shuttle mechanism 4during a :portion of its entire stitch-forming cycle. Beginning with a portion 49a (see Fig. 7-) in "which the follower '50 is located prior to the beginning `of a sewing cycle, the camgroove comprises a circumferential portion 4gb, a first vforiffardly extending straight portion 69C, a first helical portion 49d, a second straight pora 'first rearwardly rextending straight portion f, -a second helical portion 49E and a nal rearwardly extending straight portion 45511 which terminates in the stop lportion 49a. -As

the :follower 5E) lapproaches the portion 49a Vthe Y projecting head portion 4.51, of the bushing 45, carried-by the thumb-piece tl, rdepresses the plunger-42 which thereafter snaps into -the bore 45 land yield-ingly retains the shuttle mechanism in its retracted position.

Operation The operation ,of the instrument, above described, when suturing wounds by the seamshown in Fig. .is .illustrated by Figs. l to 5, inclusive, and is as follows With the spool I3 and .bobbin 3o wound with suitable suture-threads n and s, respectively, with the thread n threaded through the thread-guide l0 and thence through the needle-eye andwith the free ends of the two threads tied together as shown at t in Figs. 1, 2, 5 and 20 the operator makes an initial stitch z' beyond and across one end of the wound, designated as w. This is eiTected by inserting the needle through the flesh at opposite sides of the wound, projecting the shuttle through a thread-loop cast out by the needle, retracting the shuttle, withdrawing the needle and thereafter tightening the stitch by bodily moving the instrument away from the wound, all as will hereinafter be described in detail. Thereafter by making a succession of stitches along the wound, each spaced from the last stitch, a continuous lock-stitch seam will be made drawing thenesh, at the opposite sides of the wound, together into abutting relation as indicatedat v in Figs. V1, 2 and 22.

Each stitch is made in the following manner: The operator, grasping the handle of the instrument as illustrated in dotted lines in Fig. 1, with the thumb against the side of the thumb-piece 4 I, places the point oi the needle on the fiash adjacent one side of the wound. Then by turning the hand and rotating the instrument forwardly substantially on lits longitudinal axis, (pressure being applied against the side of he thumbpiece) the point of the needle is caused to pass into and out of the flesh at opposite sides of the wound, as indicated in Fig. 2. It will be noted that during lthis portion of the operation the shuttle mechanismv is retracted and rotated to an out-of-the-Way position Where it does not obstruct .the view of the wound or interfere with the manipulation of the needle.

Z. Still further forward movement includes additionally interlocking the Having passed the needle through the esh as shown in Fig. 2 the operator next depresses the thumb button 48, thereby releasing the detent 42, 415, and rotates the shuttle mechanism downwardly about the axis of the shaft, the follower 50 passing through the portion 1591 of the shuttlecontrolling cam-groove 4S. This rotation of the shuttle mechanism, together with a slight back- Ward rotation of the entire instrument on its longitudinal axis places the pointed end 23a of the shuttle 23 in alignment with, but slightly behind, the thread-loop Z thrown out by the needle 4. Next the operator places his thumb against the rear face #Hb of the thumb-piece 4l, (as shown in Fig. 3) and pushes forwardly thereon. This moves the shuttle mechanism forwardly on the shaft 2 and rprojects the pointed end of the shuttle into the thread-loop Z (as shoWn in Fig. 3). Continued forward movement of the shuttle mechanism, under the inuence of the operators thumb, while the follower 59 tracks the straight portion [itc of the shuttle-controlling cam-groove t9, projects the shuttle and the bobbin therein, almost completely through the needle thread loop of the shuttle mechanismV to the position shown in Fig. 4 cornpletes the projection of the shuttle and bobbin through the loop Z and, as the follower 50 tracks the helical portion 49d of the cam-groove, the shuttle mechanism is given a combined endwise and sidewise kmovement thereby drawing the thread-loop Z 01T the rear end of the shuttle and laterally between the bobbin Si? and its rotation restrainer .361, whereupon the thread-loop is held by the shuttle retainer latch Si. Next the operator places his thumb on the front face Hd of the thumb-piece 4|, (as shown in Fig. 5) and draws rearwardly thereon. This retracts the shuttle mechanism to its initial position, the follower passing successively through the straight portion lief, the helical portion Iltis and the straight portion llh of the shuttle-controlling cam-groove 49 until it reaches its stop position 49a. The thread-loop l is then temporarily and frictionally retained between the offset portion 31a f the shuttle-retainer 3i and the side of the shuttle 23, as shown in Fig. 5. Finally the instrument is rotated reversely to withdraw the needle from the iiesh and moved bodily away from the wound to withdraw the loop Z from the shuttle-retainer and to tighten. the Tightening of the stitch, by bodily movement of the instrument, is possible because of the fact that both the spool I3 and the bobbin 35 are then locked against rotation and therefore no thread may be pulled therefrom.

As hereinbefore stated, 'this invention also contemplates suturing wounds by a method which two suturethreads at the outer face of the wound to give added strength to the seam and better to hold the oppositev marginal portions of the wound aligned and in contact with each other. This method of suturing is illustrated in Fig. 2i i which theneedle-suture n and the shuttle-suture s are locked together below the outer surface of the wound as indicated at y and additionally interlocked above said surface as indicated at 2. It will readily be perceived that with this method of suturing, the overlying threads will cooperate with the lower locked threads y to hold the Flesh, at opposite sides of the wound, in abutting co tact and will hold the marginal portions thereof in alignment With each other.

This method may be performed by use of the stitch.

instrument hereinbefore described by rotating the instrument between successive stitches thereby to interlock the needle and shuttle-sutures above the outer face of the wound. When producing this form of suture, the instrument is moved away from the wound after each stitch has been formed, thereby to tighten the stitch. Then, with the instrument held substantially in the position shown in Fig. 23 and with the needle and shuttle-sutures running directly from the last stitch to the needle and shuttle, respectively, as shown in full lines in that figure, the user rotates the instrument substantially on its longitudinal axis in the direction indicated by the arrow d to the position shown in Fig. 24. Thus it will be seen that the positions of the needle and the shuttle are reversed with respect to the last stitch formed and the two suture-threads are thereby crossed as indicated at b in Fig. 24. Further rotation of the instrument in the direction of the arrow a to effect one complete turn thereof, will cause the instrument to reassume the po-sition shown in Fig. 23 and cause the two suture-threads to be interlocked above the wound as indicated in dotted lines at c in Fig. 23. Except for this rotation of the instrument between successive stitches the method of operating the instrument is the same as above described.

This invention also contemplates the tyingoff of the seam, at the nishing end thereof, to prevent loosening of the stitches or ravelling of the seam. This is effected, as shown in Figs. 20, 21 and 22, by turning the instrument on its longitudinal axis to interlock the threads above the wound, as hereinbefore described, and thereafter making through either the needle puncture of the last stitch sX of the seam or closely adjacent thereto, a tying stitch p thus interlocking the threads both above and below the surface of the wound and finally severing the ends n and s of the needle and shuttle-sutures, respectively, at a substantial distance from the wound. Thereafter, the pulling of either thread end will merely result in the pulling of the interlocked loops beneath the surface of the Wound to the opposite sides of the needle puncture without drawing the end of either thread through the needle puncture. In Figs. 21 and 22 the needle and shuttle-sutures are shown in full lines as severed a substantially equal distance from the tying stitch p. Now if the end of the needle-thread n be pulled outwardly as indicated in dotted lines in Fig. 22 the loop 3 of shuttle-thread will be pulled completely through the' flesh to the position shown in said Fig. 22 but the end s thereof will still project from the opposite side of the needle puncture of the tying stitch. Further pulling on the needle-suture u will not further affect the loop as the strain is then transmitted directly to the interlo-cked threadloops above the wound and thence to the nal stitch sx of the seam. Pulling on the shuttlethread will result in a similar action only in the opposite direction as shown in dotted lines in Fig. 22.

While it may be desirable to have the two suture-threads locked together beneath the surface of the wound, as shown in Figs. 20 and 2l, this is not essential. If desired, the so-called ladder stitch of Fig. 19 may be produced by pulling unevenly on the two threads when tightening the stitch. If greater tightening action is exerted on the shuttle-thread s that thread will lie straight along the surface of the flesh at one side of the wound and the needle-thread n will extend through the esh and interlock with the shuttle-thread at one sideof the wound as shownV in Fig. i9. It will readily be understood that if greater tightening .action is exerted on the needle-thread than-.onthe shuttlc-thread, the result will be reversed, and the needle-thread will lie straight along the surface of the Vflesh and the shuttle-thread will extend through the flesh and interlock withV the needlethread at the opposite side of the wound.

Figs. 19 and 20at illustrate another form of tying Stitch for tying-olf the suturing seam to prevent ravelling thereof. As disclosed in those figures a tying stitch p is made either through the needle puncture of the last suturing stitch or closely adjacent thereto in a manner similar to the making of the last stitch and without interlocking the suture-threads above the wound disclosed in Figs. 20 and 21. The sutures are then severed a substantial distance from the wound. With this form of tying stitch, if the end of the needle-thread is pulled until the thread extends substantially straight,` out from the last suturing stitch SX of the seam, as indicated in Fig. 20a, the loop 3"' of the shuttlethread will be pulled completely through the flesh to the position shown in said figure but the end s" of the shuttle-thread will still project from the opposite side of the needle puncture of the tying stitch; Further pulling on the needle-suture n will not Vfurther aieci-J the loop s" as the strain is then transmitted directly y to the inter-locked thread-loop of thenal stitch sx of the seam which cannot pull out because of the resistance offered by the tying stitch. Pulling on the shuttle-thread will result in a similar action only in the opposite direction. ,i

In Fig. 25 there is disclosed amodied and simplied form Yof surgical stitching instrument adapted particularly for suturing wounds with the stitches and seams illustrated in Figs. 26 V27 and 28. This instrument differs from the one hereinbefore described in that it is devoid of the shuttle mechanism and therefore is not adapted to make lock stitches. Like the instrument hereinbefore described, this device includes a handle l, shaft 2, needle-carrying arm 3, curved eyepointed needle Il, needle-clamping jaw 5, spoolcarrying arm ii secured to the shaft 2, spoolholding casing l2 carried by the arm il, needlesuture spool (not shown) in the casing l2 and means similar to that disclosed in Figs. 11 and 12 for holding the spool against rotation except when pressure is applied to the cup-nut 18. The only difference between the elements disclosed in this figure and the corresponding elements disclosed in Figs. 1 to 5 and Figs. l1, 12 and 13 is that in the modified construction the shaft 2 does not contain any shuttle-controlling cam-groove corresponding Vto the groove It.

The suturing operation illustrated in FiggZ, may-readily be performed with the instrument shown in Fig. 25 by grasping the instrument by the handle, rotating it on its longitudinal axis in one direction thereby passing the pointed end of the needle 4 into and out of theY fleshat the opposite sides of the wound, seizing the free end o f the suture-thread n, rotating the instru-*- ment in the opposite direction to withdraw'the needle from the flesh, severing the suture-thread between the nesh and the needle and nnauy ty-f ing together the two ends of Athesuture-thread projecting from the esh Vat opposite sides of the wound. This operation products an individual stitch as shown at f in Fig. 26. l

The suturing seam shown in Fig. 27 may be made by the instrument shown in Fig. 2 5 by repeatedly passing the pointed end of the needle through the Yflesh as above described, slightly retracting the needle to cause it to throw out a thread-loop Z grasping that loop and carrying it forward, fully retracting the needle andagain passing its pointed end through the flesh atropposite sides oi the wound and through the previo usly formed loop Z", thus forming a conventional chain-stitch seam,

In Fig. 28 there is disclosed a suturing seam utilizing an overedge or overcast chainstitch. This seam also may be made by the in,- strument shown in Fig. 25 by operating it as described in connection'with the seam shown n Fig. 27 except that the threads-loopA l isY carried diagonally across the wound w and the needle, in. entering the flesh in. makingl the next suc.- ceeding. stitch, passes into and through said loop.

From the foregoing it will be perceived that I have provided a new and. improved. method of suturing wounds and have also provided a sim.- pleand practical hand-carried and hand-manipulated. instrument by means of which that method may be practiced.

Having thus set forth` the nature of the. invention, what I claim herein is:-

1x. A surgical stitching instrument, comprising a. handle, a` shaft projecting from said handle, a curved eye-pointed needle mounted on said shaft with the plane of the needle transverse to the longitudinal axis of the shaft, a support car-` ried by saidinstrument and projecting to one sidethereof, a suture-supply spool mounted-on said support with its axis off-set from the longitudinal axis of the instrument, means including interengaging elements providedV by said support and said spool, respectively, for preventing rotation of the spool, and means for bodily shiftingv said spool to disengage it from the rotation-preventing element provided by said support;

2. A surgical stitching instrument as set forth inv claim 1 in which the support forfthe suturesupply spool carries an endwise shiftable'spoolsupporting pin and astationary spool-engaging stud; in which a flange of thespool is formed withaperturesV adapted to receive said stud; .in

which spring means acts to shift the spool intoengagement with said stud to lock the spool against rotation;y and-in which manually actuable-means is provided for shifting said-pin and` spool axially to disengage the spool from said stud.

3. A surgical stitching instrument as set-forth inclaim 1 in which the support for the suturesupply spool carries a stationary spool-retaining element; in which the spool is provided with a portion adapted to engage .said element to preventrotation of the spool; in which aspring normally urges said spool and element into locking engagement; and in which manually actuable means is providedfor shifting said spool,

axially to disengage it from said element,

4. A surgical stitching instrument comprising;

a., handle, a shaft projecting from and aligned with said handle, a curved eye-pointed needle mounted on said shaft with the plane of thev needle transverse to the longitudinal axis of said shaft and with the center-of curvature of the needle substantially coincident with the axis of said shaftana handle.

Y lated to` said shaft, and manually actuable means.

5. A surgicalstitching instrument comprisin a handle, a shaft projecting axially from saic handle, an arm projecting laterally from the end of said shaft remote from said handle, a needleclamp at the free end of said arm, and a curved eye-pointed needle mounted in said needleclamp.

6.A surgical stitching instrument comprising a handle, a Yshaft projecting axially from said handle,A an arm projecting laterally from the end of said shaft remotevfrom said handle, a spoolholder supported by said instrument adjacent the juncture of said shaft and handle and a needleclamp at the free end cf said arm.

7. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, an arm projecting laterally fromy the end of said shaft remote from said handle, a curved eyepointed needle removably secured to said arm, a.- suture supply spool mounted' onl said instrument between said handle and needle-clamp, andmanually releasable means to lock said spool against. rotation.

8. InY a hand-carried and; hand-nianipulated surgical stitching instrument having a handler and a shaft projecting from said handle, thev combination with a curvedY eye-pointedv needle, carried by said shaft, of a shuttle having; a rectilinear loop-taking movement relative tov saidneedle and lengthwise of said shaft.

9. In a hand-carriedY and hand-manipulated; surgical stitching instrument having a needle,-V supporting shaft,v the combination with a curvedr eye-pointed needle carried by straightmovement relative to said needle and lengthwise of said shaft and a movement sidewise of. itself said shaft, of a.

after it has been projected wellintoq the needlethread loop, and manually actuable means for. giving said movements tosaidshuttle.v

10. A hand-operated surgical stitching instrument comprising suture-carrying eye-pointed and iixed element` ll. A hand-operated,surgical stitching instrument having, in combination, Van eye-pointedv needle carrying a suturing thread, a needle-holder, a loop-taker complemental to said needle and,

adapted, to take thread y. loops therefrom in the formation of stitches, said loop-taker being movably supported'by-said needle-holder, means on` said needle-holderA to retain said loop-taker inv an out-of-the-way position removed from saidy needle, and means` tofmove said loop-taker from said out-of-the-way position into loop-taking. position relative to said needle.

12. A hand-operatedsurgical stitching instrument comprising a thread-carrying..eye-pointed;

needle-element, a loop-takerY element` complemental to said needle-element andadapted to. take thread,,loopstherefrom in the .formationofv stitches, and a shaft carrying said elements, said` needle-element being xedly related t0 saidlshaft and said loop-taker element being, movablyirefor movingsaid loop-,taker element.

13. A hand-carried and hand-manipulated surgical stitchinginstrument having, in combination, complemental needle andmshuttle ele-- ments, av shaft supporting said elements,v means. ,tomove said shuttlegelement-in apredetermined;

shuttle having a rectilinear loop-takingv path on said shaft to cause yit to take threadloc-ps from said needle, a bobbin carried by said shuttle and adapted to be passed through said thread-loops to, form lock-stitches, and a supporting handle connected to said shaft.

le. A surgical stitching instrument having, in combination, a curved eye-pointed needle adapted to carry a suture-thread, a shaft carrying said needle, a handle on said shaft remote. from said needle, a shuttle-holdermovable on said shaft between said handle and needle, and a suturecarrying shuttle in said shuttle-holder.

l5. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, a curved eye-pointed needle mounted at the free end of said shaft with the plane of the needle transverse to the longitudinal axis of said shaft, a shuttle, and a shuttle-holder slidable on and lengthwise of said shaft.

l5. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, a curved eye-pointed needle mounted at the free end of said shaft with the plane of the needle transverse to the longitudinal axis of said shaft, a shuttle, and a shuttle-holder rotatable on and slidable lengthwise of said shaft.

i7. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, a curved eye-pointed needle mounted at the free end of said shaft with the plane of the needle transverse to the longitudinal axis of said shaft, a sleeve slidable on said shaft, a shuttle, and a shuttle-holder laterally offset from and fixed to said sleeve. v

if. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, a curved eye-pointed needle ,mounted at the free end of said shaft with the plane of the needle transverse to the longitudinal axis of said shaft, a sleeve slidable on said shaft, a shuttle, a shuttle-holder laterally offset from and fixed to said sleeve, a suture bobbin in said shuttle, and manually releasable means on said shuttie-holder tolock said bobbin against rotation in said shuttle.

19. A surgical stitching instrument having, in combination, a curved thread-carrying needle, a

shaft carrying said needle, a handle for saidshaft, a thread-carrying shuttle movable relative to said shaft, and manually releasable devices to loch the needle and shuttle suture-threads against endwise movement relative to said instrument.

20. A surgical stitching instrument having, in combination, a curved eye-pointed needle, a shaft carrying said needle, a handle for said shaft, a needle-suture-supply spool, a holder therefor, a shuttle movable relative to said shaft, a suturecarrying bobbin held by said shuttle, and manually releasable means to lock said spool and bobbin against rotation in their respective holders.

2l. In a surgical stitching instrument, a shuttle comprising a hollow cylindrical body havingl a loop-taking point at one end and an opening at its opposite end, a suture bobbin in said shuttle, a shuttle-carrier, and manually releasable means on said shuttle-carrier extending through the open end of said shuttle into locking engagement with said suture bobbin to prevent rotation of said bobbin within said shuttle at all times except when released by the operator.

22. A surgical stitching instrument having a handle, a shaft projecting from said handle, a curved eye-pointed needle carried by said shaft with its plane transverse to the longitudinal axis of said shaft, a shuttle, a shuttle-carrier offset from the longitudinalV axis of said shaft and mounted Ato slide lengthwise of and turn about said axis, and cam-and-follower devices on said shaft and shuttle-carrier to control the rotative position of said shuttle-carrier on said shaft in the motion of the shuttle-carrier longitudinally of said shaft.

23. kA surgical stitching instrument having a handle, a shaft projecting from said handle, a curved eye-pointed needle carried by said shaft with its plane transverse to the longitudinal axis of said shaft, a shuttle, a shuttle-holder offset from the longitudinal axis of said shaft -and mounted to slide lengthwise of and turn about said axis, cam-and-follower devices on said shaft and shuttle-holder to control the rotative position of said shuttle-holder on said shaft in the motion of the shuttle-holder longitudinally of said shaft, and manually releasable means toV lock said shuttle-holder to said shaft in a retracted position.

24. In a hand-carried and hand-manipulated surgical stitching instrument, the combination with a curved eye-pointed needle and a handle on which said needle is mounted with the plane of the needle transverse to the longitudinal axis of said handle, of a straight shuttle, and manually operated means to project said shuttle lengthwise of itself and said handle and transversely of the plane of the needle into a sutureloop presented at the concave side of said needle.

25. A surgical stitching instrument having, in combination, a curved needle formed with a suture-carrying eye adjacent the point thereof,V a shaft carrying said needle and having its longitudinalaxis substantially normal to the plane of said needle, a suture-carrying shuttle, a shuttlc-holder slidable lengthwise of and turnable about the axis of said shaft, and means to first turn said shuttle-holder about the shaft axis from an out-of-the-way position into loop-taking position and thereafter to slide the shuttleholder lengthwise of the shaft axis to project the shuttle into a suture-loop presented by said needle.

26. Ahand-carried and hand-manipulated surgical stitching instrument having, in combination, a curved eye-pointed needle, a shuttle, a shuttleholder, means including a shaft to support said shuttle-holder in an out-of-the-Way position relative to said needle, and means including an element slidable and rotatable on said shaft to shift said shuttle-holder first in one direction into position for cooperation of said shuttle with said needle and then in a different direction to project the shuttle into a thread-loop presented by said needle.

27. A surgical stitching instrument comprising a handle, a shaft projecting from said handie, a curved eye-pointed needle mounted. on said shaft with the plane of the needle normal to the longitudinal axis of said shaft, a shuttleholder movable lengthwise of said shaft, a shuttle carried by said shuttle-holder and cooperating with said needle in the formation of stitches and a thumb-piece projecting from said shuttleholder radially of the axis of said handle and cooperating with the handle to facilitate manual rotation of said instrument substantially on f its longitudinal axis, and to actuate said shuttleholder.

v28. A surgical stitching instrument having, in combination, a curved needle formed with a suture-carrying eye adjacent the point thereof, ashaft carrying said needle andhaving its lonvholder gitudinal axis substantially normal to the plane ofsaid needle, a handle on said shaft,. av suture'- carrying shuttle, va shuttle holder slidable lengthwise of and turnable about the axis of saidV shaft, a continuous shuttle-holder-directing cam-groove formed in the periphery of said' shaft and a stud on said shuttle-holder engaging said cam-groove, said cam-groove having a rst portion extending circtnnferentially thereabout, a second portion extending lengthwise of the shaft, a third portionextending substantially helically around the shaft, said second and third portions extending forwardly away from said handle and serving to vdirect the shuttleholder in its forward movement, fourth por.-

tion extending lengthwise of the shaft, a fthv portion extending helically around the shaft in a direction opposite to the rst named helical portion and a sixth portion extending lengthwise ofthe shaft andconnecting with said first. portion, said fourth, fifth and sixth portions of the cam-groove serving to direct said shuttleholder in its retracting movement.

29. A surgical stitching instrument having, in combination, a shaft, a curved'eye-pointed nee-' dle mounted thereon, a shuttle, a shuttle-holder slidingly mounted on said shaft, means to support said shuttle-holder in an out-of-the- Way position relative to said needle, means to shift said shuttle-holder on said shaft rst in one direction into position for cooperation with said'needle, then in a different direction to project the shuttle through a thread-loop presentf ed by said needle and finally to retract it to said out-of-the-way position, and a manually controlled detent to lock said shuttle-holder in said out-of-the-Way position.

30. A surgical stitching instrument comprising a handle, a shaft projecting from said handle, a curved eye-pointed needle mountedat thev free end of said shaft with the plane of the needle transverse to the longitudinal axis of said shaft, a sleeve slidable on said shaft, arm projecting radially from said sleeve, a' shuttleholder carried by said arm, and having a' trough-like shuttle receiving portion, a shuttle located in said trough-like portion and having its pointed end projecting from the open end thereof, and a shuttle retainer secured to said shuttle-holder and overlying said trough-like portion to maintain said shuttle therein.

3l. A surgical stitching instrument comprising a handle, a shaft projecting from said handle,. a curvedv eye-pointed needle mounted at the free end of said shaft with the plane -oi' the needle transverse to the longitudinal of said shaft, a sleeve slidable on said shaft, anarrn projecting radially from said sleeve, a shuttlecarried by said arm, and` having a trough-like shuttle receiving portion, a shuttle located in said trough-like portion and hating its pointed end projecting from the open end thereof, a shuttle-retaining element pivc .ly mounted on saidYshuttle-holder and swingablev into position to maintain said shuttle holder, and means to secure said element in shuttle-holding position.

32. In a surgical stitching instrument, a shuttlecomprising a hollov7 cylindrical body h a loop-taking point at one Vend anc-o at its opposite end, a suture bobbin in shuttle and having an aperture in one end thereof, a shuttle-holder, a non-rotatable spring-r-ossed plunger carried by said shuttle-holder with its axis substantially inline withv theaxis-of saidY itsV bobbin, the forward end of said plunger being adapted to engage the aperture in said bobbin to prevent rotation thereof, and manually actuable means to withdraw the forward end of said plunger from the aperture in the bobbin to perniit rotation of the. bobbin in the shuttle.

33. In a surgical stitching instrument, a shuttle' comprisingA a hollow cylindrical body having a yloop-taking point at one end and an opening at its opposite end, a suture bobbing in said shuttle and having a transverse siot in one end thereof, a shuttle-holder, a non rotatable spring-pressed plunger carried by said shuttleholder with its axis substantially in line with the axis of said bobbin, the forward end of said plunger being flattened and adapted to fit into the slot in said bobbin to prevent rotation-thereof, and a manually actuable lever fulcrumed on said shuttle-holder and engaging said plunger towithdraw the forward end of the plunger fromthe slotv in the bobbin to permit rotation of the bobbin.

34. A surgical stitching instrument having, in combination, a curved eye-pointed needle, a shaft carrying said needle, a handle for said shaft, a shiftable needle-suture-supply spool, a holder therefor comprising a fixed casing, interengaging means provided by said spool and casing to prevent rotation of said spool in said casing, and manually operable means for bodily shifting said spool thereby to render said interengaging means ineffective to hold said spool against rotation.

35. A surgical stitching instrument having, in combination, a curved eye-pointed needle, a shaft carrying said needle, a handle for said shaft, a needle-suture-supply spool, a holder therefor comprising a cup-like casing secured to said shaft and adapted to receive said spool, a spring-pressed plunger mounted coaxially in said casing and extending through said spool, a

nut threaded on said plunger to retain saidv spool' thereon, interengaging elements on said spool'and casinga-dapted to prevent rotation of the spool in the casing, an abutment carried by said plunger adapted to engage said bobbin, and manually actuable means to shift said plunger and the abutment carried thereby axially thereby to disconnect said interengaging means thereby to permit rotation of said spool.

36. A surgical stitching instrument comprising a handle, a shaft projecting from said handie, an arm projecting laterally from the end of said shaft remote from said handle, the forward free end of said arm being formed with a needle-receiving slot, a needle-clamping jaw slidingly mounted on the free end of said arm and having a javv portion cooperating with the Walls of said slot to clamp the shank of a needle therebetween, a threaded pin connected to said jaw and extending through an apertine formed lengthwise of said arm, and a manually rotatable nut, Vlocated in a transverse opening in said arm and spaced'from the end thereORthrea-ded on said pin for shifting said clamping jaw to effoot clamping and unclaniping of said needle.

37. A surgical stitching instrument 'comprising a handleQa shaft projecting from said handle, arcurved thread-carrying eye-pointed needle mounted on said shaft with the plane of the needle transverse Y toV the longitudinal axis of the shaft and with the center of curvature of the needle substantially coincident with the axis of the shaft, a shuttle, and a shuttle-holder supe ported on and slidable lengthwise of the shaft'to dle, an arm projecting laterally from the end of 10 said shaft remote from said handle, a curved eye-pointed needle mounted on said arm with the plane of the needle transverse to the axis of said shaft, a second arm carried ey said in: strument and projecting radially therefrein, and a suture supply spool mounted on said seeond arm with its axis off-set from the longitudinal axis of the instrument.

JOHN D. Kal-ELE.

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