US2472009A - Surgical dressing - Google Patents

Surgical dressing Download PDF

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Publication number
US2472009A
US2472009A US60812245A US2472009A US 2472009 A US2472009 A US 2472009A US 60812245 A US60812245 A US 60812245A US 2472009 A US2472009 A US 2472009A
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Prior art keywords
dressing
portion
body
portions
elastic
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Gardner William James
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Cleveland Clinic Foundation
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Cleveland Clinic Foundation
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/08Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound

Description

y 31, 1949- w. J. GARDNER 2,472,009

SURGICAL DRESSING Filed Aug. 1, 1945 IN V EN TOR. W/l. L/A M 7A M55 GAEDNEE Patented May 31, 1949 TEEN 1's: OFEI 2,472,009. 3 SURGIQAL DRESSING Willianmflameszfiiardner, Cleyelzynd-Heights; Ohio; 7 assign to Qieyelgr gi Clinie Foundation, a non-,- profiteorporation of Ohio Appliatioiwm gi stf l, 1945; Sei ial No. 08,122 la flleinis (Cl. 128--3 3 5) This invention relates to surgical dressingean'd:

more eparticularly pto: aneimprovedi iclosureviand ciressinge enabling: traetionzltozhezeplaeedimn tithe:

wound and whi'chtdressingis :ofsthezgenerazl charmaoteiedescribed in my -Pa-tent No;;=2,42L, 193 -5=:;

Itis Well known E01:thGSGrVQISBdfiiHfihG artrthalt; it, iszdesireble; inrcases .LOfi Wounds-sonzcutsiltmbringz th'}:raIW veciges. of: the; wound: togethrei'z Thise em: ablesethea healingi actionzto takerplaceemoreirapei idly, reduces the danger of infection, and reduces; thessizezohthascar; Hereto-foraaethei raw edges attire: wound: have: beeniibrought' togetheniimvarei iousgma'nners: the mostacomm'on of lwhichawvasihy sutu rin'gs; This-,:.:a1though.1efiectivwhasiitstdisadm vantages, iforeif ithe' zipatient" is iuconsciousgiit, ris:

painful anchhasiatendency; to 6&USG1S1'1OCKJ1 thermore; there :is -.thendangen:.of zinieotion iron. the :suture; and if the stitchessaresinotkclqseetoe gether; there iSt-hfl3116111181631kfOLthBgWOllIldii'lQ gem between the stitches. :,;;Thi-s siS alsora, timeiohsum e; ingz; operations Afterwthe: wonndsisihealedsf themi 1512,1501 thee obl'em of removing; the stitchesmnd: the Stitch-6S:i hemSelvesnhaJ fi'fl. tendemmtorfomm a scares: Since there. is ardefinitelimititoithe num ber of stitchesgthat may; be used; there zisrza lsote tendency for the strain-th rein touheisueh as 110 cause. zthemxtoete'ar loose;

Still:tether;methods,es eheasaelempssi ta mie a s-( alle: here deiiniteed s enteees C; mos cannot be u8dw n-2 t a e teens e d an a es;iitieh ieno h, ew theiw un t ethen-= a t; a a tou iquewhn. ciremetion For ;the +1argera W01111d S;gWh s in 1 -.fi s.-h nemove emrefi'ee "sewin -b tto sw itehe sk n a rubber bands between them for trac its disadvantages. particu ara i dya te e-a endant 1 all the prion processes. is the time necessary, total the wounds a d -applytheedres in :1;-Thee a er.-

gether-.:,:, The :woundsmay have -treetion-o applied; thereto; along :their entirewlength whioh: traction: is. sevehiyedistributed and 1 is 'maintained allethe; time theigdressinggisgin plecepn- The dressing; be ;app1ie.d Without discomfort. ztoethe ipetientn quicklygand easily 'by vthose: with- 5 modieumsioi, skills, ItfHlSO edapts itselito temporary dress:r in g -since it eanlbe quicklyendeesily removed; withoutv discomfort to the; patient, It-iselsqsvery; usefnts providing I itraction :over ,large openz wounds whereit is desirableto -stretch the; skin to sever-denuded: areas.

Still}, other; advantages -ofthe iinvention snoh; as;-cleanliness; ;thee1imination:.of trauma and theg additional protection afforded; againsteiniectioni wit beeomewmore, apparent from-;the ,fo11 owinge deioription which 1 is illustrated; by :the mqcome; panyingndmwings anctiormse part o f 1,the;spBr:. fic t on.

I In;the:drawings:

Figiqfll is e side elevational --vieW;-oi a dressing; oftmy invention;

Fig=;2 is a top/plan viewthereof;

Fig. 3 is a bottom plan view thereof;

. Fig. 1 is an enlargedsectioni-taken on the lines 4-1-4 05, Fig.3;

F i- 4 1 5 is a diegremmaticrzviewa shgwihg ijhtt' manner, of its application to a wound;-

Fig. 6 .isan enlarged iregn entery.,1: 1a,n view.;;of the skin engaging. portion; of ethe dressing-p Fig. is -.a perspective view o fa, clipflused foi seenringthe dressing. together;

Fig-,;8 is -a magnified-view; of onezofcthe shin engagingfbedrbs orspicules :Qfise side elewationaleview of form of theinvention; and.

{L0 is arbottom ple n view-thereof n ry n -w n n i f re i nree vigiekan intermediate-body portion ofihighlylela s mew??? tic material, such'as rubbeitelatex-ormnetof the 1 3 portions which are rendered inelastic providing tabs which may be grasped by the fingers providing a convenient means for manipulating the dressing when attaching the same to the wounded member of a patient.

More specifically, as shown in the accompanying drawings, throughout which like parts have been designated by like reference characters, the dressing includes a composite strip, the center portion ID of which may be constructed of rubber, latex or any of the synthetic compounds having a high degree of elasticity. This elastic center or mid portion will preferably be made in various lengths and widths adapting the device to be used to dress various sizes and types of wounds. At opposite ends of the elastic portion, there are non-elastic portions ll. These are preferably provided by uniting with the elastic in these zones a layer of fabric l2.

Preferably, the bond between the fabric and rubber is effected during the curing of the rubber and in such a manner that a continuous layer of rubber is provided on the under side, as viewed in Figs. 1 and 4, with the rubber extending into the interstices in the fabric as well as uniting with the individual fibers of the fabric. The top of the fabric remains comparatively free from the rubber, however, thus providing a relatively rough and relatively stiff surface which enables the same to be better gripped by the fingers. There is thus provided a composite strip having a center portion which is highly elastic and end portions which are inelastic and which strip has a continuous rubber underside and is provided with roughened upper end surfaces. The addition of the fabric to these ends not only reduces the elasticity of the strip at these points, but also stiifens the strip and provides more body to it which, as will be seen later, assists in securing the other parts to the strip. The amount of stiffness of the ends is a matter of choice and may be varied between relatively wide limits. Preferably, a certain amount of flexibility is desirable.

Means are provided for connecting the composite strip to the body of a patient in such a manner that the elasticity of the mid portion is utilized to apply traction through the connector means on the opposite sides of a wound. This generally comprises metal members having sharp points that penetrate into the skin. Specifically, these members may each include a fiat body portion I 5, adapted to lie fiat against the under side of the strip at a zone H, and having an end portion which curves downwardly as indicated at l6 and then turns backwardly at I! to form a transversely extending lip. The edge of the lip 11 is provided with a plurality of needle like projections r spicules 18, which extend toward the mid portion of the dressing.

There is thus provided a member which is generally hook shaped in longitudinal section and has sharp points. Two of these members are used in connection with each of the composite strips, being secured to the inelastic portions adjacent the elastic portion and in such a manner that the projections l8 point in the general direction of the center of the strip. These members are secured to the underside of the composite strip with the fiat part disposed adjacent the elastic zone and the bight of the hook being toward the end of the composite strip, by cementing and a clip (Fig. '7). The clip comprises a fiat strip which engages with the upper surface of the fabric 12, and-the ends of which extend around the edges of the flat body portion 15 at 2| and are then bent backward at 22 against the underside of the flat body portion l5. If desired, the bent part 2| may be notched at 23 to facilitate the bending of the clip and provide a tighter joint between the clip and the projection carrying body portion l5 to thus more securely grip the composite strip therebetween. Prior to assembly, cement is applied to the adjacent faces of the body portion l5 and the composite strip at the under side, and the body portion and composite strip brought together and held in position by the clip until the cement has an opportunity to set. After assembly, the cement and the clip both cooperate to hold the parts securely together.

It will be apparent that the point carrying metal members may be secured to the composite strip in other manners than that shown, but I have found that the means illustrated and described are very effective, economical and easy to construct.

The ends ll of the composite strip extend beyond the attaching members and provide tabs which may be grasped by the fingers or forceps for manipulation of the device. The effectiveness of these tabs is increased by having the upper surface comparatively free from rubber, which leaves a good rough gripping surface, the roughness of which depends upon the coarseness of the fabric.

The projections [8 may be provided on the edge of the lip l! in various manners. I have found that one manner of forming them is by lapping as shown in the copending application of Valentine B. Seitz, Serial No. 561,365, filed November 1, 1944, and which has become abandoned. Preferably, the projections are disposed in closely spaced relation along the edge of the lip, and as best shown in Fig. 8, and may be substantially pyramidal in form. In one case, I have found that 20 of these points per inch and each approximately .004 inch square at the base and .020 inch in length provide a very effective action. It will be apparent that the number and size may be varied. By lapping the points, they may be made very sharp, which allows them to penetrate with very little trauma. Having the points closely spaced enables traction to be evenly distributed over a wide area, and the length is so gauged as to prevent deep and painful penetration.

Fig. 5 shows the manner of application of the dressing of my invention. The body of a patient is shown at 30 and as containing a cut 3|. The cut will ordinarily be gaping but is shown nearly pulled together due to the traction exerted by the dressing.

In applying the dressing, the ends, or tabs ll, of the dressing are grasped between the fingers and pulled in opposite directions. This causes the mid portion it! to be stretched.

Preferably, the thumbs engage with the clips 20, and the elements carrying the sharp projections may thus be tilted so that the projections l8 point in a generally downward direction but still point toward the medial portion of the dressing. The projections I8 are then brought into engagement with the skin on opposite sides of the cut and the projections l 8 gently pressed into the skin and toward the wound from opposite sides while at the same time the tension on the tabs H is released. The tension exerted by the part l0 then holds the projections in the skin, their penetration, however, being limited by the length of the projections.

Because the projections are sharp, very little discomfortis experienced, nor do they penetrate "fai' 'e'riough to cause any damage to the flesh under the skin, error that matter, the ski-n itself.

As is best illustrated in Fig. 5, the skin adjacentthe projections, and between the projections and the wound, tends to heap up providing a more effective engagement therewith, and the curved struc'tu're FG'pr-ovides a clearance space preventing the projections from being displaced from their engagement by this heaping up."

' T-he "dressing, after the tabs H- are released, assumes; a: position substantially as shown in Fig. 5, the part' Hi causing th connector mean-s and their projections to'be steadily pulled in toward the wound. The placement of the proj'ections causes this traction to be distributed over a wide area with the result that considerable traction may be produced which soon draws the edges of the wound together, materially increasingthe-healing rate and speeding epithelization i by reducing the area to be epithelized.

' 'If desired, the traction can be enhanced by fastening a strip of adhesive tape over the ends H: and/or the connector means to hold the same more closely to the body of the patient.

It will be seen that the traction exerted is largely determined by the character of the rubleer;- The invention adapts itself very readily to making dressings of various widths and lengths.

It also enables the dressing tobe placed directly over the wound, and the rubber will not adhere as readily as the conventional dressings to the excretions therefrom. The material of the strip may be sufficiently transparent to allow the wound'to be viewed Without removing the dressingfIf desired, the wounded member may be wrapped with a gauze bandage for further protection andto absorb the excretions from around the edges and prevent foreign matter from enteri'ng under the edge of the dressing.

It can be seenthat the dressing may be applied in a matter of seconds, and if the user thereof is not satisf ed with the manner of its placement, it may be as quickly removed and reapplied, all without pain or discomfort to the patient. Because of itsc onstruction, traction may be applied inadirection to better close the wound, and the wound edges may be brought so close together that it is unnecessary to use a gauze bandage i e tl d e t the i d li n Fig.5, it will be noted thatthe, actual point of traction is .displaced somewhat from the edge thl'woun'd. The p oint where th traction is applied, may be varied to some extent by the length of theintermediate elastic portion. In some'instances, however, it may be desirable to apply thetractionalong close to the edge of the mi it t i QUQ the Wound t0 e closed more and also provides more skin Oneither sideof the with?! whi m e r c ed- 'I n rjigs 9'and l0, Lhaveillustrated a modified form of; the. invention which allows traction to' be applied, closer. to. th edge of. the wound apdwhich also permits greater traction to be ed, The principle difference; between this dre ing and; that of the other figuresis in the pro sion-of a, downwardly, and inwardly extendmg, nortiontll whichextends at substantially the same",anglelasthepart [land is provided with pointson spicules l 85 Thusthe, elements which are.,'secured to thefinelas'tic parts of. the compositastrip re,each provided with two sets of skin'enge'gin DQintSQQneset o fwhichis the same e; ngembodiment, the other set a nwardly. ewn, her from. n

adaptedtoi engage with tneaskin close to theedge of the wound,

Thus substantially twice as much adhesion may be realized, and traction may be applied very close to the edge of the wound which affords a still. greater amount of skin that may be stretched.

In some cases, it may also be desirable-to construct a dressing similar to that shown in Figs. 9 and 10- but with the outer set of spicules l-8 and the supporting portions l6-I I: removed and only the portion 46 with the spicules 18" remaining. It will be seen, however, that in this case it is most desirable to have additional means to hold the end of the metal member having the sharp projections from tilting, asin this structure, the tendencywould-befor the spicules- |8-' to act; as a fulcrum about which the portion 4i!- could revolve, and the dressing would thus be pulled'out of engagement.

It will alsobe seen that more than one dressing may be used if desired and in such a manner as to place greater traction in one area than another, and that it is possible to use thesedressings in such a manner that the elastic portions cross each other if desired, thus putting traction on wounds from different directions.

Having thus described my invention, 1 am aware that numerous. andextensive departures may be made therefrom without departing from the spirit or scope of my invention.

I claim:

1. A dressing comprising a mid-portion of a material having a high elasticity, end port-ions extending from said elastic mid portion and comprising a stiffening material to which said elastic portion is secured to hold said elastic material against stretching and provide relatively stiif end portions, means for attaching'said dressing to the body of a patient comprising'metalskin: gripping members, said stiffened portion extending beyond said metalportions to provide tabs to facilitatemanipulation of the dressing'when attaching or removing the same from the patients body.

2. A dressing comprising a mid, portion of a material having a high elasticity, end, portions extending from said elastic mid portion andcomprising a stiffening material to which said elastic portion is secured to hold said elastic material against stretching and provide relatively stifi end portions, means for attaching said dressingtoa patients body comprising metal skin gripping members and means for, securing said stiffened portion and said gripping members together, said stiffened portion extending beyond said metal portions to provide tabs to facilitate manipulation of the dressing when attaching or removing the same from the body of a patient.

3. A dressing of theclass described comprising a resilient body portionand end portions ofrelatively non resilient material extending therefrom, means toattach said dressing to the. body of .a patient with theresilient. portion over. a. wound comprising metal skin engagingmembershaving portions, for engagement with theskin on opposite sides of they wound and spaceditherefrom, means to attachsaid members to thesaidnon-resilient portions, and means.fonmanipulating saiddress ing comprising ends of said non-resilient-portions extending. clearof said. metalskin engaging members.

4. A dressing comprising: means. to-exertgtrace tion on apatients body including anelastio ponie oi ubb l r h ike nd: p r ionsextendme.

from said resilient portion including means to stiffen the end portions and hold said end portions against stretching, means for securing said dressing to a patients body by engagement with the healthy portions of said body comprising metal members provided with sharpened projections adapted to engage with said body and means for securing said members to said stiffened portions, said stiffened portions extending beyond said metal portions to provide convenient means for manipulating the dressing for attachment or detachment.

5. A dressing comprising means to exert traction on a patients body including an elastic portion of rubber or the like, end portions extending from said resilient portion including means to stiiien the end portions and hold said end portions against stretching, means for securing said dressing to patients body by engagement with the healthy portions of said patients body comprising metal members provided with sharpened projections adapted to engage with the patients body and means for securing said members to said stiffened portions, said stifiened portions extending beyond said metal portions to provide convenient means for manipulating the dressing for attachment or detachment and having a roughened surface providing a friction surface for engagement with the fingers or a manipulating tool.

6. A dressing comprising an elastic portion, members for attaching said dressing to a patients body comprising metal members secured to said dressing at spaced apart points and each having downward curved parts and the ends provided with sharpened points adapted to penetrate into the skin of the patient.

7. A dressing comprising an elastic portion, body attaching members for said dressing comprising metal members secured to said dressing at spaced apart poin s and each having a downward curved portion and the edge provided with sharpened points disposed at spaced intervals along the edge extending from the edge toward the mid portion of the dressing and adapted to penetrate into the skin of the patient.

8. A dressing comprising an elastic mid portion and members for attaching the dressing to the body of a patient each comprising a portion adapted to be secured to said elastic portion and having a longitudinally curved portion curving downward away from said elastic portion and terminating in a portion extending at an angle toward the center of the dressing and away therefrom and a second portion spaced inwardly from said first portion and extending at an angle away from said elastic portion but toward the center line of said dressing each of said portions having a plurality of spaced projections on its edge adapted to penetrate the skin of the patient to provide a plurality of spaced traction engaging parts on each side of a wound.

9. A dressing comprising an elastic mid portion and non-elastic end portions, members for attaching the dressing to the body of a patient each comprising a. flat metal body portion and means for securing said metal body portions to said non-elastic portion, each of said metal body portions having a longitudinally curved portion curving away from said non-resilient portion and a portion extending toward the center of the dressing having a row of sharp points for engagement with the skin disposed along its edge, said dressing adapted to be applied to a patients body by stretching the same and applying to the body, the resiliency of the mid portion causing said 8 points to penetrate the skin after the dressing is in position, said non-resilient portions extending beyond said metal portions to provide tabs to facilitate manipulation of the dressing.

ii). A dressing including a traction exerting member having an elastic mid portion of rubber or like material adapted to be stretched and having characteristics which cause it to tend to return to its original form when the stretching power is removed, end portions for said member comprising fabric joined to said members 0n the upper surface thereof and reinforcing said memher in its opposite end zones and holding the end portions against stretching, means to secure said dressing to a patient comprising metal members secured to said reinforced end zones adjacent said mid portions and having a portion at the edge most remote from said mid portion extending in the general direction toward said mid portion provided with sharpened projections for engagement with the skin.

11. A surgical dressing comprising an elastic body member of rubber or like material having an intermediate zone of high elasticity and opposite end zones each having means for rendering said end portions inelastic, comprising fabric, having inte Juices, secured to one surface thereof with said body having portions extending into the interstices of the fabric, means for securing said dressing to the body of a patient comprising thin sheet metal members each including a substantially hat body portion adapted to lie flat against the under of said end zone and a metal clamp member extending across said end zone on the other side thereof having portions bent over the sides of said metal member and against the bottom face thereof to securel clamp the corresponding member to the corresponding end zone, the corresponding members each having a portion beyond said clamp curved downward away from said end zone and extending backward toward said intermediate portion, the edge of each memher being provided with a plurality of spaced sharp projections adapted for engagement in the skin of the patient, and said end portions of said body member extending beyond said securing members to provide tabs adapted to be grasped to facilitate application and removal of the dressing.

12. A dressing comprising an elastic mid portion and no-n-elastic end portions, members for attaching the dressing to the body of a patient each comprising flat metal body portion and metal clamps for clamping each of said metal portions to said non-elastic portion, each of said metal portions having a. longitudinally curved part curvin awa from said non-resilient portion and a backwardly extending portion having a plurality of sharp points for engagement with the skin, said dressing adapted to be applied to the body of a patient by stretching the same and applying to the patients body, the resiliency of the portion causing said points to remain in the skin after the dressing is in position.

13. A surgical dressing comprising an elastic body member of rubber or like material having an intermediate zone of high elasticity and opposite end zones each having means for rendering said end portions inelastic comprising fabric, said elastic body member having portions extending into the interstices of the fabric, means for securing said dressing to the body of a patient comprising thin sheet metal members each re spectivel including a substantially fiat body portion adapted to lie, respectively flat against the under side of the respective one of said end zones,

10 and respective metal clamp members extending REFERENCES CITED across respective end zones on the other sides thereof having portions bent over the sides of g fs are of record m the said metal members and against the respective bottom faces of said metal members to securely 5 UNITED STATES PATENTS clamp said members to said end zones, said mem- Number Name Date bers each having a portion beyond the clamp as- 363,538 Penny May 24 1887 sociated therewith and extending backward to- 1 620,162 Martin Man 1927 Ward said intermediate portion, the edge of each 2:012 755 De Mum Aug 1935 member being provided with a plurality of sharp 10 2325006 Laub NW 1940 projections adapted for engagement in the skin 2,399545 Davis 1946 of the patient, and said end portions of said body member extending beyond said securing mem- FOREIGN PATENTS bers to provide tabs adapted to be grasped to Number Country t facilitate application and removal of the dressing. 15 608,605 Germany Jan. 23) 1935 WILLIAM JAMES GARDNER.

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