US2655153A - Surgical apparatus - Google Patents

Description

Oct. 13, 1953 H. J. KLoTz SURGICAL APPARATUS Filed Feb. *4, 1949 Amf ATT RNEY Patented Oct. 13, 1953 UNITED STATES PATENT OFFICE 12 Claims.

'I'his invention relates to improvements in surgical apparatus. More particularly, this invention relates to an improved support and pouch that can be set adjacent a surgical opening to receive and hold any discharge from that opening. s

It is therefore an object of the present invention to provide an improved support and pouch which can be set adjacent a surgical opening to collect andhold any discharge from that opening.

In the treatment of human diseases and ailments it is sometimes necessary to form an opening in the patients anatomy and to maintain that opening for indefinite periods of time. Where a periodic or continuous discharge is anticipated from that opening, provision must be made to receive and hold that discharge. One operation that occasionally requires the maintenance, for a short time, of an opening in the patients anatomy is an appendectomy performed after the appendix has burst; the 'opening permitting draining of undesired fluids from the abdominal cavity. Another operation requiring the maintenance of an opening in the patients anatomy is a colostomy, wherein the large intestine I is caused to extend through the abdominal Wall.

A generally similar operation is an iliostomy, wherein the small intestine is caused to extend through the abdominal wall. After these and other operations have been performed, it is necessary to receive and hold the discharges from the if i' surgical openings made during those operations.

Various methods and apparatus have been proposed to facilitate the receiving and holding of such discharges; and one method contemplates the placing of a large quantity of cotton or gauze adjacent the opening. The cotton or gauze will, when used in suicient quantities and when properly set adjacent an opening, receive and hold the discharge from that opening; but that gauze or cotton must be removed and replaced frequently. That removal and replacement is not only a very expensive procedure but it usually entails considerable irritation and chaiing of the skin, because the cotton or gauze is usually held in place by adhesive tape; and the removaland Water-resistant liner or bag Within the cup. The discharge is supposed to pass through the openings in the pad and cup into the liner or bag; and the bag is supposed to hold that discharge until the two pieces of the cup are separated for removal of the bag. However, the bag must be quite small, because the two-piece cup must be small enough to be worn; the bag is held rather loosely within the cup and the discharge could fail to reach the bag but instead could engage and soak through the absorbent pad; no provision is made for venting gases; and the entire apparatus must be moved away from the users anatomy before the absorbent pad can be replaced. Another apparatus which has been proposed has an apertured support of rubber, a bag with its open end extending through the aperture of the support and spread over the surface of that support, a stopper that extends into the aperture of the support, and a coating of wax over the open end of the bag, the stopper and the support. This apparatus does not provide for the venting of gases; it can only be assembled with difficulty since the wax must be melted and applied evenly to the bag, the stopper, and the support; the entire apparatus must be moved away from the person of the user before the bag can be separated from the support; and the use of a stopper increases the likelihood that the opening in the apparatus will get iout of register with the surgical opening. The absence of a vent is quite serious because the gases that are sometimes attendant upon a discharge can force the bag and support away from the users body and permit soiling and staining of the users clothing. Moreover, the action of the organs of the body can sometimes create a suction which, in the absence of a vent for the bag, can draw part of the organs into the apparatus. In addition,4 the use of rubber against the skin is very undesirable because rubber chafes the skin and has an unpleasant feel. Still another apparatus, that has been proposed to receive and hold the discharge from surgical openings, consists of a large rubber pouch which is held ydirectly adjacent the skin around the surgical opening by a wide belt. This pouch has an opening at the top thereof and it is stiffened adjacent that opening to insure ready flow of the discharge into the pouch. However, that stiffness of the pouch makes it awkward for the user to move his limbs. Moreover, the heavy weight and large size of the pouch and belt cause excessive perspiration of the skin under the belt and pouch, and this perspiration permits the pouch to slip and uncover the sur- -vrv bottom surfaces of the support I 0 are straight while the two side edges are arcuate.

The numeral I6 denotes a pouch of thin, flexible, moisture-resistant, non-absorbent material. A number of plastic materials and treated fabrics could be used but polyethylene is preferred because of its superior strength and durability. The pouch I6 4has an upper portion which is somewhat wider thanrthe space between the two holding surfaces I2 on the support I0 and which is approximately as high as the support I0, and it has a bottom portion 20 which is considerably wider and deeper than the support I0. The pouch I6 can be made in a number of ways, but it is preferably made by heat-sealing two pieces of polyethylene together.

The material of which the pouch I6 is made must be thin enough and flexible enough so the rear wall of that pouch can be fitted into the recess formed by the holding surfaces I2 and the front surface of support I0. At such time, the front wall of pouch I6 will extend forwardly of the support III and its holding surfaces I2. The pouch I 6 has an opening I8 in the rear wall thereof; and when the rear wall of pouch I6 is fitted into the recess, formed by holding surfaces I2 and the front surface of support I0, the opening I8 will be in register with the opening I4 in support I0. The opening I8 is the same size as opening I4 and will be immediately adjacent that opening, and thus anyl discharge from the surgical opening has immediate and full access to pouch I6. This discharge will move from opening I8 to the large bottom Zeef the pouch, and that bottom can be made large enough to receive all of the discharge normally expected from-the surgical opening. The top of the pouch I6 is not sealed but instead is left open, and it will remain open while the pouch is in use.

The numeral 22 denotes a retainer which is used with thesupport I0. It is desirable to make this retainer of the same material as support Iii, but retainer 22 can be made of any suitable material. The retainer 22 has an opening 24 in the approximate center thereof, and that opening is the same size as the opening I4 in support I0 and the opening I8 in the pouch I8. The side edges of the retainer 22 define planes which converge in front of and below the retainer, and which are generally parallel to the planes defined by the holding surfaces I2 on support I3. The side edges of retainer 22 coact with the front and rear surfaces of that retainer to give that retainer a generally frusto-triangular configuration in elevation and plan; and those side edges fit between the holding surfaces I2 on support I0.

The retainer 22 is dimensioned so it can fit within the top portion of pouch It and so the pouch and retainer can both fit within the recess formed by the holding surfaces I2 and the front surface of support I0. When the retainer 22 and pouch I6 are positioned between holding surfaces I2 on support I6, the side edges and rear wall of that retainer will press the rear wall of the pouch tightly against the holding surfaces I2 and front surface of support III. The clearance between the rear wall of pouch I6 and the holding surfaces I2 and front surface of support I0 will preferably be so small that it will be scarcely visible to the unaided eye; that clearance being greatly exaggerated in Fig. 2 for the purposes of illustration. The engagement of retainer 22 and pouch I6 with support I0 will place the openings I4, I8 and 24 in register, thus providing a large unobstructed passage for the discharge from the 6 surgical opening; and the holding surfaces I2 of support I0 and the side edges of retainer 22 will coact to resist further downward movement of pouch I6 or retainer 22.

The support I0 and its retainer 22 are held in position adjacent a surgical opening in the anatomy of the user by a belt 28 which has relatively non-elastic portions adjacent the support I I) and has a readily extensible portion 3|] oppositely di'sposed of that support. The relatively non-elastic portions of belt 28 are preferably of a washable. strong fabric such as duck, and the readily extensible portion 30 is preferably of a Washable elastic. Because the readily extensible portion 36 is disposed on the opposite side of the users anatomy from the support I6, any yielding of the belt must occur on the opposite side of the users anatomy; and that yielding will have vlittle or no effect upon the position of the support I0. As a result, the user can bend, stoop, stretch, and turn without causing the support It to change position. An adjusting element 3I, of usual design and construction, is provided intermediate the ends of the readily extensible materialr 3,0 to enable one size belt to accommodate a number of persons of different sizes. Hook and loop fasteners 32, of usual design and construction, are also provided intermediate the ends of the portion 3B to facilitate the fitting rof the 4belt and support around the body of the user.

The belt 28 is secured to the support Il) by spring hooks 26 which pass through headings at the ends of the belt 28, and the hooks seat in the openings I5 in the top and bottom of the support I Il. These hooks provide full support for the top and bottom of the support I0; but they can easily be separated from the support I0 by bending them until one or the other of their ends slips out of one Vof the openings I5, and they can easily be separated from the belt 28 by withdrawing them' from the headings at the ends of that belt. As a result, each and every one of the elements of the apparatus provided by the present invention can be separated from the other elements, and all of those elements can be fully cleaned and sterilized.

In use, the rear surface of the support I0 is placed directly against the bare skin of the user; and this is Very desirable since that surface is smooth and is completely free from rough spots. No'part of the retainer, pouch, or belt can interpose itself between the support and the users skin, and thus complete freedom from raw edges is fully assured. The support I0 will be set so the opening I4 therein encircles the surgical opening in the anatomy of the user. Thereafter the belt 28 will be passed around the body of the user, and the adjustable element 3| adiusted to place a slightA tension in the resilient portion 36 when the hook and loop fasteners 32 are closed. This tension need not be great since the support is light in weight, is curved to nt the body and will thus not need to be deformed, and will not tend to dislodge itself from its position adjacent the surgical opening. i

The small amount of tension required in the belt 28 is of great value since it minimizes perspiration of the skin beneath the belt, thus keeping the belt and the support from becoming slippery from perspiration. In addition, that small amount of tension obi/lates the need of a wide, heavy belt which would hamper the movements of the user and which would roll and become uncomfortable. i

Once the support I6 has been set in position 7 adjacent the surgical opening, the belt E28 iwill hold lit there; and thereafter the retainer 22 can ibe :slipped inside A:the pouch ZIS through the open top thereof and can be set so the fopening 2i .in fthe reainer 22 `is register with ithe opening -IB in the pouch 15. The front wallfof the pouch alli can then be grasped and :drawn away from the front surface of retainer 22, thereby .pulling -the rear wall of pouch `IfI tightly against the .rear surface :and -the side 4edgesnof retainer 22. When this is done, the rear lwall of 1pouch elacts -as a skin or'coating for rthe retainer 22; and that :retainer 22 and pouch :It can be handled as a unit and Vcan :be inserted between the holding 'surfaces I2 on support `t0. As the retainer 22 land pouch iI .6 'move downwardly between the -hold- Ving 'surfaces I2, the openings .24 :and 118 -in :re- .tainer 22 :and pouch I6 will move 'into register with opening'l 4 in support .'IO; andfthose-openings 'will .be held .in register thereafter 'by the 'coaction of holding surface i2 4and Kthe side edges vof retainer 22. .Even .if the discharge from the surgical opening were to be quite heavy, ,theweight of that discharge could not=displace`the pouch I 6 or retainer 22 because the wedging action of .holding surfaces 'I2 and the side edges Yof retainer 22 increases as the downward forces Von a'etainer 5212 increase. Asa `matter of fact, the weight of the discharge will merely tend to scat the pouch I6 and Vretainer 22 more 'solidly in `support 1:0. Once the'retainer .22 and pouch IS have 'been set `in position in support IU, the rfront kwall `of the pouch can be released; and thereafter its upper fend rwill assume the position shown in Fig. 2 and 'serve `as a vent.

lThe Aflexibility of the material of which the pouch If6 is made is such that .the front wall -of that pouch willbend and `fiatten 'out 'beneath vthe clothing lof the user fand thus :be finconspicuous, `but will :permit that .front wall to fbend sand yield `as-the discharge 'from the surgicalropening Apasses through zthe 'opening I;8 Vin :the ,pouch YIS. :Any gases 'that escape Awith the discharge `will :readily be vented Vthrough .the Aopen top of the'pouch I6; and Athat top will always be held vertically above the opening I8 by ythe support Iii and retainer 22, thus preventing 'accidental 4removal of the contents thereof.

When, after one or more discharges, the Apouch AI6 'requires emptying, `the'zuser need only retire, -grasp the lfront wall of the pouch fI6 tightly enough to cause it to hold retainer 22, and then move the pouch I6 and retainer 22 zupwardly. A piece of disposable tissue :can be heldin readiness to clean the opening I4 inthe support :I 0 and to clean the exposed skin between `.the :surgical opening and the periphery of opening III. 'The walls of the pouch I6 immediately below the bottom of vretainer 22 can then be 'pressed together to force the retainer 22 'upwardly through the open upper end of `pouch IIB, thus `making it possible to grasp the upper end of retainer 22 with a piece of disposable tissue. In this way, the pouch I6 and retainer 22 are separated from the support I0, and the retainer 22 is separated from the pouch I6 without any risk ofthe users hands contacting the discharge from the surgical opening.

The retainer 22 can be cleaned with water, if available, or with a piece of disposable tissue, and the pouch I6 can be cleaned or can be discarded. 'The retainer can then be inserted within Ythe cleaned pouch or a fresh pouch, and the retainer and pouch assembled with 'the support. 'The lentire procedure requires but a `few seconds,

:and it :can lbe done .neatly without `undressing to any substantial degree.

With either of these constructions, great freedom of movement .can be enjoyed by the user; and users -of these .constructions have been enabled to play athletic games such as football, basketball and tennis, and they have also `been enabled to move quickly, as in dancing, hiking, or the like. The Vconstructions also do not interfere with bending -of the limbs since the fpouch will readily yield if .engaged by a limb. .Moreover, the user is more willing toengage in activities since the constructions do not bulge -or show through the users clothing.

The constructions can be .-made quite compact; supports and retainers usable -for .colostomy and iliostomy patients being no more'than afquarter of an inch (-1/4) thick each. The pouches can be made of material of about two hundredths -(0;02) of an inch thick; thus :making the voverall thickness of the apparatus -less than one .-half (1i/2) an inch. The support is vapproximately four (4) inches wide and three (3) inches l.high and the opening M is `approxinciately :two 4.(2) inches in diameter. Consequently thesupport -I has a very substantial -area -in contact with the body and it avoids undue pressures -on the area adjacent the surgical opening; and this .is -desirable since it avoids discomfort `for .the user. The pouch is `about four v(1i) .inches wide at the top and about five and Vone half (5l/2l) inches -wide at the bottom; and the overall length .of the pouch is about ten (l0) inches. The .relatively non-elastic portions of belt 28 are about three and one half (S1/2') inches wide while the readily extensible Vportion -30 is rabout .one .half (1/2) inch wide.

Whereas two preferred embodiments .of ithe present invention have been shown .and `described, it should be obvious to Athose .skilled in the art that various Vchanges .may .be 'made .in .the form of the invention without affecting thescop thereof.

lWhat I claim is:

1. Apparatus that can :be .placed adjacent .a surgical opening to receive and ,hold .the 'discharge from that opening and that .comprises .a

support yof stiff material, -said -support having .a curved surface thereon, saidcurved surface .being adapted to engage that portion `of the .anatomy -of the user which surrounds said surgical .opening, an'opening Ythrough said -support, holding surfaces on said support, said holding surfaces defining kplanes that converge in front of .and below said support, said holding surfaces cooperating `with a surface on saidsupport todene a recess that is frustotriangular in elevation and plan, a pouch spaced from the .user by said support, said .pouch being of .flexible material that can be bent .and fitted .between .the holding surfaces on said support, an opening adjacent .the top of said pouch vto vent gases, an openingin said pouch below Ysaid top to `permit inlet of .dischargesaidinlet opening being registerable with the opening in said support, `said pouch being bendable by the clothing of the wearer to -lie fiat against said support but also being .bendable to permit vpassage of dischargeinto-said pouch, :a retainer adapted to -be wholly disposed 4within said pouch and to releasab-ly secure said pouch to said support, an opening in said retainer 4that is registerable with said Ainlet 'opening Ain said `pouch and said opening 'in said ."support, the edges of said retainer .defining .planes stha't converge -in front Yof and 'below lsaid rretainer, :said

retainer being of Y,f rusto-triangular configuration in elevation and plan, and a beltY to hold said support adjacent a surgical opening, said belt having wide, relatively Y inflexible portions adjacent said support but having a narrow, readilyextensible portion oppositely vdisposed of said support, said belt being releasably secured to said support, said pouch being bendable to permit grasping of said retainer without requiring the users hands to contact said retainer.

2. Apparatus that can be placed adjacente surgicalopening'to receive and hold the discharge from that openingv and that comprises a support of stiff material, said support having a curved surface thereon, said curved surface being adapted to engagev that portion of the anatomy of the user which surrounds said surgical opening, an opening through said support, holding surfaces on said support, said holding surfaces defining planes that converge in front of and below said support, said holding surfaces cooperating with a surface on said support to define a recess that is frusto-triangular in elevation and plan, a pouch spaced from the user by said support, said pouch being of flexible material that can be .bent and fitted between the holding surfaces on said. support, an opening adjacent the top of said pouchto vent gases, an opening in said pouch below said top to permit inlet of discharge, said inlet opening being registerable with the opening insaid support, said pouch being benda-ble by the clothing of the wearer to lie flat against said support but-also being bendable-to permit passage of discharge into said pouchy a retaineradaptedto bewholly disposed within said pouch and to releasab-ly-.secure said pouch to said support,- an ,opening in said retainer that is registerable with saidinlet opening in said pouch and said openingin said support, the edges ofsaid retainer dening planes that converge in front of and below said retainer, said retainer being of frusto-triangular configuration in elevation and plan, and a belttohold said support adjacent a Ysurgical opening.

3. Apparatus that can be placed adjacent a L support of stiff material, said support having a define a recess that is frusto-triangular in elevation and plan, and a retainer, said retainer being of frusto-triangular conguration in elevation and plan.

4. Apparatus that can be placed adjacent a surgical opening. to receive and holdthe discharge from that opening and that comprises a support of stii material, said support having a curved surface thereon, said curved surface being adapted to engage that portion of the anatomy ofthe user which surrounds said surgical opening, an opening through said support, holding surfaces on said support, said holding surfaces defining planes that converge in front of and below said support, a pouch spaced from the user by said support, said pouch being of flexible material that can be bent and fitted between the holding surfaces on said support, an opening adjacent the top of said pouch to vent gases, one wall of said pouch having a portion thereof that is belowsaid opening and is selectively movable toward and away fromsaid support to selectively restrict and ,prevent the flow of gases to said opening, an opening in said pouch below said tcp to permit inlet of discharge, said inlet opening being registerable with the opening in said support, said pouch being bendable Vby the clothing of the wearerY to rnove toward and lie flat against said support land largely close said vent opening but also being bendable to permit passage of discharge into said pouch and to permit. opening of said Vent opening, and a retainer that has edges which are registerable with said holding surfaces on said support and that engages said pouch and secures said pouch to said support,

5. Apparatus that can be placed adjacent aY surgical opening to receive and hold the discharge from that opening and that comprises a support, an opening through said support, a pouch spaced from the userbb'y said support, an opening adjacent the top of said pouch to vent gases, one wall of said pouch having a portion thereof that is below said opening and is selectively movable toward and away from said support yto selectively restrict and permit the flow of gases to said opening, a second opening in said pouch that is registerable with said opening in said support, said pouch being bendable by the clothing of the wearer to move toward and lie flat against said support and largely close said vent opening but also being bendable to permit .passage of discharge into said pouch and to permit opening of said vent opening, and a retainer that is registerable with said support and that enpermit the flow of gases to said opening, a second opening in said [pouch that is registerable with said opening in'saidsupport, a retainer that is regopening in saidk support, a retainer that is dif .mensioned to fit between saidvholding surfaces A on said support and that engages said pouch and f isterable with said support, and that secures said pouch' to said support, and intertting surfaces on Vsaid retainer and saidv support, said pouch being offlexible material'and` bending and fitting between the interfitting surfaces on said retainer i and said support.

7. Apparatus that can be placed Vadjacent a surgical opening to receive and Vhold the discharge from that opening and that Ycomprises a support, an opening through said support, holding surfaces on said support, a pouch, an opening in said pouch that is registerable with said releasablysecures said pouch to said support, an

lopening in saidretainerrthat is registerable with C said openings in said pouch and said support,

the edges of said retainerY having surfaces complementary to the holding surfaces on said support, and a second opening in said-pouch, said second opening in said pouch being larger than' said retainer and'serving as a vent, said retainer ,A i being dimensioned 'to be insertable into said pouch through said second 4'opening Iand to nt wholly within said pouch, the wall of said pouch asse-,115s

11 having a portion thereof that is disposed below said second opening and is selectively movable toward and away'from' another wall of said pouch to selectively restrict and permit the iiow of gases to said second opening.

8. Apparatus that can be placed adjacent a surgical opening to receive' and hold the discharge from that opening and that comprises a support, an opening through said support, holding' surfaces on said support, a' pouch spaced from the user by said support, an opening adjacent the top of saidA pouch tovent gases, one wall of said pouchY having a portion thereof that is belowl said opening and is selectively movable toward'and away from said support to selectively restrict and permit the flow of gases to said openi'ng, a second-opening in said pouch that isregisterable` with said opening in said support, said pouch being of flexible material that can loe-bent and fitted between the' holding surfaces onsaid support, said pouch being bendableby the'clothing of the wearer to move towardA and lie flat against said support but also being bendahleto permit passage of discharge-into said-pouch, aV retainer' that is dimensioned to iitwholly within said pouch and is dimensioned to fit between said holding surfaces on said support and that engages said pouchA and releasablyseoures saidy pouch to said support, and an opening in said retainer that is' registerable with said second opening in saidpouch and said openingin said support, the edges of said retainer having surfaces complementary to the holding'l surfaces on said support.`

9. Apparatus that canbe placed adjacent a surgical opening to receiveV and hold the discharge from that openingl andr that comprises a support, an opening through said' support, holding surfaces onsaid support, a pouch, an opening inv said pouch that registerable with said opening in said support, al second opening in said pouch tov serve as a vent, one Wall of said pouch having a portionthereof that is disposed below'said second opening and is selectively movabletoward and away'from another wall of said pouch to selectively restrict and permit; the' flow ofl gases to said' opening; anda retainer thaten'- gages said pouch and" releasably secures said pouch to said support, said retainer being held by the holding surfaces on said support, said retainer' being dimensionedto be Wholly disposed within said pouch, said secondY opening. being larger than said retainer to permit the inserf2 tion ori said retainer into said poucnthroughsaid second' opening. v

10. ApparatusA that canbe' placed adjacent a surgical opening to# receive' and hold the discharge from that opening and that comprisesa support, an opening-A through said support, holdingI surfaces on said support, said' holding surfacesl defining elongaaed, flat planes that converge i`n front of-afnd'belowlsaid support, a pouch; an opening in said pouch that is registerable with said opening ini said support anda retainer, the-edges of'saidi retainer defining elongated,.fiat planes that converge infront" of' and' belowf said retainer,l said retainer having its edges-l registerable with said holdingv surfaces on said support and engaging said pouch to secureV said pouch to said support.

1l. Apparatus that can be placed adjacenta surgical opening to receive and hold the di'schargefrom'- that opening and that comprises a support, an opening through said support, elongated', flat holding surfaces on said support that are inclined' relative to each other toprovide aA Wedging action a pouch', an opening in said pouch that is registerable with said opening in saidsupport, and a retainer, said retainer having surfaces thereon which are registerable Withsaid'surfaces on said support and engaging said pouch toIV releasably secure said" pouch to said` support.

12; ApparatusI that can be placed adjacenta surgical' opening to receiveV and hold'y the discharge from that opening andI that comprises a' support of stiff material having the form of air arcuate plate', an opening through said support, apouch, an opening in said pouch that is registerable with` said opening in said' support, spaced guides on said support, and a retainer, said' guides being spaced apa-rt to receive and hold said retainer, said retainer engaging said pouch and securing'saidl pouch to said support, said guidesv being elongated and flat.

HENRY J KLSOTZ.

References Cited Vin the lei ofV this patent UNITED STATES PATENTS Number Name Date 2,232,054 DanielsY Feb. 18;.19'41 2,294,5'3T Carhart r Septi- 1, 1942 2,327,514 Fenwick es-- Aug.. 24,. 1943 2,341,984 Graves .a Feb. 15,v 1944 2,441,508 Porcell. v May 11,1948

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