US3068869A - Tissue suture clamp - Google Patents

Tissue suture clamp Download PDF

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US3068869A
US3068869A US84372359A US3068869A US 3068869 A US3068869 A US 3068869A US 84372359 A US84372359 A US 84372359A US 3068869 A US3068869 A US 3068869A
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clips
wound
clip
opposite
sides
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Sheiden Charles Hunter
Harold R Lutes
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Sheiden Charles Hunter
Harold R Lutes
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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

Dec. 18, 1962 c. H. SHELDEN ETAL 3,068,869

TISSUE SUTURE CLAMP Filed oct. 1, 1959 s sheets-sheet 1 30 Z0 fg 43 /mw wif 23 INVENTOR.

Dec. 18, 1962 c. H. sHELDEN ETAL. 3,068,869

TISSUE SUTURE CLAMP Filed Oct. l, 1959 5 Sheets-Sheet 2 IN V EN TOR.

l lax/MKM Dec. 18, 1962 c. H, sHELDEN ETAL 3,068,869

TISSUE SUTURE CLAMP Filed oct. 1, 1959 s sheets-sheet s 5' Hlm/rie imam Hwa@ /Q arf-.f

IN VEN TOR.

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United tat-jes Patent @dice Patented Dec. 18, 1962 3,668,869 THSSUE SUTURE CLAll/H3 Charles Hunter Shelden, 744 Fairmount, and Harold R. Lutes, 556 Wchigan Blvd., both of Pasadena, Calif. File-d Get. 1, 1959, Ser. No. 843,723 13 Claims. (Cl. 12d-337) The invention relates to surgical devices and has particular reference to a means for closing wounds which takes the place of conventional stitching. More particularly the invention is concerned with the provision of clips so constructed that they can be attached to the skin and tissues on opposite sides of a cut, lacera-tion, or wound and the sides of the wound brought together and held together by engagement of the clips with each other until healing takes place.

For closing wounds the two layer method employing silk sutures has long been accepted as standard. Excellent wound healing has been obtained by this method which comprehends sewing opposite sides of a wound together by use of a needle and sutures, the suture being knotted to hold the sides of the wound in position until the healing has been achieved. It then, of course, is necessary to cut and withdraw the sutures before final healing takes place. Although satisfactory in many regards, several disadvantages have been obvious. One disadvantage comprehends undue consumption of time in drawing the sides of the wound together so that blood loss is more .than desired. Also a considerable amount of foreign material may be left in the wound as, for example, silk fibers from the sutures. Buried sutures which are not removed may ultimately work to the surface, but Iin the meantime healing is not perfect.

Some time later use was commenced of an inverted mattress suture of tautalum wire employed particularly for closing wounds in the scalp. This method makes use of sewing tantalum wire through opposite sides of the wound by use of a curved needle and the ends of wire then twisted together to hold opposite sides of the wound in position. Both the tantalum wire method and the suture method emphasize the drawing together of both inner and outer layers of tissue so that the healing will be complete on the inside as well as on the outside.

The tantalum wire technique has been more rapid allowing better hemostasis when removed and leaving no foreign material in the wound. Stainless wire has since replaced tantalum but the method of use and advantages are similar.

Even in the last instance, however, the disadvantages of delay persist and sides of a wound drawn together by this technique have not left a perfectly smooth skin surface after healing has been complete, leaving instead obvious marks of the stitching.

lt is therefore among the objects of the invention to provide a new and improved apparatus and technique for drawing together the sides of a wound in the scalp or elsewhere on the body in a manner which is quick, certain, and effective in the production of a highly desired healing of the wound.

Another object of the invention is to provide a new and improved device by means of which skin and tissue can be grasped effectively -at locations on opposite sides ofthe Wound and at the most desired location, thereby making it possible to draw the sides of the Vwound together neatly and to adjust to the proper degree and there holding the sides irmly together for as long a time as may be necessary for complete and proper healing.

Still `another object of the invention is to provide a new and improved suture clip which can be quickly inserted through the skin and tissues by a continuous rapid motion, the device being ci such character that both inner and outer layers are grasped effectively, thereby making it possible to join both layers with a proper degree of pressure sutcient to stop the tlow of blood with the least possible delay and, moreover, to close the wound in such fashion that when healing linally t-akes place, the wound mark is extremely obscure, the clips, moreover, being of such construction that the clips themselves once removed do not leave their own particular marks.

Also included among the objects of the invention is to provide a new and improved suture clip device identifiable as a tissue suturing clamp which can be quickly and effectively applied by a trained individual virtually without assistance, the clips being capable of iirmly attaching themselves to each other, thereby to hold the sides of the wound immovably in position once attached, the clips, moreover, being of such construction that they can be manufactured inexpensively, used for long periods of time, edectively sterilized between uses, and readily matched together so as to obviate the need for right and left-hand elements.

With these and other objects in view, the invention consists in the construction, arrangement and combination of the various parts of the device, whereby the objects contemplated are attained, as hereinafter set forth, pointed out .in the appended claims and illustrated in the accompanying drawings.

In the drawings:

:FIGURE 1 is a perspective View lof a pair of clips attached to each other as they would be in use.

FIGURE 2 is an exploded View showing a pair of clips separated from each other but in the positions they would have immediately preceding interengagement and locking together.

vFiGURE 3 is a bottom View of a pair of clips in engaged relationship with one of the pair shown in section.

FIGURE 4 is a transverse sectional View showing the sides of an open wound before engagement with the clips `and showing a pair of clips in the positions of first engagement, one of the clips being partially broken away to show .the interior structure.

`FlGURE 5 is a transverse sectional view similar to FGURE 4 showing both clips securely attached to the sides of the wound and drawn further towards each other, thereby to begin the closing of the wound.

FIGURES. 6 is a transverse sectional View similar to FIGURES 4 and 5 but showing the clips interlocked with each other, thereby holding the sides of the wound in position for healing.

FIGURE. 7 is a perspective view showing two pairs of clips applied to and closing a wound in the scalp of an individual.

In an embodiment of the invention chosen for the purpose of illustration a pair of clips 10 and 11 are shown but these clips are identical, thereby obviating the need for providing right-hand and left-hand clips. -Ience, but a single style of clip is needed and as long as there are an even number of clips, every clip will be capable of use inasmuch as they are completely interchangeable.

Each clip consists of a somewhat bevelled outer Wall 12, a pair of side walls 13 and 14, an upper surface 15 and a lower surface 16. It will be noted that the lower surface is somewhat arcuate in form, thereby enabling it to better conform to the curvature of the body portion where the clips are being used. This is especially valuable for scalp wounds to t the contour of the scalp, that being a portion of the body which does not accommodate itself as readily to the application of the clips.

On the side of the clip immediately opposite the outer wall 12 is an inner wall indicated generally by the reference character 17, the inner wall comprising an interlocking edge of special shape. This interlocking edge contains a projection 1S and immediately adjacent the projection 1S a deep pocket 19 which is complementary in shape to the projection. On the side of the projection opposite from the pocket is a shoulder 20 and on the side of the pocket 19 opposite the projection is a shoulder 2i. It will be noted particularly from an examination of FIGURES l, 2 and 3 that the projection of the clip 10 is adapted to t snugly within the pocket 19 of the clip 11 and that the projection 18 of the clip 11 is adapted to lit snugly within the pocket 19 of the clip 10. The shoulders 26 and 21 of the respective clips 1t) and 11 abut each other on one side as do the respective shoulders 21 and 20 on the other side.

On the side wall 13 of each clip is a slot 22. The slot 22 is identical with a slot 23 in the side wall 14 and when two clips are brought together, as shown in FIGURES 1 and 3, the slots form a single kcontinuous slot.

Located in the slot 22 is an arm or hoek arm 24 which is pivotally secured in the slot by use of a rivet 25. The arm has a hooked end 26 and in the hooked end is an opening 27 which is adapted to engage around the shank 28 of a rivet 29 in the slot 23. This engagement is clearly shown in FIGURE 3. To further facilitate manipulation of the arm is a finger grip 30 which consists of a bentover portion of the arm so formed and located that it overlies the adjacent side walls 13 and'14 when the arm is engaged. In engaged position virtually all of the arm 24 is received within the slots 22 and 23 except the overlying linger grip 30.

Adjacent the projection 18 and pocket 19 `of the clip and on the underside adjacent the lower surface 16 is a recess 31 which extends entirely across the clip from one side wall 13 to the other side wall 14. The upper arcuate shape of the recess 31 clearly appears in FIGURES l and 4 through 6.

On the underside of each clip and extending outwardly of the lower surface is a series of sharp teeth. These teeth` are arranged in sets of two, there being provided a pair of long teeth 32 and 33 and a pair of short teeth 34 and 35. The precise arcuate shape of the teeth is of singular importance and the shape in general is shown to good advantage in FIGURES 4, and 6. As there shown the long teeth 32,V 33 have inner ends 36 recessed and embedded in the body of the clip. It should be added that clips of the kind herein described are advantageously made by any one of a number of synthetic plastic resinous materials which are of such character that they can be used in contact with the body without any prospect of harmful eiects. The outer portion of the long teeth 32, 33 consists of a gently curved mid-portion 37 and a tip 38 which is turned at a smaller radius of curvature.

Similarly the short teeth 34, 35 have each a recessed inner end 39 effectively embedded in the plastic of the clip itself. The teeth have an outwardly extending midportion 41 having a relatively large radius of curvature and a tip 42 curved to a slightly different degree, asshown in FIGURE 4, which is a curvature substantially different from the curvature of the tip 38 of the long teeth.

In the body portion-of the clipis a hole 43 which extends entirely through the clip and permits a view from one side through to the other.

When the clips are to be applied, the following method is found most acceptable. The longer teeth 32, 33 of each of a pair of clips and 11 are inserted iirst, using a motion that is down and at the same time toward the scalp margin, assuming for the sake of example only thatV downwardly until the short teeth 34, 35 engage the tissues. It will be noted that the tissues are very approximately indicated as consisting predominantly of an outer layer 46 and an inner layer 47, although in practice there may be multiple layers not as clearly defined as in the example given.

It should further be noted that the full distance between the tip 38 -of each long tooth and the lower surface 16 of the clip is something less than the aggregate thickness of the inner and outer layers 46 and 47. It will further be noted that the distance between the tip 42 of the small teeth and the lower surface 16 is slightly less than the thickness of the outer layer 46.

Subsequent to engagement of the teeth with the outer and inner layers of skin, as illustrated in FIGURE 5, clips opposite each other are drawn together to the positions illustrated in FIGURE 6. It will be noted that in these positions the outer and inner layers adjacent the edges 44 and 45 are bulged outwardly slightly and that the recess 31 in each instance -receives thev bulged portion of thev joined edges 44, 45.

In the positions there illustrated the arms 24 of the respective clips are pivoted from outer positions illustrated in FIGURE 2 to inner positions illustrated in FIGURES laterally with respect to each other and also cannot shift vertically with respect to each other due in the last instance to the engagement of the arms inthe slots. Hence, once the interlock is accomplished, the clips will remain firmly attached together and will not permit the wound to be disturbed. v Y

Once healing has finally taken place and the clips are to be removed, the arms are lirst disengaged and then each clip is lifted from position, thereby causing the teeth to be withdrawn. The puncture wounds'of `the teeth are virtually insignicant and leave no scar. EX- cellent hemostasis results even in individuals having extremely vascular scalps. On numerous occasions where these clips have been employed, the forehead limb of transfrontal craniotomies have been closed by using only two clips without galeal or subcutaneous sutures. Healing has been excellent and aspiration of a wound following the use of clips has never been necessary. Although the more ditlicult applications have been for the closure of craniotomy wounds, it is of practical value to employ the clips in the closure of traumatic scalp lacerations with a minimum of equipment, time and assistance. It is only necessary to clip thehair short for an inch or so on each side of the wound and shave the one-half inch along the margins of the wound. This allows for more satisfactory application of the short teeth, thus allowing better eversion and approximation of the scalp margins. A group of three or four pairs of clips, which may be enough to close a six to eight inch scalp laceration, can be placed in a metal, plastic or suitable sterilizing material, sealed in a sterile glass tube, and made available for immediate use in an emergency room or carried as emergency equipment on ambulances or in a physicians bag.

Although primary attention has been given to scalp wounds, it is understood that wounds on various other locations'on the body can be closed equally effectively with clips of the type herein described, having virtuallyY the same shape and description lor modified to a slight degree, depending upon the character of the surface` of the body where the wound is encountered. The clips are relatively small and although the size 'is not critical, clips n of less than about one inch square have been found advantageous.

Although we have herein shown and described our invention in what we have conceived to be the most practical and preferred embodiment, it is recognized that departures may be made therefrom within the scope of our invention, which is not to be limited to the details disclosed herein, but is to be accorded the full scope of the claims so as to embrace any and all equivalent structures and devices.

Having described our invention, what we claim as new and desire to secure by Letters Patent is:

l. A device for closing wounds during the healing period comprising a pair of individual separate matched clips having faces adapted to lie adjacent opposite sides of the wound, said clips having elongated edges in face to face engagement when assembled and having matching locking means respectively for said edges adapted to interlock one with the other when in use, sharp projections extending outwardly of said faces for engaging tissue on opposite sides of the Wound and fastening means acting between the clips adapted to hold the clips together in wound closing position.

2. A device for closing wounds during the healing period comprising a pair of matched clips having faces adapted to lie adjacent opposite sides of the wound, said clips having locking edges adapted to interlock one with the other when in use, sets of separate long and short sharp projections of similar contour and configuration extending outwardly of said faces, said short projections having bases thereof located adjacent the respective locking edge and being adapted to engage outer layers of tissue and said long projections having bases thereof located more remotely from the respective locking edge and said long projections having tips thereof adapted to engage inner layers of tissue on opposite sides of the wound, and fastening means acting between the clips adapted to hold the clips together in wound closing position.

3. A device for drawing multiple outer and inner layers of skin tissue together to close opposite sides of a wound during the healing period comprising a pair of matched substantially identical clips having body contacting faces adapted to lie adjacent opposite sides of the wound, said clips having adjacent elongated interlocking edges in releasable engagement with each other when in use and each said clip having a plurality of separate teeth projecting outwardly from the body contacting face having curved pointed tips, certain of said teeth having said curved tips at a relatively lesser distance from said face enabling penetration only of the outer layers of skin, and certain other teeth having said curved tips at a greater distance from said face enabling penetration into the inner layers of skin, said tips of said teeth being curved generally toward said interlocking edge, and fastening means acting between opposite interlocked clips for holding said clips and the respective sides of the wound together.

4. A device for drawing multiple outer and inner layers of skin tissue together to close opposite sides of a wound during the healing period comprising a pair of matched substantially identical clips having body contacting faces adapted to lie adjacent opposite sides of the wound, said clips having adjacent elongated interlocking edges in releasable engagement when in use and each said clip having a plurality of sets of separate teeth projecting outwardly from the body contacting face and having curved tips directed inwardly toward the respective edge, one set of teeth lying adjacent the interlocking edge having a relatively shorter length enabling penetration of the tips to only the outer layers of skin, another set of relatively longer teeth lying further removed from said interlocking edge and having a length enabling penetration of the tips into the inner layers of skin, and releasable fastening means acting between opposite interlocked clips for hold- 6 ing said clips and the respective sides of the wound together.

5. A device for drawing multiple outer and inner layers of skin tissue together to close opposite sides of a wound during the healing period comprising a pair of matched substantially identical clips having body contacting faces adapted to lie adjacent opposite sides of the wound, said clips having adjacent interlocking edges when in use and each said clip having a plurality of sets of teeth projecting outwardly from the body contacting face, one set of teeth lying adjacent the interlocking edge having a relatively shorter length enabling penetration only of the outer layers of skin, another set of relatively longer teeth lying further removed from said interlocking edge and having a length enabling penetration into the inner layers of skin, said teeth having tips thereof curved generally toward said interlocking edge, each said face having a longitudinal portion of a recess along the interlocking edge adapted to match the longitudinal portion of the recess of the other clip for reception of outer portions of the skin when the wound is closed, and fastening means acting between opposite interlocked clips for holding said clips and the respective sides of the wound together.

6. A device for drawing together multiple outer and inner layers of skin tissue of a body member together to close opposite sides of a wound comprising a pair of duplicate matched clips having body contacting faces adapted to lie adjacent opposite sides of the wound and having said faces substantially conforming to the surface of said body member, opposite side walls on the clip, mutually interlocking edge elements on said clips having a relationship when engaged interlocked against lateral and vertical shifting, a plurality of sharp teeth projecting from the body contacting face of each clip having tips thereof curved toward the respective mutually interlocking edge elements, said interlocking elements including fastening means for holding said clips together, said fastening means comprising a hook arm pivotally mounted in one clip having a hooked end receivable in the clip opposite thereto when in use, means in said clip opposite thereto adapted to receive said hooked end when the arm is engaged therewith.

7. A device for drawing multiple outer and inner layers of skin tissue together to close opposite sides of a wound comprising a pair of duplicate matched clips having body contacting faces adapted to lie adjacent opposite sides of the wound, mutually engaging edges on said clips having an interlocked relationship when engaged, a plurality of sharp teeth projecting from the body contacting face of each clip having tips thereof curved toward the respective mutually engaging edge, and fastening means for holding said clips and sides of the Wound together, each said. clip comprising opposite side walls extending away from the mutually engaging edge, said fastening means comprising means forming retention elements in said side walls, a hook arm pivotally mounted in the retention element of one clip having a hooked end receivable in the corresponding retention element of the clip opposite thereto when in use, and a finger grip on each hook arm projecting outwardly of the retention element when in use.

8. A device for drawing multiple outer and inner layers of skin tissue together to close opposite sides of a wound comprising a pair of duplicate matched clips having body contacting faces adapted to lie adjacent opposite sides of the wound, irregular mutually engaging edges on said clips having an interlocked relationship when engaged, a plurality of sharp teeth projecting from the body contacting face of each clip having tips thereof curved toward the respective mutually engaging edge, and fastening means for holding said clips and sides of the wound together, each said clip comprising opposite side walls extending away from the mutually engaging edge, said fastening means comprising means forming matching slots in said side walls, a hook arm pivotally mounted U in the slot of one clip having a hooked end receivable in the corresponding slot of the clip opposite thereto when in use, a rivet in said corresponding slot adapted to receive said hooked end when the arm is in the respective slot and a finger grip on the side of each hook arm projecting outwardly of the slot when in use.

9. A device for closing wounds during the healing period comprising a pair of matched clips having faces adapted to lie adjacent opposite sides of the Wound, sharp projections extending outwardly of said faces for engaging tissue on opposite sides of the wound and fastening means acting between the clips adapted to hold the clips together in wound closing position, said sharp projections comprising curved teeth having longitudinal axes thereof of varied curvature wherein the radii diminish progressively from a relatively great radius at the face outwardly to a relatively small radius at the outermost end.

10. A device for closing wounds during the healing period comprising a pair of identical clips having smooth contoured faces adapted to overlie substantial portions of the body adjacent opposite sides of the wound, sharp projections extending outwardly of said faces for engaging tissue on opposite sides of the wound and interlocking releasable fastening means on opposite sides of the clips acting between the clips adapted to hold the clips together in wound closing position, and means forming `drainage holes located in mid-areas of the faces and extending between the face of each clip adjacent the wound and a face opposite thereto.

11. A device for closing wounds during the healing period comprising a pair of identical clips having smooth contoured outside and inside faces, said inside faces being adapted to lie adjacent opposite sides of the wound, sharp tion of the human body whereupon the clips are used whereby to reduce local swelling.

12. A device for closing wounds during the healing period comprising a pair of separate matched identical clips, each clip having a body contacting face adapted to lie adjacent one side of a wound, a matching edge thereof adapted to face the wound and transverse sides thereof extending transversely relative to said matching edge, and an identical clip on the opposite side thereof, a matching edge on said last clip when in use being in contact with said rst matching edge, and identical releasable fastening means on respective transverse sides of each clip, said fastening means when in use being in engagement with said identical clip on the relative opposite transverse side.

13. A device for closing wounds during the healing period comprising a pair of matched identical clips, each clip having a body contacting face adapted to lie ad-V jacent one side of a wound, a matching edge thereof adapted to face the Wound and an identical clip on the opposite side thereof and identical releasable and rigid fastening means adapted to engage said identical clip on the opposite side, and means forming a portion of a recess along the matching edge adjacent said body contacting face, said portion in operative position forming a recess of predetermined limited depth receptive of a bulge of tissue formed during healing of the wound.

'References Cited in the file of this patent Y UNITED STATES PATENTS 268,632 Danforth Dec. 5, 1882 583,455 Bush June 1, 1897 2,254,620 Miller Sept. 2, 194.1 2,472,009 Gardner May 3l, 1949 2,669,747 Deturanto Feb. 23, V1954 FOREIGN PATENTS 253,445 Italy June 17, 1927 16,715 Austria July 13, 1903 418,970 France Oct. 1 4, 1910

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US4637380A (en) * 1985-06-24 1987-01-20 Orejola Wilmo C Surgical wound closures
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US2254620A (en) * 1939-11-14 1941-09-02 George I Miller Clip
US2472009A (en) * 1945-08-01 1949-05-31 Cleveland Clinic Foundation Surgical dressing
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Cited By (93)

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