WO1981001508A1

WO1981001508A1 - Debridement tool and method

Info

Publication number: WO1981001508A1
Application number: PCT/US1980/001573
Authority: WO
Inventors: R Norsen
Original assignee: R Norsen
Priority date: 1979-11-26
Filing date: 1980-11-25
Publication date: 1981-06-11
Also published as: EP0040635A1

Abstract

A blunt edged, knife-like tool for use in the medical treatment of severe burn cases wherein partial thickness burns are debrided of the eschar or residual dermal debris with a minimum of damage to generating tissue and a surprisingly limited amount of pain to the patient. The device comprises a handle (1, 1') and a blunt blade (3, 3') having convex upper and lower surfaces (10, 11), which blade is moved laterally under the eschar and over the rejuvenating skin bed to lift and separate the eschar from the skin bed with a minimum of damage to the skin bed.

Description

DEBRIDEMENT TOOL AND METHOD

DESCRIPTION

Technical Field

The present invention relates to a medical device used in the treatment of burn cases. This invention further relates to a method of debridement of partial thickness burns and more particularly a tool for the separation of the eschar or residual dermal debris from the underlying rejuvenating skin bed with a minimum of patient discomfort.

The residual dermal debris or eschar of a partial thickness burn can contain harmful infectious bacteria and restrict the regrowth of skin buds and nerve endings in the burned epidermal area. For the burn patient's rapid and complete recovery it is vital that the eschar be removed.

Methods taught by the prior art for eschar removal have been both damaging to the underlying rejuvenating skin bed and unacceptably painful to the burn patient.

Background Art

One method of the prior art has been to cut the eschar from its tissue attachment to the underlying skin bed with scissors and then further separate the eschar from its attachments to the skin bed by means of a pulling action with forceps. It has also been the practice in the prior art to abrade the eschar from its tissue attachment with rough plastic sponges. Usually an aqueous solution bath or a moisturizing cream is applied to soften and loosen the eschar before removal is attempted. In either method the sensitive regenerating nerve tissue and new skin buds are severed or abraded at great pain and discomfort to the patient as well as hampering the ultimate healing of the burn. These techniques of the prior art have such a damaging effect on the regenerating nerve endings of the new skin bed that the burn patient must often be heavily sedated

Disclosure of Invention

This invention provides a tool for treatment of burns and a method for using the tool which debrides eschar from underlying rejuvenating skin bed and does so with a minimum of pain to the burn patient and with a minimum of damage to the nerve endings, skin buds and other components of the rejuvenating skin bed.

The debridement tool is constructed of a handle having a longitudinal axis, for a single-handed grasp by the user, a shank which slopes downwardly from the axis of the handle to provide a separation of the hand from the tissue being debrided and a substantially planar blunt-edged means attached to the shank and lying in a plane which slopes slightly upward relative to the handle axis and which blade has a blunt double edged configuration substantially defined by a convexity of both its top and bottom surfaces.

When the user causes the blade to translate laterally beneath the eschar and above the rejuvenating skin bed, the skin bed is pushed down by the convex bottom surface but not damaged and the eschar is lifted and effectively separated from the skin bed without damage to the sensitive nerve tissue and new skin buds.

It is an object of this invention to provide a tool and method for the debridement of partial thickness burns, which tool and method for using same is less painful to the burn patient and less damaging to the underlying rejuvenatin ^{skin bed}' /"SURE OMPI Another object of this invention is to provide a tool and method whose design and use permits a minimum of sedation for debridement.

A further object of this invention is to provide a tool and method for debridement which promotes faster rejuvenation by the skin bed.

Brief Descriptions of the Drawings

Figure 1 is a side elevational view of the debridement tool.

Figure 2 is a perspective view of the debridement tool.

Figure 3 is a plan view of the debridement tool.

Figure 4 is a cross sectional view of the blade means of the debridement tool taken along lines 4-4 of Figure 3.

Figure 4 (a) is a much enlarged fragmentary view of the cross section shown in Figure 4.

Figure 5 is a plan view of a second embodiment of the debridement tool.

Figure 6 is an enlarged cross sectional view of the device shown in Figure 5 taken along lines 6-6 thereof.

Figure 6(a) is a much enlarged fragmentary view of the cross section shown in Figure 6.

Description of a Preferred Embodiment

As shown in Figure 3, one preferred embodiment of the debridement tool is constructed of a single piece of a suitable material, preferably a metal if the tool is to be sterilized by autoclaving or a strong plastic or metal if the tool is to be used a single time and then discarded. The debridement tool is elongated along its longitudinal axi and is of a sufficient length for convenient manipulation by a user. The blade means 3 is attached to a shank 2 dependin from a handle 1. The tip of the debridement blade 3 is smoothly rounded and contoured to minimize damage to tissue adjacent to the eschar being manipulated.

One preferred embodiment of the debridement tool as shown in Figures 1 - 4 is manufactured from a single piece o metal which has been bent, cut, shaped and polished to form handle 1, shank 2, and blade 3. Handle 1 is substantially planar along its longitudinal axis and has been bent down¬ wardly at angle B to form shank 2, which is also substantial ly planar along its longitudinal axis. Shank 2 is bent once again at angle A to form blade 3. The lengths of handle 1, shank 2, and blade 3 are in the approximate respective ratios of 3.0:1.0:1.5. The angle A between shank 2 and blade 3 is approximately 30°, and the angle B between shank 2 and handle 1 is approximately 15°. As shown in Figure 3, the width of the extreme tip 5 of debridement blade 3 is approximately 2/3rds the width of the shank 2, the debridement blade 3^' tapering smoothly from the shank 2 to the tip 5. The user of the debridement tool 12 can insert the wedge-like debridement blade 3 between the^'eschar and the rejuvenating skin bed at blade tip 5. Once the debridement blade 3 is between the eschar and skin bed the taper of the blade 3 is used to wedge the full length of blade 3 between said layers. As shown in Figure 3, the extreme tip 5 of the debridement blade 3 has rounded edges to prevent the debridement blade 3 from unnecessarily snagging or gouging any rejuvenating epidermal tissue while in use. The upwardly tilting aspect of the longitudinal axis of the debridement blade with respect to the longitudinal axis of the handle 1 is an additional feature which lessens the chance of any gouging or snagging of the rejuvenating skin bed by the debridement blade 3.

As is shown in Figure 4, the cross section of the

_ OMPΓ debridement blade 3 taken along line 4-4 perpendicular to the longitudinal axis of the debridement blade 3 has a convexity of both top and bottom surfaces. In the preferred embodiment of Figures 1 - 4 the top surface 10 convexity is described by the arc of a circle of approximate radius of .40 inches to 0.5 inches. The. preferred range of radii lengths for describing the convexity of the bottom surface is from 1.5 to 2.0 inches. The blunt edges 7 and 8 of the debridement blade 3 in the preferred embodiment are described by the arc of a circle of approximate radius of 0.005 + 0.002 inches. When the debridement blade is moved laterally under the eschar and over the rejuvenating skin bed, the convex bottom surface 11 presses the skin buds and regenerating nerve endings down, the blunt edges 7 and 8 of the blade wedge up and separate the eschar from the rejuvenating skin bed and the convex top surface 10 of the said blade lifts and separates the eschar from the rejuvenating skin bed. A properly imparted lateral motion causes the edge 7 or 8 and the surfaces 10 and 11 to act as a wedge between the eschar and the rejuvenating skin bed.

A second preferred embodiment is shown in Figures 5, 6, and 6(a) of the drawings. The debridement tool shown therein comprises a handle I¹, a shank 2¹, a blade means shown generally at 3' and a tip 5'_* all of v/hich substantially correspond to the similarly numbered elements of the device described above. In this embodiment the blade means 3¹, the shank 2' and the handle 1' are all formed from a sheet of metallic or other suitable material of construction into a curved cross sectional shape much like that shown in Figure 6. Figure 6, being a cross sectional view taken along lines 6-6 of the blade of Figure 5 has had the upper surface thereof ground substantially flat to form land 14 as best seen in Figure 6 (a) . The device is so formed so that land 14 extends along each side of the upper surface of the blade and entirely around the tip 5' . The intersection of the land 14 with the convex lower surface 18 occurs at a convexity 12 which extends around the periphal edge of the blade 3' . Thus a convexity is observed on both, the upper and lower surfaces of the blade means 3", an abrasively machined surface 14 extends across a portion of the upper surface of blade 3. The interior of blade 3' is formed in a concave or hollowed out region 16. Both the shank 2' and the handle 1' of the device shown in Figure 5 have a substantially concave upper surface extending from region 16 of the blade. The tip 5' of the debridement tool shown in Figure 5 comprises a substantially circular tip with the flat land 14 extending about the periphery thereof. From the land 14 the tip is progressively relieved into a concavity adjoining area 16.

The blade segment 3' of the debrider shown in Figures 5,6 and 6(a) has an edge blunted and polished to prevent cutting of the extremely tender and easily damaged skin buds being formed in the burned area beneath the eschar. Figure 6 (a) shows rounded edge 12 as being a carefully polished and blunted surface joining a lower surface 18 with land 14. In the preferred embodiment of the apparatus shown in Figures 5,6 and 6(a) the edge 12 has a diameter of approximately

0.005 j- 0.002 inches and a total width of the blade means of approximately 0.3 +_ 0.1 inches. The overall length of the tool is about 5 to 6 inches. The tool has a profile substan ially as shown for the other preferred embodiment in Figure However the angles A and B may be made through a radius of approximately one inch.

A further alternate embodiment of the invention herein comprises a removable blade segment removably fast- ened to a reusable handle means. The blade has essentially the same shapeand construction as the blade of the devices shown in either Figure 3 or Figure 5 and described fully above as the first and second preferred embodiments of this invention. The blade is attached by known means to a handle such as is widely used by surgeons but which is equipped wit a suitably angled portion adjacent to the attachment area. convex lower surface of the blade, including the tip area, i necessary joined with an upper surface of the blade, either

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_ OMP in the configuration as shown in Figure 3 with the entire upper surface convex or, corresponding to the configuration shown in Figures 5, 6, and 6(a), with the upper surface relieved into a concave area joined to the convex lower surface by a flat or nearly flat land along a blunt line of intersection. The blunt intersection provides a convex upper and lower surface which may be gently thrust between the rejuvenating skin bed and the eschar to lift the eschar from the skin bed without cutting or otherwise damaging the rejuvenating skin buds. The land ground off of the upper surface of the blade may be flat or slightly convex and serves as the eschar engaging surface of the tool. The polished, smooth, convex lower surface contacts and gently depresses the rejuvenating skin bed.

The tool described above is preferably formed of a suitable metal which can be readily worked in conventional metal-working machinery and which can be rendered sterile by autoclaving, gamma radiation, or the like. Preferably, the device is constructed of stainless steel and is intended for single use to avoid the possibility of transfer of infections from one patient to another, a most serious problem in the treatment of burns. Alternately, a suitable, strong plastic or other materials may be used.

In the method of use of either embodiment of the debridement tool described above, the eschar is first soft¬ ened with creams or solution baths. The user grasps the handle means 1 or 1' of the debridement tool and moves the debridement blade 3 or 3' laterally beneath the eschar and over the rejuvenating skin bed to separate the eschar from the skin bed. The downwardly sloping aspect of the long¬ itudinal axis of the plane of shank 2 with respect to the longitudinal axis of the plane of handle 1 provides a separation of the user's hand on handle 1 from the surface being debrided. The smooth round periphal edges of the extreme ends 5 and 5' of the debridement tool prevent snagging of the tender regenerating skin tissue by the

WR EA fT debridement tool.

As the debridement blade is moved laterally by the tool user, the blade is wedged between the rejuvenating skin bed and the eschar. The rejuvenating skin bed is gently pushed down and the eschar is separated and lifted by the blade. The debridement patient experiences a minimum of pai and the rejuvenating skin bed receives a minimum of growth- retarding damage.

The convexity of surfaces 10 and 11 could also be varied from the preferred embodiment. Such variations could be made to better suit individual users and individual burn patients. In addition, the lengths of handle 1, shank 2 and blade 3 and the angles A and B, could be varied to meet a prescribed debridement situation.

While the debridement tool and method taught herein have been described with reference to specific embodiments thereof it will be understood that various changes and additions may be made therein without departing from the scope and spirit of the essential features involved.

For the purposes of this patent, a "blunt edge" is the edge of an otherwise sharp blade that has been polished to remove burrs and to render the blade edges sufficiently dull so that they will separate the eschar from the rejuven¬ ation skin buds or nerve tissue with minimum damage to the skin buds and nerve tissue.

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Claims

- 9 -I claim:

1. A blunt-bladed handheld burn treatment tool for burn debridement comprising: an elongated handle means, having a longitudinal axis, adapted to be grasped by a user, a shank means attached to said handle means at one end thereof, said shank means being angled downwardly from the axis of the handle, and a blade member extending outwardly from the shank means, said blade member being elongated and positioned in a plane which is angled upwardly with respect to the axis of the handle, said blade having a substantially convex upper and lower surface intersecting at a blunt edge, whereby lateral motion of the blade beneath the eschar but above the underlying bed without cutting into said underlying bed.

2. The device of Claim 1 wherein the device is of a single piece construction.

3. The device of Claims 1 and 2 wherein the device is no wider or thicker than the widest and thickest points on the blade.

4. The device of Claim 1 wherein the end of the handle, the edge of the handle and the end of the blade present rounded and smooth contours.

5. The device of Claim 1 wherein the blade is blunte and smoothed of its cutting sharpness but yet retains an adequacy of blade sharpness to lift and separate eschar fro rejuvenating growth below.

6. The device of Claim 1 wherein the shank has a downward-sloping aspect to permit a separation of the hand on the handle from the surface being debrided.

7. The device of Claim 1 wherein the device is constructed of a suitable material which will allow steril¬ ization of the device.

8. The device of Claim 1 wherein the device is constructed of a suitable inexpensive material which will allow disposability.

9. The device of Claim 1 wherein the device is constructed of a material and in a thickness which will all a hand-applied pressure suitable for debridement without breakage of the device.

10. A method of treatment of a serious skin burn are comprising the steps of: inserting a blunt edged debridement tool between esch and tissue, said tool having an elongated blade means with convex upper and lower surfaces intersecting at a blunted edge, said blade means being attached to and angled upwardly from a handle means; working said tool laterally along between said tissue and eschar to lift and remove eschar from said tissue, the blunt edge of said tool separating and lifting the eschar without cutting regenerating nerve and skin bud tissue; and removing said lifted eschar from said skin tissue wit a minimum of damage thereto whereby healing of the burn is promoted.

11. The apparatus of Claim 1 wherein said blade memb

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OM upper surface further comprises a substantially flat land adjacent at least one side of a central concavity.

12. The apparatus of Claim 11 wherein said flat land extends along each side of said blade member and comprises the eschar supporting surface of said tool.

13. The apparatus of Claim 1 or 11 wherein said blade member has a smoothly rounded tip having a blunted tissue engaging surface at the intersection of said upper and lower surfaces to separate eschar from regenerating tissue.

14. A blade for a burn treatment tool comprising: an elongated, blunt, generally planar element having means at one end thereof engaging a handle; a smoothly contoured tip on said element opposed- to said handle engaging means; a smooth convex lower, skin engaging surface on said element; and an upper surface on said element having at least the periphery thereof convex; said upper and lower surfaces meeting in a blunt, smooth intersection about the periphery of said blade.

15. The blade of Claim 14 wherein said upper surface further includes a central concave zone.

16. The blade of Claim 15 wherein a substantially planar land extends between said central concave zone and said blunt smooth intersection.

17. The blade of Claim 14 wherein said blunt smooth intersection has a radius of curvature of 0.005 + 0.002 inches.

18. The apparatus of Claim 16 wherein said substant¬ ially planar land extends longitudinally along both sides of said blade and around said tip.