CN102186510B - 减压伤口闭合和处理系统及方法 - Google Patents

减压伤口闭合和处理系统及方法 Download PDF

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CN102186510B
CN102186510B CN200980141174.7A CN200980141174A CN102186510B CN 102186510 B CN102186510 B CN 102186510B CN 200980141174 A CN200980141174 A CN 200980141174A CN 102186510 B CN102186510 B CN 102186510B
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基思·帕特里克·希顿
伊恩·詹姆士·哈德曼
克里斯托弗·盖伊·科沃德
科林·约翰·霍尔
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Abstract

提供了一种减压伤口闭合系统，其在表面伤口上产生闭合力并且可选地给体腔或组织部位提供减压。密封的收缩构件在被放置在减压下时产生闭合力。一种说明性的系统包括第一附接构件和第二附接构件，密封的收缩构件与第一附接构件和第二附接构件连接，并且其中当减压被提供给密封的收缩构件时，闭合力在第一附接构件和第二附接构件之间产生。提供了其它的系统和方法。

Description

减压伤口闭合和处理系统及方法
相关申请 
根据美国法典第35卷第119条(e)款，本发明要求2008年10月29日提交的标题为“Reduced-Pressure，Wound-Closure System and Method”的美国临时专利申请序列号61/109,410、2008年10月29日提交的标题为“Reduced-Pressure，Abdominal Treatment System and Method”的美国临时专利申请序列号61/109,486、2008年10月29日提交的标题为“Open-Cavity，Reduced-Pressure Wound Dressing and System”的美国临时专利申请序列号61/109,390，以及2008年10月29日提交的标题为“Reduced-Pressure，Deep-Tissue Closure System and Method”的美国临时专利申请序列号61/109,448的利益。为了所有的目的，所有这些临时申请在此通过引用被并入。 
技术领域
本发明大体上涉及医疗处理系统，并且更具体地涉及减压伤口闭合和处理系统及方法。 
背景 
无论伤口或损坏的组织区域的病因是外伤、手术还是其它原因，伤口的适当护理对于结果都很重要。当伤口涉及需要重新进入的位置例如腹膜腔和更一般地腹腔时，存在唯一的挑战。很多时候，当手术或外伤涉及腹腔时，建立便于重新进入的伤口处理系统允许更好和更容易的护理，并且有助于解决诸如腹膜炎、腹腔间隔室综合症(ACS)以及可能抑制伤口和内部器官的最终愈合的感染的情况。在提供这样的护理中，可能期望从腔 移除不需要的流体，帮助接近筋膜和其它组织，或最终帮助在表皮水平处的伤口本身上提供闭合力。除非另外指明，如本文所使用的，“或”不要求互斥性。 
目前，可使用缝线、U形钉、夹具和其它机械设备来闭合表皮上的腹部开口，以允许保持和牵引皮肤。这样的设备经常引起穿刺性伤口或可引起其它伤口。如果发生严重的浮肿，极大的压力可能被置于闭合设备上，且该压力可能引起伤害。例如，如果压力因浮肿而升高，则接缝可能会撕开。 
对于用于允许重新进入腹腔的总系统，已发展了大量的技术。一种方法是在腔中放入毛巾，然后使用诸如止血钳的夹具使皮肤在毛巾上方闭合。虽然简单并迅速，但结果被视为不是最佳的。另一种方法是所谓的“Bogota袋(Bogota bag)”。使用这种方法，将袋缝入覆盖打开的腹部的位置中，以便提供屏障。有时称为“真空填塞(vac pack)”的再一种方法是将毛巾填塞在伤口中，然后将排液管放入腹部中，并用盖布覆盖腹部。最后，使用一种减压方法。这种方法在Hunt等人的并且转让给德克萨斯州San Antonio的KCI Licensing有限公司的美国专利7,381,859中被说明。为了所有的目的，在此通过引用将美国专利7,381,859并入。 
概述 
现有伤口闭合设备和减压处理系统的问题通过本文中所述的说明性实施方式的系统、设备和方法来解决。根据一个说明性实施方式，用于给患者身上的表面伤口提供闭合力的减压伤口闭合系统包括：第一附接构件，其用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第一部分；和第二附接构件，其用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第二部分。第一附接构件与第二附接构件间隔开。减压伤口闭合系统还包括密封的收缩构件，该密封的收缩构件与第一附接构件和第二附接构件连接，并且可操作来在被放置在减压下时收缩。减压伤口闭合系统可操作来在减压被提供给密封的收缩构件时在第一附接构件和第二附接构件之 间形成闭合力。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力的减压伤口闭合系统包括：第一附接构件，其用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第一部分；和第二附接构件，其用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第二部分。第一附接构件与第二附接构件间隔开。该减压伤口闭合系统还包括环形壁(circumferential wall)，该环形壁与第一附接构件和第二附接构件连接。减压伤口闭合系统还包括密封的收缩构件，该密封的收缩构件与环形壁的至少一部分连接，并且可操作来在被放置在减压下时收缩。减压源与密封的收缩构件流体连接，并且可操作来将减压输送至密封的收缩构件。当减压由减压源提供给密封的收缩构件时，闭合力形成。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力的减压伤口闭合系统包括： 
多个附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮； 
环形壁，其与所述多个附接构件连接，所述环形壁用于紧邻表面伤口布置； 
密封的收缩构件，其与所述环形壁的至少一部分连接，并且可操作来在减压下收缩； 
减压源，其与所述密封的收缩构件流体连接，并且可操作来将减压输送至所述密封的收缩构件；以及 
其中，当所述减压由所述减压源提供给所述密封的收缩构件时，闭合力形成。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力并且用于将减压输送至组织部位的减压伤口闭合和处理系统包括伤口闭合子系统和减压处理子系统。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力 并且用于将减压输送至组织部位的减压伤口闭合和处理系统包括： 
伤口闭合子系统，其包括： 
第一附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第一部分， 
第二附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第二部分，其中，所述第一附接构件与所述第二附接构件间隔开， 
密封的收缩构件，其与所述第一附接构件和所述第二附接构件连接，并且可操作来在减压下收缩， 
闭合减压源，其可操作来将第一减压输送至所述密封的收缩构件， 
其中，当所述第一减压被提供给所述密封的收缩构件时，闭合力在所述第一附接构件和所述第二附接构件之间形成，以及 
减压处理子系统，其包括： 
歧管，其紧邻所述组织部位布置，所述歧管可操作来分配减压并且接收流体， 
密封构件，其用于放置在患者表皮上并且可操作来在所述歧管上形成气动密封，以及 
处理减压源，其可操作来将第二减压输送至所述歧管。 
根据另一种说明性实施方式，制造用于给患者身上的表面伤口提供闭合力的减压伤口闭合系统的方法包括以下步骤：形成用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第一部分的第一附接构件；和形成用于可释放地附接至紧邻表面伤口的边缘的患者表皮的第二部分的第二附接构件。制造减压伤口闭合系统的方法还包括形成可操作来在被放置在减压下时收缩的密封的收缩构件，以及将密封的收缩构件与第一附接构件和第二附接构件连接。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力 的减压伤口闭合系统的制造方法包括以下步骤： 
形成用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第一部分的第一附接构件； 
形成用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第二部分的第二附接构件；以及 
形成可操作来在减压下收缩的密封的收缩构件； 
形成减压接口。 
根据另一种说明性实施方式，用于给患者身上的表面伤口提供闭合力的方法包括以下步骤：将第一附接构件可释放地附接至紧邻表面伤口的边缘的患者表皮的第一部分；和将第二附接构件可释放地附接至紧邻表面伤口的边缘的患者表皮的第二部分。第一附接构件与所述第二附接构件间隔开。用于提供闭合力的方法还包括提供密封的收缩构件，以及将该密封的收缩构件与第一附接构件和第二附接构件流体连接。密封的收缩构件可操作来在被放置在减压下时收缩。用于提供闭合力的方法还包括将减压提供给密封的收缩构件，由此闭合力在第一附接构件和第二附接构件之间形成。 
参考附图和下面的详细描述，说明性实施方式的其它目的、特征和优势将变得明显。 
附图的简要说明 
图1是减压伤口闭合和处理系统的说明性实施方式的示意性截面，该示意性截面具有被表示为方框图的部分； 
图2是图1的减压伤口闭合和处理系统的一部分的示意性截面图； 
图3A是减压伤口闭合系统的一部分的说明性实施方式的示意性透视图； 
图3B和图3C是显示在非收缩位置(图3B)和收缩位置(图3C)中的图3A的说明性实施方式的示意性平面图； 
图4A是减压连接器的示意性透视图； 
图4B是图4A的减压连接器的正视图； 
图5A是减压伤口闭合和处理系统的另一说明性实施方式的一部分的示意性截面图；以及 
图5B是减压伤口闭合和处理系统的另一说明性实施方式的一部分的示意性截面图。 
说明性实施方式的详细描述 
在下面的说明性实施方式的详细描述中，参考形成其一部分的附图。这些实施方式足够详细地被描述，以使本领域技术人员能够实践本发明，且应理解，可采用其它的实施方式并且可进行逻辑结构的、机械的、电的以及化学的变化而不偏离本发明的精神和范围。为避免对于使本领域技术人员能够实践本文所述的实施方式所不必要的细节，本描述可省略本领域技术人员已知的一些信息。因此，下面的详细描述不应在限制的意义上理解，并且说明性实施方式的范围仅由所附的权利要求限定。 
参考图1-2，并最初参考图1，示出了减压伤口闭合和处理系统100的说明性实施方式。减压伤口闭合和处理系统100可包括减压处理子系统102和伤口闭合子系统104。减压处理子系统102可用于使用减压来处理组织部位106。组织部位106可以是任何人类、动物或其它生物体的身体组织， 包括骨组织、脂肪组织、肌肉组织、真皮组织、血管组织、结缔组织、软骨、腱、韧带或任何其他组织。组织部位106可以在诸如腹腔110的体腔内，并且可包括各种组织层，组织层包括真皮108中的伤口。使用减压处理子系统102的处理可包括移除诸如腹水或渗出液的流体、输送减压或提供保护性屏障。 
在说明性的实施方式中，减压伤口闭合和处理系统100呈现在腹腔110和具有伤口边缘112的表面伤口111的环境中。其它的皮下组织114也可以被打开，例如脂肪组织、肌肉、筋膜等。腹腔110显示为具有形成表面或支撑物的腹部内容物116。 
减压伤口闭合和处理系统100的减压处理子系统102帮助使减压输送至组织部位106和腹腔110。减压处理子系统102包括布置在腹腔110内的歧管118，以使减压分配在腹腔110内并且接收流体。歧管118可包括或相关于在非粘性包层(non-adherent envelope)122中的歧管构件120或第二歧管。非粘性包层122在第一侧上具有孔124，并且在面向内(或面向组织)的第二侧上具有孔126。孔124和126便于如箭头128所示的流体流动。孔124和126可采用任何形状，例如矩形开口、圆形开口、多边形、狭长切口(细长狭槽)等。非粘性包层122可由柔性膜例如聚氨酯膜、盖布材料或任何非粘性材料形成。 
可通过减压处理子系统102将减压施加于腹腔110和组织部位106，以帮助促进渗出液、腹水或其它液体、细菌、纤维蛋白、死组织、毒素、残留血等的移除。减压还可在某些情况中用于刺激另外组织的生长。在组织部位106处的伤口的情况下，肉芽组织的生长以及渗出液和细菌的移除可帮助促进伤口愈合。在非创伤性或非缺陷性组织的情况中，减压可用于促进可被采集并移植到另一组织部位的组织的生长。在其它情况中，流体移除可能是施加减压的主要原因。 
如本文所使用的，“减压”一般指压力小于组织部位106处的环境压力。在大部分情况中，减压将小于患者所在位置处的大气压。可选地，减压可小于组织部位106的流体静压。除非另外指明，本文所陈述的压力值是表压。 
歧管118和歧管构件120布置在腹腔110中，并且可布置在组织部位106处或在组织部位106附近。一般，包含歧管构件120的非粘性包层122靠着组织部位106、特别是紧邻腹部内容物116布置。歧管118相邻于非粘性包层122布置。歧管118和歧管构件120可采用多种形式。如本文所使用的，术语“歧管”一般指被设置成帮助向诸如组织部位106的组织部位施加减压、输送流体或从诸如组织部位106的组织部位移除流体的物质或结构。歧管118和歧管构件120一般包括多个流动通道或通路，所述多个流动通道或通路相互连接，以改善提供至紧邻歧管118和构件120的区域以及从紧邻歧管118和歧管构件120的区域移除的流体的分布。歧管118和歧管构件120可由生物相容性材料形成，该生物相容性材料能够被放置成与组织接触，并且分配减压。歧管的实例可包括且不限于具有被布置成形成流动通道的结构元件的设备、诸如开孔泡沫的多孔状泡沫、多孔组织聚集物、以及包括或制备成包括流动通道的液体、凝胶和泡沫。 
歧管118和歧管构件120可以是多孔的，并且可以由泡沫、纱布、毡垫或任何其它适合于特定生物应用的材料制成。在一个实施方式中，歧管118和歧管构件120由多孔泡沫制成，该多孔泡沫包括充当流动通道的多个相互连接的小室或孔。多孔泡沫可以是聚氨酯开孔网状泡沫，例如由德克萨斯州San Antonio的Kinetic Concepts股份有限公司制造的GranuFoam材料。其它的实施方式可包括在某些位置处的“闭孔”，以帮助引导流动。在一些情况中，歧管118、歧管构件120和非粘性包层122可用于将诸如药物、抗菌物、生长因子和其它溶液的流体分配至组织部位106。其它层可作为歧管118或歧管构件120的部分例如吸收材料、芯吸材料、疏水性材料和亲水性材料被包括。 
密封构件132可放置在表皮108中的表面伤口111上方，特别是被制成叠盖伤口边缘112以提供气动密封。因此，密封构件132在歧管118和非粘性包层122上方提供密封。密封构件132可以是用于将歧管118和非粘性包层122固定在组织部位106处的覆盖物。尽管密封构件132可以是不渗透的或半渗透的，但是密封构件132在密封构件132安装在歧管118上方之后能够将减压维持在组织部位106处。密封构件132可以是由硅树脂基化合物、丙烯酸、水凝胶或水凝胶形成的材料、或包括预定组织部位所需的不渗透特性或渗透特性的任何其它生物相容性材料形成的柔性上覆盖布(over-drape)或膜。
密封构件132还可包括附接设备136，以将密封构件132固定至患者表皮108。附接设备136可采用多种形式；例如，可使用密封胶带或可将粘合剂134沿着密封构件132的周边或密封构件132的任何部分定位，以提供气动密封。粘合剂134还可以被预先涂敷并且用可释放的构件(未显出)覆盖，所述可释放的构件在涂敷的时候被移除。 
诸如口140的第一减压接口138或连接器可用于将减压从第一减压输送导管142输送至歧管118。第一减压接口138还可将任何渗出液、腹水或其它流体从歧管118输送至减压输送导管142。歧管118中的减压在箭头144所示的方向上牵引流体并且将流体牵引至第一减压输送导管142。第一减压接口138允许流体从歧管118传递到第一减压输送导管142。例如，使用歧管构件120从组织部位106收集的流体可经由第一减压接口138进入第一减压输送导管142。在另一个实施方式中，减压处理子系统102可不包括第一减压接口138，并且第一减压输送导管142可直接插入密封构件132和歧管118中。第一减压输送导管142可以是医用导管、多腔构件、管或用于输送减压的任何其它装置。 
减压子系统148可用于提供被输送至第一减压输送导管142的减压。减压子系统148可包括将减压输送至供应导管152的第一减压单元或源150，供应导管152将减压输送至三通阀154。减压的一部分可离开三通阀154穿过第二减压输送导管156。减压的另一部分可离开三通阀154穿过减压导管158。位于减压导管158上的可以是任何数量的设备，例如减压反馈单元160，其例如可向三通阀154提供有关减压导管158内的减压调节的反馈。减压导管158将减压输送至罐162，罐162可操作来保留从组织部位106输送至罐162的任何流体。离开罐162的减压被输送至第一减压输送导管142。第一减压输送导管142可被认为是输送第二减压或处理减压。通过减压子系统148将第二减压或处理减压置于所需的压力和条件下，以用在组织部位106处的减压处理中。 
很多不同的设备例如代表性设备166可被添加至第一减压输送导管142的中间部分164。输送至第一减压输送导管142的减压一般被选择为在-50mmHg至-500mmHg的范围中，并且更一般在-100mmHg至-300mmHg的范围中。设备166可以是压力反馈设备、体积检测系统、血液检测系统、感染检测系统、流量监控系统、温度监控系统等。这些设备中的一些可与其它部分整体地形成；例如，罐162可包括一个或多个过滤器，例如防止液体离开的疏水性过滤器。 
有很多形成与减压伤口闭合和处理系统100一起使用的减压的方式。在所示的说明性实施方式中，第一减压单元150用于两种应用，即，用于伤口闭合和用于减压处理。在可选的实施方式中，将第一减压单元150用作第二减压输送导管156的源并且使第二减压单元151(以虚线示出)将减压输送至减压导管158可能是合乎需要的。 
作为减压伤口闭合和处理系统100的一个方面，帮助将闭合力提供给表面伤口111特别是在伤口边缘112之间施加闭合力可能是合乎需要的。如图1和图2所示，伤口闭合子系统104可用于这种目的。伤口闭合子系统104形成由箭头170所示的闭合力。闭合力被传递至患者的表皮108，并且将伤口边缘112推向彼此。伤口闭合子系统104可以是用于闭合任何表面伤口的独立系统，或用作较大的系统例如减压伤口闭合和处理系统100的部分。 
伤口闭合子系统104可包括围绕并且紧邻表面伤口111的伤口边缘112间隔开的多个附接构件，例如第一附接构件172和第二附接构件184。第一附接构件172具有第一基底构件174和第一壁构件176。第一基底构件174具有第一侧178和面向内(面向患者)的第二侧180。第一基底构件174和第一壁构件176可以由多种材料制成，但是提供一些柔性的材料是优选的；例如，第一附接构件172可形成有由聚丙烯或刚性硅树脂等制成的第一基底构件174和第一壁构件176。第一粘合剂182或其它附接设备可应用于第一基底构件174的面向内(面向患者)的第二侧180，以允许第一基底构件174可释放地直接附接至患者的表皮108的一部分，或间接地附接，如果聚氨膜或其它密封构件132首先放置在表皮108上。除了粘合剂182之外，胶合剂、U形钉、或缝线、或其它有创或无创方法也可用于将第一基底构件174附接至无损伤的表皮组织。第一附接构件172可直接地应用在表皮108的顶部上或密封构件132的顶部上，使得无论什么力施加在第一附接构件172上都直接地或间接地被传送至表皮108。提到将第一附接构件172应用于表皮108应被认为包括在密封构件132的顶部上的应用。 
第二附接构件184从第一附接构件172几乎直接越过表面伤口111，例如表皮伤口。第二附接构件184与第一附接构件172类似。虽然伤口闭合子系统104仅示出两个附接构件172、184，其它附接构件可以按间隔开的方式围绕表面伤口111散布。两个附接构件172、184与密封的收缩构件188配合允许形成箭头170所示的闭合力，但另外的附接构件允许形成径向地越过不同形状的表面伤口111的力。 
一个或多个附接构件例如附接构件172具有减压接口，其用于从第二减压输送导管156接收减压。例如，如图2中清楚地示出的，第一附接构件172可包括第二减压接口183。穿过第二减压接口183被输送的减压用于形成闭合力。 
伤口闭合子系统104包括密封的收缩构件188，以形成闭合力。密封的收缩构件188可由收缩歧管材料或构件形成，收缩歧管材料或构件可以是与歧管118相同类型的材料。可选地，使用具有比用于歧管118或气动设备的材料更少的孔或洞的收缩歧管材料可能是合乎需要的。另外，有在竖直方向(对于图1中所示的方位)上收缩较小而在水平或横向平面(对于图1中所示的方位)中收缩较多的材料可能是合乎需要的。密封的收缩构件188具有第一侧190和面向内(面向患者)的第二侧192。密封的收缩构件188还具有外围边缘194。密封的收缩构件188可通过具有应用于第一侧190的第一密封构件196(图2)和应用于密封的收缩构件188的面向内(面向患者)的第二侧192的第二密封构件198(图2)并且密封外围边缘194而被密封。 
密封的收缩构件188的外围边缘194可由外围密封构件200密封。可选地或另外地，第一壁构件176也可用作外围密封构件以密封外围边缘 194，或另一块密封材料可被使用。相似地，面向内的第二侧192可通过靠着密封构件132或患者的表皮108放置来密封。密封的收缩构件188还可通过涂覆有不透气材料来密封。密封的收缩构件188可使用第一密封构件196和第二密封构件198来密封，第一密封构件196和第二密封构件198可由聚氨酯膜或硅树脂形成。第一密封构件196和第二密封构件198可在它们的端部被超声焊接或RF焊接或以其它方式连接，以覆盖外围边缘194。当减压被提供给密封的收缩构件188时，密封的收缩构件188收缩以形成箭头170所示的闭合力。 
密封的收缩构件188可在密封的收缩构件188的一部分上形成有用于接收第一减压接口138的延伸部分202的开口201。延伸部分202可穿过密封的收缩构件188延伸并进入歧管118中。在可选实施方式中，第二减压接口183和第二减压输送导管156可被省略，并且第一减压接口138的一部分与密封的收缩构件188流体连接。因此，在该可选实施方式中，单个减压源和导管可用于提供闭合力和减压处理。对图5A和图5B的说明性实施方式也同样如此。 
在操作中，通过首先将歧管材料应用在腹部内容物116上可将减压伤口闭合和处理系统100用在体腔例如腹腔110中。例如，具有非粘性包层122的歧管构件120可放置在腹部内容物116上，并且歧管118紧邻非粘性包层122布置。可将表面伤口111的伤口边缘112在可能的程度上集合在一起，然后将密封构件132放置在表皮108上，以在表面伤口111上方提供气动密封。使用第一粘合剂182可将第一附接构件172应用于紧邻伤口边缘112的患者的表皮108(或如所示在密封构件132上)。相似地，第二附接构件184可紧邻相对侧上的伤口边缘112被应用。或在第一附接构件172与第二附接构件184被应用于表皮108之前或然后，将密封的收缩构件188与第一附接构件172和第二附接构件184连接。该连接可以用多种不同的方式完成，例如通过使用粘合剂189和191、胶合剂、粘结等。可以是减压口140的第一减压接口138可被应用，使得延伸部分202到达歧管118中。第一减压输送导管142可与第一减压接口138流体连接，并且与第一减压单元150(或可选的第二减压单元151)流体连接。第二减 压输送导管156可与第二减压接口183流体连接。 
减压伤口闭合和处理系统100被启动，以使第一减压单元150穿过准备第二减压或处理减压以及第一减压或闭合减压的三通阀154输送减压，该第二减压或处理减压经由减压导管158被输送至第一减压输送导管142，且第一减压或闭合减压被输送至第二减压输送导管156。穿过第一减压输送导管142被输送的处理减压在歧管118处得以实现，歧管118如箭头144和128所示牵引流体，并且将减压分配在腹腔110内。同时，闭合减压穿过第二减压输送导管156被输送至密封的收缩构件188，这使密封的收缩构件188收缩，形成如箭头170所示的闭合力，该闭合力将第一附接构件172和第二附接构件184拉向彼此，并由此拉向伤口边缘112。 
现在参考图3A-3C，示出了用于在表面伤口上提供闭合力的减压闭合设备300。减压闭合设备300可用作像图1的减压伤口闭合和处理系统100那样的减压伤口闭合和处理系统的一部分，或用作独立的设备。减压闭合设备300具有多个附接构件：第一附接构件302、第二附接构件304、第三附接构件306和第四附接构件308。每个附接构件302、304、306、308具有用于可释放地将附接构件附接至患者的表皮(或密封构件)的附接设备。例如，第一附接构件302包括用于将第一附接构件302附接至患者的表皮的粘合剂310，并且相似地，第三附接构件306具有粘合剂312。虽然未示出，第二附接构件和第四附接构件还具有用于将附接构件固定至患者的表皮的设备，例如粘合剂。虽然无创装置通常被视为是优选的，但也可能可使用缝线、U形钉或其它有创机械装置将附接构件302、304、306和308固定。另外，可使用其它的无创附接设备，例如胶合剂、粘结剂等。 
与多个附接构件连接的壁314形成具有内部空间的环形壁，收缩构件316或收缩材料放置在该内部空间中。密封的收缩构件316至少在紧邻每个附接构件302、304、306、308的点处附接至壁314。壁314可由聚丙烯、刚性硅树脂或允许壁314在密封的收缩构件316收缩时弯曲的其它半刚性材料制成。壁314可以被模制、铸造或使用其它技术形成。密封的收缩构件316可以由与图1中的密封的收缩构件188相同类型的材料制成。密封的收缩构件316需要被密封并且可由膜、层或盖布密封。在密封的收缩构 件316上的膜或其它材料可被应用到第一侧或顶侧318(对于所示的方位)。使用覆盖外围边缘的壁314、在底部上提供密封的密封构件(例如图1中的密封构件132)以及放置在顶侧318上方的膜或盖布，密封的收缩构件316也可至少部分地被密封。还可在顶侧318上喷密封胶以形成密封。密封的收缩构件316可简单地被包封在聚氨酯膜中，该聚氨酯膜被熔接以形成围绕收缩构件316的包层。可形成穿过密封的收缩构件316的开口320。开口320允许放置延伸至减压闭合设备300下方的歧管例如图1中的歧管118的减压接口的一部分。开口320类似于图1中的开口201，并且根据所期望的使用是可选的。减压导管322将减压输送到密封的收缩构件316中。这可以通过将减压导管322直接应用于密封的收缩构件316的任何部分中来完成，但也可使用在壁314的一部分上所形成的减压接口324例如口来完成。 
在操作中，附接构件302、304、306和308围绕表面伤口放置，并且可释放地附接至表皮(或密封构件)。相对的附接构件例如附接构件302和304在表面伤口的相对侧上。因此，例如第一附接构件302和第四附接构件308每个可释放地固定至不同的间隔开的部分处的伤口的一侧，并且附接构件304和306每个可放置在伤口的相对侧上。在安装减压闭合设备300时，减压闭合设备300最初处于非收缩位置中。一日被安装，减压就被提供给减压导管322且密封的收缩构件316收缩，使外壁314的至少部分被拉向彼此，并且又形成在附接构件例如302和304之间传递的闭合力。因此，闭合力被形成，并通过附接构件302、304、306和308被传递至表皮。图3B显示出处于非收缩位置中的减压闭合设备300，而图3C显示出处于收缩位置中的减压闭合设备300。 
现在参考图4A和图4B，示出了减压连接器400的一个说明性的实施方式。减压连接器400可操作来流体连接两个不同的隔室或区域。在图4A和图4B的说明性实施方式中，减压连接器400具有第一端402和第二端404。在第二端404上形成进入部分406。进入部分406可成形为倒置的圆锥形部分，以便于穿过诸如密封构件和歧管的不同材料插入。在第一端402上，多个凹槽408可被定位成便于流体流动。在第一端402和第二端404 之间可形成凸缘部分410。凸缘部分410具有第一表面412和第二表面414。在可选的实施方式中，第一端402还可成形并配置成容易穿过密封构件或其它材料进入。图5A和图5B中示出减压连接器400的两种不同的说明性应用。 
参考图5A，示出了减压伤口闭合和处理系统500的一部分。减压伤口闭合和处理系统500在大部分方面类似于图1的减压伤口闭合和处理系统100，并且为了表示出大体类似的部分，参考数字被调整400。歧管518放置在诸如腹腔510的体腔内，以帮助在其中提供减压处理。歧管518显示为紧邻皮下组织514和表面伤口511。 
密封构件532放置在腹腔510和表面伤口511上方的患者的表皮508上。表面伤口511具有伤口边缘512。密封构件532具有帮助形成与患者的表皮508的气动密封的粘合剂534。如所应用的密封构件532在腹腔510上方形成气动密封。 
伤口闭合设备或子系统的一部分571也被表示出。该部分571包括密封的收缩构件588的一部分。密封的收缩构件588至少部分地由第一密封构件596和第二密封构件598密封。密封的收缩构件588至少在某些部分附接至患者的表皮508。当向密封的收缩构件588的内部提供减压时，密封的收缩构件588收缩，并且由此向内牵引和形成传递至表面伤口511的闭合力。 
在图5A和图5B的说明性实施方式中，通过减压源将减压提供给减压导管542。减压导管542与具有延伸部分602的减压接口538连接。在图5A的实施方式中，延伸部分602穿过密封构件532延伸并进入歧管518中。因此，减压被输送至歧管518，并如箭头544所示将流体拉向延伸部分602。在该实施方式中，添加了减压连接器400。减压连接器400配置有在密封的收缩构件588的内部内的第一端402和在歧管518内的第二端404。减压连接器400由此将密封的收缩构件588与歧管518流体连接。由此将减压从减压接口538输送至歧管518，并输送至密封的收缩构件588的内部。穿过减压连接器400被输送的减压如箭头545所示牵引密封的收缩构件588内的流体。 
减压连接器400的第一表面412邻接密封构件532，且第二表面414邻接歧管518。减压连接器400可以用多种方式配置。例如，参考图3A和图5A，减压连接器400可被放置在密封的收缩构件316的室(例如室325)上方，并且穿过其上的密封构件被推动。进入部分406成形为便于这样的进入。其上的密封构件在插入之后应自密封，但密封材料的另一部分也可被添加在插入点的上方。在插入期间，减压连接器400被推到密封的收缩构件316中，直到第二表面414邻接第二(对于所示方位为底部)密封构件598并且进入部分406延伸出密封的收缩构件316。现在主要参考图5A，然后进入部分406可穿过密封构件532插入并进入歧管518中。如早些时候提到的，可采用用于配置减压连接器400的多种方式，并且减压连接器400可采用许多不同的配置，但所配置的减压连接器400在功能上提供密封的收缩构件588和歧管518的流体连接。 
现在参考图5B，示出了另一可选的实施方式。在图5B的实施方式中，减压接口538的延伸部分602在密封的收缩构件588内终止，并且在密封的收缩构件588内输送减压。减压连接器400以与先前所示相同的方式来配置，但现在将减压输送至歧管518。换而言之，流体穿过歧管518、穿过减压连接器400、穿过密封的收缩构件588的内部被汲取至减压接口538的延伸部分602，然后穿过减压导管542。 
虽然在一些说明性、非限制性的实施方式的情况中公开了本发明和它的优势，但应理解，可以进行不同的变化、替换、置换和变更而不偏离如所附的权利要求所限定的本发明的范围。 

Claims (24)

1.一种减压伤口闭合系统，用于给患者身上的表面伤口提供闭合力，所述减压伤口闭合系统包括：
第一附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第一部分；
第二附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第二部分，其中，所述第一附接构件与所述第二附接构件间隔开；
密封的收缩构件，其与所述第一附接构件和所述第二附接构件连接，并且可操作来在减压下收缩，其中，所述密封的收缩构件包括：
收缩歧管材料，其具有第一侧和面向患者的第二侧以及外围边缘；
第一密封构件，其紧邻所述收缩歧管材料的所述第一侧布置；
第二密封构件，其紧邻所述收缩歧管材料的所述面向患者的第二侧布置；以及
外围密封构件，其靠着所述收缩歧管材料的所述外围边缘布置；其中，所述第一密封构件、第二密封构件和外围密封构件可操作来气动地密封所述收缩歧管材料；并且
其中，当减压被提供给所述密封的收缩构件时，闭合力在所述第一附接构件和所述第二附接构件之间形成。
2.如权利要求1所述的减压伤口闭合系统，还包括与所述第二附接构件连接的减压接口。
3.如权利要求1所述的减压伤口闭合系统，其中，所述第一附接构件包括第一基底构件和第一粘合剂；并且所述第二附接构件包括第二基底构件和第二粘合剂。
4.如权利要求3所述的减压伤口闭合系统，还包括与第一基底构件连接的壁构件和与所述壁构件连接的减压接口。
5.如权利要求1所述的减压伤口闭合系统，其中，所述外围密封构件包括第三密封层。
6.如权利要求1所述的减压伤口闭合系统，其中，所述外围密封构件包括壁。
7.如权利要求1所述的减压伤口闭合系统，其中，所述第一附接构件包括：
第一基底构件，其具有第一侧和面向内的第二侧；
第一壁，其与所述第一基底构件连接；以及
第一粘合剂，其与所述第一基底构件的所述面向内的第二侧连接。
8.一种减压伤口闭合系统，用于给患者身上的表面伤口提供闭合力，所述减压伤口闭合系统包括：
多个附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮；
环形壁，其与所述多个附接构件连接，所述环形壁用于紧邻表面伤口布置；
密封的收缩构件，其与所述环形壁的至少一部分连接，并且可操作来在减压下收缩，其中，所述密封的收缩构件包括：
收缩歧管材料，其具有第一侧和面向内的第二侧以及外围边缘；
第一密封构件，其紧邻所述收缩歧管材料的所述第一侧布置；
第二密封构件，其紧邻所述收缩歧管材料的所述面向内的第二侧布置；以及
外围密封构件，其紧邻所述收缩歧管材料的所述外围边缘布置，其中，所述第一密封构件、第二密封构件和外围密封构件可操作来气动地密封所述收缩歧管材料；
减压源，其与所述密封的收缩构件流体连接，并且可操作来将减压输送至所述密封的收缩构件；并且
其中，当所述减压由所述减压源提供给所述密封的收缩构件时，闭合力形成。
9.如权利要求8所述的减压伤口闭合系统，其中，所述环形壁包括聚丙烯。
10.如权利要求8所述的减压伤口闭合系统，其中，所述环形壁包括刚性硅树脂。
11.如权利要求8所述的减压伤口闭合系统，其中，所述多个附接构件中的每个附接构件包括第一基底构件和第一粘合剂。
12.如权利要求8所述的减压伤口闭合系统，其中，所述外围密封构件包括第三密封构件。
13.如权利要求8所述的减压伤口闭合系统，其中，所述外围密封构件包括壁。
14.如权利要求8所述的减压伤口闭合系统，其中，所述多个附接构件中的每个附接构件包括：
第一基底构件，其具有第一侧和面向内的第二侧；
第一壁，其与所述第一基底构件连接；以及
第一粘合剂，其与所述第一基底构件的所述面向内的第二侧连接。
15.一种减压伤口闭合和处理系统，用于给患者身上的表面伤口提供闭合力并且用于将减压输送至组织部位，所述减压伤口闭合和处理系统包括：
伤口闭合子系统，其包括：
第一附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第一部分，
第二附接构件，其用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第二部分，其中，所述第一附接构件与所述第二附接构件间隔开，
密封的收缩构件，其与所述第一附接构件和所述第二附接构件连接，并且可操作来在减压下收缩，其中，所述密封的收缩构件包括：
收缩歧管材料，其具有第一侧和面向内的第二侧以及外围边缘；
第一密封构件，其紧邻所述收缩歧管材料的所述第一侧布置；
第二密封构件，其紧邻所述收缩歧管材料的所述面向内的第二侧布置；以及
外围密封构件，其紧邻所述收缩歧管材料的所述外围边缘布置，其中，所述第一密封构件、第二密封构件和外围密封构件可操作来气动地密封所述收缩歧管材料，以及
闭合减压源，其可操作来将第一减压输送至所述密封的收缩构件，
其中，当所述第一减压被提供给所述密封的收缩构件时，闭合力在所述第一附接构件和所述第二附接构件之间形成；以及
减压处理子系统，其包括：
歧管，其紧邻所述组织部位布置，所述歧管可操作来分配减压并且接收流体，
密封构件，其用于放置在患者表皮上并且可操作来在所述歧管上形成气动密封，以及
处理减压源，其可操作来将第二减压输送至所述歧管。
16.如权利要求15所述的减压伤口闭合和处理系统，其中，所述闭合减压源包括所述处理减压源。
17.如权利要求15所述的减压伤口闭合和处理系统，其中，所述闭合减压源和所述处理减压源包括：
减压单元；
减压接口；
减压输送导管，其可操作来流体地连接所述减压单元和所述减压接口；
其中，所述减压接口可操作来与所述歧管流体连接；以及
减压连接器，其可操作来流体地连接所述密封的收缩构件和所述歧管。
18.如权利要求15所述的减压伤口闭合和处理系统，其中，所述闭合减压源和所述处理减压源包括：
减压单元；
减压接口；
减压输送导管，其可操作来流体地连接所述减压单元和所述减压接口；
其中，所述减压接口可操作来与所述密封的收缩构件流体连接；以及
减压连接器，其可操作来流体地连接所述密封的收缩构件和所述歧管。
19.如权利要求15所述的减压伤口闭合和处理系统，其中，所述第二减压在-100mmHg与-350mmHg之间。
20.一种用于减压伤口闭合系统的制造方法，所述减压伤口闭合系统用于给患者身上的表面伤口提供闭合力，该方法包括以下步骤：
形成用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第一部分的第一附接构件；
形成用于可释放地附接至紧邻所述表面伤口的边缘的患者表皮的第二部分的第二附接构件；
形成可操作来在减压下收缩的密封的收缩构件，
其中，所述密封的收缩构件包括：
收缩歧管材料，其具有第一侧和面向内的第二侧以及外围边缘；
第一密封构件，其紧邻所述收缩歧管材料的所述第一侧布置；
第二密封构件，其紧邻所述收缩歧管材料的所述面向内的第二侧布置；以及
外围密封构件，其紧邻所述收缩歧管材料的所述外围边缘布置，其中，所述第一密封构件、第二密封构件和外围密封构件可操作来气动地密封所述收缩歧管材料；以及
形成减压接口。
21.如权利要求20所述的制造方法，还包括将所述密封的收缩构件与所述第一附接构件和所述第二附接构件连接。
22.如权利要求20所述的制造方法，还包括将所述减压接口与所述密封的收缩构件流体连接的步骤。
23.如权利要求20所述的制造方法，还包括形成环形壁以及将所述环形壁与所述第一附接构件和所述第二附接构件连接。
24.如权利要求23所述的制造方法，还包括将所述密封的收缩构件与所述第一附接构件和所述第二附接构件连接，其中，将所述密封的收缩构件与所述第一附接构件和所述第二附接构件连接的步骤包括将所述密封的收缩构件与所述环形壁的至少一部分连接的步骤。
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EP2594299A2 (en) 2013-05-22
MX2011004416A (es) 2011-05-31
CA2741271C (en) 2013-03-19
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US20190282405A1 (en) 2019-09-19
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RU2469745C1 (ru) 2012-12-20
CA2740646A1 (en) 2010-05-06
CN103908705A (zh) 2014-07-09
AU2009310392A1 (en) 2010-05-06
KR101687519B1 (ko) 2016-12-16
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JP2012507352A (ja) 2012-03-29
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CN103877628A (zh) 2014-06-25
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AU2009310389B2 (en) 2015-08-20
EP2974755A1 (en) 2016-01-20
EP2594299A3 (en) 2018-03-07
CN102196830B (zh) 2014-10-15
EP2341955B2 (en) 2021-09-01
US10905594B2 (en) 2021-02-02
US20100106106A1 (en) 2010-04-29
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US20140068914A1 (en) 2014-03-13
US20180256406A1 (en) 2018-09-13
US20100106187A1 (en) 2010-04-29
CN102196827A (zh) 2011-09-21
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US20100106115A1 (en) 2010-04-29
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EP2896414B1 (en) 2020-11-04
RU2011114218A (ru) 2012-12-10
CN102196829B (zh) 2014-03-26
US20160158067A1 (en) 2016-06-09
KR20110083692A (ko) 2011-07-20
EP2341955B9 (en) 2015-03-18
CN102186511A (zh) 2011-09-14
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US9549856B2 (en) 2017-01-24
US20150065968A1 (en) 2015-03-05
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KR20110083691A (ko) 2011-07-20
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AU2009310393B2 (en) 2013-02-28
CN102186510A (zh) 2011-09-14
US20100106188A1 (en) 2010-04-29
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