CN103908705A - 模块化的减压伤口闭合系统和方法 - Google Patents
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Abstract
本申请涉及模块化的减压伤口闭合系统和方法。一种用于在表面上提供闭合力的模块化的减压伤口闭合系统将包括可操作来形成为到达并围绕表面伤口的闭环的柔性带和连接到柔性带的多个模块化的闭合构件。减压源被流体连接至多个模块化的闭合构件。模块化的闭合构件可操作来在表面伤口上产生闭合力。模块化的闭合构件的一部分被可释放地连接至接近表面伤口的患者的表皮,而另一部分被连接至柔性带。来自减压源的减压被传送至每一个模块化的闭合构件以在表面伤口上产生闭合力。提出了方法和其他系统。
Description
本申请是申请日为2009年5月15日,申请号为200980142677.6,发明名称为“模块化的减压伤口闭合系统和方法”的申请的分案申请。
相关申请
根据美国法典第35卷第119条(e)款,本发明要求享有下述专利的汇集的利益:2008年10月29日提交的美国临时专利申请序列号61/109,410,题目为“Reduced-pressure,Wound-Closure System and Method”;2008年10月29日提交的美国临时专利申请序列号61/109,486,题目为“Reduced-Pressure,Abdominal Treatment System and Method”;2008年10月29日提交的美国临时专利申请序列号61/109,390,题目为“Open-Cavity,Reduced-Pressure Wound Dressing and System”;以及2008年10月29日提交的美国临时专利申请序列号61/109,448,题目为“Reduced-Pressure,Deep-Tissue Closure System and Method”。所有这些临时申请为了所有目的在此通过引用被并入。
技术领域
本发明通常涉及医学治疗系统,且更具体涉及模块化的减压伤口闭合系统和方法。
背景
无论伤口或组织的受损区域的病因是外伤、手术或其他原因,合适地护理伤口对结果都是重要的。当伤口涉及需要再进入的位置如腹膜腔且更通常是腹腔时,存在唯一的挑战。很多时候,当手术或外伤涉及腹腔时,建立有利于再进入的伤口处理系统允许更好且更容易的护理并有助于解决诸如腹膜、腹腔间室综合征(ACS)以及可能抑制伤口和内部器官最终愈合的感染的情形。在提供这种护理时,可能期望从腔中去除不需要的流体,帮助接近筋膜和其他组织,且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,否则正如本文中使用的,“或”并不要求相互排他性。
目前,腹部上的表皮开口可以采用缝线、钉、夹具以及允许保持和牵拉皮肤的其他机械设备来闭合。这种设备通常造成穿刺性伤口或其他伤口。此外,如果出现严重的水肿,大量的压力就会施加在闭合设备上且压力可能造成损伤。例如,如果因水肿产生压力升高,那么接缝可能被撕开。
关于允许再进入腹腔的整个系统,已经发展了许多技术。一种方法是将手术巾置于腔中,然后使用诸如止血钳的夹具在手术巾上闭合皮肤。虽然简单而快速,但结果还不是最满意的。另一种方法是所谓的“Bogota袋”。采用此方法,袋被缝到合适的位置以覆盖敞开的腹部,以便提供屏障。有时候称为“vac pack”的又一种方法是在伤口内填塞手术巾,然后将引流管置于腹部内且用盖布覆盖腹部。最后,已经采用减压方法。这种方法显示在Hunt等人的且转让给德克萨斯州San Antonio的KCI Licensing有限公司的美国专利第7,381,859号中。美国专利第7,381,859号为了所有目的在此通过引用被并入。
概述
通过本文描述的示例性实施方案的系统、设备和方法解决了现有的伤口闭合设备和减压治疗系统存在的问题。根据一个示例性的实施方案,模块化的减压伤口闭合系统包括:柔性带,其可操作来形成为闭环;和多个模块化的闭合构件,其选择性地被连接至柔性带。多个模块化的闭合构件中的每一个包括附接构件、密封的收缩构件和连接构件。每一个附接构件用于可释放地附接至接近表面伤口的边缘的患者表皮的一部分和密封的收缩构件的一部分。每一个密封的收缩构件可操作来在减压作用下收缩。每一个连接构件被连接至相应的密封的收缩构件且可操作来选择性连接至柔性带。每一个模块化的闭合构件还包括流体连接密封的收缩构件的用于将减压传送至密封的收缩构件的减压接驳体。模块化的减压伤口闭合系统还包括减压源,其被流体连接至多个模块化的闭合构件的每一个的每一个减压接驳体。
根据另一个示例性的实施方案,一种用于给表面伤口提供闭合力的模块化的减压伤口闭合系统,该系统包括:
柔性带,其可操作来形成为闭环;以及
多个模块化的闭合构件,其选择性地被连接至柔性带,多个模块化的闭合构件中的每一个包括:
附接构件,其用于可释放地附接至接近表面伤口的边缘的患者表皮的一部分,附接构件具有底座和壁,
密封的收缩构件,其具有第一端和第二端,第二端被连接至附接构件,其中密封的收缩构件可操作来在减压作用下收缩,
连接构件,其被连接至密封的收缩构件的第一端,连接构件可操作来选择性连接至柔性带,以及
减压接驳体,其流体连接密封的收缩构件,用于将减压传送至密封的收缩构件。
该模块化的减压伤口闭合系统还可包括减压源,该减压源被流体连接至多个模块化的闭合构件的每一个的每一个减压接驳体,减压源可操作来将减压传送至多个模块化的闭合构件的每一个减压接驳体。
该模块化的减压伤口闭合系统还可包括减压源,减压源可被流体连接至多个模块化的闭合构件的每一个的每一个减压接驳体,减压源可操作来将减压传送至多个模块化的闭合构件的每一个减压接驳体,且其中对每一个模块化的闭合构件,减压接驳体可被连接至连接构件。
该模块化的减压伤口闭合系统还可包括减压源,减压源可被流体连接至多个模块化的闭合构件的每一个的每一个减压接驳体,减压源可操作来将减压传送至多个模块化的闭合构件的每一个减压接驳体,且其中对每一个模块化的闭合构件,减压接驳体可被连接至附接构件。
在该模块化的减压伤口闭合系统中,柔性带可形成有多个带开口,且其中多个模块化的闭合构件的每一个的每一个减压接驳体可被依尺寸制造且可被配置成穿过带开口延伸。
在该模块化的减压伤口闭合系统中,每一个密封的收缩构件可包括收缩歧管材料。
在该模块化的减压伤口闭合系统中,其中:对每一个模块化的闭合构件,减压接驳体可被连接至连接构件;柔性带可形成有多个带开口,且其中多个模块化的闭合构件的每一个的每一个减压接驳体可被依尺寸制造且被配置成穿过带开口延伸;以及每一个密封的收缩构件可包括收缩歧管材料。
根据另一个示例性的实施方案,一种模块化的减压伤口闭合系统的制造方法包括下述步骤:形成可操作来形成为闭环的柔性带;和形成多个模块化的闭合构件。形成多个模块化的闭合构件的步骤对多个模块化的闭合构件的每一个包括下述步骤:形成用于可释放地附接至接近伤口的边缘的患者表皮的一部分的附接构件以及形成密封的收缩构件。密封的收缩构件可操作来在减压作用下收缩。形成多个模块化的闭合构件的步骤还包括将密封的收缩构件的第二端连接至附接构件以及形成连接构件。连接构件可操作来选择性连接至所述柔性带。形成多个模块化的闭合构件的步骤还包括将连接构件连接至密封的收缩构件的第一端。示例性的方法还可以包括将闭合的减压源流体连接至多个模块化的闭合构件的步骤。闭合的减压源可操作来将减压传送至多个模块化的闭合构件的每一个。
该制造方法还可包括:将减压接驳体流体连接至每一个模块化的闭合构件的密封的收缩构件以便将减压传送至密封的收缩构件。
进一步地,将减压接驳体流体连接至密封的收缩构件的步骤可包括将减压接驳体连接至连接构件。
进一步地,将减压接驳体流体连接至密封的收缩构件的步骤可包括将减压接驳体连接至附接构件。
进一步地,在该制造方法中,将减压接驳体流体连接至密封的收缩构件的步骤可包括将减压接驳体连接至连接构件;形成柔性带的步骤可包括形成具有多个带开口的柔性带的步骤;以及形成密封的收缩构件的步骤可包括形成包括收缩歧管材料的密封的收缩构件的步骤。
该制造方法还可包括下述步骤:提供闭合的减压源;以及将闭合的减压源流体连接至多个模块化的闭合构件的每一个减压接驳体,闭合的减压源可操作来将减压传送至多个模块化的闭合构件的每一个减压接驳体。
在该制造方法中,形成柔性带的步骤可包括形成具有多个带开口的柔性带的步骤。
在该制造方法中,形成密封的收缩构件的步骤可包括形成包括收缩歧管材料的密封的收缩构件的步骤。
根据另一个示例性的实施方案,一种处理患者身上的表面伤口的方法包括下述步骤:
提供间隔构件;
提供多个模块化的闭合构件,多个模块化的闭合构件中的每一个包括:
附接构件,其用于可释放地附接至接近表面伤口的边缘的患者表皮的一部分,附接构件具有底座和壁,
密封的收缩构件,其具有第一端和第二端,第二端被连接至附接构件,其中密封的收缩构件可操作来在被置于减压下时收缩,
连接构件,其被连接至密封的收缩构件的第一端,连接构件可操作来选择性连接至间隔构件,以及
减压接驳体,其流体连接密封的收缩构件,用于将减压传送至密封的收缩构件;
在间隔构件上连接多个模块化的闭合构件;
接近表面伤口放置间隔构件,使得多个模块化的闭合构件在表面伤口周围间隔开;
提供减压源;
将减压源流体连接至多个模块化的闭合构件的每一个减压接驳体;以及
将减压传送至多个模块化的闭合构件的每一个减压接驳体,由此每一个模块化的闭合构件产生闭合力。
在该方法中,间隔构件可包括柔性带。
该方法还可包括向体腔提供减压。
该方法还可包括从减压源向体腔提供减压。
在该方法中,流体连接减压源的步骤可包括将减压导管连接至减压接驳体。
在该方法中,对多个模块化的闭合构件中的每一个,减压接驳体可被连接至连接构件。
在该方法中,提供间隔构件的步骤可包括提供形成有多个带开口的柔性带。
在该方法中,多个模块化的闭合构件的每一个密封的收缩构件可包括收缩歧管材料。
根据另一个示例性的实施方案,一种向患者身上的表面伤口提供闭合力的方法包括下述步骤:提供可操作来形成为闭环的柔性带和提供多个模块化的闭合构件。提供闭合力的方法还包括下述步骤:将柔性带成形为靠近表面伤口的闭环以及提供减压源。提供闭合力的方法还包括下述步骤:将减压源流体连接至多个模块化的闭合构件以及将减压传送至多个模块化的闭合构件的每一个。当传送减压时,模块化的闭合构件产生闭合力。在此示例性的实施方案中,多个模块化的闭合构件的每一个包括用于可释放地附接至接近表面伤口的边缘的患者表皮的一部分的附接构件和密封的收缩构件,密封的收缩构件具有第一端和第二端。密封的收缩构件的第二端被连接至附接构件。密封的收缩构件可操作来在被置于减压下时收缩。多个模块化的闭合构件的每一个还包括被连接至密封的收缩构件的第一端的连接构件和流体连接密封的收缩构件的用于将减压传送至密封的收缩构件的减压接驳体。
根据另一个示例性的实施方案,一种用于利用减压来闭合患者表皮上的伤口的模块化的伤口闭合系统包括:
多个闭合设备,其在受减压影响时收缩,每一个闭合设备具有远端和近端;
柔性的构件,其用于将多个闭合设备保持在间隔开的关系中,且近端在伤口的边缘的内侧;
多个附接装置,其用于将多个闭合设备的远端可释放地连接至在伤口的边缘的外侧的患者表皮;以及
多个减压连接器,用于向多个闭合设备提供减压。
在该伤口闭合系统中,多个闭合设备可以包括多个密封的收缩构件,且其中多个闭合设备可以被可拆卸地配合至柔性的构件。
在该伤口闭合系统中,多个闭合设备可以在环境压力下具有第一容积(V1)而在减压下具有第二容积(V2),且其中V1>V2。
在该伤口闭合系统中,多个闭合设备可以被可滑动地配合至柔性的构件。
参照附图和下面的详细描述,示例性的实施方案的其他目的、特征以及优势将变得明显。
附图的简要说明
图1是模块化的减压伤口闭合和治疗系统的示意性横截面图,且一部分呈现为框图;
图2是模块化的减压伤口闭合系统的一部分的示例性实施方案的示意性透视图;
图3是图2的模块化的减压伤口闭合系统的模块化的闭合构件的一部分的示意性横截面图;
图4是图2-3的示例性的模块化的减压伤口闭合系统的示意性横截面图,该减压伤口闭合系统被示为部置在患者的表面伤口上;
图5是模块化的闭合构件的一部分的示例性实施方案的示意性横截面图;以及
图6是模块化的闭合构件的一部分的示例性实施方案的示意性横截面图。
示例性实施方案的详述
在下面示例性实施方案的详述中,参照了构成示例性实施方案的一部分的附图。足够详细地描述这些实施方案,以使本领域的技术人员能够实施本发明,而且应该理解,可使用其他实施方案,并可做出逻辑结构、机械、电及化学变化,而并不偏离本发明的精神或范围。为避免对使本领域技术人员能够实施本发明不必要的细节,描述可省略对本领域技术人员熟知的某些信息。因此,以下详细描述不应在限制性的意义上被理解,并且示例性实施方案的范围仅由所附权利要求限定。
参考图1,呈现了一种减压伤口闭合和治疗系统100的示例性实施方案。减压伤口闭合和治疗系统100可以包括减压治疗子系统102和模块化的减压伤口闭合子系统104。减压治疗子系统102可以用于使用减压来治疗组织部位106。组织部位106可以是任何人、动物或其他生物体的身体组织,包括骨组织、脂肪组织、肌肉组织、皮肤组织、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可以在体腔内,例如腹腔110内,且可以包括多个组织层,其包括表皮108内的伤口。用减压治疗子系统102进行治疗可以包括去除诸如腹水或渗出物的流体,传送减压或提供保护屏障。
在示例性的实施方案中,在腹腔110和具有伤口边缘112的表面伤口111的背景下,呈现了减压伤口闭合和治疗系统100。其他皮下组织114也可以是敞开的,例如脂肪组织、肌肉、筋膜等。腹腔110显示为具有腹部容纳物116,其形成表面或支撑体。
减压伤口闭合和治疗系统100的减压治疗子系统102帮助将减压传送至组织部位106和腹腔110。减压治疗子系统102包括设置在腹腔110内的歧管118以将减压分配在腹腔110内并接纳流体。歧管118可以包括在不粘合的包围物122内的歧管构件120或第二歧管。不粘合的包围物122在第一侧面上具有孔124且在面向内的(面向组织的)的第二侧面上具有孔126。孔124和126促进流体流动,如由箭头128表示的。孔124和126可以采用任何形状,例如矩形开口、圆形开口、多边形、狭缝(细长的槽)等。不粘合的包围物122可以由柔性的膜例如聚氨酯膜、盖布材料或任何不粘合的材料形成。
可以由减压治疗子系统102将减压施加到腹腔110和组织部位106以帮助促进渗出物、腹水或其他液体、细菌、血纤蛋白、死组织、毒素、残留血等的去除。在某些情形中,减压还可以用于刺激额外的组织的生长。在组织部位106处的伤口的情形中,肉芽组织的生长以及渗出物和细菌的去除可以有助于促进伤口的愈合。在非伤口或非缺损的组织的情形中,减压可以用于促进可以被获得并移植至另一组织部位的组织的生长。在其他情形中,流体去除可能是施加减压的主要原因。
正如本文中使用的,“减压”一般指小于组织部位106处的环境压力的压力。在大多数情况下,此减压将小于患者所处位置的大气压力。可选地,减压可小于组织部位106处的流体静压。除非另外指明,否则本文中所述的压力值是表压。
歧管118和歧管构件120被设置在腹腔110内且可以被设置在组织部位106处或其附近。包含歧管构件120的不粘合的包围物122通常被设置成贴住组织部位106,且尤其是接近腹部容纳物116。歧管118被设置成邻近不粘合的包围物122。歧管118和歧管构件120可以采用许多形式。正如本文中使用的,术语“歧管”通常指被提供来帮助将减压施加至组织部位、将流体传送至组织部位或从组织部位去除流体的物质或结构,组织部位例如是组织部位106。歧管118和歧管构件120通常包括将所提供的流体分配至接近歧管118和歧管构件120的区域或从接近歧管118和歧管构件120的区域去除所提供的流体的多个流体通道或路径。在一个实施方案中,歧管118和歧管构件120通常包括互连的多个流体通道或路径以改善流体的分配。歧管118和歧管构件120可以从能够被放置成与组织接触且分配减压的可生物相容的材料形成。歧管的实例可以包括但不限于具有布置成形成流动通道的结构元件的设备、多孔状泡沫例如开孔泡沫、多孔的组织结缔、以及包括或固化以包括流动通道的液体、凝胶和泡沫。
歧管118和歧管构件120可以是多孔的且可以由泡沫、纱布、毡垫或适于特定生物应用的任何其他材料制成。在一个实施方案中,歧管118和歧管构件120由包括起到流动通道作用的多个互连的小室或孔的多孔泡沫制成。多孔泡沫可以是聚氨酯、开孔泡沫、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材料。其他实施方案可以包括“闭孔”。在一些情形中,歧管118、歧管构件120和不粘合的包围物122可以用于将诸如药物、抗菌剂、生长因子和其他溶液的流体分配至组织部位106。其他层可以作为歧管118和歧管构件120的一部分被包括在内,这些部分例如是吸收性材料、芯吸材料、疏水性材料、亲水性材料等。
密封构件132可以被置于表皮108中的表面伤口111之上,且尤其是被制成覆盖伤口边缘112以提供气动密封。因而,密封构件132在歧管118和不粘合的包围物122之上提供密封。密封构件132可以是盖,该盖用于将歧管118和不粘合的包围物122固定在组织部位106处。当密封构件132可能是不可渗透的或可半渗透的时,在将密封构件132安装到歧管118上后,密封构件132能够在组织部位106处维持减压。密封构件132可以是由硅氧烷基化合物、丙烯酸类、水凝胶或形成水凝胶的材料或任何其他可生物相容的材料形成的柔性的上盖布或膜,任何其他可生物相容的材料包括预期的组织部位所需要的不可渗透性或渗透性特征。
密封构件132还可以包括附接装置136以将密封构件132固定至患者的表皮108。附接装置136可以采用许多形式,例如,可以使用密封带,或可沿着密封构件132的外周或密封构件132的任何部分设置粘合剂134以提供气动密封。粘合剂134也可以被预先敷贴且覆盖有在被敷贴时去除的可释放的构件(未显示)。
诸如口140或连接器的第一减压接驳体138可以用于将减压从第一减压传送导管142传送至歧管118。第一减压接驳体138还可以从歧管118传送任何渗出物、腹水或其他流体。歧管118内的减压在由箭头144所示的方向上牵拉流体并至第一减压传送导管142。第一减压接驳体138允许流体从歧管118通至第一减压传送导管142。例如,使用歧管构件120和歧管118从组织部位106收集的流体可以经由第一减压接驳体138进入第一减压传送导管142。在另一个实施方案中,减压治疗子系统102可以不包括第一减压接驳体138,且第一减压传送导管142可以被直接插入到密封构件132和歧管118内。第一减压传送导管142可以是医疗导管、多腔构件、管件或用于传送减压的任何其他装置。
减压子系统148可以用于供给被传送至第一减压传送导管142的减压。减压子系统148可以包括将减压传送至导管152的第一减压单元或源150,导管152将减压传送至三通阀154。减压的一部分可以通过第二减压传送导管156离开三通阀154。减压的另一部分可以通过减压导管158离开三通阀154。在减压导管158上可以设置任意数目的设备,例如减压反馈单元160,其可以例如向三通阀154提供关于减压导管158内的减压的调节的反馈。减压导管158将减压传送至罐162,罐162可操作来容纳从组织部位106传送至罐162的任何流体。离开罐162的减压被传送至第一减压传送导管142。第一减压传送导管142可以指传送治疗减压,因为其内的减压已经被减压子系统148置于期望的压力和条件处以用在组织部位106处的减压治疗中。传送至第一减压传送导管142的减压通常被选择成在组织部位106处在-50mm Hg到-500mm Hg的范围内且更通常在-100mm Hg到-300mm Hg的范围内。
许多不同的设备如设备166可以被添加到第一减压传送导管142的中间部分164。设备166可以是压力反馈设备、容积检测系统、血液检测系统、感染检测系统、流量监测系统、温度监测系统等。这些设备中的一些可以与其他部件整体地形成;例如罐162可以包括一个或多个过滤器,如防止液体离开的疏水过滤器。
存在产生或供给与减压伤口闭合和治疗系统100一起使用的减压的许多方式。在所示的示例性实施方案中,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治疗。在可选的实施方案中,可能期望使用第一减压单元150作为第二减压传送导管156的源且使第二减压单元151(以虚线显示)将减压传送至减压导管158。
作为减压伤口闭合和治疗系统100的一个方面,还期望帮助向表面伤口111提供闭合力且尤其是在伤口边缘112之间施加闭合力。如图1所示,模块化的减压伤口闭合子系统104可以用于此目的。模块化的减压伤口闭合子系统104产生由箭头170表示的闭合力。闭合力被传递至表皮108并将伤口边缘112推向彼此。模块化的减压伤口闭合子系统104可以是用于闭合任何表面伤口或用作较大的系统如减压伤口闭合和治疗系统100的一部分的独立的系统。
模块化的减压伤口闭合子系统104包括间隔构件如柔性带171和与柔性带171相关的多个模块化的闭合构件169,间隔构件被成形为在伤口边缘112内侧的闭环(参见,例如图4)。可选地,间隔构件可以是使模块化的闭合构件169保持在间隔开的关系中的一个或多个系线或使模块化的闭合构件169保持在间隔开的关系中的置于模块化的闭合构件169的顶部之上的柔性粘合膜。每一个模块化的闭合构件169具有密封的收缩构件195、连接构件181和附接构件211。在形成闭环之前,多个模块化的闭合构件169如第一模块化的闭合构件173和第二模块化的闭合构件175被附接至柔性带171。多个模块化的闭合构件169类似于图2中的模块化的闭合构件308。被包括在柔性带171上的模块化的闭合构件169的数目由围绕表面伤口111所需的环的尺寸确定。
多个模块化的闭合构件169中的每一个模块化的闭合构件具有第一端177和第二端179,第一端177通常被置于表面伤口111的内侧,而第二端179通常被置于表面伤口111的外侧。每一个连接构件181被连接至相应的模块化的闭合构件169的第一端177。在图1的示例性的实施方案中,每一个连接构件181包括附接开口或附接环185,柔性带171可以穿过该附接开口或环185被放置。附接环185允许每一个模块化的闭合构件169被设置在沿着柔性的带171的期望的位置中。
减压接驳体186被连接至每一个模块化的连接构件181。多个减压导管187被流体连接至减压接驳体186以向其提供减压。通过第二减压传送导管156供给的减压被流体连接至分配器223,分配器223被流体连接至多个减压导管187,多个减压导管187被流体连接至多个减压接驳体186以将减压传送至每一个模块化的闭合构件169。对每一个模块化的闭合构件169来说,减压接驳体186将减压传送至密封的收缩构件195。每一个减压接驳体186还可以起到销的作用以将相应的连接构件181相对于柔性的带171保持在合适的位置。
模块化的伤口闭合子系统104的每一个模块化的闭合构件169包括用于产生闭合力的密封的收缩构件195。密封的收缩构件195可以由与歧管118是同类型材料的收缩歧管材料形成。可选地,可能期望使用具有比用于歧管118的材料少的孔或孔洞的收缩歧管材料。此外,可能期望有将在垂直方向(对于图1显示的方位)上收缩程度较低而在水平或横向平面(对于图1显示的方位)中收缩程度较高的材料。在可选的实施方案中,密封的收缩构件195可以使用气动设备形成以产生闭合力。例如,可以使用在减压作用下缩陷的室。密封的收缩构件195具有第一侧面190和面朝内的第二侧面192。密封的收缩构件195被密封以在密封的收缩构件195的内部空间周围形成气动密封。
多个模块化的闭合构件169的每一个连接构件181包括底座203和壁209。底座203和壁209被整体地形成或另外通过诸如焊接、粘结、粘合、接合等的任何技术被连接。每一个附接构件211具有底座213和壁215。附接构件211的底座213和壁215被整体地形成或另外通过诸如前面提到的任何技术被连接。粘合剂197或其他附接设备可以用于将密封的收缩构件195固定到相应的连接构件181的底座203。粘合剂205或其他附接设备还可以用于将密封的收缩构件195的外周边缘207连接到相应的连接构件181的壁209。粘合剂217或其他附接设备可以用于将密封的收缩构件195固定到相应的附接构件211的底座213。粘合剂219或其他附接设备还可以用于将密封的收缩构件195固定到相应的附接构件211的壁215。粘合剂227或其他附接设备可以用于将底座213可释放地附接到表皮108(或如果已经部置在表皮上,就附接到密封构件)。
在操作中,减压伤口闭合和治疗系统100可以通过首先将歧管材料施用在腹部容纳物116上而被使用在体腔如腹腔110内。例如,具有不粘合的包围物122的歧管构件120可以被置于腹部容纳物116上且歧管118被设置成靠近不粘合的包围物122。可以使表面伤口111的伤口边缘112聚集到可能的程度,然后将密封构件132置于表皮108上以在表面伤口111上提供气动密封。
医护人员可以测量或估计表面伤口111的周长,然后利用查找表确定模块化的闭合构件169如第一模块化的闭合构件173的数目,模块化的闭合构件需要被添加至柔性带171。柔性带171还被切割或以其他方式依尺寸制造成合适的长度。所期望的多个模块化的闭合构件169如模块化的闭合构件173和175被添加至柔性带171。柔性带171被形成为闭环,该闭环的周长小于表面伤口111的周长。闭环实质上位于表面伤口111的中心且每一个附接构件211被固定至患者的表皮108(或密封构件132)。在这方面,正如本文中使用的,对附接至患者的表皮108的提及应该被认为包括附接至表皮108上的密封构件132。
可以应用可以是减压口140的第一减压接驳体138,使得延长部分202进入歧管118内。第一减压传送导管142可以被连接至第一减压接驳体138以提供与第一减压单元150(或可选的第二减压单元151)的流体连接。第二减压传送导管156可以被流体连接至分配器223。多个减压导管187被流体连接至分配器223和多个减压接驳体186。
激活减压伤口闭合和治疗系统100,使得第一减压单元150通过三通阀154传送减压,这为被传送至第一减压传送导管142的治疗减压和被传送至第二减压传送导管156的闭合减压作准备。在歧管118处实现通过第一减压传送导管142被传送的治疗减压,歧管118按照由箭头144和128所示的牵拉流体并将减压分配在腹腔110内。闭合减压通过第二减压传送导管156被传送至分配器223且通过多个减压导管187被传送至多个模块化的闭合构件169。闭合减压被多个模块化的闭合构件169接收并被传送至每一个密封的收缩构件195的内部,且使每一个密封的闭合构件195收缩且由此在柔性带171与附接构件211之间产生闭合力。最终结果是提供了向内推伤口边缘的闭合力。
现在参考图2-4,呈现了模块化的减压伤口闭合系统300的示例性的实施方案。模块化的减压伤口闭合系统300可以被用作图1的模块化的减压伤口闭合子系统104。模块化的减压伤口闭合系统300可以包括具有多个模块化的闭合构件308的柔性带302。每一个模块化的闭合构件308包括附接构件320和连接构件314。使用模块化的构件308允许适应许多尺寸和形状的表面伤口而不需要大量储备不同尺寸和形状的伤口敷料或设备。
柔性带302在图2中显示为在线性位置且在图4中被成形为闭环304。柔性带302被成形为围绕表面伤口306的闭环304,例如患者表皮上的开口。多个模块化的闭合构件308被选择性地连接至柔性带302。柔性带302上包括的模块化的闭合构件308的数目由围绕表面伤口306所需的闭环304的尺寸确定。因而,为了在图4中围绕表面伤口306,在柔性带302上包括8个模块化的闭合构件308。再次参考图2,每一个模块化的闭合构件308具有第一端310和第二端312。
每一个连接构件314被连接至每一个模块化的闭合构件308的第一端310。在图2所示的示例性的实施方案中,每一个连接构件314包括附接环或开口316,柔性带302可以穿过附接环或开口被放置。附接环316允许沿着柔性带302将每一个模块化的闭合构件308设置在期望的位置。每一个附接环316的一部分可以与带开口318接驳以帮助将连接构件314保持在柔性带302上的合适的位置。可选地或此外,减压接驳体326可以起到钉的作用以将连接构件314相对于柔性带302保持在合适的位置。
现在主要参考图3,呈现了连接构件314。减压接驳体326被显示为连接至连接构件314。减压导管327被流体连接至减压接驳体326以向减压接驳体326提供减压。减压接驳体326将减压传送至密封的收缩构件328,且正如前面提到的,减压接驳体326可以起到销的作用以将连接构件314相对于柔性带302保持在合适的位置。
密封的收缩构件328由与前面提到的图1的密封的收缩构件195相同或类似的材料制成。密封的收缩构件328被密封以围绕密封的收缩构件328的内部空间形成气动密封。粘合剂329或其他附接设备(例如,接合剂、焊接、钩等)可以用于将密封的收缩构件328固定至底座331。粘合剂335或其他附接设备(例如,接合剂、焊接、钩等)也可以用于将密封的收缩构件328的外周边缘333附接至连接构件314的壁323。
再次主要参考图2,附接构件320可以被连接至密封的收缩构件328的第二端312的每一个。每一个附接构件320可以被形成有底座322和壁324。粘合剂(未明确显示)或其他附接设备(例如,接合剂、焊接、钩等)可以用于将密封的收缩构件328固定至底座322。粘合剂(未明确显示)或其他附接设备(例如,接合剂、焊接、钩等)也可以用于将密封的收缩构件328固定至壁324。
现在主要参考图5,可选的减压接驳体427被呈现为连接构件416的一部分。可以通过连接构件416将减压提供给密封的收缩构件428。连接构件416选择性地附接至柔性带402。粘合剂430可以用于将密封的收缩构件428固定至连接构件416。连接构件416可以具有壁424和底座422,壁424和底座422被整体地形成或另外通过任何技术如焊接(RF焊接或超声焊接)、粘结、粘合、接合等被连接。减压接驳体427可以被形成在底座422上并被配置成进入歧管118或歧管垫。减压接驳体427依尺寸制造且被配置成接合歧管480,歧管480与减压源流体相通或被流体连接至减压源。减压被传送至歧管480,歧管480通过减压接驳体427将减压传送至密封的收缩构件428。
再次主要参考图2-4,将呈现操作模块化的减压伤口闭合系统300的一种示例性的方法。在操作中,医护人员估计表面伤口306的尺寸并确定适于表面伤口306的尺寸的模块化的闭合构件308的数目。基于表面伤口306的周长的测量结果的查找图表或查找表可以用于提议模块化的闭合构件308的合适数目。接着,将合适数目的模块化的闭合构件选择性地连接至柔性带302。柔性带302随后形成为闭环304,闭环304优选地被依尺寸制造成在表面伤口306的外周边缘的内侧。采用任意数目的装置来固定柔性带302以形成闭环304,这些装置是例如棘轮、按扣、紧固件、棘轮拉紧器、柔性钉和槽构件等。随后,多个附接构件320的每一个被附接至靠近表面伤口306的边缘的患者的表皮。与前面一样,附接构件320被附接到表皮的陈述可以包括附接构件320被附接至正在用于减压治疗的密封构件。
在应用每一个附接构件320时,底座322可以具有敷贴在面朝内的第二表面336上的粘合剂(参见图1的粘合剂227)或其他附接设备。粘合剂可以在粘合剂上具有在使用前去除的可释放的背衬。因而,医护人员将扯掉背衬,暴露粘合剂,然后将粘合剂按压到表皮(或密封构件)上。接着,与多个连接构件314的每一个相关的每一个减压接驳体326例如通过减压导管327或分配器(未显示)被连接至减压源。(可选地,图5的减压接驳体427可能已经被引入歧管480内,如果使用歧管的话)。在激活减压源之后,减压被供给至减压导管327,减压导管327通过减压接驳体326将减压传送至密封的收缩构件328。减压使密封的收缩构件328收缩。当密封的收缩构件328收缩时,密封的收缩构件328产生由图4中的箭头340表示的闭合力。闭环304实质上保持在相对的位置,且因而每一个附接构件320向内拉表皮。
如果还期望减压治疗,闭环304在闭环304的中间提供了易于容纳减压接驳体342的敞开区域。减压接驳体342可以用于向减压治疗系统(参见,例如图1中的减压治疗子系统102)供给减压。
现在主要参考图6,呈现了减压接驳体526的另一个可选的示例性实施方案。减压接驳体526被形成为附接构件520的一部分。附接构件520包括整体地形成的或以其他方式被连接的底座522和壁524。粘合剂530或其他附接设备(例如,粘结料、接合剂、焊接等)可以将收缩构件528的一部分保持或固定至底座522。粘合剂534或其他附接设备(例如,粘结料、接合剂、焊接等)可以将收缩构件528的一部分保持至壁524。底座522的面朝内的侧面536上的粘合剂535或其他附接设备(例如,粘结料、接合剂、缝合等)可以用于将底座522附接至患者的表皮(或密封构件)。在此示例性的实施方案中,被流体连接至减压导管527的减压接驳体526穿过壁524延伸并将减压传送至密封的收缩构件528。
再次参考图4,将呈现另一个实施方案。在此可选的实施方案中,设定数目的模块化的闭合构件308被可滑动地附接至带302且可以照此设置在闭合的工具箱中。当应用伤口闭合系统300时,医护人员在待使用的带302的一部分上使设定数目的模块化的闭合构件308恰当地分开-通常彼此等距离-并形成闭环304。带302的任何额外的部分,即,不需要形成闭环的部分可以被切割或去除。
根据另一个示例性的实施方案,一种用于使用减压来闭合患者表皮上的伤口的模块化的伤口闭合系统包括在受到减压影响时收缩的多个闭合设备。每一个闭合设备具有远端和近端。系统还包括柔性的构件,该柔性的构件用于将多个闭合设备保持在间隔开的关系中,且近端在伤口边缘的内侧。系统还包括多个附接装置,其用于将多个闭合设备的远端可释放地连接至患者表皮的伤口边缘的外侧。系统还包括用于向多个闭合设备提供减压的多个减压连接器。多个闭合设备可以被形成为多个密封的收缩构件。多个闭合设备可以被可拆卸地配合至柔性的构件。多个闭合设备在环境压力下具有第一容积(V1)而在减压下具有第二容积(V2),且其中V1>V2。多个闭合设备可以被可滑动地配合至柔性的构件。
虽然已经在某些示例性的、非限制性的实施方案的背景下公开了本发明及其优势,但是应当理解,可以做出各种变化、替换、置换和改动而并不偏离由所附权利要求限定的本发明的范围。
Claims (21)
1.一种用于给表面伤口提供闭合力的装置,所述装置包括:
间隔构件,其可操作来形成为闭环;以及
多个模块化的闭合构件,其以间隔开的关系选择性地被连接至所述间隔构件。
2.如权利要求1所述的装置,其中所述间隔构件是柔性带。
3.如权利要求1所述的装置,其中所述间隔构件包括一根或多根系线。
4.如任一项前述权利要求所述的装置,其中所述多个模块化的闭合构件中的每一个包括:
附接构件;
收缩构件,其具有第一端和第二端,所述第二端被连接至所述附接构件,其中所述收缩构件适合于在减压作用下收缩;以及
连接构件,其被连接至所述收缩构件的所述第一端,所述连接构件可操作来选择性地连接至所述间隔构件。
5.如权利要求4所述的装置,其中每一个收缩构件包括收缩歧管材料。
6.如权利要求4所述的装置,还包括流体连接至所述收缩构件的减压接驳体。
7.如权利要求4所述的装置,还包括减压接驳体,所述减压接驳体连接至所述连接构件且可操作来将减压传送到所述收缩构件。
8.如权利要求4所述的装置,还包括减压接驳体,所述减压接驳体连接到所述附接构件且可操作来将减压传送到所述收缩构件。
9.如权利要求6-8中任一项所述的装置,还包括减压源,所述减压源被流体连接至所述多个模块化的闭合构件中的每一个的所述减压接驳体。
10.如权利要求6或权利要求7所述的装置,其中:
所述间隔构件形成有多个开口;并且
所述多个模块化的闭合构件中的每一个的所述减压接驳体被依尺寸制造且被配置成穿过所述开口中的一个延伸。
11.如权利要求6或权利要求7所述的装置,其中:
所述间隔构件形成有多个开口;
所述多个模块化的闭合构件中的每一个的所述减压接驳体被依尺寸制造且被配置成穿过所述开口中的一个延伸;并且
所述收缩构件包括收缩歧管材料。
12.如权利要求6-8中任一项所述的装置,还包括流体连接至每一个减压接驳体的分配器。
13.如权利要求4所述的装置,其中:
所述连接构件包括底座和连接到所述底座的壁;并且
所述收缩构件的所述第一端连接至所述连接构件的所述底座。
14.如权利要求4或权利要求13所述的装置,其中:
所述附接构件包括底座和连接到所述底座的壁;并且
所述收缩构件的所述第二端连接至所述附接构件的所述底座。
15.一种用于闭合组织部位的装置,所述装置包括:
多个闭合设备,其被配置成在减压作用下收缩;
柔性的构件,其用于将所述多个闭合设备保持在间隔开的关系中;
多个附接设备,其适合于将所述多个闭合设备可释放地连接至所述组织部位的边缘;以及
多个减压连接器,其用于向所述多个闭合设备提供减压。
16.如权利要求15所述的装置,其中所述柔性的构件是带。
17.如权利要求15或权利要求16所述的装置,其中所述柔性的构件可操作来形成为环。
18.如权利要求15或权利要求16所述的装置,其中:
所述多个闭合设备包括多个密封的收缩构件;并且
所述多个闭合设备被可拆卸地配合至所述柔性的构件。
19.如权利要求15或权利要求16所述的装置,其中所述多个闭合设备被可滑动地配合至所述柔性的构件。
20.如权利要求15或权利要求16所述的装置,还包括:
减压单元;以及
分配器,其流体连接至所述减压单元并流体连接至所述多个闭合设备。
21.如权利要求15或权利要求16所述的装置,还包括:
减压单元;
三通阀,其流体连接至所述减压单元;
第一减压传送导管,其连接至所述三通阀;
第二减压传送导管,其连接至所述三通阀;
歧管,其流体连接至所述第一减压传送导管;以及
分配器,其流体连接至所述第二减压传送导管并流体连接至所述多个闭合设备。
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