US 3802438 A
Method and apparatus for closing an incision in the body of a patient including forming a suture by passing a loop of wire through opposite sides of the incision and inserting the end portions of the wire into and through bores formed in a splice plate comprising a substantially rectangular member having a pair of parallel bores formed longitudinally therethrough. The end portions of the wire are then inserted into an instrument for applying a controlled tension to said wire comprising a pair of parallely spaced legs having mechanisms for fixedly holding each respective wire end portion therein. A rack and pinion arrangement is activated to increase the distance between the legs thereby tensioning the wire at a controlled rate. When sufficient closure of the incision is attained, the splice plate is crimped thereby splicing the wires therein. The end portions of the wire extending beyond the splice plate are cut flush with an edge surface of the splice plate thereby forming a safe suture. An alternate embodiment includes having the length of suture wire prethreaded on the splice plate prior to the operation.
Beschreibung (OCR-Text kann Fehler enthalten)
United States Patent 1191 Wolvek 1451 Apr. 9, 1974 SURGICAL INSTRUMENT  Inventor: Sidney Wolvek, Brooklyn, NY.
 Assignee: Technibiotics, Inc., Brooklyn, NY.
 Filed: Mar. 31, 1972  Appl. No.: 240,185
 US. Cl. 128/335  Int. Cl A611 17/00  Field of Search 128/334, 335, 335.5, 339. 128/303 R, 20, 345, 121, 124, 334 C, 346.
92 R, 92 B, 92 D; 254/66; 140/934, 93.2;
Primary ExaminerRichard A. Gaudet Assistant Examiner1-lenry J. Recla Attorney, Agent, or FirmDarby & Darby 5 7 ABSTRACT Method and apparatus for closing an incision in the body of a patient including forming a suture by passing a loop of wire through opposite sides of the incision and inserting the end portions of the wire into and through bores formed in a splice plate comprising a substantially rectangular member having a pair of parallel bores formed longitudinally therethrough. The end portions of the wire are then inserted into an in-  R f s Cit d strument for applying a controlled tension to said wire UNITED STATES PATENTS comprising a pair of parallely spaced legs having 3 015 685 l 1962 G l h l 174 90 mechanisms for fixedly holding each respective wire 3477436 1969 g et a 5 end portion therein. A rack and pinion arrangement is 2359O83 9/1944 81/41"? activated to increase the distance between the legs 11/1946 jjji 81/418 thereby tensioning the wire at a controlled rate. When 3,541,591 11/1970 Hoegermanm 128/335 sufficient closure of the incision is attained, the splice 538,451 4/1895 Bauve 254/66 plate is crimped thereby splicing the wires therein. 1,481,414 l/1924 Cary 24/23 W The end ortions of the wire extendin be ond the P g y 1,6 5, 5 1928 Llebo ltz 339/276 R splice plate are cut flush with an edge surface of the 3,581,551 6/1971 wllkmso" 128/325 splice plate thereby forming a safe suture. An alter- 2,327,683 8/1943 Warner et a1. 24/123 W "ate embodiment i d having the length of Suture FOREIGN PATENTS OR APPLlCATlONS wire prethreaded on the splice plate prior to the oper- 204,25s 11/1956 Australia 140/1235 anon- 2,0l3,707 4/1970 France 128/335 494,960 9 1919 France 128/335 10 Clam, 9 Draw'ng F'gures SURGICAL INSTRUMENT BACKGROUND OF THE INVENTION This invention relates to a method and apparatus for use during surgical operations, and more particularly to a method and apparatus for closing incisions made in certain bones during surgery in the chest and other regions.
In the course of surgery in and around the chest cavity area, and more particularly during heart surgery, an incision is commonly made in the sternum, or breast bone, in order to gain access to that portion of the body which is being operated upon. Of course, subsequent to the completion of the operation the incision must be closed.
In one method used in the past to accomplish this closure, the sternum is punctured to form an opening 'on one side of the incision with a chisel-ended circular needle, a thin wire brought down and through this opening and then brought up through a similarly formed opening in the sternum on the other side of the incision. The portions of the wire extending outwardly from the sternum are then manually pulled together to achieve a tight closure of the incision. In this method the wires are pulled together using a hemostat or needle holder and when the incision is deemed by the physician to have beenclosed sufficiently the wire ends are spliced by twisting them together. The twisted end is cut leaving five to seven twists at the closure.
Many difficulties have arisen in the use of the prior art method described hereinabove. The uncontrolled physical pulling on the wire by the physician to obtain sufficient closure of the incision, has often resulted in one or more of the wires snapping. Too much tension applied to the wires may also cause the sternum to be cut involving serious injury to the patient. Further, the hemostat may slip from the wire with a consequent risk of damage to both the equipment and the patient. In addition, at the inception of the wire splicing operation, the twisting of the wire changes the loading on the suture from a linear (tension) loading to a shear loading. This reduces the holding power of the wire. Also, the resulting six or seven twists which remain in the body may either irritate the .periosteum of the sternum or pierce the skin, only a small layer of which is present over the sternum in this area, in many cases. The twisted portions of the wire may also provide an infection path should the loose end pass through the skin.
SUMMARY OF THE INVENTION Accordingly, an object of this invention is to provide a new and improved apparatus for assisting in the closure of incisions made in bones during surgery.
Another object is the provision of a new and improved incision closing instrument which controls the amount of tension placed on the wires during the closing of the incision.
Still another object is to provide a new and improved incision closing instrument which will safely grasp the wire used for closing the incision.
A further object is to provide a new and improved wound closing instrument which maintains the suture in tension at all times.
A still further object of this invention'is the provision of a wound closing instrument which assures the absence of any surplus wire which might irritate the anatomical region about the chest cavity or pierce the surrounding skin and to provide a closure which is more acceptable from a cosmetic point of view.
In accordance with a preferred embodiment of this invention, these and other objects are achieved by providing an instrument removably connectable to wire end portions which have been passed through openings formed in the sides of the bone adjacent the incision and drawing these ends in a controlled manner to apply tension to the wire. Prior to fastening the wire end portions to the instrument, the wire end portions are passed in opposite directions through a splice plate which, although confining those portions of the wire contained therein, permits movement of the wire ends through the plate. After the wire has been tensioned to a sufficient amount to close the incision, a tool having appropriately formed jaws crimps the splice plate to hold and fasten the wires contained therein. The wire end portions extending beyond the splice plate are then cut off flush with the splice plate edges. In an alternative embodiment the wire is passed through the splice plate prior to the operation.
DESCRIPTION OF THE DRAWINGS A more complete description of the invention and many of the attendant advantages thereof will be readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings in which:
FIG. 1 is a plan view of an instrument according to the present invention;
FIG. 2 is a side view of the instrument shown in FIG.
FIG. 3 is an end view of the splice plate greatly exaggerated in size according to the present invention;
FIG. 4 is a view of the splice plate of FIG; 3 in section taken along line 44;
FIGS. 5a and 5b are a perspective view and a side view respectively showing the relative position of the incision and wire suture according to the present invention;
FIGS. 6a and 6b are a front elevational view and a plan view respectively of a crimping tool according to the present invention; and
FIG. 7 is a plan view of an alternate arrangement of the splice plate and suture according to the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT Referring now to the drawings wherein like reference characters designate identical or corresponding parts throughout the several views, and more particularly to FIGS. 1 and 2 thereof, a wound or incision closing instrument 10 is shown as including a substantially L- shaped member 12 coupled in a manner described below to an angularly shaped member 14 so that the two can move relative to each other. L-shaped member 12 is formed with a first leg 16 integral with and at right angles to a second longer leg 18. Leg 16 has a recessed surface 20 formed in its free end which extends a limited distance and terminates in a knurled vertical wall 22. A knurled wheel 24 is mounted off center about a pivot 26 so that the wheel 24 acts as a cam upon rotation by grasping and turning a spoke 24a and defines a passage 25 in cooperation with wheel 24 which is closable upon rotation of the wheel.
The second, longer leg 18 of member 12 has a straight gear or rack 28 fastened by conventional fasteners 29 within an insert 31 formed therein which extends along a substantial portion of the leg. It should be understood that the rack 28 may also be formed integrally with member 12.
The angular shaped member 14 includes a body portion 30 and a leg 32 formed in a generally L-shaped relationship. The body portion 30 is formed with a channel 34 having a rectangular cross section through which the rack 28 can pass. A pinion gear 36 (shown in phantom in FIG. 1) is pivotally mounted to body portion 30 sufficiently close to channel 34 such that a portion thereof extends therewithin and the teeth of pinion 36 mesh with the teeth of the rack 28. A spoked wheel 44 is connected to gear 36 to provide a means for turning the gear. The spokes are used to permit rotation of gear 36 by one or two fingers of the hand. This makes it easier to use the instrument during surgery. As should be apparent, rotation of the pinion gear 36 by turning the spoke wheel 44 will move member 14 relative to member 12.
A rotatable detent wheel 46 is threadedly mounted in body portion 30 of member 14 adjacent channel 34. The detent wheel 46 includes a lock washer (not shown) positioned directly beneath the wheel and extending over a portion of leg 18 of L-shaped member 12. Rotation of wheel 46 downwardly into body portion 30 will cause the lock washer to bear against the upper surface of leg 18 thereby fixing the position of L-shaped member 12 with respect to angular shaped member 14.
Leg 32 of member 14 has a recessed surface 38 formed in the free end portion thereof and, in a manner like recessed surface in leg 16, is terminated by a vertical knurled wall 40. A knurled wheel 42 is mounted off center about a pivot 41, in a manner similar to wheel 24, so that the wheel can act as a cam, upon rotation by grasping and rotating attached spoke 42a. A second closable passage 43 is defined between the wheel 42 and the wall 40.
Referring more particularly to FIG. 1 and FIG. 2, upon assembly of the instrument 10, it is seen that the passages and 43 are substantially colinear. Further, the lower faces 48 and 50 of the L-shaped member 12 and the angular shaped member 14 respectively do not have any protrusions extending therefrom and are substantially flat. This enables the physician to lay the instrument on the chest cavity of the patient during an operation withoutdanger of causing injury by puncturing or lacerating the body tissue in contact with the instrument. It is to be understood that the two passages may be formed in a manner other than as specifically shown. For example, threaded bores may be formed in the ends of legs 16 and 32 or the closable passages may be formed on a surface laterally extending from each leg.
FIGS. 3 and 4 show one embodiment of a splice plate 52 for use with the present invention, greatly exaggerated in size. Splice plate 52 is a three dimensional body having a rectangular shape and is formed of a suitable biologically acceptable material, such for example, as stainless steel. A pair of bores 56 and 58 are parallely formed adjacent to each other through the long dimension of plate 52. Typical dimensions of splice plate 52 include about 5 millimeters in the long dimension, about 4 millimeters in width and about 2.5 millimeters in thickness (FIG. 3). The diameter of bores 56 and 58 are such that the suture wires used to close the incision or wound can slide through the bores and is typically about 0.94 millimeters. It is to be understood that although the splice plate is shown as substantially rectangular, other shapes may be utilized having dimensions of the same order as those described above.
The operation of the instrument can be ascertained by referring to FIG. 5. The sternum 60 of a patient is shown having an incision 62 formed therein with the periosteum 61 overlying the sternum. As shown in FIG. 5b, a stainless steel wire suture 64 is passed through holes formed on either side of the incision in the sternum, the holes having been previously opened by any suitable instrument. The end portions 64a, 64b of the sture 64 are then directed through bores 56 and 58 in splice plate 52 in opposite directions by the doctor closing the incision.
The doctor next takes the instrument and places the end portions 64a, 64b of suture 64 within passage 25 and the other within passage 43 in the respective legs 16 and 32 of the instrument 10. The instrument can be laid flat on the patients chest at this time. The wheels 24 and 42 are then rotated by spokes 24a and 42a. The camming action of the wheels 24 and 42 grab the respective wire end portions 64a, 64!) between walls 22 and 40 and the respective knurled wheels 24 and 42. The use of the camming action and the spokes on wheels 24 and 42 in combination with the open passages 25 and 43 is advantageous since it is relatively easy to lay the end of the suture in the passages between the wheel and its corresponding knurled wall rather than to thread the suture through a hole, an operation which would become even more difficult when working with a bloody suture wire. Further, the cam arrangement universalizes the instrument for all diameters of suture wire. Also the use of the spokes on the wheels 24, 42 permits easy turning of the latter to provide an arrangement for quickly fastening the ends of the suture to the instrument.
With the detent wheel 46 in a loose position, spoked wheel 44 is rotated by the doctor in the appropriate direction to cause angular shaped member 14 to move away from leg 16. This action causes the loop of wire 64 to tighten. This tightening action is continued thereby drawing together the sides of the sternum adjacent the incision. During or just prior to the inception of the incision closing procedure, the splice plate 52 may be grasped between the jaws 68 of a crimping tool 66 and held therebetween as the sides of the sternum are drawn together. The crimping tool 66 may be a conventional compound pliars tool having identical opposed jaws 68. Each jaw 68 may be formed having a substantially horizontally disposed inwardly projecting surface 69 integrally formed with a bevelled, substantially vertical projection 70 recessed from the inner edge thereof. The surfaces 69 form a platform for the splice plate 52 as it is grasped during the wound closing procedure. The maximum separation of the jaws 68 is preferably fixed so that the space 71 between the projecting surfaces is smaller than the width dimension of the splice plate thereby assuring that the splice plate will not pass therebetween into the non-functional portion of the jaws but rather will be positioned between the bevelled projections 70. As the sternum is drawn together, the handles 72 of crimping tool 66 are squeezed gently so. that the projections 70, although bearing against the sides of the splice plate, will not deform it. After the sternum is closed, the handles 72 are squeezed together tightly thereby causing the bevelled projections to move into and deform the splice plate. The inwardly projecting surfaces 71 serve as a movement limiting device by mutually abutting upon sufficient inward movement. Thus, the amount of deformation is limited by the distance that surfaces 69 extend inwardly. The maximum pinching 74 (FIG. 5a) on each side of the splice plate is preferably about 0.5 mil limeters. Finally, the excess of the wire suture ends 64a, 64b extending through splice plate 52 is sheared off flush with the edge surface of the plate. Thus, no rough edges are left which might injure the patient. This process is repeated between four to six times along the incision until the wound is completely closed.
A particularly efficient arrangement of the instrument and associated apparatus includes the splice plate 52 having the length of suture wire 64 previously passed through one of the bores as shown in FIG. 7. A surgical needle 80 is provided on one end of the wire and the other end of the wire is folded back on itself for about one-eighth inch, thereby maintaining the splice plate along the length of wire. The surgery proceeds much the same as described above. However, several advantages are attained using the alternate configuration of pre-wired splice plate. Openings on either side of the incision need not be previously formed since the surgical needle may be used to do so as the suture is formed. Since the plate has become an intergral part of the easily manipulated suture wire, the difficulty in handling the small splice plate is greatly reduced. One of the in-surgery splice plate hole-finding operations is eliminated for the surgeon since the splice plate is strung onto the suture wire prior to the operation. Further, there is no longer any need to spend time identifying the plate hole size (and therefore wire size) since the plate is now predisposed on the matching suture wire size,
An alternative arrangement of the apparatus includes providing individual splice plates apart from the suture wires and performing the threading procedure during the operation. To provide a measure of caution against inadvertently dropping splice plate 52 into the chest cavity, a thin thread or wire 76 (FIG. 4), for example of silk or other inert material, is attached to the splice plate at a bore 60, formed at one end of plate 52 transverse to bores 56,58. Thus, if the splice plate were dropped during the operation, location of the plate and its retrieval are quick and easy. The attached thread may also be used to preliminarily tag" the splice plate indicating the size wire which may be used in the suture.
In cases where splice plate 52 was made extremely small, the crimping operation was found to be difficult due to the fact that the splice plate tended to fall into a notch 78 (FIG. 5A) left in the periosteum after the incision. For this reason, a minimum length of about 4 millimeters was found to be optimum for the long dimension of the splice plate. Of course, it is preferable for the splice plate to be as small as possible and a long dimension of not more than about 8 millimeters is desirable.
Thus, the surgical instrument described above provides for a controlled tensioning of the suture by a precise rotation by the physician of spoked wheel 44. The flat faces 48 and 50 permit resting the instrument on the body of the patient during the operation. The use of only one hand of the doctor is necessary to operate any of the cams or gears contained in theinstrument thereby allowing the physician free use of the other hand. Further, the danger of exposed rough twisted wire splices irritating or infecting the surrounding body tissue is obviated by the use of the splice plate 52 with a subsequent removal of exposed wire end portions flush therewith.
What is claimed is:
l. A surgical splice plate for locking two end portions of surgical suture wire together comprising:
a member formed of a deformable material which is biologically acceptable to the human body having at least one passage formed therethrough receivable of said suture wire end portions, said member having a long dimension greater than 3 millimeters but does not exceed 9 millimeters,
said splice plate adapted to be implanted within the human body during the closing of an incision subsequent to a surgical operation.
2. A splice plate according to claim 1 wherein said biologically acceptable material is stainless steel.
3. A splice plate according to claim 1 wherein two passages are formed in the splice plate, each passage receivable of an end portion of the suture wire.
4. A splice plate according to claim 3 wherein said passages are generally parallel to each other.
5. A splice plate according to claim 1 wherein an elongate flexible member is attached to said splice plate at one end having means for identifying the splice plate attached to the other end.
6. A suture splicing assembly comprising:
a splice plate for locking two end portions of surgical suture wire together including a member formed of a deformable material which is biologically acceptable to the human body having a pair of substantially parallel passages formed therethrough receivable of said suture wire end portions, said member having a long dimension which does not exceed 9 millimeters, and I a length of suture wire passing through one of said passages, said wire having a surgical needle fastened thereto at one end and the other end folded upon itself, thereby maintaining said wire within said one of said bores.
7. An assembly as recited in claim 6 wherein said splice plate and said suture wire are formed of the same material.
8. An assembly as recited in claim 7 wherein said material is stainless steel.
9. A method for closing an incision in the body of a patient comprising the steps of:
forming a suture by passing a loop of a wire through openings formed in tissue of the patient on opposite sides of the incision;
inserting at least one end portion of said wire through at least one bore formed in a splice plate of deformable material;
tensioning the end portions of said wire in opposite directions in a controlled manner;
crimping said splice plate to fix the ends of the wire therein; and
cutting those portions of wire not within the formed loop flush with said splice plate.
10. A method as recited in claim 9, wherein both end portions of said wire are inserted through said at least one bore in opposite directions.
a m m