US20090248072A1 - Surgical threading device - Google Patents

Abstract

A threading device that includes an elongated tube having first and second opposite ends and a fiberoptic core. The elongated tube includes an interior and a suture securing location defined therein. At least one of the ends of the elongated tube includes a blunt tip that is translucent. The fiberoptic core includes at least one fiberoptic strand extending through the interior of the elongated tube that illuminates the translucent tip when the at least one fiberoptic strand is energized.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 11/566,618, filed Dec. 4, 2006, the entirety of which is incorporated herein by reference
FIELD OF THE INVENTION
• The present invention relates generally to methods and devices for plastic surgery and, more particularly, to a necklift procedure that is minimally invasive and to instruments for performing the procedure.
BACKGROUND OF THE INVENTION
• Conventional neck rejuvenation surgeons advocate procedures that alter the anatomy of the neck to restore a more youthful neck contour. These involve platysmal manipulation such as muscle advancement and/or division, and frequently sub-platysmal fat excision. Partial resection of submandibular gland tissue may be performed as well. These techniques vary in complexity and may result in significant complications, including post-operative bleeding, nerve injury, permanent visible skin deformities caused by muscle division, or over-resection of fat.
• Plastic and reconstructive surgeons have long sought to develop methods and devices to aid in the support of physical structures that have lost their natural tension and support. The most often treated areas include the face, the chest region, the buttocks and other regions that lose tension and sag. Current devices are not always adequate in providing a natural-looking structure to prevent such loss of tension in these structures.
• The aging process causes gradual and predictable changes in the soft tissue layers of the lower face and neck, the anatomical basis of which has been well documented. Loss of elasticity and fragmentation of collagen results in rhytid formation and skin redundancy. Subcutaneous fat thickens and droops or is ptotic and becomes more noticeable. Stretching of the fascia and musculature results in a loss of the supporting ‘sling’ of the submentum, often resulting in submandibular gland ptosis. Further loss of tone and muscular atrophy results in banding of the medial platysmal borders, blunting of the cervicomental angle and loss of lateral mandibular definition.
• The classical necklift's failure in adequately addressing the consequences of aging in the neck has prompted the development of a number of modifications and adjunctive procedures. These include skin excisions, various lipoplasty techniques, anterior or posteriorly based platysmal transection, resection, or plication procedures, SMAS-platysma flaps, and even suture suspension techniques. However, these modifications have their limitations.
• Problems with scar contractures and hypertrophic scarring have resulted in the near abandonment of midline skin excision with subsequent Z, W or T-plasty. Liposuction or direct lipocontouring plays an important role in the aging neck.
SUMMARY OF THE PREFERRED EMBODIMENTS
• In accordance with a first aspect of the present invention, there is provided a method of creating a suture support matrix under the skin of a person. The method includes the steps of connecting a threading device to the first end of a suture, inserting the threading device through a first opening in the skin, pulling the threading device through a second opening in the skin, reinserting the threading device through the second opening in the skin, pulling the threading device through a third opening in the skin, reinserting the threading device through the third opening in the skin, pulling the threading device through a fourth opening in the skin, disconnecting the threading device from the first end of the suture, connecting a threading device to the second end of the suture, inserting the threading device through the first opening in the skin, pulling the threading device through a fifth opening in the skin, reinserting the threading device through the fifth opening in the skin, pulling the threading device through the fourth opening in the skin, disconnecting the threading device from the second end of the suture, and tying the first and second ends of the suture into a knot. The threading device includes an elongated main body portion having first and second opposite ends. The second end of the elongated main body portion is connected to the first end of the suture.
• In preferred embodiments, the first, second, third, fourth and fifth openings include skin ports inserted therein through which the threading device is inserted, and the threading device includes fiberoptic core that lights its tip. In another preferred embodiment, the threading device is connected to a handset before being inserted through the first opening in the skin, and the threading device is disconnected from the handset after at least a portion of the threading device has been pulled through the second opening in the skin.
• In accordance with another preferred embodiment of the present invention, there is provided a threading device that includes an elongated tube having first and second opposite ends and a fiberoptic core. The elongated tube includes an interior and an eyelet defined therein. The first end of the elongated tube includes a blunt tip affixed thereto and the second end includes a threaded connector. The blunt tip is translucent. The fiberoptic core includes at least one fiberoptic strand extending through the interior of the elongated tube that illuminates the translucent tip when the at least one fiberoptic strand is energized.
• In accordance with another preferred embodiment of the present invention, there is provided a threading device that includes an elongated tube having first and second opposite ends and a fiberoptic core. The elongated tube includes an interior and a suture securing location defined therein. At least one of the ends of the elongated tube includes a blunt tip that is translucent. The fiberoptic core includes at least one fiberoptic strand extending through the interior of the elongated tube that illuminates the translucent tip when the at least one fiberoptic strand is energized.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention may be more readily understood by referring to the accompanying drawings in which:
• FIG. 1 is a perspective view of a tape template in accordance with a preferred embodiment of the present invention;
• FIG. 2 is a view of the tape template ofFIG. 1 being used to mark puncture locations on a patient's chin;
• FIG. 3 is a front elevational view of a lancet in accordance with a preferred embodiment of the present invention;
• FIG. 4 is a perspective view of the lancet ofFIG. 3;
• FIG. 5 is a view of the lancet ofFIG. 3 being used to make a puncture;
• FIG. 6 is a side elevational view of a handset in accordance with a preferred embodiment of the present invention;
• FIG. 7 is a sectional side elevational view of the handset ofFIG. 5 showing the fiberoptic core;
• FIG. 8 is a cross-sectional view of the handset ofFIG. 5 before docking with a skin port in accordance with a preferred embodiment of the present invention;
• FIG. 9 is a cross-sectional view showing the skin port inserted through a patient's skin before deployment;
• FIG. 10 is a cross-sectional view showing the skin port inserted through a patient's skin after deployment;
• FIG. 11 is a perspective view of the skin port;
• FIG. 12 is a cross-sectional view of another embodiment of a skin port;
• FIG. 13 is a side elevational view of a threading device in accordance with a preferred embodiment of the present invention;
• FIG. 14 is a sectional side elevational view of the threading device ofFIG. 13;
• FIG. 15 is a view of the threading device ofFIG. 13 being used on a patient;
• FIG. 16 is another view of the threading device ofFIG. 13 being used on a patient;
• FIG. 17 illustrates the threading device ofFIG. 13 passing through the subcutaneous facial ligaments and neurovascular structures.
• FIG. 18 is a side elevational view of a knot positioning implement in accordance with a preferred embodiment of the present invention;
• FIG. 19 is a view of a patient with a threaded skin port placed in the midline sub-mental access site and a suture knot extending therethrough;
• FIG. 20 is a cross-sectional view of the knot positioning implement ofFIG. 15 pushing the knot through the threaded skin port and under a patient's skin;
• FIG. 21 is a side elevational view of a threaded skin port in accordance with a preferred embodiment of the present invention;
• FIG. 22 is a sectional side elevational view of the threaded skin port ofFIG. 21;
• FIG. 23 is a perspective view of the threaded skin port ofFIG. 21;
• FIG. 24 is a side elevational view of a fiberoptic suture in accordance with a preferred embodiment of the present invention; and
• FIG. 25 is a view of a patient with the support matrix shown in hidden lines.
• Like numerals refer to like parts throughout the several views of the drawings.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• Described herein are preferred embodiments of a technique for plastic surgery (e.g., liposuction to a person's chin or jaw area) that only uses one small incision. The technique involves several steps which each require specific instrumentation. The technique is referred to herein as Percutaneous Trampoline Platysmaplasty.
• The liposuction portion of the procedure is performed without a large incision under the chin. The placement of the suture support matrix is performed through several small access sites in the neck area under the jaw. The advantage is that the entire support system can be placed without the typical large incision under the chin that is necessary for the surgeons to see the operative field. In addition the surgery is less invasive and does not require an extensive dissection of the skin in the area under the chin.
• The accurate placement of the support suture (also referred to herein as the support structure orsupport matrix200 and is shown inFIG. 25) will be described herein along with the description of each of the individual instruments or devices that may be used in connection with such procedure.
• As described above, the inventive aspects of the present invention involve the placement of thesupport matrix200 and not the actual liposuction technique. Therefore, it will be understood that any references to liposuction techniques herein are only exemplary.
• It will be appreciated that terms such as “front,” “back,” “top,” “bottom,” “side,” “upwardly” and “downwardly” used herein are merely for ease of description and refer to the orientation of the components as shown in the figures. It should be understood that any orientation of the instruments and articles and the components thereof described herein is within the scope of the present invention.
• Referring toFIGS. 1-2, template tape (or tape members)10 will be described. In a preferred embodiment,tape10 is a clear piece of tape withperforations12 therethrough that are spaced apart at predetermined locations.Tape10 includes adhesive thereon so that it can be secured to the patient's skin. In an exemplary embodiment,tape10 is a one inch wide clear tape with about 2 mmcircular perforations12 defined therethrough that are spaced about every 5 mm along the center of the tape. Theperforations12 are preferably positioned along the longitudinal center of thetape10, however this is not a limitation on the present invention. In another embodiment,tape10 is not clear. In a preferred embodiment,tape10 is provided in roll form. However, this is not a limitation on the present invention.
• Tape10 is used in immediate pre-operative planning to determine the placement ofaccess sites14, which will determine the placement of thesupport matrix200.Tape10 is used as a guide to help provide proper placement of each suture and its corresponding pivot point (as described below).Perforations12 are used to markaccess sites14 for the surgery.
• In a preferred embodiment, first andsecond tape members10 are placed on each side of the skin overlying the undersurface of the mandible, as is shown inFIG. 2. Preferably,tape10 is utilized with the patient sitting upright, which allows the natural neck contours to be visible. This is not a limitation on the present invention, however. The surgeon usestape10 and the plurality ofperforations12 to develop a surgical approach that is individually tailored for each patient, depending on the correction desired. As those skilled in the art will appreciate, placement of thesupport matrix200 will be different for different patients depending on the patient's anatomy.
• The exemplary 5 mm span betweenperforations12 allows placement of pivot points in close proximity. This results in a dense support matrix allowing elevation of muscle and glandular tissue. For example, pivot points may be placed 1-2 cm apart if minimal support is needed. Those skilled in the art will be able to make determinations as to where theaccess sites14 should be located based on the patient's needs. For example, as is shown inFIG. 2, the surgeon has only chosen fouraccess sites14 on each side.
• As shown inFIG. 2, after thetape10 has been placed and the surgeon has determined the structure of thesupport matrix200, the surgeon marks skin exposed through the desiredperforations12 with a surgical marking pen or the like. Thesemarkings14 indicate the areas that require suture placement to elevate the soft tissue of the neck. In a preferred embodiment, as is shown inFIGS. 2 and 5, themarkings14 made using thefirst tape member10 are symmetrical to themarkings14 made using thesecond tape member10.
• As will be described below, each of themarkings14 define a location or access site that will be punctured to allow subcutaneous access at that location. For simplicity, because each access site is marked and then punctured, the access sites, markings and punctures will all be labeled14 herein.
• As will be appreciated by those skilled in the art, in areas where significant platysmal banding or glandular ptosis is evident significant support will be required. To achieve this, multiple suture strands will be required. As each area to be elevated is recognized, a correspondingtape perforation12 is marked14 to insure that suture placement is accurate.
• It will be understood thattape10 is preferably used before performing liposuction. However, this is not a limitation on the present invention. In another embodiment,tape10 can be used after liposuction is performed. In another embodiment, thetape10 can be omitted and the surgeon can mark or puncture the skin as desired.
• It will appreciated by those skilled in the art that thetape10 can be used on areas of the body other than the chin. For example, the tape (and the remainder of the procedure described below) can be used for a cheek lift.
• After the desiredmarkings14 have been made, the patient is ready for liposuction. The patients head and neck are prepped and draped in a sterile fashion and local anesthetic is injected into the area under the chin. A small opening (referred to herein as the midline sub-mental access site) is made in this area. Tumescent fluid is injected into the entire area under the chin, including the neck region. Liposuction is performed on the entire region. Upon completion, the area is once again infiltrated with the tumescent fluid. This subcutaneous infusion results in the elevation of the skin from the platysma muscle.
• With reference toFIGS. 3-5, after completion of liposuction, the patient is ready for placement of thesupport matrix200. Alancet40 is used to createaccess sites14 by puncturing the dermis at the points marked usingtape10.
• As shown inFIG. 3,lancet40 includes ablade42 that has twosharp edges43 that end at apoint44 with twoblunt edges46 therebelow. In a preferred embodiment,blade42 is about 8 mm in length. Blunt edges46 ofblade42 extend from a flange or stopmember48 that preventsblade42 from going deeper into the skin than desired.Flange48 ensures consistent depth of blade penetration. Also,blade42 is sized to allow placement ofskin ports80 as described below.
• Stop member48 has anupper surface48aand alower surface48b. Theblade42 extends upwardly from theupper surface48aof thestop member48. As is shown inFIG. 3, the twosharp edges43 each have first and second ends43aand43b, respectively and the twoblunt edges46 each have first and second ends46aand46b, respectively.
• In a preferred embodiment, the first ends43aof thesharp edges43 meet atpoint44 and extend downwardly frompoint44 at an angle of 90° or less. The first ends46aof the twoblunt edges46 extend downwardly from the second ends43bof the twosharp edges43. The sharp edges43 andblunt edges46 meet at an obtuse angle. The second ends46bof the twoblunt edges46 are connected to thestop member48, which, in a preferred embodiment, is disc-shaped. However, this is not a limitation on the present invention. In an alternative embodiment, theblade42 can extend from thestop member48 at a non-right angle (e.g., an acute angle).
• In a preferred embodiment,lancet40 includes anattachment member50 that extends downwardly from thelower surface48bof thestop member48 and allows thelancet40 to be secured on astandard scalpel handle52. In another embodiment,lancet40 can be provided with a unitary handle.
• The subcutaneous infusion described above results in the elevation of the skin from the platysma muscle. Once infiltrated, theaccess sites14 are developed by puncturing of the skin with thepercutaneous lancet40 at the markings developed usingtape10, as shown inFIG. 5.Lancet40 allows puncturing of the skin in order to gain access to the neck region and preferably ensures that each access site is as small as possible, allowing the placement of thesupport system200.
• It will be understood that in a preferred embodiment,lancet40 creates punctures instead of incisions, which minimalizes trauma and the risk of scarring. However, incisions can be used in another embodiment.
• Referring toFIGS. 6-7, the next instrument used in the procedure is a handset or handle60.Handset60 is embodied in a reusable insertion device with aninstrument dock64 at an end thereof. In a preferred embodiment,handset60 also includes a fiber-optic light port62. In a preferred embodiment, the handset is ergonomically designed to fit into the surgeon's hand when gripped. However, this is not a limitation on the present invention. Preferably,handset60 is made of a metal, such as stainless steel or titanium. However, it can be made of other materials, such as a plastic or the like. As is described below,instrument port64 is compatible with a number of the instruments that are used in the inventive surgical procedure. The design structure and form allows right to left hand interchangability with ease and precision.
• In a preferred embodiment,instrument dock64 includes an inner threaded surface or threadedfemale connector66 and a largermale connector68 that interlocks with the skin ports80 (described below) allowing deployment and illumination. Theinstrument dock64 is adapted to dock with certain instruments, as will be described more fully below.Handset60 will be described more fully below in conjunction with the instruments with which it is intended to be used.
• The fiberopticlight port62 allows docking with a fiberoptic light cord (not shown). The transmission of fiberoptic light through thehandset60 illuminates each device when it is attached to the working end orinstrument dock64.
• In a preferred embodiment, thehandset60 includes afiberoptic core70, which is made up of at least one, and preferably a plurality, of fiberoptic strands. When a fiberoptic light cord is connected tolight port62, the light is transmitted through the fibers and out through anopening72 that is coaxial withfemale connector66.
• In another embodiment other types of lighting can be used. For example, LED, incandescent, fluorescent and other light sources can be used. However, it will be understood that the light transmission is not a limitation on the invention. The handset60 (and associated instruments) can be provided without a fiberoptic core.
• FIGS. 8-11 show askin port80. In a typical procedure, a plurality ofskin ports80 are used. In a preferred embodiment,skin ports80 are disposable clear plastic sleeves that are each inserted into one of theaccess sites14 created bylancet40.
• Generally,skin port80 includes a flange orcuff82 that has atube84 that extends from it. One end of the tube orsleeve84 is inserted into thepuncture14 in the skin until theflange82 rests against the outer surface of the skin. Theflange82 andtube84 cooperate to define atunnel86 that will provide access to the area under the skin. Preferably, theport80 is comprised of colored clear plastic. However, theport80 can also be made of other materials, does not have to be clear and does not have to be colored.
• In a preferred embodiment, thehandset60 is used to deploy eachport80 through theindividual access sites14. Preferably, theskin ports80 come in a kit, however this is not a limitation on the present invention. Thehandset60 design allows quick interlocking with theskin port80 to remove it from the kit. It will be understood that any design that allows thehandset60 to interlock with or engage theskin port80 so that it can be deployed into theaccess site14 is within the scope of the present invention.
• In a preferred embodiment, theport80 is snap fit onto themale connector68. For example, as shown inFIG. 8, themale connector68 can include aridge68aextending circumferentially therearound that cooperates with anindented ring82ain theflange82. Theridge68aandindented ring82aprovide a snap fit so that theport80 is engaged with themale connector68 of thehandset60. Other snap fit arrangements are contemplated.
• Thetube84 is then inserted through theaccess site14. As shown inFIGS. 8-11, in a preferred embodiment, theskin port80 includes an anchor system that comprisesthreads88 on the outer surface of thetube84 and afolding mechanism90. Thefolding mechanism90 preferably includes a pair offolding members90athat are attached to an internally threadedring90bthat moves up and down thetube84 onthreads88.
• As is shown inFIG. 8, themale connector68 includes a plurality ofteeth68bon an end thereof that are adapted to interlock withteeth82bon theport80. When theport80 is engaged with theinstrument dock64,teeth68bengage or mesh withteeth82b. After thetube84 has been inserted through theaccess site14, to deploy thefolding mechanism90, thehandset60 is turned in a clockwise direction (port80 can be designed to deploy in a counter-clockwise direction as well). Becauseteeth68band82bare engaged, thetube84 turns withhandset60 and withinflange82, thereby causing the internally threadedring90bto move upwardly alongthreads88. As can be seen inFIG. 11,folding members90ainclude afold crease90c. As threadedring90bmoves upwardly, thefolding members90afold, as shown inFIG. 10, thereby providing an anchor and preventingport80 from pulling out ofaccess site14. Thefolding members90acan be disposed in an unfolded position (FIG. 9) and a folded position (FIG. 10).
• In a preferred embodiment,flange82 includes a plurality ofspikes94 extending downwardly therefrom that burrow into the skin and help anchor theport80 in place.
• During placement of theport80, because thehandset60 includes thefiber optic core70 and theskin port80 is clear, upon insertion, transcutaneous visualization of the lighted probe tip will allow safe deployment ofskin port80. Because of the anchoring system, as the handset is withdrawn, theridge68apulls out of theindented ring82aand theskin port80 is secured in place. In another embodiment, the surgeon can use his/her thumb to aid in separating theport80 from theinstrument dock64.
• Preferably, theports80 are disposable and are only used for a single surgery. It will be understood that the ports are simply used to gain access to the surgical field. Therefore, the type of port used is not a limitation on the present invention. Any type of port that provides access through the skin is within the scope of the present invention. The transillumination of light gives three dimensional feedback to the surgeon.
• As shown inFIG. 12, in an alternative embodiment,port96 can have atube84 that is oriented at a non-right angle with respect to theflange82. For example,tube84 can be oriented at a 45 degree angle with respect to the flange.
• FIGS. 13-17 show athreading device100. In a preferred embodiment,threading device100 is a stainless steel malleable rod or tube that includes aneyelet102 defined therein and a rounded,blunt tip104. Preferably,threading device100 also includes afiberoptic core106 allowing illumination oftip104. In this embodiment, thetip104 is preferably made of a translucent material, such as a plastic that is affixed to the main body of thethreading device100.Threading device100 includes anend108 that is designed to dock withinstrument dock64 ofhandset60. In a preferred embodiment, end108 is threaded for engagement withfemale connector66, however, it will be appreciated thatend108 can dock withinstrument dock64 in a number of different ways. For example,instrument dock64 can include a set screw that holds threadingdevice100 in place or some type of snap or press fit can be provided. In another embodiment, a clamp or chuck, similar to that on a drill can be used. Also, end108 can be internally threaded and can dock with an externally threaded instrument dock.Instrument dock64 allows quick connection and disconnection withthreading device100.
• In an embodiment wherehandset60 includes a fiber-optic light port62, docking of end108 (which includes anopening108atherein) withinstrument dock64 allows the transmission of light to tip104 of threadingdevice100. In another embodiment other types of lighting can be used. For example, LED, incandescent, fluorescent and other light sources can be used.
• It will be understood that,eyelet102 is used to secure thesuture150. Eyelet102 can be located anywhere along threadingdevice100.
• In use, threading device100 (and suture150) are inserted through thevarious skin ports80 and thesupport matrix200 is weaved and created.
• An exemplary construction of asupport matrix200 will now be described. For example, as shown inFIG. 15, afterfirst end150aof thesuture150 is connected to eyelet102, thehandset60 is grasped by the surgeon and the threading device is inserted through afirst skin port80a. The lightedtip104 of threadingdevice100 illuminates the work area and transilluminates through the skin allowing the surgeon to determine the proper placement of thesupport matrix200 and the location of thetip104. As described above, in a preferred embodiment,port80 is clear for aiding in the passage of thethreading device100. In other words, when thetip104 of threadingdevice100 gets close toport80 it will transilluminate.
• Thethreading device100 is preferably long enough that it can be threaded from one side of the jaw line to the other such that thetip104 is brought out through asecond skin port80bon the opposite side of the jaw from which it was inserted. At this point, thetip104 is grasped by the surgeon and thesuture150 is pulled through the area under the neck. Then thethreading device100 is disconnected from thehandset60 allowing thethreading device100 and thesuture150 to be pulled through thesecond skin port80b, as is shown inFIG. 16.
• Thethreading device100 is then turned and reconnected to thehandset60 and is then reinserted throughsecond skin port80band is passed subcutaneously to the contralateral side exiting throughthird skin port80c. Thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled throughthird skin port80c.
• Next, thethreading device100 is turned and reconnected to thehandset60 and is then reinserted throughthird skin port80cand is passed subcutaneously to the contralateral side exiting throughfourth skin port80d. At this point, thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled throughfourth skin port80d.
• Thethreading device100 is then turned and reconnected to thehandset60 and is then reinserted throughfourth skin port80dand is passed subcutaneously to the contralateral side exiting throughfifth skin port80e. At this point, thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled throughfifth skin port80e.
• Next, thethreading device100 is turned and reconnected to thehandset60 and is then reinserted throughfifth skin port80eand is passed subcutaneously to the midline sub-mental access site which preferably includes a threaded skin port120 (described more fully hereinbelow). Thethreading device100 andfirst end150aofsuture150 are pulled through the threadedskin port122 and the threading device is disconnected from thehandset60. Thefirst end150aofsuture150 is then cut from and/or untied from thethreading device100.
• Now, the second end (or distal end)150bofsuture150, which is extending fromfirst skin port80ais secured to theeyelet102 of thethreading device100 and thethreading device100 is connected to thehandset60. Thehandset60 is grasped by the surgeon and the threading device is inserted through thefirst skin port80aand is passed subcutaneously to the contralateral side exiting throughsixth skin port80f. At this point, thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled throughsixth skin port80f.
• Next, thethreading device100 is turned and reconnected to thehandset60 and is then reinserted throughsixth skin port80fand is passed subcutaneously to the contralateral side exiting throughseventh skin port80g. At this point, thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled throughseventh skin port80g.
• Thethreading device100 is then turned and reconnected to thehandset60 and is then reinserted throughseventh skin port80fand is passed subcutaneously to the contralateral side exiting througheighth skin port80h. At this point, thethreading device100 is once again disconnected from thehandset60 and is reconnected after the threading device andsuture150 are pulled througheighth skin port80h.
• Next, thethreading device100 is turned and reconnected to thehandset60 and is then reinserted througheighth skin port80hand is passed subcutaneously to the threadedskin port120 at the midline sub-mental access site. Thethreading device100 andsecond end150bofsuture150 are pulled through the threadedskin port120 and the threading device is disconnected from thehandset60.
• As will be understood by those skilled in the art, thetube84 on theskin ports80 is long enough that when thethreading device100 is inserted therethrough thesuture150 will anchor itself by encircling the facial retaining ligaments during the procedure described above. Preferably, each time thethreading device100 andsuture150 are passed through aport80, the suture is secured on the facial retaining ligaments, thereby creating an anchor or pivot point.
• It will be understood that the number ofaccess sites14,ports80 and/or passes, etc. described above are merely exemplary and any number can be used in the presently described procedure, as required by the particular surgery.
• Transcutaneous light transmission from thetip104 of thethreading device100 gives feedback allowing the surgeon to determine the location of thetip104 as thesupport matrix200 is weaved and created. This feedback allows the placement of each individual strand relative to areas of needed support. This allows placement of thesuture strands150 adjacent to the muscle, deep to the skin and fat layers.
• Preferably, in eachport80, the end of thetube84 that is associated with theflange82 has a beveled or taperededge84a, which helps prevent thetip104 of thethreading device100 from catching inside thetunnel86, during insertion.
• In another embodiment, twothreading devices100 that are each connected to an opposite end of thesuture150 can be used. In this embodiment thefirst threading device100 does not have to be disconnected from the end of thesuture150 before the second end of thesuture150 is threaded through the skin. In yet another embodiment, thesuture150 can come in a kit with twodisposable threading devices100 attached to the opposite ends150aand150b. After forming thematrix200, thethreading devices100 can be cut from thesuture150 and then the suture can be tied.
• FIGS. 19-23 show the threadedskin port120 used for the midline sub-mental access site. The threadedskin port120 is inserted at the same time as theskin ports80 described above. However, this is not a limitation on the present invention. Theport120 includes aflange122 having atube124 extending therefrom. Thetube124 is preferably threaded126. As is shown inFIG. 22, thetube124 andflange122 cooperate to define atunnel128 therethrough. In a preferred embodiment, the portion of thetunnel128 in theflange122 includes a beveled or taperededge128a.
• In a preferred embodiment, theport120 includes a pair ofhandle portions130 extending upwardly from theflange122 that aid the surgeon in threading theport120 into the midline sub-mental access site. However, thehandle portions130 are not a limitation on the present invention and can be omitted. It will be understood that any skin port that allows access through the skin is within the scope of the present invention. For example,skin port80 or something similar can be used at the midline sub-mental access site. In another embodiment,port120 can be used ataccess site14. In a preferred embodiment,port120 is clear for aiding in the passage of thethreading device100. In other words, when thetip104 of threadingdevice100 gets close to theport120 it will transilluminate.
• In use, thetube124 is inserted into the midline sub-mental access site. Thehandle portions130 are grasped and theport120 is turned so that thethreads126 are threaded into the skin until the bottom surface of theflange122 rests against the outer surface of the skin.
• In another embodiment, a port similar toskin port80 described above, but somewhat modified can be used for mid-line access. In this embodiment, the flange includes a threaded interior that engages the threads on the exterior of the tube. The distal ends of the folding members are connected to a ring that is not internally threaded. This ring allows the tube to rotate therein, but (because it is not internally threaded) does not cause the ring to ride up the threads of the tube. The opposite ends of the folding members are connected to the flange.
• With this configuration, when the tube is rotated (preferably by engagement with the handset or with a surgeon's fingers), the threaded engagement of the exterior of the tube with the interior of the flange causes the tube to move outwardly (with respect to the interior of a patient's body). This action causes the folding members to fold at the crease. In use with a patient, in the folded position, the proximal end of the tube is located outside of the patient's body, and the distal end has moved closer to the flange than it was in the unfolded position.
• With reference toFIGS. 18-20, a knot positioning implement140 is shown and described. After both ends150aand150bof thesuture150 are threaded and thesupport matrix200 has been created, the two suture ends150aand150bare brought out through the midline sub-mental access site (through port120), as is shown inFIG. 19. Asingle throw knot150cis placed (it will be understood that the type of knot is not a limitation on the present invention) and the knot positioning implement140 is utilized to set theknot150c.
• Oneend142 of the knot positioning implement140 (which is preferably threaded) docks with thehandset60 and theother end144 is forked. The forkedend144 is used to push theknot150cthrough thetunnel128 of threadedskin port120 and under the skin. In a preferred embodiment, the knot positioning implement140 includes afiber optic core152 and anopening152athrough which light is transmitted to illuminate the work area when placing theknot150c.
• After theknot150chas been pushed through the threadedport120, threadedport120 is twisted out of the access site and theother skin ports80 are removed using thehandset60. To do this, themale connector68 is inserted into theport80 so that theridge68asnaps into theindented ring82aand theteeth68band82bengage one another. Thehandset60 is then twisted, thereby turningtube84 and causing the internally threadedring90bto travel back downthreads88 and unfolding folding thefolding members90a. In another embodiment, theports80 can be removed by hand.
• After atraumatic removal of theports80 and120, steristrips are then placed as desired and a neck compression garment is fitted onto the patient. SeeFIG. 25 for the final configuration of theexemplary support matrix200.
• In a preferred embodiment, the suture that is used in the procedure is a 4.0 braided polyester suture. In a more preferred embodiment, as shown inFIG. 24, the suture design contains at least onefiberoptic strand150dintertwined with the non-fiberoptic strands. Thesuture150 is braided as is known in the art with one, two or three fiberoptic strands and one or two non-fiberoptic strands, as is desired. This aids in the transillumination of thesuture150 to check subcutaneous placement after thesuture150 has been placed. Thefiberoptic strand150dwill illuminate when thehandset60 fiberoptic light coupled with the knot placement implement140 is approximated to the suture during tying. Light transmitted to the suture allows the surgeon to visualize placement of thesupport matrix200 as it is secured. The non-fiberoptic strands can be made of any material known in the art, such as nylon, polypropylene, or other non-absorbable material.
• At any point during the creation of thesupport matrix200, suture placement can be confirmed by placing the handset60 (or any light source) at one of theends150aor150bof thesuture150, thereby transmitting light down thefiberoptic strand150dto check placement of thesuture150.
• The illumination of the suture pathway allows the surgeon to determine the location of the suture. Overall, suture illumination gives the surgeon feedback relating to the anatomical movement of each pivot point.
• It will be appreciated by those skilled in the art that the fiberoptic suture can be utilized in all areas of surgery or other materials where a lit binding material is needed, and not just in the technique described herein. In another embodiment, the threading device may be a straight or curved needle. Application of light energy during a surgical procedure will confirm suture placement and accuracy. Application of light post-operatively could allow surgeons to understand the evolution of suture placement related to time and aging.
• In an alternative embodiment, the neck skin can be elevated from the platysma muscle via an incision similar to that used in the standard procedure discussed above to allow the surgeon to visualize the operative field and then the suture matrix can be placed through theports80 andaccess sites14.
• It is contemplated that the above described instruments can be sold in kits. For example, a kit with all or any combination of the instruments, including thetape10, a marking pen,lancet40,handset60,skin ports80,threading device100, threadedskin port120, knot positioning implement140 andsuture150 can be sold.
• The embodiments described above are exemplary embodiments of the present invention. Those skilled in the art may now make numerous uses of, and departures from, the above-described embodiments without departing from the inventive concepts disclosed herein. Accordingly, the present invention is to be defined solely by the scope of the following claims.

Claims (17)

1. A threading device for suturing, the device comprising:

a. an elongated tube having first and second opposite ends, an interior and a suture securing location, wherein at least one of the first and second ends of the elongated tube includes a blunt tip, wherein the blunt tip is translucent, and

b. a fiberoptic core comprising at least one fiberoptic strand extending through the interior of the elongated tube, whereby the translucent tip is illuminated when the at least one fiberoptic strand is energized.

2. The threading device ofclaim 1 wherein the elongated tube is malleable.

3. The threading device ofclaim 2 wherein the suture securing location is defined at approximately the longitudinal center of the elongated tube.

4. The threading device ofclaim 3, wherein the elongated tube is made of metal.

5. The threading device ofclaim 1 further comprising a suture permanently attached to the suture securing location.

6. The threading device ofclaim 3 further comprising a suture secured to the suture securing location.

7. The threading device ofclaim 3 further comprising a suture permanently attached to the suture securing location.

8. A threading device for suturing, the device comprising:

a. an elongated tube having first and second opposite ends and an interior, wherein at least one of the first and second ends of the elongated tube includes a blunt tip, wherein the blunt tip is translucent, wherein the elongated tube is malleable,

b. a fiberoptic core comprising at least one fiberoptic strand extending through the interior of the elongated tube, whereby the translucent tip is illuminated when the at least one fiberoptic strand is energized, and

c. a suture permanently attached to the elongated tube at approximately the longitudinal center thereof.

9. A method of creating a suture support matrix under the skin of a person, the method comprising the steps of

a. providing a suture having first and second opposite ends, wherein the suture has a first threading device connected to the first end and a second threading device connected to the second end, wherein the first and second threading devices each include an elongated main body portion having first and second opposite ends,

b. inserting the first threading device through a first opening in the skin,

c. pulling at least a portion of the first threading device through a second opening in the skin,

d. reinserting the first threading device through the second opening in the skin,

e. pulling the first threading device through a third opening in the skin,

f. disconnecting the first threading device from the first end of the suture,

g. inserting the second threading device through the first opening in the skin,

h. pulling the at least a portion of the second threading device through a fourth opening in the skin,

i. reinserting the second threading device through the fourth opening in the skin,

j. pulling the second threading device through the third opening in the skin,

k. disconnecting the second threading device from the second end of the suture, and

l. tying the first and second ends of the suture into a knot.

10. The method ofclaim 9 wherein the user performing the method connects the first and second ends of the suture to the first and second threading devices, respectively.

11. The method ofclaim 9 wherein the first and second ends of the suture are permanently connected to the first and second threading devices, respectively.

12. The method ofclaim 9 wherein the first and second threading devices each include at least one lighted tip.

13. The method ofclaim 12 wherein the first and second threading devices each include a fiberoptic core.

14. The method ofclaim 9 wherein the first threading device is connected to a handset before being inserted through the first opening in the skin, and wherein the first threading device is disconnected from the handset after at least a portion of the first threading device has been pulled through the second opening in the skin.

15. A method of creating a suture support matrix under the skin of a person, the method comprising the steps of

a. connecting a threading device to the first end of a suture, wherein the threading device includes an elongated main body portion having first and second opposite ends,

b. inserting the threading device through a first opening in the skin,

c. pulling at least a portion of the threading device through a second opening in the skin,

d. reinserting the threading device through the second opening in the skin,

e. pulling the threading device through a third opening in the skin,

f. disconnecting the threading device from the first end of the suture,

g. connecting a threading device to the second end of the suture,

h. inserting the threading device through the first opening in the skin,

i. pulling the threading device through a fourth opening in the skin,

j. reinserting the threading device through the fourth opening in the skin,

k. pulling the threading device through the third opening in the skin,

l. disconnecting the threading device from the second end of the suture, and

m. tying the first and second ends of the suture into a knot.

16. The method ofclaim 15 wherein the threading device connected to the first and second ends of the suture is the same threading device.

17. The method ofclaim 15 wherein the threading device connected to the first end of the suture is different from the threading device connected to the second end of the suture.

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