US20100106112A1 - Wound irrigation device - Google Patents

Abstract

An apparatus includes a fluid permeable dressing and a cover membrane configured to extend over the fluid permeable dressing. A tube is coupled to the fluid permeable dressing and is configured to apply suction through the fluid permeable dressing. A fluid reservoir is coupled to the cover membrane, the fluid vessel including an inlet port configured to receive a fluid and an outlet port fluidically coupled to the fluid permeable dressing.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application is a divisional of U.S. patent application Ser. No. 11/851,944, entitled “Wound Irrigation Device,” filed on Sep. 7, 2007, which is a divisional of U.S. patent application Ser. No. 11/237,880, entitled “Wound Irrigation Device,” filed on Sep. 29, 2005, which is a continuation of U.S. patent application Ser. No. 11/198,148, entitled “Wound Irrigation Device,” filed Aug. 8, 2005, now abandoned; each of which is hereby incorporated by reference in its entirety.
BACKGROUND
• The invention is generally directed to a method and apparatus for the promotion of wound healing. More particularly, the present invention relates to providing fluid irrigation and vacuum drainage of a wound. Negative pressure wound therapy, also known as vacuum drainage or closed-suction drainage is known. A vacuum source is connected to a semi-occluded or occluded wound dressing. Various porous dressings comprising gauze, felts, foams, beads and/or fibers can be used in conjunction with an occlusive semi-permeable cover and a controlled vacuum source.
• In addition to using negative pressure wound therapy, many devices employ concomitant wound irrigation. For example, a known wound healing apparatus includes a porous dressing made of polyurethane foam placed adjacent a wound and covered by a semi-permeable and flexible plastic sheet. The dressing further includes fluid supply and fluid drainage connections in communication with the cavity formed by the cover and foam. The fluid supply is connected to a fluid source that can include an aqueous topical antibiotic solution or isotonic saline for use in providing therapy to the wound. The fluid drainage can be connected to a vacuum source where fluid can be removed from the cavity and subatmospheric pressures can be maintained inside the cavity. The wound irrigation apparatus, although able to provide efficacious therapy, is somewhat cumbersome, difficult to use, and generally impractical. Such a device does not address various factors concerning patients, specifically ease of use, portability and the ability to provide therapy with a minimum amount of unwanted mechanical noise.
• Other devices use vacuum sealing of wound dressings consisting of polyvinyl alcohol foam cut to size and stapled to the margins of the wound. The dressings are covered by a semi-permeable membrane while suction and fluid connections are provided by small plastic tubes introduced subcutaneously into the cavity formed by the foam and cover. Such devices alternate in time between vacuum drainage and the introduction of aqueous medicaments to the wound site. Such devices also fail to address portability, ease of use and noise reduction.
SUMMARY OF THE INVENTION
• One embodiment of the invention is directed to a wound irrigation system using an electromechanical vacuum apparatus that includes a microprocessor-based device having stored thereon software configured to control the electromechanical vacuum apparatus. A first vacuum pump is electrically associated with the microprocessor and is capable of generating a vacuum. An optional second vacuum pump is electrically associated with the microprocessor and is capable of maintaining a predetermined vacuum level. A first electronic vacuum-pressure sensor is operably associated with the vacuum pump(s) and said microprocessor for monitoring vacuum level. A fluid-tight collection canister includes an integrated barrier to prevent contents from escaping the canister. Canulated tubing is associated with the canister and vacuum pump(s) for communicating vacuum pressure therefrom. A second electronic vacuum-pressure sensor is operably associated with the canister and the microprocessor for monitoring canister vacuum. A dressing includes of a porous material and semi-permeable flexible cover, Canulated tubing is associated with the dressing and the canister to communicate vacuum pressure therefrom. An irrigation vessel contains a fluid to be used in irrigating the wound. Canulated tubing is associated with the irrigation vessel and the dressing to communicate fluid thereto. The electromechanical vacuum apparatus has an integrated compartment that can hold the irrigation vessel. The electromechanical vacuum apparatus may optionally include a device for regulating the quantity of fluid flowing from said irrigation vessel to said dressing. The electromechanical vacuum apparatus may include batteries enabling portable operation thereof.
• An embodiment of the invention includes a method for improving the generation and control of a therapeutic vacuum. In this embodiment, a multi-modal algorithm monitors pressure signals from a first electronic vacuum-pressure sensor associated with a vacuum pump and capable of measuring the output pressure from the pump. The algorithm further monitors pressure signals from a second electronic vacuum-pressure sensor associated with a collection canister and capable of measuring the subatmospheric pressure inside the canister. The canister is connected to the vacuum pump by a canulated tube that communicates subatmospheric pressure therefrom. The canister is connected to a suitable dressing by a canulated tube that communicates subatmospheric pressure thereto. At the start of therapy, both the first and second electronic vacuum-pressure sensors indicate the system is equilibrated at atmospheric pressure. A first-mode control algorithm is employed to remove rapidly the air in the canister and dressing, and thus create a vacuum. The first-mode implemented by the control algorithm is subsequently referred to herein as the “draw down” mode. Once the subatmospheric pressure in the canister and dressing have reached a preset threshold as indicated by the first and second electronic vacuum-pressure sensors respectively, the algorithm employs a second-mode that maintains the desired level of subatmospheric pressure in both the canister and the dressing for the duration of the therapy. The second-mode implemented by the control algorithm is subsequently referred to herein as the “maintenance” mode. The second-mode control algorithm is configured to operate the vacuum pump at a reduced speed thus minimizing unwanted mechanical noise. In an alternative embodiment, a second vacuum pump can be used for the maintenance mode, which has a reduced capacity, is smaller, and produces significantly lower levels of unwanted mechanical noise. The second-mode control algorithm is configured to permit the maintenance of vacuum in the presence of small leaks, which invariably occur at the various system interfaces and connection points. The method can be performed by, for example, a microprocessor-based device.
• In another embodiment application-specific dressings are configured according to the individual needs of varying wound types. A myriad of new materials that broadly fall into the categories of antibacterial, biodegradable, and bioactive can be used to create highly efficacious wound dressings. For a material to function with a wound irrigation and vacuum drainage system, the dressing composition can be porous enough to permit the uniform distribution of subatmospheric pressure throughout the dressing and subsequently to facilitate the removal of fluids therethrough. In addition, the dressings possess various mechanical properties that can create the proper macro-strain and micro-strain on the wound bed believed to contribute to the production of growth factors and other cytokines that promote wound healing. Accordingly, some embodiments include several dressing arrangements that use, for example, the aforementioned materials to produce dressings for specific wound types.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a schematic block diagram of an embodiment of the invention for providing wound irrigation and vacuum drainage.
• FIG. 2 is a flow diagram for a method according to an embodiment of the invention.
• FIG. 3 is an illustration of a maintenance-mode control circuit according to an embodiment of the invention.
• FIG. 4 is an illustration of a maintenance-mode control circuit according to another embodiment of the present invention.
• FIGS. 5A-5C are illustrations of a device according to an embodiment of the invention for providing portable wound irrigation and vacuum drainage.
• FIG. 6 is a second illustration of a device according to an embodiment of the invention for providing portable wound irrigation and vacuum drainage.
• FIG. 7 is a third illustration of a device according to an embodiment of the invention for providing portable wound irrigation and vacuum drainage.
• FIG. 8 is an illustration of an application-specific dressing according to an embodiment of the invention incorporating an antibiotic silver mesh between the dressing substrate and wound.
• FIG. 9 is an illustration of an application-specific dressing according to an embodiment of the invention incorporating biodegradable materials in the dressing.
• FIG. 10 is an illustration of an application-specific dressing according to an embodiment of the invention incorporating bioactive materials in the dressing.
DETAILED DESCRIPTION
• Although those of ordinary skill in the art will readily recognize many alternative embodiments, especially in light of the illustrations provided herein, this detailed description is of an embodiment of the invention, the scope of which is defined only by the claims appended hereto.
• As illustrated inFIG. 1, a wound irrigation and vacuum drainage system is referred to by the numeral100 and generally includes amicrocontroller101 having an embeddedmicroprocessor102, Random Access Memory (RAM)103 and Read Only Memory (ROM)104.ROM104 contains the programming instructions for a control algorithm150 (seeFIG. 2).ROM104 is non-volatile and retains its programming when the power is terminated.RAM103 is utilized by the control algorithm for storing variables such as pressure measurements, alarm counts and the like, which thecontrol algorithm150 uses while generating and maintaining the vacuum. A membrane keypad anddisplay160 is electrically associated withmicrocontroller101 throughcommunication cable164. Membrane switches161 provide power control andmembrane switches162 are used to preset the desired vacuum levels. Light emitting diodes (LEDs)163 are provided to indicate alarm conditions associated with canister fluid level and dressing leaks.
• Microcontroller101 is electrically associated with, and controls the operation of; afirst vacuum pump105 and an optionalsecond vacuum pump107 throughelectrical cables106 and108 respectively.First vacuum pump105 and optionalsecond vacuum pump107 can be one of many types including, for example, the pumps sold under the trademarks Hargraves® and Thomas®. Vacuum pumps105 and107 can use, for example, a reciprocating diaphragm or piston to create vacuum and are typically powered by a D.C. motor that can also optionally use a brushless commutator for increased reliability and longevity. Vacuum pumps105 and107 are pneumatically associated with anexudate collection canister114 through a single-lumen tube115. In one embodiment,canister114 has a volume which does not exceed 1000 ml. This can prevent accidental exsanguination of a patient in the event hemostasis has not yet been achieved at the woundsite.Canister114 can be of a custom design or one available off-the-shelf and sold under the trademark Medi-VAC®. In addition, afluid barrier129 is associated withcanister114 and is configured to prevent fluids collected incanister114 from escaping into tubing115 and fouling the vacuum return path.Barrier129 can be of a mechanical float design or may have one or more membranes of hydrophobic material such as those available under the trademark GoreTex™. Asecondary barrier113 using a hydrophobic membrane is inserted inline with pneumatic tubing115 to prevent fluid ingress into the system in theevent barrier129 fails to operate as intended. Pneumatic tubing115 connects tofirst vacuum pump105 and optionalsecond vacuum pump107 through “T”connectors111 and112 respectively.
• Vacuum-pressure sensor109 is pneumatically associated withfirst vacuum pump105 andoptional vacuum pump107 and electrically associated withmicrocontroller101 throughelectrical cable110.Pressure sensor109 provides a vacuum-pressure signal to themicroprocessor102 enablingcontrol algorithm150 to monitor vacuum pressure at the outlet of thevacuum pumps105 and107. Anacoustic muffler128 is pneumatically associated with the exhaust ports ofvacuum pumps105 and107 and is configured to reduce induction noise produced by the pumps during operation. In normal operation ofirrigation system100,first vacuum pump105 is used to generate the initial or “draw-down” vacuum while optionalsecond vacuum pump107 can be used to maintain a desired vacuum within the system compensating for any leaks or pressure fluctuations.Vacuum pump107 can be smaller and quieter thanvacuum pump105 providing a means to maintain desired pressure without disturbing the patient.
• Abattery127 is optionally provided to penult portable operation of thewound irrigation system100.Battery127, which can be Nickel-Metal-Hydride (NiMH), Nickel-Cadmium, (NiCd) or their equivalent, is electrically associated withmicrocontroller101 throughelectrical cables136 and137.Battery127 is charged by circuits related withmicrocontroller101 while an external source of power is available. When an external source of power is not available and the unit is to operate in a portable mode,battery127 supplies power to thewound irrigation system100.
• Asecond pressure sensor116 is pneumatically associated withcanister114 through a single-lumen tube119.Pressure sensor116 is also electrically associated withmicrocontroller101 and provides a vacuum-pressure signal tomicroprocessor102 enablingcontrol algorithm150 to monitor vacuum pressure insidecanister114 and dressing123. A “T”connector118 is connectedpneumatic tube119 topressure sensor116 and a vacuum-pressure relief solenoid120 configured to relieve pressure in thecanister114 and dressing123 in the event of an alarm condition, or if power is turned off.Solenoid120, can be, for example, one available under the trademark Pneutronics®;Solenoid120 is electrically associated with, and controlled by,microprocessor101 throughelectrical cable130.Solenoid120 is configured to vent vacuum pressure to atmosphere when the electrical coil is de-energized as would be the case if the power is turned off. Anorifice restrictor121 is provided inline withsolenoid120 andpneumatic tube119 to regulate the rate at which vacuum is relieved to atmospheric pressure whensolenoid120 is de-energized.Orifice restrictor121 is, for example, available under the trademark AirLogic®.
• A wound dressing123 includes a sterileporous substrate131, which can be a polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material, a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®, aninlet port134 and asuction port135.Dressing substrate131 is configured to distribute evenly the vacuum pressure throughout the entire wound bed and has mechanical properties suitable for promoting the formation of granular tissue. In addition, when vacuum is applied to dressing123,substrate131 creates micro- and macro-strain at the cellular level of the wound stimulating the production of various growth factors and other cytokines and promoting cell proliferation. Dressing123 is fluidically associated withcanister114 through a single-lumen tube122. The vacuum pressure in the cavity formed bysubstrate131 of dressing123 is largely the same as the vacuum pressure insidecanister114 minus the weight of any standing fluid insidetubing122. Afluid vessel124, which can be a standard I.V. bag, contains medicinal fluids such as aqueous topical antibiotics, physiologic bleaches, or isotonic saline.Fluid vessel124 is removably connected to dressing132 thoughport134 and single-lumen tube125. An optionalflow control device126 can be placed inline withtubing125 to permit accurate regulation of the fluid flow fromvessel124 to dressing123. In normal operation, continuous woundsite irrigation is provided as treatment fluids move fromvessel124 through dressing123 and intocollection canister114. This continuous irrigation keeps the wound clean and helps to manage infection. In addition, effluent produced at the woundsite and collected bysubstrate131 will be removed tocanister114 when the system is under vacuum.
• Referring toFIG. 2, an example of the general processing steps ofalgorithm150 are illustrated.Algorithm150 includes a continuously executing “Main Loop”270 having six functional software modules:Initialization module210, CheckMembrane Switches module220,Update Display module230, UpdateVacuum Control module240, Check for Alarms (full canister, leak, internal)module250, and ResetWatchdog Timer module260.
• Atinitialization step210, all the variables associated with the operation of thecontrol algorithm150 are reset. Theinitialization step210 can execute, for example, when power is applied to the system. The variables that can be reset include, for example, alarm flags, alarm time counters, pressure targets, pressure limits and internal variables used for storing mathematical calculations.
• Atstep220, thealgorithm150 checks for any user input via the membrane keypad. Atstep221, any keypresses are checked. Atstep222, all therapy-related parameters are updated. For example, a user may press the vacuum-level-presetswitch162 which would be detected atstep221. The new target pressure selected by the user would then be stored as a therapy parameter instep222. If no keys are pressed, or once the therapy parameters have been updated subsequent any key press,algorithm150 updates the display atstep230.
• Atstep230, all status LED's are updated including any alarm indications that may have been identified in the previous pass through themain loop270.
• Atstep240,algorithm150 monitors and updates control of the vacuum pump(s)105 and107, and ventsolenoid120. Atstep241, the actual pressure at the pump(s)105 and107 and thecanister114 is read via electronic vacuum-pressure sensors109 and116, respectively. These analog readings are digitized and stored for use on the next pass throughmain loop270. Atstep242, vacuum limits and targets are selected based on the pre-determined therapy parameters identified instep220. Atstep243, a decision is made regarding in which mode the pump(s) will be operated. If the first-mode is selected atstep243,algorithm150 will operatevacuum pump105 at full-power minimizing the time to remove the air fromcanister114 and dressing132. If the second-mode is selected atstep243,algorithm150 will operatevacuum pump105 at partial-power providing just enough airflow to keep up with any leaks in the system as described in detail earlier. In this mode, pump105 operates very quietly and would not disturb the patient. Alternatively, and described in more detail hereinbelow, anoptional pump107 can be utilized in conjunction withpump105 during second-mode operation. In this embodiment, pump107 is smaller and quieter thanpump105 and has reduced airflow capacity.Pump107 is configured to provide just enough airflow to compensate for system leaks or other loss of vacuum.
• Once the mode is selected atstep243,algorithm150 produces electronic control signals that turn the vacuum pump(s)105 and107 on or off atstep244. In addition, and as described in detail hereinabove, asolenoid valve120 vents vacuum pressure to atmosphere when power is terminated, or in the event vacuum pressure exceeds the preset limits established atstep242. Atstep245, the control signals are provided and are based on comparisons between actual pressure, target pressure and the preset high-pressure limit. Mode determination, vacuum pump control, and vent control are all based on comparisons between the pre-selected target pressure levels and actual pressure readings obtained atsteps241 and242, respectively.
• After pressure adjustments are made and the actual pressure readings obtained atstep240, thealgorithm150 checks for alarm conditions atstep250. Atstep251, leak conditions, which are readily identified by analyzing the readings frompressure sensors109 and116, are identified. If a leak condition is detected atstep251, thealgorithm150 waits three minutes before flagging the leak alarm and alerting the user atstep230 during the next pass throughmain loop270. Atstep252, a full canister condition is checked, again easily identified by analyzing the readings frompressure sensors109 and116. If a full canister condition is detected atstep252, thealgorithm150 waits one minute before flagging the full canister alarm and alerting the user atstep230 during the next pass throughmain loop270. Atstep253, the readings frompressure sensors109 and116 are examined to determine if any internal errors exist. An internal error would occur if one pressure sensor indicated a pressure reading, for example, 30 mmHg higher or lower than the other sensor. Again, if the internal error condition is detected atstep253, thealgorithm150 waits two minutes before flagging the internal error alarm and alerting the user atstep230 during the next pass throughmain loop270.
• After completion ofsteps220,230,240 and250,algorithm150 will reset the watchdog timer atstep260. The watchdog timer is provided as a safety feature in the event of an unanticipated software glitch and is incorporated within embeddedmicroprocessor102. In theevent control algorithm150 “locks up”,main loop270 would no longer function. Whenmain loop270 ceases to function, the hardware watchdog timer would not be reset atstep260 and would therefore timeout. Once the watchdog timer has timed-out, it will automatically reset embeddedmicroprocessor102 andalgorithm150 will re-initialize all variables and parameters atstep210. Subsequent to the re-initialization,algorithm150 would again sequentially execute the modules as described above viamain loop270.
• Referring now particularly toFIG. 3, an example of a linear control circuit associated with vacuum pump(s)105 and107 includes acontrol input301, which is a digital signal provided bymicrocontroller101.Digital control input301 is associated with the second-mode described above. Whendigital control input301 is in its low or off state,diode304 becomes forward biased and subsequently dischargescapacitor303. After a short period of time, the voltage acrosscapacitor303 trends towards zero and the capacitor is substantially fully discharged. Whendigital control input301 is in its high or on state,diode304 becomes reverse biased and is effectively removed from the circuit. In this case, with said second-mode activated,resistor302, which is in series withcapacitor303, will begin to chargecapacitor303 at a rate determined by the values of both components and proportional to 1/R*C. After approximately 1/R*C seconds have elapsed,capacitor303 becomes fully charged and no additional current will flow throughresistor302. The voltage acrosscapacitor303 will be approximately equal to the magnitude of thedigital control input301 voltage. The junction ofresistor302 andcapacitor303 is connected to the base terminal of anNPN bi-junction transistor305.Transistor305 can be, for example, a TIP-32C.Transistor305 is configured as an emitter follower and in this arrangement will provide current amplification. The positive terminal of vacuum pump(s)105 and107 is connected to the emitter terminal oftransistor305 while the collector terminal oftransistor305 is connected directly to the 12-volt power supply307. Anadditional capacitor306 is provided to prevent unwanted transients on the power supply caused by the inductive loading of vacuum pump(s)105 and107. The negative terminal of vacuum pump(s)105 and107 and the negative terminal ofcapacitor303 are connected to the commonground reference point308.
• When thedigital control input301 transitions from its low-to-high state, the voltage acrosscapacitor303 begins to ramp-up slowly until reaching a maximum 1/R*C seconds later. Because of the configuration oftransistor305, the voltage rise at the emitter terminal will mirror the voltage rise at the base terminal, thus the voltage supplied to vacuum pump(s)105 and107 will also slowly ramp-up until reaching a maximum 1/R*C seconds later. As the voltage supplied to the pump(s) increases, the pump(s) will operate faster and thus produce more outflow and increased vacuum. Since the time constant is selectable by choosing appropriate values forresistor302 andcapacitor303, the rate at which the pumps begin to increase speed can be pre-selected and can permit operation at a slower and quieter speed for an extended period of time. As the pump(s)105 and107 begin to increase their outflow, vacuum in thesystem100 is increased. This increase is measured byalgorithm150, which subsequently changes the state ofdigital control input301 in response thereto. As described in detail above, once target pressure has been re-established, the pump(s)105 and107 will be shut off. As thedigital control input301 transitions from its high-to-low state after target pressure is met,diode304 rapidly dischargescapacitor303 as described earlier, and the voltage supplied to pump(s)105 and107 is effectively removed turning the pump(s) off.
• Referring now particularly toFIG. 4, an example of a Pulse Width Modulation (PWM)control circuit400 associated with vacuum pump(s)105 and107 includes anastable multivibrator circuit401 configured with a duty-cycle that can be varied from approximately 10 to 90 percent.Multivibrator circuit401 can be, for example, an LM555, and is referred to further herein as “Timer”401. A 12-volt power supply417 provides electrical power totimer401 and vacuum pump(s)105 and107.Capacitor414 is connected between thepower supply417 and thecommon ground point414.Capacitor414 functions to remove transients from thepower supply417 due to inductive loading produced by the operation of pump(s)105 and107. In some embodiments of the invention, vacuum pump(s)105 and107 have three terminals—a positive and negative terminal for power, and athird terminal416 that is the PWM control input. The positive terminal of pump(s)105 and107 connects to thepower supply417. The negative terminal connects to the drain lead of aMOSFET402, such as, for example, an IRF510, commonly available and sold under the trademark International Rectifier®. The source lead ofMOSFET402 connects to thecommon ground point414.MOSFET402 switches the power on and off to pump(s)105 and107 in response to acontrol input412. The signal fromcontrol input412 is provided bymicrocontroller101 and acts in conjunction with mode-select signal411. Aresistor413 is connected between the gate ofMOSFET402 andcommon ground point414 and provides ground reference for the gate ofMOSFET402 and drive impedance forcontrol input412.
• Timer401 has several peripheral components that control the frequency of operation and the duty-cycle of the output waveform.Capacitor408 stabilizes an internal voltage reference and keeps the output frequency constant.Diodes405 and406 charge and dischargecapacitor407 throughresistors403 and404.Resistor404 andcapacitor407 determine the output frequency whilevariable resistor403 determines the duty-cycle and can be adjusted from 10 to 90 percent. Typically the output frequency would be between 10 kilohertz and 20 kilohertz to minimize switching noise as these frequencies are above the nominal range of human hearing. The output oftimer401 is used as thePWM input416 and varies the motor speed of pump(s)105 and107 in proportion to duty-cycle. A high duty-cycle causes the pump motor to run faster and produce greater outflow while a low duty-cycle causes the pump motor to run slower and quieter with an associated reduction in outflow.
• A digital-mode signal from mode select411 indicating the second mode, which enables selection of said first-mode or said second-mode, is provided tocapacitor407 throughdiode409. When the mode-select signal from mode select411 transitions from a high to low state,diode409 is forward biased and rapidly dischargescapacitor407. Whencapacitor407 is in its discharged state, the PWM signal416 generated bytimer401 is forced high. A constant, high PWM is equivalent to a 100% duty-cycle and thus pump(s)105 and107 run at maximum in this configuration. As mode-select signal from mode select411 transitions from a low to high state,diode409 is reverse biased and therefore effectively removed from the circuit.Timer401 then operates in an astable mode producing a reduced duty-cycle PWM signal416.Resistor410 is connected between modeselect input411 andcommon ground point414 to provide drive impedance formicrocontroller101.
• Whencontrol algorithm150 determines that the first-mode (draw-down) is required such as when the system is initializing and drawing-down the dressing, mode select signal from mode select411 will be in a low state while control-input signal fromcontrol input412 will be in a high state. This configuration will cause vacuum pump(s)105 and107 to produce the greatest amount of outflow. Likewise whencontrol algorithm150 determines that said second-mode (maintenance) is required such as when the measured therapeutic vacuum level dips below the predetermined low-limit, mode-select signal from mode select411 will be in a high state while control-input signal fromcontrol input412 will be in a high state. This configuration will cause vacuum pump(s)105 and107 to operate at a slower speed producing reduced outflow and reduced unwanted mechanical noise while simultaneously restoring therapeutic vacuum to the target level. If control-input signal fromcontrol input412 is in a low state, the pump(s) are disabled and do not operate at all. This acts as a safety feature in the event of a component failure that causes pump(s)105 and107 to latch in an on-state.
• Referring now particularly toFIG. 5A, another embodiment of aportable system500 for providing therapeutic wound irrigation and vacuum drainage is illustrated.System500 includes a self-containedplastic housing501 configured to be worn around the waist or carried in a pouch over the shoulder for patients who are ambulatory, and hung from the footboard or headboard of a bed for patients who are non-ambulatory. A membrane keypad anddisplay504 is provided to enable the adjustment of therapeutic parameters and to turn the unit on and off. Depressingmembrane switch505 will turn the power tosystem500 on while depressingmembrane switch506 will turn the power off.Membrane switch509 adjusts the target therapeutic pressure up and likewisemembrane switch510 adjusts the target therapeutic pressure down. In some embodiments of the invention,system500 has three pressure settings LOW, MEDIUM and HIGH which generally correspond to, for example, 70 mmHg, 120 mmHg and 150 mmHg, respectively. Although these three pressure settings are provided by way of example, they are not intended to be limiting because other pressures can be utilized for wound-type specific applications.Membrane LEDs LOW522,MEDIUM523 and HIGH524, indicate the current target therapeutic setting of the unit.LED507 indicates a leak alarm andLED508 indicates a full-canister alarm. When either alarm condition is detected, these LEDs will light in conjunction with an audible chime.Housing501 incorporates acompartment502 that is configured in such a way as to receive and store astandard IV bag503.IV bag503 may contain an aqueous topical wound treatment fluid that is utilized bysystem500 to provide continuous irrigation. In some embodiments, the wound treatment fluid can be introduced directly intocompartment502. Additionally, theIV bag503 can be externally coupled to the device. As shown inFIG. 5B, abelt clip514 is provided for attaching to a patient's belt and an optional waist strap or shoulder strap is provided for patient's who do not wear belts.
• As shown inFIG. 5C, anexudate collection canister511 comprises a vacuum-sealing means517 and associated hydrophobic filter520 (not shown),vacuum sensor port518 and associated hydrophobic filter519 (not shown), frostedtranslucent body521, clear graduatedmeasurement window522, locking means523 andmultilumen tubing512.Collection canister511 typically has a volume less than 1000 ml to prevent accidental exsanguination of a patient. Vacuum sealing means517 mates with a corresponding sealing means516 that is incorporated inhousing501. In addition, locking means523 has corresponding mating components within said housing.Hydrophobic filters519 and520 can be, for example, those sold under the trademark GoreTex® and are ensured the contents ofcanister511 do not inadvertently ingresshousing501 and subsequently cause contamination of thetherapy device500.Vacuum sensor port518 enablesmicrocontroller101 to measure the pressure within thecanister511 as a proxy for the therapeutic vacuum pressure under the dressing131.Multilumen tubing512 provides one conduit for the irrigation fluid to travel to dressing131 and another conduit for the vacuum drainage. Thus,IV bag503,tubing512, dressing131 andcanister511 provide a closed fluid pathway. In this embodiment,canister511 would be single-use disposable and may be filled with a gelling substance to enable the contents to solidify prior to disposal. Gelling agents are available, for example, under the trademark Isolyzer®.
• As shown inFIG. 5A, at the termination oftubing512, a self-adhesive dressing connector515 is provided for attaching the tubing to drape132 with substantially air-tight seal.Dressing connector515 can have an annular pressure-sensitive adhesive ring with a release liner that is removed prior to application. In actual use, asmall hole530 can be cut indrape132 anddressing connector515 would be positioned in alignment with said hole. This enables irrigation fluid to both enter and leave the dressing through a single port. In an alternative embodiment,tube512 bifurcates at the terminus and connects to two dressingconnectors515 which allow the irrigation port to be physically separated from the vacuum drainage port thus forcing irrigation fluid to flow though the entire length of the dressing if it is so desired.
• Referring now toFIG. 6, and according to a further embodiment of the invention, adressing system600 for providing therapeutic wound irrigation and vacuum drainage is illustrated.Dressing system600 includes a sterileporous substrate131, which can be fabricated from polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material; a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®; a singlelumen drainage tube122 for the application of vacuum and removal of fluids from the woundsite; and apliable fluid vessel601 situated between thesemi-permeable cover132 and theporous substrate131.Fluid vessel601 comprises a self-sealingneedle port603 situated on the superior aspect of the vessel and aregulated drip port602 situated on the inferior aspect of the vessel.Needle port603, permits the introduction of ahypodermic needle604 for the administration of aqueous topical wound treatment fluids. These aqueous topical fluids can include antibiotics such as Bacitracin or Sulfamide-Acetate; physiologic bleach such as Chlorpactin or Dakins solution; and antiseptics such as Lavasept or Octenisept.Regulated drip port602 permits fluid withinvessel601 to egress slowly and continuously intoporous substrate131 whereupon the therapeutic benefits can be imparted to the woundsite. Single-lumen drainage tube122 provides enough vacuum to keep the dressing600 at sub-atmospheric pressure and to remove fluids, which include the irrigation fluid and wound exudate. The advantage of dressingsystem600 is the incorporation into the dressing ofvessel601 thus eliminating the need for an external fluid vessel and associated tubing and connectors making the dressing more user friendly for patient and clinician alike.
• In normal clinical use, dressing600 is applied to the wound site by first cuttingporous substrate131 to fit the margins of the wound. Next,semi-permeable drape132 with integrated (and empty)fluid vessel601 is attachedpositioning drip port602 central to theporous substrate131. Once thedrape132 is properly sealed around the periwound, a properly preparedhypodermic needle604 can be inserted in self-sealingneedle port603, andfluid vessel601 subsequently can fill with the desired aqueous topical wound treatment solution.
• Referring now particularly toFIG. 7, and according to another embodiment of the invention, adressing system700 for therapeutic wound irrigation and vacuum drainage is illustrated. Thesystem700 includes a sterileporous substrate131, which can be fabricated from polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material; a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®; a singlelumen drainage tube122 for the application of vacuum and removal of fluids from the woundsite; and apliable fluid vessel601 situated outside and superior to saidsemi-permeable cover132.Fluid vessel601 comprises a self-sealingneedle port603 situated on the superior aspect of the vessel and aregulated drip port602 situated on the inferior aspect of the vessel. In addition, an annular adhesive ring is provided on the inferior aspect ofvessel601 surroundingregulated drip port602 for subsequent attachment to drape132.Needle port603 permits the introduction of ahypodermic needle604 for the administration of aqueous topical wound treatment fluids. These aqueous topical fluids can include antibiotics such as Bacitracin or Sulfamide-Acetate; physiologic bleach such as Chlorpactin or Dakins solution; and antiseptics such as Lavasept or Octenisept.Regulated drip port602 permits fluid withinvessel601 to egress slowly and continuously intoporous substrate131 through a hole indrape132 whereupon the therapeutic benefits can be imparted to the woundsite. Single-lumen drainage tube122 provides enough vacuum to keep the dressing600 at sub-atmospheric pressure and to remove fluids which include the irrigation fluid and wound exudate.
• In normal clinical use, dressing700 is applied to the wound site by first cuttingporous substrate131 to fit the margins of the wound. Next,semi-permeable drape132 is applied over the woundsite covering thesubstrate131 well into the periwound area. A hole approximately ¼″ diameter is made indrape132 central toporous substrate131. Lastly,fluid vessel601 is attached by adhesiveannular ring605 withdrip port602 aligned with the hole previously cut indrape132. Once thefluid vessel601 is properly sealed to thedrape132, a properly preparedhypodermic needle604 is inserted in self-sealingneedle port603 andfluid vessel601 subsequently filled with the desired aqueous topical wound treatment solution.
• Referring now particularly toFIG. 8, an embodiment of an application-specific dressing800 of the invention is illustrated. The dressing800 includes a sterileporous substrate131, which can be fabricated from polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material; a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®; a singlelumen drainage tube122 for the application of vacuum and removal of fluids from the woundsite; singlelumen irrigation tube125 to facilitate the application of aqueous topical wound fluids to awound bed801; and a perforated woven cloth impregnated withmetallic silver810 and bonded toporous substrate131, for providing an antibiotic action within the wound. Alternatively, and as depicted inFIG. 8, anintegrated dressing connector515 can be used withmulti-lumen tubing512 permitting the wound irrigation and vacuum drainage system to fluidically communicate with dressing800.
• Antibiotic silver layer810 is fenestrated to permit the unimpeded removal of fluids from thewound bed801 through thesubstrate131 and subsequently throughvacuum drainage tubing122 or512. In addition, fenestrations inlayer810 permit the even distribution of sub-atmospheric pressure across thewound bed801 and permit granular tissue formation. Use of silver in a wound as part of a wound dressing is available to the clinician under the trademark(s) Acticoat™ and Silvadene™ and others. Silver can be utilized specifically for burns, sternotomy, radiated fistulas, traumas, and open fractures. Silver is utilized in treating multiple resistant staph aureus (MRSA), preventing odor, reducing incidence of infection and to promote general healing. This embodiment combines the use of silver with wound irrigation and vacuum drainage to provide therapy to the specific wound types identified hereinabove.Antibiotic silver layer810 can be made of a silver coated woven nylon such as that commercially available under the trademark SilverIon® from Argentum Medical. The material can be fabricated from woven nylon coated with 99.9% pure metallic silver utilizing a proprietary autocatalytic electroless chemical (reduction-oxidation) plating technology. Alternatively, a non-woven material such as ActiCoat® Foam from Smith and Nephew, uses two rayon/polyester non-woven inner cores laminated between three layers of High Density Polyethylene (HDPE) Mesh. This material, like the SilverIon® material, can also be fenestrated and used with dressing800. Theantibiotic layer810 is bonded toporous substrate131 using a number of available techniques including: in-mold binding, adhesives (such as methyl methacrylate-based bonding agents), and RF or Ultrasonic welding.
• Dressing800 is applied to the wound as described in detail hereinabove. Because of the potential chemical interactions between the various materials used in the construction of dressing800, attention can be paid to the types of aqueous topical wound fluids used to ensure compatibility.
• Referring now particularly toFIG. 9, another embodiment of an application-specific dressing900 is illustrated. The dressing900 includes a sterileporous substrate910, which can be fabricated from polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material; a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®; a single-lumen drainage tube122 for the application of vacuum and removal of fluids from the woundsite; single-lumen irrigation tube125 to facilitate the application of aqueous topical wound fluids to awound bed801; and a sterile porous layer ofbiodegradable material910 bonded toporous substrate920, for providing an inducement to healing within the wound.Biodegradable layer910 is placed substantially within the wound site and is in intimate contact withwound bed801.Biodegradable layer910 can be made from myriad materials such as polylactide-co-glycolic acid (PLGA). Alternatively, and as depicted inFIG. 9, anintegrated dressing connector515 can be used withmulti-lumen tubing512 permitting the wound irrigation and vacuum drainage system to fluidically communicate with dressing900.
• Biodegradable layer910 is porous with similar mechanical characteristics tosubstrate920 to permit the unimpeded removal of fluids from thewound bed801 through thesubstrate920 and subsequently throughvacuum drainage tubing122 or512. In addition, porosity inlayer910 permits the even distribution of sub-atmospheric pressure across thewound bed801 and encourages granular tissue formation intolayer910.Biodegradable layer910 is bonded tosubstrate920 in such a way that it will readily release fromsubstrate920 when the dressing is removed from the wound so that thebiodegradable layer910 remains in place and provides a matrix through which tissue growth can occur. The adhesives for removably bonding layers910 and920 include, for example, cured silicones, hydrogels and/or acrylics. The thickness oflayer910 can be selected such that ingrowth, which can be as much as 1 mm per day for a typical wound, will not entirely infiltratelayer910 and invade theremovable substrate920. Alternatively,biodegradable layer910 can be made up of a matrix of beads adhered together with the same kinds of releasable bonding agents discussed in detail above.
• Dressing900 is suited for wound types that have large defects or voids, which require rapid filling of tissue to provide a foundation for re-epithelialization in the final stages of healing. These application-specific wounds include necrotizing fasciitis, trauma, and iatrogenic wounds such as would occur with certain oncological procedures. In addition to addressing soft tissue repairs, dressing900 can be configured to heal large bone defects such as those that result from surgical treatment of osteocarcinoma, and trauma where significant bone loss occurs. For these types of wounds,biodegradable layer910 would be made of a rigid material that would serve as a matrix to encourage osteoblast invasion and bone growth into the defect. As described above, the material that makes uplayer910 would remain in the wound after the dressing is removed.
• Dressing900 can be applied as described above in the previous embodiments; the only significant difference being that during dressing changes, the biodegradable portion,layer910, would remain in the wound. With a conventional dressing change, typically all the dressing material and debris would be removed to prevent possibility of foreign body reaction and infection. Here, subsequent dressing would be applied over the previous dressing'sbiodegradable layer910 facilitating tissue grown therein. Once a suitable foundation of granular tissue has formed in the wound, the clinician would discontinue use of the biodegradable dressing substituting instead one of the other dressing materials and configurations disclosed hereinabove until the wound was completely healed.
• Referring now particularly toFIG. 10, an embodiment of an application-specific dressing1000 is illustrated. The dressing1000 includes a sterileporous substrate1030, which can be fabricated from polyurethane foam, polyvinyl alcohol foam, gauze, felt or other suitable material; a semi-permeableadhesive cover132 such as that sold under the trademark Avery Denison®; a single-lumen drainage tube122 for the application of vacuum and removal of fluids from the woundsite; single-lumen irrigation tube125 to facilitate the application of aqueous topical wound fluids to awound bed801; a sterile porous layer ofbiocompatible material1020 releasably bonded toporous substrate1030; and anautologous graft layer1010 integrated withbiocompatible material1020 for stimulating a healing response in a wound.Biocompatible layer1020 andautologous graft layer1010 are placed substantially within the wound site withautologous graft layer1010 in intimate contact withwound bed801. Alternatively, and as depicted inFIG. 10, anintegrated dressing connector515 can be used withmulti-lumen tubing512 permitting the wound irrigation and vacuum drainage system to fluidically communicate withdressing1000.
• Biocompatible layer1020 can be an acellular dermal matrix manufactured from donated human skin tissue, which is available under the trademark AlloDerm® from LifeCell Inc. This dermal matrix has been processed to remove all the cells that lead to tissue rejection while retaining the original biological framework. Cells taken from the patient or other molecules can subsequently be seeded into thismatrix forming layer1010. These cells or molecules can include but are not limited to: fibroblasts, platelet derived growth factor (PDGF), Transforming Growth Factor Alpha (TGF-α), Transforming Growth Factor Beta (TGF-β) and other cytokines. PDGF is a polypeptide hormone derived from platelets, which stimulate fibroblasts to migrate and lay down collagen and fibronectin thereby initiating wound repair. If targeted cells are taken from the patient and seeded intobiocompatible layer1020 forminglayer1010, the body will not reject them. In addition to seeding the inferior aspect oflayer1020 with the above described autologous cells or molecules, the superior aspect oflayer1020 can be seeded with live dermal cells taken from the patient using a mesh graft or micrografting technique. The configuration of twograft layers1010 enclosing abiocompatible layer1020 permits intrinsic tissue regeneration in such a way as to minimize the formation of scar tissue and maintain original structure.
• Dressing1000 is designed for wound types that require reconstruction where the newly regenerated tissue has cellular structure similar to the original tissue. These application-specific wounds include surgical dehiscence, burns, and diabetic ulcers.
• In normal clinical use, the dressing1000 would be prepared on a patient-by-patient basis first by harvesting the requisite cells from donor sites followed by processing (when necessary to derive bioactive components) then seeding the cells or cytokines into thebiocompatible layer1020. Special care and handling can be used in the preparation of dressing1000 to promote preservation of the bioactive components and maintenance of the sterility of the dressing. Once the dressing has been properly configured for the patient, it is applied as described in detail hereinabove. When dressing changes occur,biocompatible layer1020 andautologous graft layer1010 will remain in the wound much like thebiodegradable dressing900 also described in detail above.
• The above described embodiments are set forth by way of example and are not limiting. It will be readily apparent that obvious modifications, derivations and variations can be made to the embodiments. For example, the vacuum pump(s)105 and107 described hereinabove as either a diaphragm or piston-type could also be one of a syringe based system, bellows, or even an oscillating linear pump. Similarly, thevacuum control algorithm150 described in detail above as multi-modal could be one of many other algorithms well known to anyone of ordinary skill in the art. Likewise, use of PLGA as a biodegradable substance for a component of dressing900 could be one of many different types of biodegradable materials commonly used for implantable medical devices. Accordingly, the claims appended hereto should be read in their full scope including any such modifications, derivations and variations.

Claims (21)

1. An apparatus, comprising:

a porous substrate;

a semi-permeable cover coupled to the porous substrate;

a first tube coupled adjacent to the porous substrate, the first tube configured to be coupled to a vacuum source;

a second tube coupled adjacent to the porous substrate, the second tube configured to be coupled to a liquid supply source;

a first graft layer bonded to and adjacent with a surface of the porous substrate;

a therapeutic material having a first surface and a second surface substantially opposite the first surface, the first surface coupled to and adjacent with the first graft layer, the therapeutic material being at least one of a silver-impregnated material, a biodegradable material, or a biocompatible material; and

a second graft layer coupled to and adjacent with the second surface of the therapeutic material, the second graft layer configured to be in direct contact with a wound when the therapeutic material is disposed within the wound.

2. The apparatus ofclaim 1, wherein the therapeutic material is woven nylon coated with substantially pure metallic silver.

3. The apparatus ofclaim 1, wherein the therapeutic material is polylactide-coglycolic acid (PLGA).

4. The apparatus ofclaim 1, wherein the therapeutic material is an acellular dermal matrix.

5. The apparatus ofclaim 1, wherein the therapeutic material is an autologous graft.

6. The apparatus ofclaim 1, wherein the therapeutic material is woven nylon coated with substantially pure metallic silver, the therapeutic material being fenestrated.

7. The apparatus ofclaim 1, wherein the therapeutic material is porous.

8. The apparatus ofclaim 1, wherein the therapeutic material, the first graft layer and the second graft layer are configured to remain within the wound when the porous substrate is removed from the wound.

9. The apparatus ofclaim 1, wherein the second graft layer is formed by seeding the therapeutic material with cells taken from a patient.

10. The apparatus ofclaim 1, wherein the therapeutic material includes skin tissue taken from a human other than a patient to be treated, the first graft layer including cells taken from the patient to be treated.

11. The apparatus ofclaim 1, wherein the therapeutic material includes cytokines.

12. An apparatus, comprising:

a porous substrate having a first portion and a second portion mutually exclusive from the first portion, the porous substrate including a polyurethane foam;

a semi-permeable cover coupled to the porous substrate;

a first tube having a first end portion coupled to the first portion of the porous substrate and a second end portion configured to be coupled to a vacuum source, the first tube being in fluidic communication with the porous substrate;

a second tube having a first end portion coupled to the second portion of the porous substrate and a second end portion configured to be coupled to a liquid supply source, the second tube being in fluidic communication with the porous substrate, the second tube being distinct from the first tube;

a first graft layer releasably bonded to and adjacent with the porous substrate, the first graft layer including cells taken from a patient to be treated;

a therapeutic material having a first surface and a second surface substantially opposite the first surface, the first surface being coupled to and adjacent with the first graft layer, the therapeutic material including human cells; and

a second graft layer coupled to and adjacent with the second surface of the therapeutic material such that the therapeutic material is disposed between the first graft layer and the second graft layer, the second graft layer configured to be in direct contact with a wound when the therapeutic material is disposed within the wound, the second graft layer including cells taken from the patient to be treated,

the first graft layer, the therapeutic material and the second graft layer being configured to be collectively released from the porous substrate and remain within the wound when the porous substrate is removed from the wound.

13. The apparatus ofclaim 12, wherein the human cells of the therapeutic material are taken from a human other than the patient to be treated.

14. The apparatus ofclaim 12, wherein the human cells of the therapeutic material are taken from the patient to be treated.

15. The apparatus ofclaim 12, wherein the first graft layer is releasably bonded to the porous substrate using at least one of a cured silicone adhesive, a hydrogel adhesive or an acrylic adhesive.

16. An apparatus, comprising:

a porous substrate;

a semi-permeable cover coupled to the porous substrate;

an integrated dressing connector coupled to the semi-permeable cover and in fluidic communication with the porous substrate;

a multi-lumen tube configured to be physically coupled to the integrated dressing connector, the multi-lumen tube defining a first lumen configured to be coupled to a vacuum source and a second lumen configured to be coupled to a liquid supply source;

a first graft layer bonded to and adjacent with a surface of the porous substrate;

a second graft layer configured to be in direct contact with a wound when the therapeutic material is disposed within the wound; and

a therapeutic material coupled to, adjacent with and disposed between the first graft layer and the second graft layer, the therapeutic material being at least one of a silver-impregnated material, a biodegradable material, or a biocompatible material.

17. The apparatus ofclaim 16, wherein the therapeutic material is woven nylon coated with substantially pure metallic silver.

18. The apparatus ofclaim 16, wherein the therapeutic material is polylactide-coglycolic acid (PLGA).

19. The apparatus ofclaim 16, wherein the therapeutic material is an autologous graft.

20. The apparatus ofclaim 16, wherein the therapeutic material is woven nylon coated with substantially pure metallic silver, the therapeutic material being fenestrated.

21. The apparatus ofclaim 16, wherein:

the first graft layer is releasably coupled to and adjacent with the surface of the porous substrate, and

the therapeutic material, the first graft layer and the second graft layer are configured collectively to remain within the wound when the porous substrate is removed from the wound.

Images