US20100298637A1 - Suture with a pointed end and an anchor end and with equally spaced tissue grasping protrusions located at successive axial locations - Google Patents

Abstract

A tissue connector has a first pointed end, an anchor end, a body with a periphery and a plurality of protrusions projecting from said periphery of said body. The plurality of protrusions are adapted to grasp tissue in a direction of movement of the first end of the connector through tissue and are not adapted to grasp tissue in an opposite direction of movement of the connector through tissue, which is in the direction of the anchor end. At axial locations of said body, three said protrusions are about equally located about the periphery of said body. At axial locations on a cylindrical periphery of the body protrusions are locate at about 120 degree spacings.

Description

CLAIM TO PRIORITY
• This application is a continuation of U.S. application Ser. No. 11/968,494, filed Jan. 2, 2008, now allowed; which is a continuation of U.S. application Ser. No. 11/747,085, filed May 10, 2007, now pending; which is a continuation of U.S. application Ser. No. 10/420,119, filed Apr. 21, 2003, now U.S. Pat. No. 7,226,468, issued Jun. 5, 2007; which is a continuation of U.S. application Ser. No. 09/629,428, filed Jul. 31, 2000, now abandoned; which is a continuation of U.S. application Ser. No. 08/324,529, filed Oct. 18, 1994, now U.S. Pat. No. 6,241,747, issued Jun. 5, 2001; which is a continuation-in-part of U.S. application Ser. No. 08/055,989, filed May 3, 1993, now abandoned. All the above claimed priority applications are incorporated herein by reference in their entireties.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• This invention relates to a barbed tissue connector, and more particularly, to such a connector which can be used to quickly and effectively close a body wound.
• 2. Description of the Prior Art
• Human wounds are typically repaired with a filament introduced into the tissue by a needle attached to one end. After piercing the opposing faces of the wound, the needle is removed, and the ends of the suture are tied together with at least three overhand knots. Such a technique requires considerable time and expertise on the part of the surgeon. There are also a number of other drawbacks to repairing a wound in this manner. For example, it is very difficult to use sutures to repair wounds where there is insufficient space to properly manipulate the suture, especially those wounds repaired using fiber optic visualization. The suture forms a loop as it is tied, and this loop constricts blood flow to the tissue in its confines, promoting necrosis of the wound margins. Further, if the needle's passage was noncircular, the tissue will be distorted as it is secured by the suture.
• Alternatives to conventional sutures are known in the prior art. Staples, as shown, for example, in U.S. Pat. No. 4,994,073, to Green, are often used for approximating the superficial layer of the wound. Staples, however, are generally unsuitable for deeper layers of tissue.
• The patent to Alcamo, U.S. Pat. No. 3,123,077, discloses a roughened suture which can be passed through tissue in one direction, but resists movement in the opposite direction. The Alcamo suture, however, still must be sewn, as by a conventional technique, and the trailing end must be secured with knots. Thus, although there is less slippage of the suture in the wound, most of the disadvantages of sutures noted above are also found in the Alcamo suture.
• The patent to Tanner, U.S. Pat. No. 3,716,058, discloses a relatively rigid suture with one or more barbs on opposite ends of an arcuate body. One disadvantage of the Tanner suture is that the rigid barbs, which protrude from the suture as it is inserted, will lacerate tissue and prevent retrograde repositioning. Further, since the barbs are only placed at the ends of the suture, the forces applied to the tissue by the barbs will be limited to a relatively small area; this substantially increases the pressure on the blood vessels ensnared by a barb and severely restricts blood flow to the area.
• It will be seen from the foregoing that there is a need for a tissue connector which can be placed more expeditiously than sutures, is self-retaining, obviates distortion of the tissue, can close tissue inaccessible to conventional procedures, and which preserves blood flow by broadly distributing the retention force.
SUMMARY OF THE INVENTION
• It is an object of the present invention to overcome the aforementioned problems in the prior art and to provide an improved tissue connector.
• In accordance with the present invention there is provided a barbed tissue connector comprising: an elongated body having a point formed on one end, the body being formed of a material sufficiently hard for the point to pierce tissue and enable the connector to be inserted in tissue when a substantially axial force is applied to the body; and a plurality of barbs projecting from the body, the barbs being disposed around the periphery of the body along a length of the body which extends from adjacent the one end to a predetermined location on the body, the barbs being configured such that they are yieldable in a direction toward the body and are generally rigid in an opposite direction, and the barbs being sufficiently resilient to return to a predetermined position after deflection therefrom.
• In one embodiment of the present invention, the barbed tissue connector includes an elongated body and a plurality of barbs which are disposed in a helical pattern on the body and extend from a pointed end of the connector to a predetermined location on the body. Each barb includes a first side, which forms an obtuse angle with the body, and a second side which forms an acute angle with the body. The body is substantially rigid and sufficiently resilient to return to a predetermined position after deflection therefrom. When the connector is inserted in tissue to repair a wound, the pointed end pierces tissue and the barbs yield toward the body to facilitate entry of the connector.
• When the connector has been placed in a desired position in tissue, the barbs strongly resist movement away from this position. The connector can be inserted by gripping the connector in the hand and pushing the connector into the tissue, or the connector can be inserted by means of an inserting device which is withdrawn when the connector is in place.
• A principal advantage of the barbed tissue connector of the present invention is that it permits a surgeon to rapidly and securely attach the edges of a wound in human tissue without the necessity for threading and tying numerous individual stitches or for the use of a complicated or elaborate tool to insert the connector. The connector is configured to minimize damage to tissue when inserted and to minimize scarring or tissue necrosis across the wound. The connector is capable of insertion into the faces of a wound, can connect tissue at the bottom of a deep wound, and can connect tissue which is inaccessible to a staple. Finally, the connector of the present invention can be inserted quickly and accurately by a surgeon who only has access to tissue from a small opening or from only one direction, as, for example, during an endoscopic procedure.
• Other features and advantages will become apparent upon reference to the following description of the preferred embodiment when read in light of the attached drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a side view of the connector of the present invention, with a section broken away to more clearly show the arrangement of the barbs;
• FIG. 2 is an end view of the connector shown inFIG. 1;
• FIG. 3 is a side view of another embodiment of the present invention, with a section of a connector broken away;
• FIG. 4 is a side view of another embodiment of the present invention;
• FIG. 5 is a side view of another embodiment of the present invention;
• FIG. 6 is a side view of another embodiment of the present invention;
• FIG. 7 is a sectional view taken along the line7-7 inFIG. 6;
• FIG. 8 is a side view of another embodiment of the present invention;
• FIG. 9 is a sectional view taken along the line9-9 inFIG. 8;
• FIG. 10 is a perspective view of an inserting device for use with a barbed tissue connector of the present invention; and
• FIG. 11 is a view showing the inserting device and connector in a wound.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention allows a surgeon to rapidly and securely attach the edges of a wound in human tissue without the necessity for threading and tying numerous individual stitches or for using a complicated or elaborate tool. As used herein, the term “wound” means an incision, laceration, cut, or other condition where suturing, stapling, or the use of another tissue connecting device might be required.
• With reference toFIGS. 1 and 2, there is shown a barbed tissue connector2 constructed in accordance with the present invention. Connector2 includes a body4 which is generally circular in cross section and a plurality of closely-spaced barbs6 which extend around the periphery of the body4. A pointed end9 is formed on the body4 to facilitate penetration of the connector2 into tissue. The body4 preferably has sufficient dimensional stability to assume a substantially rigid configuration during use and is sufficiently resilient to return to a predetermined shape after deflection therefrom. In some applications, it may be desirable for the body4 to be flexible and substantially nonresilient so that the shape of an inserted connector will be determined by surrounding tissue.
• Barbs6 serve to hold the connector in tissue and resist retraction of the connector from the tissue. The barbs6 can be arranged in any suitable pattern, for example, in a helical pattern as shown inFIG. 1. In a helical pattern of barbs6, it is preferable that the number of barbs occupying one revolution not be an integer, thereby avoiding parallel axial rows of barbs; such an arrangement provides a more uniform distribution of forces on the tissue and lessens the tendency of an inserted connector2 to cut through tissue. If the number of barbs in one revolution is not an integer, the barbs in successive revolutions will be offset, as shown inFIG. 2, and the amount of offset will determine which barbs are in axial alignment. For example, if the barbs in successive revolutions are offset by ½ barb, the barbs in every second revolution will be in axial alignment, and by extension, if the barbs in each successive revolution are offset by 1/x barb, the barbs in every x revolution will be in axial alignment.
• As shown inFIG. 1, each barb6 includes a first side8 which forms an obtuse angle alpha with the body4 and asecond side10 which forms an acute angle beta with the body4. Each barb6 tapers to a point7, and the amount of difference between the angle alpha of side8 and angle beta ofside10 will control the amount of taper in the barb6. A barb6 which tapers from a broad base to a narrow tip can be effective in resisting retraction, yet will yield toward the body4 during insertion to reduce the effort and tissue damage associated with insertion of the connector2. The barbs6 can be generally conical, as shown inFIG. 1, or they can be any other shape which will function in substantially the same manner as the conical barbs.
• The configuration of barbs6 and the surface area of the barbs can vary depending upon the tissue in which the connector2 is used. The proportions of the barbs6 can remain relatively constant while the overall length of the barbs and the spacing of the barbs are determined by the tissue being connected. For example, if the connector2 is intended to be used to connect the edges of a wound in skin or tendon, each barb6 can be made relatively short to facilitate entry into this rather firm tissue. If the connector2 is intended for use in fatty tissue, which is relatively soft, the barbs can be made longer and spaced farther apart to increase the holding ability in the soft tissue. As shown inFIG. 1, the barbs6 on connector2 have a uniform unidirectional configuration, that is, the barbs6 are uniformly spaced on body4 and all the sides8 are oriented in the same direction, facing pointed end9. Connector2 can be inserted into tissue with the sides8 of each barb6 facing in the direction of motion. Connector2 will prevent movement of tissue in the direction in which it was inserted. A pair of connectors2 inserted adjacent to each other and in opposite directions will prevent movement of tissue in either direction across a wound.
• Connector2 can be formed of a material sufficiently hard for point9 to pierce tissue and enable the connector to be inserted in tissue when a substantially axial force is applied to body4. Connector2 is preferably composed of a bioabsorbable compound, such as a polyglycolic acid or polylactic acid polymer or copolymer. The use of a bioabsorbable material eliminates the necessity of removing the connector from the patient, which can be a painful and possibly dangerous process. Connector2 can be formed, for example, by injection molding.
• In one representative example of connector2 for use in muscular tissue, the body4 is formed from polyglycolic acid, has a length of 1 to 5 cm, and a diameter of about 1 mm. The diameter of a circle extending around points7 of barbs6 will be about 3 mm, and the barbs are spaced apart from each other on body4 by a distance of 1 mm. Side8 forms an angle of 135 degrees with the body4 andside10 forms an angle of 75 degrees with the body4.
• InFIG. 3, there is shown a second embodiment of the present invention in whichbarbs16 are arranged in a uniform bidirectional configuration on abarbed tissue connector12.Barbs16 are constructed in the same manner as barbs6 on connector2. A first set ofbarbs15 onconnector12 are arranged in a helical pattern and face apointed end20, and a second set ofbarbs16 onconnector12 are arranged in a helical pattern and face apointed end21. Each of the pointed ends20,21 should be sufficiently hard and sharp to easily penetrate tissue in which the connector is to be used.Connector12 is particularly suitable for applications where the edges of a wound are prone to separate.Connector12 can be used by inserting one of the ends, forexample end20, into a first side of a wound (not shown), spreading the wound slightly to expose the second side of the wound, inserting theend21 of theconnector12 into the second side of the wound, and then pressing the edges of the wound together. Thebarbs15 and16 on the ends of theconnector12 will grasp the tissue on each side of the wound and prevent the edges of the wound from spreading.
• With reference toFIG. 4, there is shown another embodiment of the present invention in which abarbed tissue connector22 has a nonuniform bidirectional configuration.Connector22 comprises a pointed end23 and one or more barbs26 facing a first direction which alternate with one ormore barbs27 facing a second direction. At each axial location, there can be a number, e.g. 4-9, of circumferentially-spacedbarbs26 or27. To insertconnector22 into tissue, the surgeon would use an insertingdevice80 as described below. The arrangement ofbarbs26,27 onconnector22 would prevent any localized movement of tissue relative to the connector in an axial direction.
• With reference toFIG. 5, there is shown another embodiment of the present invention in which abarbed tissue connector32 has a uniform bidirectional configuration.Connector32 comprises abody34 having pointed ends33 and35. A plurality of axially-spacedbarbs36 adjacentpointed end33 face towardend35, and a plurality of axially-spacedbarbs37 adjacentpointed end35 face towardend33.Barbs36 and37 can be circumferentially-spaced aroundbody34 at each axial location, or thebarbs36 and37 can be of the same construction and arranged in the same pattern as barbs6 on connector2. To insert aconnector32, the surgeon would use an insertingdevice80 as described below. If thebody34 of theconnector32 is sufficiently rigid, theconnector32 would prevent tissue retained by thebarbs36 from moving towardend35 and tissue retained bybarbs37 from moving towardend33. It will be apparent that only one end ofconnector32 needs to be pointed; two pointed ends are preferable, however, so that the surgeon does not have to take the time to insure thatconnector32 is oriented in the insertingdevice80 with a pointed end protruding from the inserting device.
• With reference toFIGS. 6 and 7, there is shown another embodiment of the present invention in which a barbed tissue connector42 comprises abody44 having apointed end45 for penetration into tissue. A head47 is formed on an opposite end ofbody44. A plurality of circumferentially-spacedbarbs46 are formed onbody44 at each of a number of axial locations. As shown inFIG. 7, threebarbs46 are formed at each axial location; however, more or less than threebarbs46 could be used for certain applications.Barbs46 include afirst side48 formed at an obtuse angle to thebody44 and a second side49 which projects frombody44 at an acute angle. The connector42 can be forced into tissue by applying a force to the head47. The connector42 can be applied by hand, or it can be inserted using an insertingdevice80 as described below.
• The connector42 can be formed entirely of a bioabsorbable material, or the head47 and thebody44 can be composed of different materials. For example, thebody44 can be composed of a bioabsorbable material, and the head47 can be composed of metal for superior strength and to facilitate insertion of the connector42. Head47 can be made flat, as shown inFIG. 6, or the head can be formed by a single ring of barbs (not shown) facing in a direction opposite to that of thebarbs46.
• In use, a series of connectors42 can be inserted into tissue, such as along the edges and in the field of a skin graft. After an adequate amount of time has passed for the wound to heal, the tissue beneath each head47 could be depressed slightly to permit the head47 to be cut from thebody44. The tissue would then rise up over the cut end of the body. Such a process would reduce scarring which could result from a long-term projection of thebody44 through tissue and would eliminate the necessity to remove connectors42 from the patient.
• With reference toFIGS. 8 and 9, there is shown another embodiment of the present invention in which abarbed tissue connector52 has a uniform unidirectional configuration.Connector52 comprises abody54 having a non-circular cross-sectional shape.Body54 includes a plurality ofbarbs56 which are generally triangular in cross section and are equally spaced around the periphery of the body at a series of axial locations. Each of thebarbs56 includes a first side58 disposed at an obtuse angle tobody54 and a second side60 disposed at an acute angle to the body.Body54 includes apointed end53 to facilitate entry in tissue. Use of a non-circular cross-sectional shape increases the surface area of theconnector52 and facilitates the formation of the multiple barbs on the connector. For example,barbs56 can be formed on a piece of stock having a triangular cross section by removing material at successive axial locations from the three edges of the stock. It will be apparent that a similar process could be used to form barbs on stock of a different cross section (not shown), for example, a rectangular or hexagonal cross section.
• In the use of the disclosed connectors, such as connectors2 and42, the surgeon can grip the connector in one hand and push the connector into the tissue. As an alternative to directly inserting the connectors into the tissue, the surgeon can use an insertingdevice80 as shown inFIGS. 10 and 11. The insertingdevice80 comprises a circulartubular body82. Thetubular body82 can be generally arcuate in an axial direction, and thebody82 is sufficiently long to contain at least a portion of a barbed tissueconnector C. Device80 has an inwardly tapered leadingend84 and an outwardly tapered, or flared, trailingend86. Ahandle83 is provided onbody82 adjacent trailingend86 to enable the surgeon to manipulate the insertingdevice80.
• In order to facilitate entry of the connector C and thedevice80 into tissue, a connector C is positioned intubular body82 with a pointed end P of the connector C extending from leadingend84. In a preferred embodiment, the interior diameter of thebody82 is made slightly smaller than the outside diameter of the connector C so that the barbs B of a connector C in thebody82 will press against thebody82; as a result, the connector C will be retained in thebody82 during insertion in tissue with the point P properly positioned outside of thebody82. The connector can also be positioned inbody82 with a barb B outside ofbody82 to insure that the connector C will not be pushed back in thebody82 during insertion. In one application ofdevice80, the surgeon inserts thebody82 having connector C therein into the patient'stissue87 until the connector C reaches a desired position, for example, the position shown inFIG. 11.Device80 is then withdrawn in the direction ofarrow90, and a barb, or barbs, B on the connector C penetrates and catches thetissue87 to hold the connector C in the inserted position.
• Use of the insertingdevice80 is particularly recommended when the connector C includes multiple barbs facing more than one direction, such asconnectors22 and32, or when the connector is too flexible for insertion without additional support.
• While the present invention has been described with respect to certain preferred embodiments thereof, it is to be understood that numerous variations in the details of construction, the arrangement and combination of parts, and the type of materials used may be made without departing from the spirit and scope of the invention.

Claims (20)

1. A tissue connector comprising:

an elongated body with a circular cross-sectional shape having a first end, a second end, a circular periphery, and a plurality of protrusions extending from said circular periphery of the body,

wherein said protrusions extend along a portion of said body and face the first end, the protrusions are adapted to grasp tissue in a direction of movement of the first end of the connector through tissue and are not adapted to grasp tissue in an opposite direction of movement of the connector through tissue;

wherein at each of a plurality of axial locations of said body, said protrusions face said first end and are about equally and circumferentially spaced about the circular periphery of the body, and

said first end including a pointed end, and said second end including a head.

2. The tissue connector ofclaim 1 wherein:

said head includes an anchor which is adapted to prevent tissue from going past said head.

3. The tissue connector ofclaim 1 wherein:

said head is larger than a diameter of said elongated body and said head is adapted to prevent tissue from going past said head.

4. The tissue connector ofclaim 1 wherein:

said head is adapted to have tissue located below said head.

5. The tissue connector ofclaim 1 wherein:

said head is adapted to be located above tissue.

6. The tissue connector ofclaim 1 and including:

a cannula through which said tissue connector is adapted to be deployed into tissue.

7. The tissue connector ofclaim 1 and including:

a cannula through which said tissue connector is adapted to be deployed into tissue during an endoscopic procedure.

8. The tissue connector ofclaim 1 wherein:

said protrusions are arranged on said periphery and adapted to lessen a tendency of said connector to damage tissue.

9. The tissue connector ofclaim 1 wherein:

said protrusions are conical.

10. The tissue connector ofclaim 1 wherein:

said connector is made of a bioabsorbable material.

11. The tissue connector ofclaim 1 wherein:

said protrusions are arranged in a helical pattern.

12. The tissue connector ofclaim 1 wherein:

said protrusions have a non-uniform configuration.

13. The tissue connector ofclaim 1 wherein:

said protrusions are located in staggered positions about said periphery of said connector.

14. The tissue connector ofclaim 1 wherein:

said pointed end is free of protrusions.

15. The tissue connector ofclaim 1 wherein said protrusions are barbs.

16. The tissue connector ofclaim 1 wherein said protrusions are tissue holding elements.

17. The tissue connector ofclaim 1 wherein at said axial locations of the plurality of axial locations, three said protrusions are about equally and circumferentially spaced about the circular periphery of the body.

18. A tissue connector comprising:

an elongated body with a circular cross-sectional shape having a first end, a second end, a circular periphery, and a plurality of protrusions extending from said circular periphery of the body,

wherein said protrusions extend along a portion of said body and faces said first end, the protrusions are adapted to grasp tissue in a direction of movement of the first end of the connection through tissue and are not adapted to grasp tissue in an opposite direction of movement of the connection through tissue; and

wherein at each of a plurality of axial locations of said body, said protrusions face said first end and are about equally and circumferentially spaced about the circular periphery of the body, and

said first end including a pointed end, and said second end including a head; and

said head is larger than a diameter of said elongated body and said head is adapted to prevent tissue from going past said head such that said head is adapted to be located adjacent to tissue.

19. The tissue connector ofclaim 18 wherein:

said head includes an anchor.

20. The tissue connector ofclaim 18 wherein at said axial locations of the plurality of axial locations, three said protrusions are about equally and circumferentially spaced about the circular periphery of the body.

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