US20140088481A1 - Controlled strain skin treatment devices and methods - Google Patents

Abstract

Devices, kits and methods described herein may be for wound healing, including but not limited to the treatment, amelioration, or prevention of scars and/or keloids. The packaging, manipulation elements, applicator and/or tensioning device maybe used to apply and/or maintain a strain in an elastic dressing.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. application Ser. No. 13/411,394, filed Mar. 2, 2012, which claims benefit under 35 U.S.C. §119(e) to a) U.S. Provisional Application Ser. No. 61/448,809, filed on Mar. 3, 2011, b) U.S. Provisional Application Ser. No. 61/476,163, filed on Apr. 15, 2011, and c) U.S. Provisional Application Ser. No. 61/605,717, filed on Mar. 1, 2012, all of which are hereby incorporated by reference in their entirety. This application is also related to U.S. application Ser. No. 11/888,978, filed on Aug. 3, 2007, and U.S. application Ser. No. 12/854,859, filed on Aug. 11, 2010, all of which are hereby incorporated by reference in their entirety.
BRIEF SUMMARY
• Devices, kits and methods described herein may be for treatment of a subject at a skin site including without limitation for wound treatment or the treatment, amelioration, or prevention of scars and/or keloids, by manipulating mechanical or physical properties of skin or by shielding skin from stresses, and/or by controllably stressing or straining the epidermis and layers of dermal tissue at or near a skin site, i.e., at or adjacent a wound or a treatment site of a subject's skin. According to variations, manipulating mechanical or physical properties may thereby modulate tensile or compressive stress at the skin site. The stress at the skin site may be reduced to levels below that experienced by normal skin and tissue. The stress at the skin site may be increased to levels above that experienced by normal skin and tissue. The stress or strain may be applied to surrounding tissue in one, two, or more directions to manipulate endogenous or exogenous stress at the skin site in one, two or more directions. According to variations, devices and methods described herein may reduce or otherwise manipulate the stress experienced by skin and/or a wound and surrounding tissues in order to treat a subject. The devices may also assist in preventing or reducing the incidence of wound dehiscence.
• According to the devices, kits and methods described herein, a skin treatment device, skin device, wound treatment device, scar or keloid treatment device, scar or keloid amelioration or prevention device, bandage, or dressing may be provided that may be applied, attached to or coupled to one or more layers of the skin or tissue of a subject (hereinafter referred to as “dressing”, “skin device” or “skin treatment device”).
• In addition to amelioration of scar formation, other uses for such skin treatment device may or may not include without limitation, for example, treating skin related conditions such as acne, blemishes, rosacea, warts, rashes (including but not limited to erythematous, macular, papular and/or bullous conditions), psoriasis, skin irritation/sensitivity, allodynia, telangiectasia, port wine stains and other arterio-venous malformations, and ectopic dermatitis; treating or improving existing scars, wrinkles, stretch marks, loose or sagging skin or other skin irregularities; lifting, pinning, holding, moving skin for various purposes such as during pre-operative preparation, during surgical procedures for example as a low-profile tissue retractor, to stabilize blood vessels during needle or catheter insertion, postoperatively, pre or post operatively for pre-treating or preconditioning skin for example, prior to scar revision, wound incision, body contouring, in mastectomy skin expansion, aesthetic skin treatment or resurfacing whether topical or subdermal, whether or not using an energy modality such as, for example, microwave, radio-frequency ablation, high-intensity focused ultrasound, laser, infrared, incoherent light, thermal (heat and/or cold, ablative or non-ablative), use of vacuum or suction, vibration or massage (e.g. ENDERMOLOGIE®, LPG Systems, France), during weight loss, or for aesthetic purposes; hair removal or hair loss; treating and/or closing skin injuries for example, incisions, wounds, chronic wounds, bed sores, ulcers (including venous stasis ulcers), preventing or reducing the incidence of wound dehiscence, diabetic skin or wound conditions, burn healing and/or relief; acting as an occlusive or negative-pressure wound dressing; protecting incisions or wounds, e.g. prevention of splitting or opening, protecting newborn belly buttons after cutting umbilical cord. Such treatments may include use of a drug or other therapeutic agent that may be applied to the skin with such device. The agents may include but are not limited to antibiotics, anti-fungals, immune modulators including corticosteroids and non-steroidal immune modulators. The agents may be provided in any of a variety of formulations, including but not limited powders, gels, lotions, creams, pastes, suspensions, etc. The devices may also be used for purposes of delivering a drug to the skin or through the skin, for example by stretching the skin and applying a drug thereto. Different configurations of the device may be amenable to the size or geometry of different body regions. The treatments may be applied to regions of any shape (e.g. linear, curved, stellate), size or depth, and to one or more regions of the body, including but not limited to the scalp, forehead, face (e.g. nose, eyelid, cheeks, lips, chin), ears, neck, shoulder, upper arm, lower arm, palm, dorsum of the hand, fingers, nailbed, axilla, chest, nipple, areola, back, abdomen, inguinal region, buttocks, perineal region, labia, penis, scrotum, thigh, lower leg, plantar surface of the foot, dorsal surface of the foot, and/or toes. Such devices may also be referred to herein as a “dressing”, “skin device” or “skin treatment device”.
• The devices, kits or methods described herein may include a packaging, carrier, support, base, applicator, handles, manipulation elements e.g. for mechanical application of force, and/or tensioning device, each of which may: contain, hold, carry or support a dressing at least temporarily; may be used to prepare a dressing for application; may be used to exert a tensioning, straining and/or stretching force to a dressing, e.g., prior to application to a subject; may be used to deliver, orient or apply a dressing; may be used to maintain a dressing in a stressed or strained configuration; may be used to stress or strain a dressing; may be used to separate the dressing from the packaging, carrier, support, base, applicator or tensioning device and/or may be used during or after application of a dressing to provide additional treatment to a wound, incision or other treatment location; and/or may be used to apply pressure to a wound, incision or other treatment location. According to some variations, a packaging, manipulation elements, backing support and/or applicator may provide structural support for a dressing while or after an adhesive liner is released. According to some variations, an assembly may be constructed to avoid folding or bending of the dressing to the extent that the adhesive on the dressing sticks to itself. For example, when some variations of the dressing are held or supported at one point or along one edge of the dressing in a cantilever configuration, the dressings will not bow, laterally deform, or otherwise deform out of plane, under their own mass or configuration.
• In some other variations of the devices and methods herein, a device with a substantially rigid support structure or that provides structural support to a dressing and that provides a particular resistance to bending or column strength when two opposing edges of the device and support structure are placed under a compressive load that causes axial compression or lateral deformation, e.g. a force similar to a hand grasping force is applied to an edge of the device, before the device buckles or folds. For example, a resistance to bending may be characterized as the peak force that is achieve as the device and support structure are compressed without compressed by 25% of its original dimension. This column strength or rigidity may vary, depending upon the direction along the device and support structure being measured. In some further variations, the peak force may be at least about 0.02 Newtons per millimeter (N/mm), about 0.03 N/mm, about 0.05 N/mm, about 0.1 N/mm, about 0.15 N/mm, about 0.2 N/mm, about 0.3 N/mm, about 0.4 N/mm or about 0.5N/mm. In some variations of devices comprising generally flat or planar devices and support structures having a thickness, the peak force may be measured by applying a compressive force along the shortest dimension of the device/support structure that is transverse to the thickness of the device/support structure. According to such variations, the device may have an aspect ratio of length to width that is greater than 1:1, 2:1 or 3:1, for example.
• A resistance to bending in the direction of dressing strain may also be measured by three-point bending, applying a transverse force to the midpoint of the applicator simply supported on two outer points at a given distance apart or support span. For example, the distance between the two points of a sample may be approximately 0.75 inches and a force that ranges from about 1 to 1.25 pounds may be applied to a sample approximately 0.35 inches in width resulting in a deflection of approximately 0.05 inches. A resistance to bending may also be measured by characterizing the force at which buckling occurs on a simply supported beam. For example, a force of approximately 0.45 pounds may be applied to a simply supported sample approximately 0.35 inches in width and may result in a deflection of approximately 0.004 inches. The resistance to bending may also be characterized by the strain of the outer surface before fracture or permanent deformation. By taking measurements of the support structure and the deflections during the test procedure, a load deflection curve may be generated and the flexural modulus of the support structure may also be calculated. In some variations, the support structure may comprise a flexural modulus of at least about 0.9 GPa, while in other embodiments, the flexural modulus is at least about 1 GPa, at least about 1.1 GPa, at least about 1.2 GPa, at least about 1.3 GPa, or at least about 1.4 GPa.
• In another example, a device of 7 cm wide by 19 cm long may be configured with a support structure comprising a paperboard, support sheet or support structure. The support structure may have an average thickness in the range of about 0.008″ to about 0.028″ or greater. In some specific variations, the support structure may have a thickness of about 0.012″, about 0.016″, about 0.018″, about 0.024″, about 0.28″ or about 0.032″, about 0.036″, about 0.04″, about 0.05″ or greater. Upon the application of force along the lengthwise edge of the 19 centimeter length, i.e. across the 7 cm width of the device, the support structure may provide sufficient rigidity or column strength to achieve peak forces of about 3 pound or more, 4 pounds or more, or of about 10 pounds or more, while being compressed, collapsed, bowed, buckled or otherwise deformed by 25% along its 7 cm width (i.e. about 1.75 cm). In some variations, the support structure may comprise scoring or regions of reduced thickness to permit some bending it at least one direction or in both directions.
• According to some variations, a device that provides structural support may have a plurality or supporting cross elements or segments extending from one edge of the length to an opposing edge or the length (or from one edge of a width to an opposing edge of a width); According to some variations there may be three or more cross elements, e.g., a cross element extending along two opposing edges and transversely across a width (or a length) and one or more cross elements extending across the width (or length) and between the cross elements along the two opposing edges. Such cross elements may or may not be coupled or connected to each other, for example, with a relatively flexible material. Such cross elements may have a total aggregate width with respect to the length of an opposing edge of about 20% or more, about 25% or more, about 30% or more, or about 35% or more. According to some variations, one or more cross elements may be provided that have a total aggregate width, relative to the length of the opposing side, between about 20% to 100%. Such cross elements may be segmented and may provide flexibility when bending in a direction and rigidity relative to the flexibility, in another direction.
• One or more devices or variations may also provide structural support or stability of the dressing as it is oriented and/or applied to the skin of a subject. According to some variations, the dressing and packaging is configured to be pre-oriented in a position facing a wound before or after the wound device is prepared for application, e.g., the adhesive liner is removed. According to some variations, a packaging or applicator is configured to be used with one hand to orient and/or apply the device to the skin of a subject. For example, in some situations, particularly where a longer or larger dressing is used, a packaging or applicator provides structural support for a dressing such that a user can effectively hold onto, manipulate and/or apply a prepared dressing with one-hand. According to some variations, the assembly may comprise a support structure. A dressing support structure is defined herein to mean a structure that is coupled whether directly or indirectly, to a back surface of a dressing that is to be applied to a subject. The support structure may further comprise at least in part, a material or structure that is more rigid than the dressing to be applied to a subject. The support structure may comprise one or more elements or segments. It may be constructed of a single substrate, a laminate or a plurality of elements coupled together and/or to the dressing. According to some variations at least 20%, 25%, 30%, 35%, or 40% of a length or width of the dressing is supported by one or more support structures extending from a first opposing side to an opposite side along a length or width of the dressing. In some further variations, the percentage of a length or width that is supported by the support structure(s) is a minimum average of support across the entire length or entire width of the device, e.g. at least a 20%, 25%, 30%, 35% or 40% average support across an entire dimension of the device, e.g. length or width. According to some variations, an entire area of a dressing is supported by a support structure. According to some variations, a base, carrier or support of a dressing may comprise at least three support structures extending transversely between opposing sides of the dressing. According to some variations, a support structure comprises interconnected members or elements. According to some variations, a base, carrier or support remains coupled to the dressing as it is applied. According to some variations, greater structural support is provided to a dressing carrier, support or base in a first direction while greater flexibility is provided in a second direction, while lesser flexibility is in the first direction and lesser structural support is provided in the second direction. According to some variations, one or more support structures may extend beyond an edge of the first opposing side. According to some variations, one or more support structures, at least in part, may extend beyond at least a portion of an edge of a first opposing side and at least in part beyond at least a portion of an edge of an opposite side. According to some variations, a support structure may extend at least 3 mm from at least a portion of an edge of the dressing. According to some variations, the packaging or applicator is configured to improve a sterile transfer of a dressing to a wound of a subject. According to variations, the packaging or applicator may be sufficiently wider or longer, or have a sufficiently larger area than a dressing providing the ability to maneuver or manipulate the support or applicator so that it provides sterile application and/or one-handed application without the need to touch the dressing. According to some variations, a margin of distance is provided from the outer edges of the dressing carrier, support or base to the dressing supported on the base or adhesive on the dressing. Such margins may be selected to prevent or resist a user from touching the dressing or dressing adhesive when grasping the edges to manipulate the dressing carrier, support, applicator or base.
• Devices, kits and methods described herein may be for the treatment, amelioration, or prevention of scars and/or keloids by creating and/or maintaining a pre-determined strain in an elastic skin treatment device that is then affixed to the skin surface using skin adhesives to transfer a generally planar (e.g. compressive) force from the bandage to the skin surface. Other uses include wound closure and skin splinting/stabilization treatments.
• In some variations, a dressing is provided, comprising an elastic sheet structure (e.g., a comprising a silicone polyurethane, TPE (thermoplastic elastomers), synthetic rubber or co-polyester material) comprising an upper surface, a lower surface, a first edge and a second edge opposite the first edge, and one or more adhesive regions. The dressing may further comprise a first release liner releasably attached to the adhesive region or regions. The adhesive region(s) may comprise a pressure sensitive adhesive. The dressing may be tapered or otherwise shaped to reduce skin tension at the edges. The dressing may have modified, reduced or no adhesive near its edges to reduce skin tension at the edges. Portions of the dressing may be unstrained and may thereby reduce strain in certain areas of the skin where the dressing is applied. In some specific examples, the unstrained area or areas are found between the edges of the dressing and the strained area(s). In some further examples, the unstrained areas are limited to this area and are not found, during application or use, between the strained areas of a single dressing, in use. In still further examples, the unstrained areas are limited to areas along the edges of a dressing that intersect the strain axis of the strained area(s), but not to areas along the edges of the dressing that are generally parallel to the strain axis.
• A device may be used to strain and/or maintain a strain on a dressing. The device may further comprise a releasable locking mechanism, attachment mechanism or adhesive, configured to maintain the member or mechanism in a strained configuration.
• According to some variations, the packaging is also sufficiently flexible in at least one direction to permit curving or shaping of the dressing to conform to the curvature or shape of the location on the body or skin where the dressing is applied. Generally, the flexibility of the packaging used to conform the dressing to the treatment site may be configured so that the treatment site is not substantially deformed during the application of the dressing; so that the application of the dressing is relatively smooth or uniform on the skin; and/or provides a uniform, predetermined, or relatively predictable strain or force to an area of skin The packaging or applicator may have flexibility in a first direction and greater rigidity in another direction. The packaging or applicator may include elements or segments that permit flexibility with respect to adjacent elements or segments.
• According to some variations, the packaging is also sufficiently flexible in at least one direction to permit curving or shaping of the dressing to conform to the curvature or shape of the location on the body or skin where the dressing is applied. Generally, the flexibility of the packaging used to conform the dressing to the treatment site may be configured so that the treatment site is not substantially deformed during the application of the dressing; and/or so that the application of the dressing is relatively smooth or uniform on the skin; and/or provides a uniform, predetermined, or relatively predictable strain and/or force to an area of skin. The packaging or applicator may have flexibility in a first direction and greater rigidity in a second direction. The first direction may be transverse to the direction of straining or have a component that is transverse to the direction of straining. The second direction may by the direction of straining or have a component that is in the direction of straining. The first direction may or may not be transverse with respect to the second direction. The packaging or applicator may include elements or segments that permit flexibility with respect to adjacent elements or segments.
• According to some variations a desired flexibility, for example having at least one component transverse to the direction of straining, may be characterized by a modified cantilevered beam bending model, i.e. applying a force to the free end of a beam, simply supported from the other end, while wrapping it around a cylindrical object with a known radius of curvature or curvature, defined as the reciprocal of the radius of the curvature. According to one variation, the force to bend the packaging or applicator around an object with a predetermined curvature may be no greater than about 3 pounds. According to one variation, the force may be no greater than about 0.3 pounds. According to one variation, the force to bend around a predetermined curvature of about a 2.5 inch radius may be no greater than about 3 pounds. In another variation, the force to bend around a predetermined curvature of about a 2.5 inch radius may be no greater than about 0.3 pounds.
• In one variation, a skin treatment system is provided, comprising an elastic planar structure with a load per millimeter width of at least 0.1 Newtons at a strain of at least 0.4, and a strain limiter coupled to the elastic planar structure and configured to resist straining of the elastic planar structure beyond a predetermined strain. The strain limiter may comprise a first handle at a first end of the at least one strain limiter, and a second handle at a second end of the at least one strain limiter. The skin treatment system may comprise at least two elongate strain limiting structures. The first handle may be contiguously or non-contiguously coupled to the elastic planar structure between the first ends of the at least two elongate strain limiting structures. The second handle may also be contiguously or non-contiguously coupled to the elastic planar structure between the second ends of the at least two elongate strain limiting structures. The predetermined strain may be at least 0.2 or 0.4. The strain limiter may be releasably coupled to the elastic planar structure. The strain limiter may be adhered to the elastic planar structure using an adhesive. The adhesive may comprise a shear-resistance to a force level that is greater than the T-peel resistance to the force level. The first handle and the second handle may comprise a substantially inelastic material relative to the elastic planar structure, which may optionally be a semi-rigid or rigid material. The strain limiter may comprise at least one flexible, inelastic elongate element. The elastic planar structure may comprise an unstrained configuration in which a distance between a first attachment region of the strain limiter and a second attachment region of the strain limiter is less than a length of the strain limiter between the first attachment region and the second attachment region, and may comprise a strained configuration at the predetermined strain wherein the distance between the first attachment region of the strain limiter and a second attachment region of the strain limiter is substantially equal to the a length of the strain limiter between the first attachment region and the second attachment region. The strain limiter may comprise a folded board with at least three two folds, or a ratchet and pawl mechanism. The strain limiter may be selectively configured to resist straining of the elastic planar structure beyond a plurality of predetermined strains. The plurality of predetermined strains may comprise graphical indicia on the strain limiter.
• In another variation, the skin treatment system comprises an elastic planar structure, comprising a tensioning axis, and a strain limiter coupled to the elastic planar structure and configured to resist straining of the elastic planar structure beyond a predetermined strain, wherein the attachment of a first end of the strain limiter to the elastic planar structure is contiguous across a dimension of the elastic planar structure transverse to the tensioning axis. The elastic planar structure may have a load per millimeter width of at least 0.1 Newtons at a strain of at least 0.4. The strain limiter may comprise a first handle at a first end of the at least one strain limiter, and a second handle at a second end of the at least one strain limiter. The skin treatment system may comprise at least two elongate strain limiting structures. The first handle may be contiguously coupled to the elastic planar structure between the first ends of the at least two elongate strain limiting structures. The second handle may also be contiguously coupled to the elastic planar structure between the second ends of the at least two elongate strain limiting structures. The predetermined strain may be at least 0.2 or 0.4. The strain limiter may be releasably coupled to the elastic planar structure. The strain limiter may be adhered to the elastic planar structure using an adhesive. The adhesive may comprise a shear-resistance to a force level that is greater than the T-peel resistance to the force level. The first handle and the second handle may comprise a substantially inelastic material relative to the elastic planar structure, which may optionally be a semi-rigid or rigid material. The strain limiter may comprise at least one flexible, inelastic elongate element. The elastic planar structure may comprise an unstrained configuration in which a distance between a first attachment region of the strain limiter and a second attachment region of the strain limiter is less than a length of the strain limiter between the first attachment region and the second attachment region, and may comprise a strained configuration at the predetermined strain wherein the distance between the first attachment region of the strain limiter and a second attachment region of the strain limiter is substantially equal to the a length of the strain limiter between the first attachment region and the second attachment region. The strain limiter may comprise a folded board with at least three two folds, or a ratchet and pawl mechanism. The strain limiter may be selectively configured to resist straining of the elastic planar structure beyond a plurality of predetermined strains. The plurality of predetermined strains may comprise graphical indicia on the strain limiter.
• In another variation, a skin treatment system is provided, comprising an elastic structure, first and second handles attached to opposite regions of the elastic structure, wherein the first and second handles are coupled to the elastic structure and configured to provide a substantially uniform tensile force across the elastic structure; and a strain indicator. The strain indicator may comprises graphical or numerical indicia of the degree of strain.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a top view of a skin treatment device in a first configuration.
• FIG. 1B is a top view of the skin treatment device ofFIG. 1A in a second configuration.
• FIG. 2A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 2C is a side elevational view of the skin treatment device inFIG. 2A.
• FIG. 2B is a top perspective view of a skin treatment device in a strained second configuration.
• FIG. 3A is a top perspective view of a skin treatment device in a relatively unstrained configuration.
• FIG. 3B is a top perspective view of the skin treatment device ofFIG. 2A in a first strained configuration.
• FIG. 3C is a top perspective view of the skin treatment device ofFIG. 2A in a second strained configuration.
• FIG. 4A is a top schematic view of a skin treatment device in a first configuration.
• FIG. 4B is a top schematic view of the skin treatment device ofFIG. 4A in a second strained configuration.
• FIG. 5A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 5B is a top perspective view of the skin treatment device ofFIG. 5A in a second configuration.
• FIG. 6A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 6B is a top perspective view of the skin treatment device ofFIG. 6A in a second, strained configuration.
• FIG. 7A is a top perspective view of a skin treatment device in an unstrained configuration.
• FIG. 7B is a bottom perspective view of the skin treatment device ofFIG. 7A in the unstrained configuration.
• FIG. 7C is a top perspective view of a skin treatment device ofFIG. 7A in a strained configuration.
• FIG. 7D is a bottom perspective view of the skin treatment device ofFIG. 7C in the strained configuration.
• FIG. 8A is a top perspective view of a skin treatment device in an unstrained configuration.
• FIG. 8B is a top perspective view of the skin treatment device ofFIG. 8A in a strained configuration.
• FIG. 9A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 9B is a top perspective view of the skin treatment device ofFIG. 9A in a second strained configuration.
• FIG. 10A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 10B is a top perspective view of the skin treatment device ofFIG. 10A in a second configuration.
• FIG. 10C is a top perspective view of the skin treatment device ofFIG. 10A in a third strained configuration.FIG. 10A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 10D is a top perspective view of the skin treatment device in a first configuration.
• FIG. 10E is a top perspective view of the skin treatment device ofFIG. 10D in a second strained configuration.
• FIG. 10F is a top perspective view of the skin treatment device ofFIG. 10D in a third strained configuration.
• FIG. 10G is a top perspective view of the skin treatment device ofFIG. 10D in a fourth strained configuration.
• FIG. 11A is top schematic view of a skin treatment device in a first configuration.
• FIG. 11B is a bottom schematic view of the skin treatment device ofFIG. 11A in the second configuration.
• FIG. 11C is a top schematic view of the skin treatment device ofFIG. 11A in a second, strained configuration.
• FIG. 11D is a bottom schematic view of the skin treatment device ofFIG. 11A in a second, strained configuration.
• FIG. 12A is top schematic view of a skin treatment device in a first configuration.
• FIG. 12B is a bottom schematic view of the skin treatment device ofFIG. 12A in the second configuration.
• FIG. 12C is a top schematic view of the skin treatment device ofFIG. 12A in a second, strained configuration.
• FIG. 12D is a bottom schematic view of the skin treatment device ofFIG. 12A in a second, strained configuration.
• FIG. 13A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 13B is a top perspective view of the skin treatment device ofFIG. 13A in a second, partially strained configuration.
• FIG. 13C is a top perspective view of the skin treatment device ofFIG. 13A in a third, strained configuration.
• FIG. 14A is a top perspective view of a skin treatment device in a first configuration.
• FIG. 14B is a top perspective view of the skin treatment device ofFIG. 14A in a second, strained configuration.
• FIG. 14C is a top perspective view of a the skin treatment device in a first configuration.
• FIG. 14D is a top perspective view of the skin treatment device ofFIG. 14C in a second, strained configuration.
• FIG. 15A is a side perspective view of a tensioning device and skin treatment device prior to straining.
• FIG. 15B is a side perspective view of the tensioning device ofFIG. 15A straining skin treatment device ofFIG. 15B.
• FIG. 16A is a side elevated view a dressing and tensioning device.
• FIG. 16B is a top view of the dressing ofFIG. 16A.
DETAILED DESCRIPTION
• It is believed that controlling, managing or modulating stresses acting in and/or on skin (“mechanomodulation”) may have beneficial effects. Modulation of mechanical stresses or effects acting in and/or on skin may translate into or induce biomechanical response, including but not limited to, responses relating to scarring, scar proliferation or other effects.
• Devices, methods, systems and kits described herein may relate to devices used to shield skin or a wound from its mechanical environment. The term “shield” is meant to encompass the unloading of stress experienced by the skin or wound as well as and/or providing a physical barrier against contact, contaminants, and the like. The stress shielding or force offloading devices and methods described here may shield the skin or a wound by unloading endogenous stress and/or exogenous stresses. In some variations, the devices may shield the skin from endogenous stress without affecting exogenous stress on the skin, e.g., devices that modify the elastic properties of the skin, etc. In other variations, the devices may shield the wound from exogenous stress without affecting endogenous stress on the skin wound. In still other variations, the devices shield the skin from both endogenous and exogenous stress.
• Devices, kits and methods described herein may treat skin at a skin site (“skin treatment device”), including without limitation, to ameliorate the formation of scars at wound sites by controllably stressing or straining the epidermis and deeper layers of dermal tissue at or near a skin site, i.e., at or adjacent a wound or treatment site of a subject's skin, thereby reducing tensile or compressive stress at the skin site. The stress at the skin site may be reduced to levels below that experienced by normal skin and tissue. The stress or strain may be applied to surrounding tissue in one, two, or more directions to reduce endogenous or exogenous stress at the skin site in one, two or more directions. Thus, devices and methods described herein may reduce the stress experienced by skin and/or a wound and surrounding tissues in order to treat a subject. The device may also assist in preventing or reducing the incidence of wound dehiscence.
• “Dressing” or “Skin Device” as used herein may include but is not limited to, a skin treatment device, wound treatment device, scar or keloid treatment device, scar or keloid amelioration or prevention device, bandage, or dressing, that may be applied, attached to or coupled to one or more layers of the skin or tissue of a subject.
• Devices kits and methods described herein may be for the preparation and/or application of a dressing. Such preparation may include but is not limited to, for example, removal of an adhesive liner, straining or tensioning a dressing, orienting a dressing for application and/or applying a medicament or other material to a portion of the dressing prior to application.
• According to some variations, the packaging, tensioning device, dressing carrier, support, base, handles, manipulation elements and/or applicator may further comprise an opening, a window, or a clear or semi-opaque portion through which a wound, incision or other location may be visualized as the dressing is applied to the skin. According to some variations, the window guides the application of a dressing so that there is an optimal or desired distance between the wound and the edges of the dressing and/or so that the dressing is in an optimal location for unloading skin stresses.
• According to some variations, a packaging, manipulation element, and/or applicator is more rigid or provides sufficient column strength in at least a first direction to be supportive of a dressing, while being relatively more flexible and less rigid in at least second direction to provide for a more conforming application to a curved or shaped skin surface of a subject or to permit curvature or shaping of the dressing where it is applied. The first and second directions may or may not be orthogonal to each other. According to some variations, a packaging applicator, tensioning device or dressing carrier, support or base is sufficiently rigid or supportive of a dressing while permitting shaping of the dressing. According to some variations, the carrier or support which may include a base and/or a cover may comprise segments of relatively more rigid material flexibly coupled to adjacent segments to provide flexibility to permit shaping of packaging/applicator and/or dressing while providing sufficient support of the dressing during application. According to some variations, segments are coupled to adjacent segments by way of a flexible material, such as a low-density polyethylene (LDPE) material, or a composite of adhesive and a thinner more flexible substrate. Alternatively, segments may be formed as a structure by manufacturing a substrate with cut-outs, slots, grooves, scoring or other openings or variations in thickness of the substrate at different locations.
• The packaging, applicator, manipulation elements tensioning device, or dressing carrier may have elements or features the provide flexibility in one direction while limiting flexibility in another direction. Each of the elements may permit flexing in a different direction than one or more of the other elements. Flexible elements may be straight, or shaped according to a desired application or location of placement. According to some variations, the flexible elements may limit flexibility when the device is being strained and permit flexibility when the device is being applied to the skin.
• According to variations, flexible elements are provided in combination with support elements that provide sufficient support to allow a user to maintain the dressing in a strained configuration. According to variations, one or more elements may be provided to maintain a strained dressing in a strained configuration, for example a securing element that secures the dressing in a strained configuration until it is applied to a subject and is released from the carrier, support, base, manipulation element, tensioning device or applicator. For example, after straining the dressing, the dressing may be adhered or attached to one or more elements of a dressing, support, base, manipulation elements, tensioning device or applicator or dressing assembly until it is released from the carrier, support, base tensioning device or applicator or assembly.
• According to some variations, the applicator may be further used to help reduce bleeding, e.g., by allowing application of a compressive force using a support structure while or after the device is applied. One or more hemostatic or coagulative agents may be applied to, or otherwise integrated with dressing to help reduce bleeding. Potential agents include chitosan, calcium-loaded zeolite, microfibrillar collagen, cellulose, anhydrous aluminum sulfate, silver nitrate, potassium alum, titanium oxide, fibrinogen, epinephrine, calcium alginate, poly-N-acetyl glucosamine, thrombin, coagulation factor(s) (e.g. II, VII, VII, X, XIII, Von Willebrand factor), procoagulants (e.g. propyl gallate), antifibrinolytics (e.g. epsilon aminocaproic acid), and the like. In some variations, the agents may be freeze-dried and integrated into the dressing and activated upon contact with blood or other fluid. In some further variations, an activating agent may be applied to the dressing or the treatment site before the dressing is used on the subject. In still other examples, the hemostatic agent may be applied separately and directly to the wound before application of the dressing, or after application to the dressing via a catheter or tube. The devices may also comprise one or more other active agents that may be useful in aiding in some aspect of the wound healing process. For example, the active agent may be a pharmaceutical compound, a protein (e.g., a growth factor), a vitamin (e.g., vitamin E), or combinations thereof. A further example of such medicament may include, but is not limited to various antibiotics (including but not limited to cephalosporins, bactitracin, polyxyxin B sulfate, neomycin, polysporin), antiseptics (such as iodine solutions, silver sulfadiazine, chlorhexidine), antifungals (such as nystatin), antiproliferative agents (sirolimus, tacrolimus, zotarolimus, biolimus, paclitaxel), grow factors (such as VEGF) and other treatments (e.g. botulism toxin. Of course, the devices may comprise more than one medicament or agent, and the devices may deliver one or more medicaments or agents.
• The dressing may comprise an elastic member, such as a sheet of elastic material. The elastic material of the dressing may comprise a single layer of material or multiple layers of the same or different materials. The material may have any of a variety of configurations, including a solid, foam, lattice, or woven configuration. The elastic material may be a biocompatible polymer, e.g., silicone, polyurethane, TPE (thermoplastic elastomers), synthetic rubber or co-polyester material. The thickness of polymer sheets may be selected to provide the dressings with sufficient load carrying capacity to achieve desired recoverable strains, and to prevent undesired amounts of creep deformation of the dressings over time. In some variations, the thickness across dressings is not uniform, e.g., the thickness across the dressing may be varied to change the stiffness, the load carrying capacity, or recovery strains in selected orientations and/or locations. The elastic material of the exemplary dressing may have a thickness in the range of about 50 microns to 1 mm or more, about 100 microns to about 500 microns, about 120 microns to about 300 microns, or in some variations about 200 microns to about 260 microns. The exemplary dressings have an edge thickness of about 500 microns or less, 400 microns or less, or about 300 microns or less may exhibit less risk of skin separation from inadvertent lifting when inadvertently brushed against clothing or objects. In some variations, the dressings are tapered near the edges to reduce thickness. A tapered edge may also ameliorate peak tensile forces acting on skin tissue adjacent to the adhesive edges of the dressing. This may or may not reduce the risk of skin blistering or other tension-related skin trauma. In other variations, the edges of the dressing may be thicker than the middle of the dressing. It is hypothesized that in some configurations, a thicker dressing edge may provide a relative inward shift of the location of the peak tensile forces acting near the dressing edge, compared to dressings of uniform thickness. The elastic material may have a load per width of at least 0.35 Newtons per mm at an engineering strain of 60% or a load per width of at least 0.25 Newtons per mm at an engineering strain of 45%. The elastic material may have a load per width of no greater than about 2 Newtons per mm at the engineering strain of about 45% to 60%, about 1 Newtons per mm at the engineering strain of about 45% to 60%, about 0.7 Newtons per mm at the engineering strain of about 45% to 60%, or no greater than about 0.5 Newtons per mm at the engineering strain of about 45% to 60%. The system elastic material may have a load per width that does not decrease from an engineering strain of 0% to 60%, a load per width plot that increases linearly from an engineering strain of 0% to 60%, or a load per width plot that is not convex from an engineering strain of 0% to 60%. The elastic material may comprise an adhesive configured to maintain a substantially constant stress in the range of 200 kPa to about 500 kPa for at least 8 hours when strained to an engineering strain of about 20% to 30% and attached to a surface. The elastic material may comprise an adhesive configured to maintain a substantially constant stress in the range of 200 kPa to about 400 kPa for at least 8 hours when strained to an engineering strain of about 20% to 30% and attached to a surface. The substantially constant stress may vary by less than 10% over at least 8 hours, or by less than 5% over at least 8 hours.
• Although the depicted dressings may have a generally rectangular configuration with a length and/or width of about 160 mm to about 60 mm, in other variations the dressing may have any of a variety of lengths and widths, and may comprise any of a variety of other shapes. Also, the corners of the dressing may be squared or rounded, for example. The lengths and/or widths of an exemplary dressing may be in the range of about 5 mm to about 1 meter or more, in some variations about 20 mm to about 500 mm, and in other variations about 30 mm to about 50 mm, and in still other variations about 50 mm to about 100 mm. In some variations, the ratio of the maximum dimension of the dressing (e.g. its length) to an orthogonal dimension to the maximum dimension (e.g. width), excluding the minimum dimension of the dressing (e.g. the thickness), may be in the range of about 1:3, about 1:2, about 1:1, about 2:1, about 3:1, about 4:1 about 5:1, about 6:1, about 7:1, about 8:1, about 9:1 or about 10:1 or greater. In some variations, the strain axis of the dressing in use may be oriented with respect to the maximum dimension or to the orthogonal dimension to the maximum dimension. In some variations, the final compressive stress and strain imposed onto the skin by the elastic material may be the result of the dynamic equilibrium between the tensile stress in the skin and the elastic material of the dressing. The skin at the skin site typically comprises an inherent tension that stretches incision site, whether or not any tissue was excised from the skin site. The elastic material and the adhesive region may be configured to be applied to a skin location so that when the dressing is stretched to a particular tension and then adhered to the incision site, tensile stress in the dressing is transferred to the incision site to compress the tissue directly under the dressing along a tangential axis to the skin surface, the stress and strain imposed onto the skin location has a net or resultant orientation or axis is also generally tangential or planar to the elastic material and/or the outer surface of the skin location, with a similar axis to the orientation or axis of the tensile stress in the dressing. The tension in the dressing will relax to a tension level that maintains equilibrium with increased tension in the skin adjacent to the dressing. The application of the dressing to the skin location may involve the placement of the dressing without overlapping or being wrapped onto itself, e.g. wherein only adjacent regions of the dressing are interconnected and wherein non-adjacent regions of the dressing are not interconnected. The actual amount of stress and strain imposed on the skin may vary, depending upon the particular person, skin location, the thickness or various mechanical characteristics of the skin layers (e.g. epidermis, dermis, or underlying connective tissues), and/or the degree of pre-existing scarring, for example. In some further variations, the wound treatment dressing may be selected or configured for use at a specific body location, such as the scalp, forehead, cheek, neck, upper back, lower back, abdominal region, upper torso (including but not limited to the breast folds), shoulder, upper arm, lower arm, palm regions, the dorsum of the hand, finger, thigh, lower leg, the dorsum or plantar surface of the foot, and/or toe. Where applicable, some body regions may be further delineated into anterior, posterior, medial, lateral, proximal and/or distal regions, e.g. the arms and legs.
• The dressing may be configured to impose a skin strain in the range of about 10% to about 60% or more, in other configurations about 15% to about 50%, and in still other configurations, about 20% to about 30% or about 40%; the dressing may also be configured to impose a strain of less than 10%. To achieve the desired degree of skin strain, the dressing may be configured to undergo elastic tensile strain in the range of about 20% to about 80% or more, sometimes about 30% to about 60%, and other times about 40% to about 50% or about 60%. The dressing may comprise any of a variety of elastic materials, including but not limited to silicones, styrenic block copolymers, natural rubbers, fluoroelastomers, perfluoroelastomers, polyether block amides, thermoplastic elastomers, thermoplastic polyurethane, polyisoprene, polybutadiene, and the like. The material of the exemplary dressing may have a Shore A durometer in the range of about 20 to about 90, about 30 to about 80, about 50 to about 80. The exemplary dressing was constructed of MED 82-5010-05 by NUSIL TECHNOLOGY LLC (Carpinteria, Calif.). Other examples of suitable materials are described in U.S. application Ser. No. 11/888,978, which was previously incorporated by reference in its entirety.
• When the dressing is applied to a skin location and allowed to at least partially recover to its base configuration, the recovery level or equilibrium level of strain in the dressing may be in the range of about 4% to about 60% or more, in other configurations about 15% to about 50%, and in still other configurations, about 20% to about 30% or about 40%. The ratio between the initial engineering tensile strain placed onto the dressing before recovery and the resulting engineering compressive strain in the skin may vary depending upon the skin type and location, but in some examples, may be about 2:1. In other examples, the ratio may be in the range of about 4:1 to about 5:4, about 3:1 to about 5:3, or about 5:2 to about 2:1. These skin strain characteristics may be determined with respect to a reference position of the body or body part, e.g. anatomical position, to facilitate reproducible measurements. The particular degree of strain may be characterized as either an engineering strain or a true strain, but may or may not be calculated based upon or converted from the other type of strain (e.g. the strain may be based upon a 45% engineering strain that is converted to a true strain).
• In some further variations, one or more characteristics of the elastic material may correspond to various features on the stress/strain curve of the material. For example, the engineering and true stress/strain curves for one specific example of the dressing comprises a material that exhibits an engineering stress of about 1.2 MPa at about 60% engineering strain, but in other examples, the engineering stress may be in the range of about 900 KPa to about 3.5 MPa, about 1 MPa to about 2.2 MPa, about 1 MPa to about 2 MPa, about 1.1 MPa to about 1.8 MPa, about 1.1 MPa to about 1.5 MPa, about 1.2 MPa to about 1.4 MPa. When unloading or relieving stress from the dressing, the material may be configured with an engineering stress of about 380 KPa at about 40% engineering strain, but in other examples, the engineering stress during unloading of the material to about a 40% strain may be in the range of about 300 KPa to about 700 KPa, about 325 KPa to about 600 KPa, about 350 KPa to about 500 KPa, or about 375 KPA to about 425 KPa. When unloading the material to an engineering strain of about 30%, the material exhibits an engineering stress of about 300 KPa, but in other examples, the engineering stress when unloading the material to about 30% strain may be in the range of about 250 KPa to about 500 KPa, about 275 KPa to about 450 KPa, about 300 KPa to about 400 KPa, or about 325 KPA to about 375 KPa. When unloading to an engineering strain of about 20%, the material may have an engineering stress of about 100 KPa, but in other examples, the unloading engineering stress at about 20% may be in the range of about 50 KPa to about 200 KPa, about 75 KPa to about 150 KPa, or about 100 KPa to about 125 KPa. In some examples, the material may be configured to at least achieve a specific range or level of engineering stress at each of the specified engineering strain levels described above, but in other examples, the material may be configured for lower levels of maximum engineering strain, e.g. up to about 30% or about 40%.
• In some examples, certain portions of the stress/strain curve may have a particular morphology. For example, for a particular level of maximum strain the loading curve may be generally linear on the corresponding true stress/strain curve. In an example using a dressing described herein, up to a true strain of about 45%, the loading curve had a generally linear configuration. In other examples, the configuration may only be linear along a portion of the loading curve or may be curved along the entire loading curve. Where the loading curve is non-linear, the loading curve may be convex, concave or both. Also, in some examples, the tangent line of the loading curve (i.e. the line between the two triangles) may also be generally co-linear.
• In some variations, the elastic material comprises a material having an elastic modulus E of at least about 1 MPa, about 1.5 MPa, about 2 MPa, about 2.5 MPa, about 3 MPa, about 3.5 MPa, about 4 MPa, about 5 MPa, about 6 MPa, about 7 MPa, about 8 MPa, about 9 MPa or at least about 10 MPa or greater. The material elastic modulus E may be no greater than about 10 MPa, about 9 MPa, about 8 MPA, about 7 MPa, about 6 MPa, or about 5 MPa, or about 4 MPa.
• In addition to the absolute stress levels at certain strain levels described above, the material may also be characterized with respect to the ratio between a) the stress to achieve a particular strain during loading, and b) the stress at the same strain during unloading. For example, the material may have a ratio of at least 4:1 to about 3:2 at each of the 20%, 30% and 40% strain levels, but in other examples, the material may exhibit these ratios only at 20%, at 30%, or at 40% strain levels, or at both 20% and 30% but not 40%, or at both 30% and 40% but not 20%. In other examples, the ratio at one, some or all of the strain levels may be in the range of about 3:1 to about 2:1, or about 5:2 to about 2:1.
• In some examples, the elastic material of the dressing may be configured under testing conditions to achieve a stable level of stress at a constant strain, e.g. the material exhibits a limited amount of stress relaxation over a particular period of time and at a particular level of strain. The period of time may be at least about 8 hours, about 12 hours, about 18 hours, about 24 hours, about 36 hours, about 48 hours, about 72 hours, about 4 days, about 5 days, about 6 days, or about a week or more. The level of strain may be about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, or about 80% or more. The stress of the exemplary dressing over various time curves may be configured to maintain an engineering stress of about 300 KPa at an engineering strain of about 30% without noticeable deviation over a period of about 1 hour, about 2 hours, about 3 hours, about 4 hours, about 5 hours, about 6 hours, about 7 hours, or about 8 hours or more. The stresses at 10% strain, 20% strain, and at 40% may be lower or higher.
• In some variations, the elastic material or the dressing may be configured under testing conditions to maintain a particular minimum level of stress when held at a constant strain over a particular time period. In an example to assess the ability of a backing material to maintain a stress and strain on skin over time, engineering strains were measured while each backing material was tensile strained to 60% at a rate of 100 microns per second and held for 10 minutes, and then dropped to a strain of 30% at a rate of 100 microns per second and held for 9 hours. For example, the exemplary dressing is able to maintain an engineering stress level of about 350 KPa at an engineering strain of 30%. In some other examples, the minimum level of stress may be about 100 KPa, about 120 KPa, about 140 KPa, about 160 KPa, about 180 KPa, about 200 KPa, about 220 KPa, about 240 KPa, about 260 KPa, about 280 KPa, about 300 KPa, about 320 KPa, about 340 KPa, about 360 KPa, about 380 KPa, about 400 KPa, about 420 KPa, about 440 KPa, about 460 KPa, about 480 KPa, about 500 KPa, about 600 KPa, about 700 KPa, about 800 KPa, about 900 KPa or about 1000 KPa or greater. The level of constant strain may be different in other configuration, with a level of about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, or about 80%. The time period over which the dressing is able to maintain a stress level may be at least about 2000 seconds, about 3000 seconds, about 4000 seconds, about 5000 seconds, about 6000 seconds, about 7000 seconds, about 8000 seconds, about 9000 seconds, about 10000 seconds, about 20000 seconds, about 30000 seconds, about 40000 seconds, about 50000 seconds, about 60000 seconds, about 70000 seconds, about 24 hours, about 36 hours, about 48 hours, about 72 hours, about 4 days, about 5 days, about 6 days, about 7 days, about 10 days, about 2 weeks, about 1 month or more. In some variations, the dressing, the elastic material and/or the adhesive material is configured to exhibit less than about a 15% change in stress or strain level over the particular period when applied to a skin surface or test surface. In other examples, the degree of change may be about 12%, about 10%, about 8%, about 6%, about 5%, about 4%, about 3%, or about 2% or less. The stress or strain may be an engineering stress or strain, and/or a true stress or strain.
• The adhesive used may be, for example, a pressure activated adhesive (PSA), as a silicone, acrylic, styrene block copolymer, vinyl ether, nitrile or other PSA. In other variations, a non-pressure sensitive adhesive may be used, including but not limited a heat or light-cured adhesive. The pressure sensitive adhesive may be made from, e.g., polyacrylate-based, polyisobutylene-based, silicone-based pressure sensitive adhesives, synthetic rubber, acrylic, and polyisobutylene (PIB), hydrocolloid, and the like. The T-peel release force and blunt probe tack force of the adhesive may be measured by a standardized test method, such as ASTM D1876 and ASTMD2979 or other appropriate method. In some variations, the T-peel release force or blunt probe tack test value of the adhesive is configured to maintain loads of at least about 50 mPa/mm for at least about 24 hours, about 48 hours, about 72 hours, about 1 week, about 2 weeks, about 3 weeks, about 4 weeks or more. In other variations, the loads may be at least about 75 mPa/mm, about 100 mPa/mm, about 125 mPa/mm, or at least about 150 mPa/mm over the particular time period. The degree of adhesion (e.g. as measured by the T-peel release force or blunt probe tack test value) may vary depending upon the degree of strain placed onto the skin or incision site, and in some variations, these time periods may be based upon an average skin strain of about 10%, about 20%, about 30%, about 40%, or about 50% or more. In some variations, the adhesive may have a T-peel release force of at least about 150 kg/m, about 160 kg/m, about 170 kg/m, about 180 kg/m, about 190 kg/m, about 200 kg/m, about 210 kg/m, about 220 kg/m, about 230 kg/m, about 240 kg/m, about 250 kg/m, about 260 kg/m, about 270 kg/m, about 280 kg/m, about 290 kg/m, about 300 kg/m, about 310 kg/m, about 320 kg/m, about 330 kg/m, about 340 kg/m, about 350 kg/m, about 400 kg/m, about 450 kg/m, or at least about 500 kg/m or higher. In some further variations, the T-peel release force may be no greater than about 1000 kg/m, about 900 kg/m, about 800 kg/m, about 700 kg/m, about 600 kg/m, about 500 kg/m, about 400 kg/m or about 300 kg/m. The blunt probe tack test value of the adhesive may be at least about 0.50 kg, about 0.55 kg, about 0.60 kg, about 0.65 kg, about 0.70 kg or about 0.75 kg or higher, and may be no greater than about 1 kg, about 0.9 kg, about 0.8 kg, about 0.7 kg, or about 0.6 kg. The T-peel release force and blunt probe tack force may be measured by a standardized test method, such as ASTM D1876 and ASTMD2979 or other appropriate method. Other features or variations of the device are described in U.S. application Ser. No. 11/888,978, filed on Aug. 3, 2007, incorporated in its entirety herein by reference.
• Release liners may be provided over the skin adhesive and may be removed prior to stressing, straining, stretching and/or applying a dressing to a subject. The release liners may comprise any of a variety of materials, including both opaque and transparent materials. The release liners may comprise Mylar or paper, or any other material with reduced adhesion to the adhesive material(s) of the device. For example, for a silicone adhesive, a fluoropolymer-treated polyester film may be used, and for an acrylic pressure sensitive adhesive, a silicone treated polyester or Mylar film or silicone treated craft paper may be used. In variations where the device has multiple separate adhesive regions, separate release liners may be provided for each region, or some regions may be covered by the same release liner.
• In some variations the assembly may comprise one or more mechanisms or elements configured to facilitate separation, release, removal or detachment of the dressing from the packaging, manipulation elements applicator or tensioning device, other attachment elements or other portions of the dressing assembly, or other elements of the devices. Release elements or releasable attachment structures may include but are not limited to pockets and tabs, hook and loop mechanism, hooks, angled bars, pivoting, rolling, rocking or sliding features associated with or coupled to attachment structures, adhesives, removable adhesives, adhesive tapes or other adhesive devices, pegs, rip cords, towel bar configurations, sliding pins, friction locks, cam locks, vacuum or suction devices, snap connectors, carpet tack, press fit connections or other connections, levers, latches, locking members, spring members, for example, or other mechanisms such as cutters or rip cords or other structures or features to facilitate tearing, cutting or separation of attachment structures or elements perforated or otherwise severable structures, that permit removal of dressing from the applicator, packaging, other portions of the dressing assembly and/or attachment structures, features, elements or portions. They may be self-releasing latches or spring members. They may be actuated when a pressure member is applied to a skin treatment device prior to removing the applicator. They may be manually actuated.
• Packaging devices, applicators, tensioning devices, and corresponding attachment features may be configured to provide multi-direction strain or additional strain in an orthogonal direction to a dressing.
• The packaging device, manipulation elements, applicator, tensioning device and/or attachment structure profile may be straight, curved or otherwise varied. For example, the shape of the elements of a device may be configured to follow the shape of the area of the subject's body to which the skin treatment device is to be attached. A packaging device, manipulation elements, tensioning device, applicator or other elements thereof may be selected or configured to have a profile that has a desirable profile for a particular body location or profile where the skin treatment device is to be placed on a subject's skin. A packaging device, manipulation element, applicator, tensioning device or elements thereof may be selected or configured to closely match a portion of a subject's body profile. The packaging device, manipulation element, applicator or tensioning device and/or an element or segment thereof, may be curved, curvable, flexible, bendable, malleable, deformable, shapeable or movable to provide alternative shapes or profiles of an attached dressing. They may be relatively curved, curvable, flexible, malleable, bendable, deformable, shapeable or movable in at least one direction while being more rigid in another direction.
• A variety of locking, latching, securing, attaching or detent mechanisms may be used to maintain the dressing, packaging, manipulation elements, applicator and/or tensioning device in a various configurations including but not limited to unstrained, partially strained, strained configurations. A variety of locking, latching or detent mechanisms may be used to maintain a dressing in a variety of configurations including unstrained, partially strained, strained. By locking the packaging, applicator, tensioning device manipulation elements or other elements coupled to the dressing, or dressing in a strained position, a predetermined strain of a given dressing may be achieved and maintained until released. The predetermined amount of strain may be a predetermined absolute percentage of strain or level of force that is independent of the shape and/or size of the treatment site.
• According to a variation, a skin treatment device is provided that may be strained prior to application to the skin of a subject. According to variations, device or device elements may provide a variable strain to the skin treatment device.
• According to variations, a skin treatment device may comprise one or more manipulation elements removably coupled to a dressing. Such variations may further comprise a strain limiter that limits or determined the amount of strain applied to a dressing. Such variations may also further comprise a strain indicator that indicates a desired strain level has been reached. A
• According to a variation, a plurality of strain indicators may be provided where each indicator indicates a different strain level or amount.
• According to a variation, a skin treatment device is provided that may be strained by a user prior to application to the skin of a subject. According to a variation, skin treatment device may include strain indicator that indicates when the dressing has been stretched by the user to a desired degree.
• According to a variation, a skin treatment device that may be strained by a user may include a strain limiter configured to prevent over straining of the device, or straining the device beyond a desired degree or amount.
• According to a variation, the strain limiting elements may prevent straining in regions where straining or less strain is desired. The strain limited skin treatment devices may also be shaped to provide a graduated strain or varying strain through the strained device. The device may be stretched by hand or may otherwise be configured to be stretched with a tensioning device, for example a set forth in application Ser. Nos. 12/854,859 and 13/345,524 incorporated in their entirety herein by reference.
• According to a variation, a skin treatment device comprises one or more relaxed threads, strings, wires or other elongate, elongatable, straightenable or stretchable members that straighten, lengthen and/or stretch to a desired amount, degree, and/or preset limit. For example, in one variation, the members may have an undulating shape when the skin treatment device is unstretched and a straight configuration when the skin treatment device is stretched to a desired degree. The members may have a sufficient tensile strength to prevent over-stretching of the skin treatment device. According to a variation the skin treatment device is constructed of multiple layers of an elastic material such as silicone with an adhesive between layers to which the members are attached initially in the relaxed, undulating, sinusoidal, unstraightened or other unstretched configuration. According to a variation, the shape limiting strings or other devices may prevent straining in regions where straining or less strain is desired. For example, the threads may be straight at the edges of the skin treatment device to prevent straining at the edges.+−
• FIGS. 1A and 1B illustrate a strainableskin treatment device110 with strain indicators and/orstrain limiters150. The strain indicators and/orlimiters150 may be visibly positioned in or on adevice assembly108 which may comprise layers of elastic material sandwiching thestrain indicators150 therebetween. The material may or may not be transparent or translucent. Indicators may also be positioned on the surface of the device. The strain indicators and/orlimiters150 may be threads, wires or other elongate or elongatable members155. In use, thedevice assembly108 is grabbed by a user at opposingsides114,115 and stretched. The opposingsides114,115 may also have removable (or non-removable) manipulation elements attached to the ends to provide for a more even or uniform strain, and may comprise an inelastic material which is the same or different as the strain indicators/limiters150. The manipulation elements may span the entire transverse dimension of thedevice110 to the axis of tensioning, as depicted inFIG. 1B, but in other variations may be less than the entire transverse dimension (e.g. having a transverse dimension sufficient to span a plurality of strain indicators/limiters150, but less than the full transverse dimension of the device110). Such elements may comprise planar members, handle members, flexible members and/or inflexible members. They may be attached and removed in a variety of manners, for example as described herein. Also, although the example depicted inFIGS. 1A and 1B depict a plurality of strain indicators/limiters150 that are equally spaced apart and have uniform lengths and uniform attachment points across a transverse dimension to the tensioning axis of thedevice110, in other examples, the indicators/limiters150 may have a variable or non-uniform spacing, may have non-uniform lengths, non-uniform attachment points, and may also be serially arranged along the tensioning axis.
• As theskin treatment device110 is stretched or strained, the device width increases and the members155 straighten. When theskin treatment device110 has been stretched or strained to a desired amount or a pre-determined or preset amount, the indicators and/orlimiters150 are in a visible or identifiably straightened configuration, for example as shown inFIG. 1B. The indicators and/orlimiters150 may also comprise a relatively inelastic material such as, e.g. a nylon string, that prevents or resist theskin treatment device110 from over stretching or straining to a degree greater than is desirable, thus limiting the strain applied to thedevice110. A skin adhesive with a protective liner may be applied to a side of theskin treatment device110 prior to stretching, stressing or straining. The liner may be removed from theskin treatment device110 prior to stretching. According to one aspect of the invention, it is believed that a range of strain is significant in providing treatment to a skin. According to variations other shapes or stretching indicators may be used where a visible change in an indicator line, shape or color may occur. Examples of a color change material or structure are described in U.S. Pub. No. 2006/0246802 to Hughes et al, which is herein incorporated by reference in its entirety.
• FIG. 2A to 2C illustrate a manually strainableskin treatment device200 that may comprise, an elastic material. Theskin treatment device200 is coupled to astrain limiting backing210 comprising a flexible inelastic or relatively less elastic material with respect to the elastic material of theskin treatment device200, such as, for example, LDPE, FEP or nylon. As shown inFIG. 2A, prior to straining, theskin treatment device200 is shown in a relaxed, folded configuration, coupled (e.g. with an adhesive such as a preferentially removable adhesive as compared to skin adhesive used on surface204) at its opposing ends201,202 to theinner surface214 of thestrain limiting backing210 at locations orareas211,212. In the relaxed configuration the length of thedevice200 is a first shorter length. The ends216,217 of thestrain limiting backing210 may extend outward oflocations211,212 and be used as grips to pull and straighten thebacking210 as shown inFIG. 2A to thereby strain and increase the length of thedevice200 to a second greater length. Theinner surface214 of the strain limiting backing may comprise an adhesive layer such as a preferentially removable adhesive as compared to skin adhesive used onsurface204 which may attach the back203 of thedevice200 to theinside surface214 of thebacking210 when the device is strained. The exposedsurface204 of thedevice200 may comprise a skin adhesive such as a pressure sensitive adhesive that secures the device to a skin surface when applied. After the device is applied to a skin surface, thebacking210 may be peeled away from thedevice200.
• FIGS. 3A to 3C illustrate a strainableskin treatment device300 which may be strained and/or stretched by exerting a tensioning force on theends307,308 of theskin treatment device300. A first opposing slidingelement305 is coupled at itsend317 to thefirst end307 of thedevice300 and a second opposing slidingelement306 is coupled at itsend316 to thesecond end308. The slidingelements305 may be removable coupled to theskin device300, for example with an adhesive such as a preferentially removable adhesive as compared to skin adhesive used on skin interfacing surface. The first slidingelement305 and second slidingelement306 are slidably coupled to each other. The first slidingelement305 comprises awindow311 and securingbar312. The second slidingelement306 comprises anelongate tab309 havingstrain value indicators310 on the top surface of theelongated tab309 so that they may be viewed throughwindow311. Thetab309 of the second slidingelement306 is positioned under the first slidingelement305 and through thewindow311 of the first slidingelement305. The securingbar312 is positioned across thewindow311 and below thetab309, to hold thetab309 in position through thewindow311. Additional securing elements such as rails or guide elements may or may not be used to guide or maintain connection or alignment of thetab309 with respect to thewindow311. The ends306,307 and/or ends316,317 may be used to grip and strain thedevice300, and may or may not comprise an inelastic material. As theskin treatment device300 is strained, theelements305,306 slide apart and thetab309 slides through thewindow311. In the first position inFIG. 3A, the device is at a 0% strain in a first unstrained configuration. InFIG. 3B, thedevice300 is strained about 25% as indicated by thestrain indicator310. InFIG. 3C the device is strained to 45% as indication by theindicator310. A user may select the amount of strain desired. A user may use theindicators310 to strain thedevice300 to a desired degree. A skin adhesive may be provided on the skin attachment side314 of thedevice300. The ends316,317 may be attached to the top surface318 (opposing a skin adhesive surface) of thedevice300 by way of an adhesive, such as a preferentially removable adhesive as compared to skin adhesive used onskin adhesive surface After straining the device300 a desired amount, it may be placed on a skin surface and the manipulation elements or slidingmembers316,317 may be removed. Alternatively, one of thesides307 or308 of the device may be applied to a skin surface. Thedevice300 may be strained a desired degree by pulling on the on the unattached one of thesides307 or308 while observing theindicia310. Once a desired strain level is reached theunattached side307 or308 may be attached to the skin and the manipulation elements or slidingmembers316,317 may be removed
• FIGS. 4A and 4B illustrate a strainableskin treatment device400 which may be strained and/or stressed by exerting a tensioning force on theends407,408 of theskin treatment device400. Aratchet404 comprises first opposingratchet element405 coupled at itsend417 to thefirst end407 of thetreatment device400, and a second opposingratchet element406 coupled at itsend418 to thesecond end408 of thetreatment device400.Ratchet elements405,406 are movably coupled to each other so that they may be separated and the device may be tensile stressed and maintained in a strained configuration. The ends407,408 of the skin treatment device and/or ends417,418 of theratchet elements405,406 may be used to grip and strain stress and/or stretch thedevice400. Thefirst ratchet element405 comprisespawls415 that engagesloped teeth416 of thesecond ratchet element406 and prevent movement backwards, loss of strain and/or complete relaxation of a tensile stressedskin treatment device400. As the ends417,418 of theratchet404 move apart, theskin treatment device400 is strained. Strain indicators orindicia410 are on thesecond ratchet element406 adjacent theteeth416 and indicate a degree of strain of thedevice400 based on which one of theteeth416 engages thepawl415. In the first position inFIG. 4A, thedevice400 is relatively unstrained and in the position indicated by strain indicator “0”410-0. InFIG. 4B, the device is strained to a maximum amount as indicated by the strain indicator “C”41c.Positions 0, A, B, and C410-0,410a,410band410ccorrespond to different teeth or positions on theratchet404 and accordingly, different strain amounts or zero strain. A user may select the amount of strain. A user may use theindicators410 to strain thedevice400 to a selected or desired amount. A skin adhesive may be provided on the skin attachment side of thedevice400 to adhere thedevice400 to the skin. The ends417,418 may be attached to the top surface419 of thedevice400 by way of an adhesive, such as a preferentially removable adhesive as compared to skin adhesive used on skin interfacing surface. Theratchet elements405,406 may be peelable from the device or otherwise removably coupled to thedevice400. After the device is applied to a subject, theratchet elements405,406 may be removed leaving thedevice400 on the skin. In other variations, one or more of the ratchet elements and/or pawl elements may be left in place or otherwise configured to be non-removable. In some variations comprising removable elements used only during the application of the device, the removable elements may be attached to the device using adhesives comprising a higher shear force resistance but a lower T-peel force resistance, relative to the same force.
• FIGS. 5A and 5B illustrate a strainableskin treatment device500 which may be strained, stretched and/or tensile stressed by exerting a tensioning force on ratchetedtabs515,516 or other manipulation elements of a strainingstructure514. Theskin treatment device500 is coupled at itsfirst end507 to afirst attachment element527. Thefirst attachment element527 is coupled at itssides531,532 to side supports517,518 of the strainingstructure514. The second andopposite end508 of theskin treatment device500 is coupled to asecond attachment element528. Thesides533,534 of second attachment element are slidably positioned inslots547,548 formed in side supports517,518 along a portion of the length. Ratchetedopenings557,558 are formed through the top surface550 of side supports517,518 along the portion of the length of theslots547,548. Thetabs515,516 are coupled throughopenings557,558 tosides533,534 respectively ofattachment element528 within theslots547,548 respectively The ratchet504 comprises theteeth526 of the ratchetedopenings547,548 andpawls525 formed in sides of thetabs515,516.Pawls525 may be disengaged from theteeth516 by depressing thebuttons535,536 on thetabs515,516 when straining thedevice500. Thepawls525 engage theteeth526 when thebuttons535,536 are released to maintain thedevice500 in a strained configuration by pushingbuttons535,536 to releasepawls525. Thebuttons535,536 may be biased by a spring in a pawl engaging direction. Whenbuttons535,536 are released at a selected position, a desired device strain is maintained or locked in.
• Thetabs515,516 may be extended to strain the attached dressing. Strain indicators orindicia540, for example as described herein may be provided on the strainingstructure514 ordevice500 to indicate a degree of strain of thedevice500. The device may be strained a selectable amount based on which ones of theteeth516 engage thepawls515. A user may use theindicators540 to strain thedevice500 to a selected or desired amount. A skin adhesive may be provided on the skin attachment side of thedevice500 to adhere thedevice500 to a subject. Theattachment elements527 and528 may be attached to thetreatment device500 by a preferentially removable adhesive as compared to skin adhesive used on skin interfacing surface of thedevice500. Thetabs515,516 are coupled to theattachment element528. The straining structure may be removable from thedevice500 leaving thedevice500 on the skin.
• FIGS. 6A and 6B illustrate a strainableskin treatment device600 withhandles615,616 coupled to afirst surface601 of atreatment device600, for example, with a peelable adhesive. Theskin treatment device600 may be strained and/or tensile stressed by exerting a tensioning force onhandles615,616. Astrain limiter610 is coupled to inner edges orwalls625,626 of thehandles615,616, respectively, for example by adhering, welding, or overmolding. Thestrain limiter610 comprises at least one element that is bent, folded, arced or otherwise shaped in a first configuration, for example, as shown for example, inFIG. 6A where the distance between theinner walls625,626 is less than when thedevice600 is strained. When a user manually strains the device by separating thehandles615,616, the strain limiter, straightens and maintains the strain by engaging theside walls625,626 in a straight configuration. Thestrain limiter610 may be constructed for example, of LDPE, FEP, nylon, metal. Thestrain limiter610 may be coupled to the side walls of thehandles615,616. Thestrain limiter610 and handles615,616 may be released from thedevice600 after it is applied to a skin surface by peeling it away.
• FIGS. 7A to 7D illustrate a strainableskin treatment device700. Thetreatment device700 is coupled to asheet710 at a first side705 of the device, for example by way of an adhesive or other securingelement720 capable of resisting shear stresses during straining, e.g., KAPTON® polyimide tape (DuPont, Wilmington, Del.). Thedevice700 may be anchored at asecond end708 to a support structure or backing730 on a first surface733 of thebacking730, for example by way of a securing element740 such as a KAPTON®tape or adhesive that is removable from thedevice700. Thedevice700 may be manually or otherwise strained by grasping or pulling thesheet710 in a straining direction. A second opposingsurface735 of thebacking730 comprises afirst row736 ofsnap buttons738 and a second (or more)row737 ofsnap buttons738 that engage with arow717 ofmating snap buttons727 on thesheet710. After thedevice700 is strained by tensioning or pulling thesheet710. Thesheet710 may be folded back so that therow717 is aligned with a row of snap buttons on thebacking730. Each row may be positioned so that a known amount of strain is created in the dressing depending on which row is used. For example, thefirst row736 ofbuttons738 would be commensurate with an amount of strain that is less that the amount of strain commensurate with thesecond row737 ofbuttons738. Accordingly a user may select an amount of strain.
• FIGS. 8A and 8B illustrate a strainableskin treatment device800. Theskin treatment device800 is coupled on afirst side804 to a correspondingfirst side814 of a stiffer or morerigid backing810. Acoupling element806 is coupled to thesecond side805 of thetreatment device800. Thecoupling element806 engages or snaps into a receivingelement816 on thesecond side815 of thebacking810. A user may manipulate thecoupling element806 to strain thetreatment device800 and then attach thecoupling element806 to the receivingelement816. Thecoupling element806 andengaging element816 may be snapped together and apart for example as with press fit a tongue in groove type connector arrangement. They also may be slid apart in a planar direction with respect to thetreatment device800 and thebacking810. Theskin treatment device800 and thebacking810 may be removably coupled on thefirst sides804,814 by way of a peelable adhesive or other coupling mechanism. For example, thefirst sides804,814 may be coupled in a similar manner ascoupling element806 and receivingelement816. Thus, after straining and attaching thetreatment device800 to thebacking810 in a strained configuration, and after applying anadhesive side802 of thestrained device800 to skin to be treated, thebacking810 may be released from thedevice800 by snapping or sliding thebacking810 apart from thedevice800.
• FIGS. 9A and 9B illustrate a strainableskin treatment device900. Afirst side904 of atreatment device900 is anchored at afirst end914 of a more stiff orrigid backing910 for example by a removable adhesive or other removable coupling element. A hook orother coupling element906 is coupled to thesecond side905 of thetreatment device900. Thecoupling element906 engages or hooks onto thesecond side915 of thebacking910. A user may manipulate thecoupling element906 to strain thetreatment device900 and then attach thecoupling element906 to thesecond side915 of thebacking910. Theskin treatment device900 may be removably coupled to thecoupling element906 by way of a peelable adhesive or other coupling mechanism. Thus, after straining and attaching thetreatment device900 to thebacking910 in a strained configuration, and after applying anadhesive side902 of thestrained device900 to skin to be treated, thebacking910 and coupling mechanism or hook906 may be released from thedevice900 by peeling apart from thedevice900.
• FIGS. 10A to 10C illustrate a strainableskin treatment device1000. Theskin treatment device1000 is coupled, for example with a peelable adhesive or other coupling mechanism, on opposingsides1004,1005 adjacent opposingsides1014,1015 of astraining backing1010 orapplicator1010. Thebacking1010 is shown in a folded configuration inFIG. 10A where a portion of thebacking1010 includes a tri-fold1030. Thefold1030 decreases the length of the backing1010 (FIG. 10A). Margins orareas1024,1025 of the opposingsides1014,1015 extend beyond thesides1004,1005 of thedevice1000 permitting a user to grasp or manipulate the free areas to exert and tensile or straining force on thedevice1000 through thebacking1010. When a straining force is exerted, the tri-fold1030 unfolds (FIG. 10B) and straightens (10C). Thebacking1010 thus limits the strain of thedevice1000. After thedevice1000 is strained, anadhesive side1002 of thestrained device1000 may be applied to skin to be treated and thebacking1010 may be removed from thedevice1000 leaving thedevice1000 on the skin.
• As shown inFIGS. 10D to 10G, a plurality offolds1070 may be provided in abacking1050. Eachfold1070 may correspond or provide a particular strain value or amount. A user may select numbers of folds depending on desired strain.Folds1070 may be configured to release sequentially as shown inFIGS. 10E to 10G, or may be secured and releasable, for straining the dressing1060, for example by a tape that resists unfolding of a particular fold unless removed.
• FIGS. 11A to 11D illustrate a strainableskin treatment device1100. Theskin treatment device1100 is coupled on opposingsides1104,1105 to sides ofsegments1114,1115 of a straining backing orapplicator1110. Thedevice1100 is free from to thebacking1110 in a straining zone between the opposingsides1104,1105. Thebacking1110 comprisessegments1114,1115 havingmiddle tab portions1124,1125 that overlap in the unstrained configuration (FIGS. 11A and 11B) wherein thebacking1110 has a first length. Margins orareas1134,1135 of sides ofsegments1114,1115 extend beyond thesides1104,1105 of thedevice1100 permitting a user to grasp the free areas to exert a tensile or straining force on thedevice1100. When a straining force is exerted, thetabs1124,1125 ofsegments1114,1115 separate. After separation, when released, theedges1144,1145 of thetabs1124,1125 engage by overlapping opposingedge portions1155,1154 ofsegments1115,1114 respectively, maintaining the backing in a lengthened configuration and thus maintaining the strain in thedevice1100. (FIGS. 11C and11D). After thedevice1100 is strained, anadhesive side1102 of thestrained device1100 may be applied to skin to be treated and thebacking1110 may be removed from thedevice1100 leaving thedevice1100 on the skin.
• FIGS. 12A to 12D illustrate a strainableskin treatment device1200. Theskin treatment device1200 is coupled on opposingsides1204,1205 to sides ofsegments1214,1215 of a straining backing orapplicator1210. Thedevice1200 is free from to thebacking1210 in a straining zone between the opposingsides1204,1205. Thebacking1210 comprisessegments1214,1215 havingmiddle edges1224,1225 that overlap in the unstrained configuration (FIGS. 12A and 12B) wherein thebacking1210 has a first length. Handleelements1234,1235 of sides ofsegments1214,1215 permit a user to grasp and manipulate thesegments1214,1215 to exert a tensile or straining force on thedevice1200. When a straining force is exerted, theedges1224,1225 ofsegments1214,1215 separate. After separation, when released, theedges1224,1225 of each have features that engage with each other, maintaining thebacking1210 in a lengthened configuration and thus maintaining the strain in thedevice1200. (FIGS. 12C and 12D). The features may be, for example a mortise and tenon (1244) type of joint. Aguide1265 on thesegment1215 may also guide theedges1224,1225 in to an aligned engagement when thedevice1200 is strained. After thedevice1200 is strained, theadhesive side1202 of thestrained device1200 may be applied to skin to be treated and thebacking1210 may be removed from thedevice1200 leaving thedevice1200 on the skin.
• FIGS. 13A to 13C illustrate a strainableskin treatment device1300. Afirst side1304 of atreatment device1300 is anchored at afirst side1314 of a more stiff orrigid backing1310 for example by a removable adhesive or other removable coupling element. Thetreatment device1300 includes slits orbreaks1303 that formfingers1307. Thebacking1310 includesmovable fingers1317 that are extendable away fromfirst end1314 ofbacking1310. Thefingers1307 of thedevice1300 are each attached to a correspondingmovable finger1317 of thebacking1310 at asecond side1315 of thebacking1310. Each of themovable fingers1317 may be extended away fromside1314 to strain acorresponding finger1307 of the device. A user may select one or more or allfingers1307 to be strained. Eachfinger1307 may also be variably strained to a desired degree.FIG. 13A illustrates anunstrained device1310 on the backing.FIG. 13B illustrates anindividual finger1307 strained.FIG. 13C illustrates allfingers1307 strained. Theskin treatment device1300 may be removably coupled to theside1314 of thebacking1310 and/oredges1305 of thefinger1307 by way of a peelable adhesive or other coupling mechanism. Thus, after straining and after applying theadhesive side1302 of thestrained device1300 to skin to be treated, thebacking1310 including thefingers1317 may be released from thedevice1300 for example by peeling apart from thedevice1300.
• FIGS. 14A and 14B illustrate a strainableskin treatment device1400. Theskin treatment device1400 is coupled on afirst side1404 to a correspondingfirst side1414 of a stiffer or morerigid backing1410. Astraining element1450 is coupled to thesecond side1405 of thetreatment device1400. Thestraining element1450 comprises a first bar or handle1451 that is coupled to thesecond side1405 of thetreatment device1400, for example, by way of an adhesive or other coupling element. Thestraining element1450 further comprises connectingbars1452 that extend throughslots1415 inrigid backing1410 and connect the first bar or handle1451 to a second bar or handle1453. A user may use thestraining element1450 to strain thetreatment device1400 by grasping the second handle orbar1453 and sliding the connectingbars1452 through the slots1415 (FIG. 14B). Theskin treatment device1400 and thebacking1410 may be removably coupled on thefirst sides1404,1414 by way of a peelable adhesive or other coupling mechanism. Thus, after straining and after applying theadhesive side1402 of thestrained device1400 to skin to be treated, thebacking1410 may be released from thedevice1400 by peeling thebacking1410 from thedevice1400.
• FIGS. 14C and 14D illustrate the strainableskin treatment device1400 andrigid backing1410 ofFIGS. 14A and 14B. A user may use thestraining element1450 to strain thetreatment device1400 by grasping the handle orbar1453 and rotating it so that the connectingbars1452 rotate with in theslot1415 as shown inFIG. 14D. After straining and after applying theadhesive side1402 of thestrained device1400 to skin to be treated, thebacking1410 may be released from thedevice1400 by peeling thebacking1410 from thedevice1400.
• FIGS. 15A to 15B illustrate a method and device for straining askin treatment device1500. A strainableskin treatment device1500 is coupled over awindow1520 of aframe1510interfacing side1515 of theframe1510. Thedevice1500 may includeextension sheets1506 coupled atsides1504,1505 of thedevice1500. Theextension sheets1506 may be flexible and relatively less elastic or inelastic thandevice1500. Astraining device1530 comprises a protrudingelement1535 on ahandle1538 where the protrudingelement1535 is shaped to fit within thewindow1520 of theframe1510. In use, the protrudingelement1535 is placed between adjacent thetreatment device1500 and is used to push thetreatment device1500 through thewindow1520, thereby straining thetreatment device1500. Thehandle1538 andframe1510 may be used together to apply thestrained device1500 to skin to be treated.
• FIG. 16A illustrates astrainable dressing1600 with an applicator ortensioning device1610 that is described in detail in U.S. patent application Ser. No. 13/345,524 incorporated in its entirety herein by reference. The dressing1600 may be strained to different distances to accommodate for multiple forces and tensile strengths within the dressing. Different forces may be desired at different locations, areas or parts of the dressing. The dressing1600 is illustrated in an unstrained configuration inFIG. 16A. A flexible, relativelyinelastic anchor sheet1624 couples afirst side1604 of thedevice1600 of afree side1614 of abase support1611 of theapplicator1610. Astraining sheet1625 couples asecond side1605 of thedevice1600 to themovable cover1612 which is pivotably or hingedly coupled theside1615 of thebase support1611. When thecover1612 is pivoted and opened, it acts to strain thedevice1600. A skin adhesive is applied to theskin adhesive side1602 of thedevice1600. Astrain limiting structure1640 is coupled to thedevice1600, e.g., the opposing backsurface1603 of thedevice1600. Thestrain limiter1640 comprises a plurality ofstrain limiting elements1641,1642,1643. Each strain limiting element may provide a different degree of strain limitation. According to a variation, a firstcentral strain limiter1642 may permit a predetermined amount of strain at a central location.Adjacent strain limiters1641,1643 may permit a predetermined amount of strain that may or may not be different and may or may not be more or less than the amount of central strain. According to a variation, theadjacent strain limiters1641,1643 permit a lesser amount of strain than thecentral strain limiter1642. Varied strain at different locations may be selected or provided on different dressings to provide a variety of dressings that may be targeted to particular body locations or applications of use.
• According to a variation, in order to reduce irritation around the edges or to focus compressive forces near a wound or treatment site, the dressing may be strained to a greater degree, or force towards the middle of the dressing. Also forces and tensile strengths may be controlled towards the edges of the dressings within the dressing.
• The strain limiters may be constructed of a flexible less elastic, as compared to the dressing material, such as an LDPE that limits strain between opposing locations where the strain limiter is coupled to the dressing. Thestrain limiting elements1641,1642,1643 may be attached to the back surface of the dressing with atape1648 such as KAPTON® tape, or peelable adhesive. An acrylic adhesive may be used to attach the LDPE to the back side of the kapton. After the dressing is strained and applied to a subject, the strain limiter may or may not be released.
• While this invention has been particularly shown and described with references to embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention. For all of the embodiments described above, the steps of the methods need not be performed sequentially.

Claims (1)

1. A skin treatment system, comprising a controlled strain treatment device.

Images