Tissue tension in surgical procedures involving soft tissues can lead to many undesirable complications. Major complications in the surgical repair of wounds under tension include tissue tears, ischemia, necrosis and dehiscence. Suture tension in any cutaneous procedure can contribute to hypertrophic scar formation from stitch pressure at the surface of the skin. Primary closure of severely atrophic skin under tension, no matter how slight, is often difficult due to extreme fragility of the tissue, which can lead to tissue tears and failure of the repair. Suture tension in high tension closures can cause stitches to settle into the skin during healing making stitch removal difficult. All wounds under excessive tension are subject to a high incidence of ischemia, necrosis and dehiscence; and, as a consequence, poor healing. Tension contributes to tissue ischemia, necrosis and dehiscence through reduction of blood supply to the healing tissues by tamponade which may reduce tissue viability and the strength of the resultant scar.
Existing surgical techniques and devices are often inefficient in the dispersion of tissue tension within soft tissues and consequently can fail in applications where dispersion of tension is necessary to avoid surgical complications. In repairs of atrophic tissues, single axis stitches (simple interrupted and vertical mattress stitches) concentrate the force of closure in a plane perpendicular to the wound and predispose the tissue to tears in the axis of closure. Multi-axis stitches such as the horizontal mattress stitch or parallel stitch do not support a repair throughout the full thickness of the wound and pull directly against the skin during closure resulting in a high degree of wound instability and tissue shear. Inflexible materials such as wire or staples can often result in an unacceptably high degree of tissue shear in certain closures and cannot be used in the repair of atrophic skin. Other methods of surgical repair commonly lack the strength (simple interrupted stitch) leverage (simple interrupted, horizontal/vertical mattress, parallel stitches) stability (horizontal mattress, parallel stitch) and ability to effectively disperse tension in a direction parallel to the wound edge (all single axis closure stitches and staples) to close wounds under high tension, satisfactorily. Intra-operative strategies for reduction of ischemia, necrosis and dehiscence include partial closure repairs, secondary intention closures, placement of relaxing incisions at closure, and delay of suture removal but the disadvantages of these approaches include an increased likelihood of infection, worsening of scarring and prolonged healing time. Devices that have been designed to disperse suture tension at the surface of the skin are often cumbersome, difficult to use, limited in applied scope and may not be suited for all types of skin, including severely atrophic skin. A method that could effectively disperse tissue tension in wound repair, while minimizing these issues, would be highly desirable.
USPTO Backgrounds
USPTO Backgrounds