US1656467A - Surgical suturing instrument - Google Patents

Description

Jan. 17, 192s. 1,656,467 J. A. BLAKE SURGICAL SUTURING INSTRUMENT Fi1ed.sept,1. 1926 2 sheets-snee.: 1

attentat "Jan.17,1926., f v C 1,656,467

` J. A. BLAKE SURGICAL suTuRING INSTRUMENT F1166 sept. 1. 1926 2 eats-sheet aucunes,

Patented Jan. 17,1928.

UNITED STATES PATENT OFFICE.

SURGICAL SUTURING INSTRUMENT.

Application ined september 1, 192e. serial No. 133;(154.

`This invention relates to surgical instruments, particularly to suturing devices, and has tor `its object the provision of a novel instrument by"means oi' which stitches or s sutures ot any suit-ablelexible material may be made in or applied to a wound or incision.

y An important object of the invention is to provide an instrument of this character so constructed and arranged that it may lo be used for applying a. series `of stitches or sutures at equally .spaced points, or individually placed stitches which may he the same or variable distances apart as preferred.

Another object is to provide aninstrument ot .this character embodying needles and handle means so connected therewith as to he capable oit operation in a step-like manner so that during the operation of takone stitch one needle will overlap the other while at the nextsucces-:ive operation it will underlie the same, the alternate or steirlilre action producing a series ot uniform stitchesat the same distance apart.

A further-object of `the invention the provision of an instrument of this character in which the construction and `arrangement oij' iliarls are such that `only the initial stitch wiil extend across the outside` of the incision or wound in visiblei'position, all the subsequent stitcheegheing concealed except at the ends where the looping, automatic or manual., ot the successive stitches is effected, the interlooping being;v automatic or manual dependent upon the selected manner in which the instrument is used.

A still further object ot the invention is lo provide a suturing device provided with adju-stable tension means for whatever' flexible material is used such as wire,gut or silk.

Another object is to provide an instrument ot this type having detachable needles ot different varieties capable of selec-tive enuiiloyment depending upon the nature oi the stitch desired.`

An additional objert is to provide a sutur-l and claimed, andillustrated in the accompanying drawings in which zv Figure l'is a tront elevation ot' the instrument showing it in normal position and equipped with the needles for citer-ting the staggered'or oltcenter stitching. A

Figure 2 is an edge elevation.

vFigure 3 is a plan viewror elevationlooking` at the needles. y

Figure 4 isa detail sectionalview through the pivot -joint showing the intermediate position of the parts tor oicenter stitching.

Figure 5 is a similar View showing the pivot elementin position within the throat orslot preparatory to arranging `the parts for on-center stitching.

Figure 6 is a View similar to Figure 5 with the pivot in the lateral slot ready for oli-center stitching. Y

Figure 7 is a detailsection `through a portion ot one handle member `showing the vdetachable mounting of the needle therein.

`Figure 8 is a section taken at right angles to Figure 7.

Figure 9 is a fragmentary side elevation showing thetension device.

Figure l() is a perspective `view of the tension plate removed.

FigureA 11 is a. cross section taken on the line 11.--11 of Figure 4. y y

F'gure 12 is a side elevation of a. portion ot' theV instrument showing the position ot the needles for starting a suture.

Figures `13, 14, 15 and 16 are similar views showing successive steps in off-center stitchmir.. i

`Figure 17 is a view showing an .incision as stitched bythe instrument, the stitches being of course greatly exaggerated tor the sake of clearness.

Figures 18, 19 and 20 are 'fragmentary `views showingthe type ot' needles employed ilor on-center stitching, thethree views illustrating successive steps.

Figure 21 is an elevation of a wound. or incision `stitched h v the onrenter method.

Figure 22 is a longitudinal section through one of the needles for eil'ecting the ott-center stitching. and

Figure 23 is al det-ail section through the and portion thereof.

Referring more particularly to the drawing.. I lmveehown the devicer as comprising a pair ot blades or handle members 1 and 2 which are somewhat similar in construction litt and o't the same general contour except that the former shown as provided with a loop 3 constituting a thumb hold Whereas the latter is provided with tivo loops el and for the oretiuger and remaining lingers .respectively. ylhe members 1 and 2 are both termed with similar' extensions (i which diverge and each ot which is formed with va socket T into which leads a hole S for apurpose to be described.

rl`he members 1 and 2 are pivotally connected by a peculiar' joint which permits the members to pivot or simple relative rotary movement in opposite directions pr for relative rotary or rocking movement on dillierent axes, depending upon the nature of the stitch or suture desired, this depending, in its turn, upon the character of the wound or incision. In the present instance, the pivot means is shown as comprising afpivot meniber 9 having a squared or other angu lar portion 10 statlonarily mounted through the member 2. Obviously this member may be welded, brazed or otherwise permanently tastened or litmaybe provided at one end with a head 11 for the purpose et preventing longitudina displacement in one direction. llVhere the member 9 passes through the member 1, it is formed with a cylindrical portion 12 which .entends for a distance preferably substantially one-halt Vthe thicknes of the member 1, the remaining portionbeing out away at opposite sides as at 13 to define a constricted neck lll terminating in a head 15 located against the outer side ot the member 1 for preventing longitudinal displacement of the member 9 in the other direction. Clearly, this pivot member S) is neces'arily formed ot at least tivo parts which are rigidly secured together zitter assen'ibling with respect to the blade or handle members 1 and 2. The member 1 is shown as formed with a longitudinally extending slot 10 of at least the same `width as the diameter of the cylindrical portion 12 et the pivot member, and located at one side of t-he slot- 16 is a lateral opening 1T oi' sul stantially the same Width as the cylindrical portion 12. A portion otthis opening leads directly into the slot 16 wherein'T the remaining portion registers with a circular hole 1S which communicates with the slot 16 through aconstricted throat 19. Clearly, when the handle members are in their normal positiernas shown in Figures 1 and i the cylindrical portion 12 of the pivot member is located Within the longitudinal slot 16 so that the handle members 1 and 2 mayv be moved relatively in a longitudinal direction simultaneously with or prior to pivoting. Bv swinging the handle members 1 and 2 with respect to each. other they may be brought into the position shown in Figure 5 so that the constricted neck portion 14 of' the pivot may be passed through the throat the grips have been squeezed together during the taking ot a stitch as will Abe described, l preterably provide a leaf spring 2O located between the members l and2 Vand secured at one -end to one, the other end having a slot 21 therein detachablyfengaged upon a pin projecting *from the .other handle member. When it .is fdesired to change the pivot 9 from engagement Within the slot 1o to engagement Withinthe ihole 18, or `vice 'versa7 it is of course necesary that the slotted end ot theispringfbe disengaged trom the pin 22 sothat the handle members may be moved relatively zto the necessary extent ior permitting manipulation to shift the pivot.

t is possible to u'eneedles of twoftypes, as will be explained, one type fbeing designated by the numeral 23 and the other `by the numeral 24. Only the former are shown in detail for the reason that both varieties possess the same general characteristics in point olf.1nounting,ietc. The Vneedles 23 Vare represented as ofidenticulconstruction and each'is formed into a curved orhoolr-shaped bodyv 25 flat on their inner, abutting 'faces and rounded on theirouter faces and termi nating in a sharp point 26 adapted to be penetratingly engaged through the edgesl A ot a u'ound or .incision B. Each needle is formed with a longitudinal passage 27 which opens out at one end to the side through a hole 28 located some distance back .of the point. The other end ot' the passage leads out to the outer edge of the needle through c liaringopening 29 in overlapping relation to which is arranged a tension device for the wide, gut. silk or other material to be used for suturing It is intended that such flexible material` indicated at 30. he used in the 'term et a single strand which may initially he cut to the proper length for sewing or stitching the particular Wound or incision in question. This fiexible member is passed through the passages 27 iubothneedles and extends across the points thereof. the ends being left free as indicated in AFigures 1 and2. v

For preventing accidental shifting of the flexible material` I provide ny tensioning device 31 which in the present instance is shown as consisting of an angular plate 32 having a tapered opening 33 therein adapted to he. brought more or less into registration `or less compressing or frictional engagement with the .flexible material. `Each needle is shown as having such a tensioning device.

`Clearly, some other structure of an equivalent nature may be provided for this purpose there 1leeing no particular limitation in this respect.

The means for soeiation with the blade or handle members 1 and 2 is here shown as comprising reduced extensions 37 formed integrally upon the needles and slidablyiengaged Within the sockete` 7, each extension beingcut away at `one side as shown at 38 to accommodate or permit inward movement of a leaf spring 39 ivlii ch is anchored to the extension at one end as shown at l0 and Which has its other end cari-yimg a pin Ll1 engage-able Within the hole S. This connection Will hold the needles lirmlywvith respect tothe blade or handle members While at the same time in case it is desired to remove the needles it is easily accomplished provided some pointed imple-` ment be inserted through the holes 8 to ell'ect disengagement of the pins 41 therefrom. Clearly, an equivalent mounting may be provided Within the spirit of the invention The needle members 24 may be constructed infidentically the same manner as the needles Q3 except that they are ot` such curved shape that the points thereof are arranged in end t'o end relation instead of being overlapped as is the case with the needles `23.

lin the operation, 4let vit be first assumed that. it is desired to sew up the Wound or incision B with a series of automatically interlinlred stitches, orby means of the olfcenter method. lnsuch an event, the pivot member 9 isarrangedto be located entirely within Vthe slot 16, `as shown in Figure 4.

W ith, say, the handle member 1 moved longi# `tinlinally with respect to the handle member 2 to bring the pivot at thelower end of the slot 1G, the point of the needle carriedfby the member 2 is torced through the edges of the incision as shown in Figure 12, the flexible material 30 beingdraivn through the edges and forming a loop 42, that portion 43 of the flexible material which initially bridged the needles being brought across the incision as shown. The operator ol' course holds the device inoiie hand with his thumb extending 4through theloop 3, his forel'inger through the loop -land his remaining fingers through the loop 5 so that the device may be manipulated inl a manner similar to scissors or holding the needles in as-` pliersf Then the handle members are then squeezed together, it is intended that prior thereto, or simultaneously therewith, (the `handle member 1 be moved downwardly so that the pivot?) will approach the other end oli. the slot 16, the intermediate position beingsliown in Figure 13 and the final position in Figure 14. As the handle members are brought together and moved relatively in a longitudinal direction, the point ofthe other needle, the one carried by the handle l, is engaged through the loop 42, dragging it down to the position shownfin Figure 15,`

and at the end ol' the relative longitudinal movement of the members land 2 thisneedle is forced through the edges of the incision,

as shown iii Figure 15, the needlecarifing the thread therein through the skin or esh. This results in anchoring the stretch 43 0f the flexible material Which initially bridged theneedles. This also forms a loop 44 at the opposite side ot' the incision from that where the loop 452 is located. The handle members rand i2 are then slid longitudinally relatively in ine opposite direction to bring the needle carried by the handle 2 to a point below the other needle, the point of the needle engaging within the loop 44: anddragging it down, as shown in Figurel. This needle is then loi-ced through the incision to the opposite side, to form the next loop in which the needle farried by the handle 1 is engaged in inentis continued until the Wound or incision is 'hilly stitched or sewed as shown in Figra similar manner. This step bystep niiove- Y lee handle members 1 and 2 manipulated to bring the pivot member 9 into the circular holle 18 so that the needles will be held in end to end relation While the handles 'are swung upon a single axis instead of being moved longitudinally as Well, as above described. In stitching with these needles, they are first arranged in spaced relation at opposite sides of the incision. shown in .Fign ure 18,y `the portion Ll5 et' the 'flexible nia` terial bridging the needles, extending across the outside ot the incision.` The operator then squeezes the handles together to force ige are `Withdrawn and the instrumentmoved to a 'new position along the incision. Upon reaching this lnew position, Vthe needlesare engaged through the loops 46 and forced through the edges of the incision. This operation is repeated until the desired number of stitches have beentaken.

. suchias is sometimes neces From the lforegoing description and a study of the drawings, it will be apparent that I have thus provided a simply constructed instrument which Will be very convenient to use not only on account of the rapidity .of the action but also on :account 'of lthe ne-atness and uniformity of thestitching. It .is really believed `that the construction, operationand :advantages Will be readil apparent to one skilled inthe art Without yiirther explanation.

The improved suturing device is admirably adapted Ifor either internal suturing, iry in abdominal operations or the like, or in external suturing of wounds, or incisions. As has been stated either of these operations may be performed with the `device arranged tor what has been termed off-*center suturing, that is, with the pivot arranged in the slot and the needles alternating in their movements. lVhen the Wound or 'incision has been seived or sutured in the manner describedand with only the single, initial strand ofthe sut-ure exposed, the edges A are forced inwardly by the bandages which are applied afterwards so that they lie in edge to edge relation, and the stitches are consequently stretched taut with the result that such relation is maintainedthroughont the healing period and a muchcleaner, smoother, single-line scar is the result, Without the usual unsightly roughness caused by the ordinary over and over stitching. The long loops at the sides of the scar may also'be readily severed when the proper .period arrives for the stitches to be removed. The form of. stitching relierred to as oncenter stitching, where the pivot remains stationary and the concentric needle-s are employed, is used solely for external sewing, because of the use of the loop-holding de vice in the lorm ot the two-pronged fork, at a certain stage in the operation ot suturing in this manner.

It Will be 'further seen that the operating surgeon in manipulating this single handed instrument, either in the ori-center or the o'ticenter method ot' using the same, has the use of his other hand to hold the edges of the wound or incision together or to apply and detach the loop-holding it'ork, thus eliminating the necessity ot an assistant surgeon to perform such functions.

'lVhile I have shown and described a preferred embodiment of the invention, it should be understood that I reserve the right to make such changes in the form, construction and arrangement of parts as will not depart Lemme? from the spirit of the invention or the scope ofthe subjoined claims.

What is claimed is:

l. In an instrument of the character described, a pair o `handle members pivoted in crossed relation land terminating in linger grips, and needles carried by the handle members adapted to operate in overlapping relation, each needle having a longitudinal passage therethrough opening out at onelside in spaced relation to the end and opening outat its other end adjacent the handle member. Y

2. In an instrument of the character described, a pair of handle members pivoted in crossed relation and terminating inlinger grips, .and needles `carried `by the .hand'le members adapted to operate .in .overlapping relation, each needle having a longitudinal passage therethroughopening out atone'side in spaced relation to the end -andgopening out at its other end adjacent the handle `member,-said `passage beingadapted forthe passage ot flexible suturing material, and means located at the second named opening orapplying tension to the suturing material.

In an instrument ofthe character describel, a pair of handle members pivoted in crossed relation and terminating in linger grips, and needles carried by the handle members adapted to operate in overlap ing relation, each needle havinga longitudinal passage therethrough opening out at one side in spaced relation Vto the end and opening out at its other end adjacent thefhandle member, the passage being for the feedof suturing material, and an adjustable plate member mounted adjacent `each secondnamed opening and apertured for the lpassage of the suturing material, the plate member being adjustable to regulate the position ot' the aperture therein with respect to the second-named opening.

A. In an instrument ot' the character described, a pair of handle members pivoted in' crossed relation and terminating in linger grips, and needles carried by vthe handle membersadapted to operate in overlapping relation, each needle havinga longitudinal passage therethroughopening out at one side in spaced relation to the end and opening out at its other end adjacent the handle member, the vpassage being lor the accommodation olil suturing material, and tension means for the material comprising an angular plate member carriedrby each needle at the second named opening and having an aperture adapted to register to a greater or less extent with the second named opening, and means for adjusting thc position of the angular plate.V Y Y 5. VIn an instrun'ient ot' the character described` a pair ot handle members pivoted in crossed relation and terminating at one end in grips, the other ends of the handle i :in

members diverging and being formed with sockets, needle members carried by the handle members and having reduced extensions engaged Within saidsockets, and latch means for retaining the extensions Within the sockets. i l

6; In an instrument of the character described, a pair ot handle members pivoted in crossed relation and terminating at one end in grips, the otherends of the handle members diverging and being formed with sockets, needle members carried by the handlemembers and having reduced extensions engaged Within said sockets, each extension being cut away at one side, a leaspring secured atl each cut away portion and carrying a pin, the handle member having a hole comi'nunicating with the socketl for the reception of said pin.

7. In an instrument of the character de scribed, a pair of handle members arranged in crossed relation,`necdles carried by the handle members, and means pivotally and slidably connecting the handle members whereby the needles ma be caused to move in different` arcuate paths.

8. In an instrument oi.' the character described, a pair of handle members carrying needles, means pivotally connecting said members and selectively coniining them to movement about a common axis and permitting relative sliding movement irrespective` of the pivoting.

9. In yan instrument of the character de-v scribed, a pair of handle members carrying needles, means pivotally connecting the members, and means permitting shifting of the pivot point.

10. In an instrument of the character described, a pair of handle members carrying the pivot point, and means for preventing the accidental shifting of the pivot point.

12. In an instrument of the character described, a pair of pivoted handle members arranged in crossed relation and carrying needles, one o't' said members having a longitudinal slot receiving the pivot for permitting longitudinal movement of the mem bers relative to each other.

13. In an instrument of the character described, a pair of handle members arranged in 4crossed relation, needles carried by the handle members, a pivot member carried by one handle member, the other handle member having a longitudinal slot and a transverse opening communicating therewith, the pivot member being `selectively engageable within said slot or said opening.

11i. In an instrument of the character described, a pair of handle members arranged in crossed relation, needles carried by the handle members, a pivot member carried by one handle member, the other handle member having a longitudinal slot and a transverse opening communicating therewith, the pivot member heilig selectively engageable Within said slot or said opening, and means for retaining the pivot member in the opening.

l5. In an instrument of the character described, a pair of handle members arranged in crossed relation, needles carried by the handle members, a pivot carried by one handle member at the point of crossing, the pivot having a cylindrical extending portion and a constricted neck portion, the other handle member having a longitudinal slot slidably engaged upon said cylindrical extending portion and having a lateral opening communicating with the slot through a constricted throat, the handle members being relatively movable to pass said constricted neck portion through the throat into said lateral opening.

In testimony, that I claim the foregoing as my own, I have hereto aiixed my signature. i

JOHN. AMMEN BLAKE.

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