CA1233720A - Strip tissue fasteners, mesh tissue fasteners, and application methods therefor - Google Patents
Strip tissue fasteners, mesh tissue fasteners, and application methods thereforInfo
- Publication number
- CA1233720A CA1233720A CA000456845A CA456845A CA1233720A CA 1233720 A CA1233720 A CA 1233720A CA 000456845 A CA000456845 A CA 000456845A CA 456845 A CA456845 A CA 456845A CA 1233720 A CA1233720 A CA 1233720A
- Authority
- CA
- Canada
- Prior art keywords
- legs
- mesh
- fastener
- fastening member
- tissue
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
Abstract
Abstract of the Disclosure Various fasteners are provided to hold together portions of mammalian tissue. The fasteners include fastening members with spaced-apart legs adapted to be passed through the tissue portions.
One embodiment of the fastener has a mesh-like receiver around each leg for engaging the legs of another identical fastening member inserted from an opposite side of the tissue portions. In other embodiments, the receiver is a separate element and is applied to a side of the tissue portions opposite the fastening member to engage the legs of the fastening member. The receiver may have a variety of forms. A number of structures are disclosed for effecting engagement of the fastening member legs with the receiver.
One embodiment of the fastener has a mesh-like receiver around each leg for engaging the legs of another identical fastening member inserted from an opposite side of the tissue portions. In other embodiments, the receiver is a separate element and is applied to a side of the tissue portions opposite the fastening member to engage the legs of the fastening member. The receiver may have a variety of forms. A number of structures are disclosed for effecting engagement of the fastening member legs with the receiver.
Description
~:337~
DESCRIPTION
_ Technical Field This invention relates, in general, to the fastening together of portions of tissue in surgical procedures.
Background of the Invention In various surgical procedures, fa~teners in the form of staples or the like are employed for holding tissue portions together ~o facilitate healing of a wound or incision. ~or example, a locking staple, having a tongue and groove structure by which the staple is locked, is disclosed in U.S.
15 Patent No. 2,881,762. A metal staple especially adapted for ligating blood vessels is disclosed in U.S. Patent No.
3,079,608. International Patent Application No. PCT/SU79/00049, ich is available to the public discloses a variety of . fastening devices and instruments for performing : 20 circular anastomoses on the large i ntestine. The aforementioned disclosures serve to illustrate the wide variety of tissue fastening devices and technique~ that may be employed in general and/or specific surgical ~ituations.
One common type of fastening device for joining or holding together soft tissue portions is the generally nU~-shaped staple whi~h is typically fabricated from a suitable metal. Such staples, although generally aescr~bed as having two legs ~oined to define a "~-shape when unclin~hed, may also be regarded a~ having a configurat~on o~ an ~open" loop when unclinched. The legs need not necessar~ly be parallel but are typically adapted for penetrating the tissue portions and ~or receiving between them some of the tissue material.
3~
Other examples of U shaped or open loop staples, as well as of methods and instruments for applying such staples to tissue, are disclosed in U.S. patent Nos. 3,252,~43, 3,482,428, 3,692,2~4, 3,790,057, 3,795,034, 3,88~,683, 4,198,982, 4,316,468, and 4,319,576.
Other tissue fastening devices have been - proposed and differ from staples ~ in that these other devices may have a plurality of components and do not have to be clinched in the manner used ~o set ~ staple. One such device is disclosed in U.S, ; Patent No. 4,060,089 and includes a fastener strip provided with a plurality of longitudinally spaced, parallel prongs which are adapted to penetrate two overlapped tissue portions from one side so that the distal ends of the prongs project frvm the ~ther side of the tissue p~rtions.
! Th~ fast~ner device further includes a retainer strip which is adapted to be placed on the other side of the tissue portions opposite the fastener strip to engage the ends of the projecting fastener strip prongs and thus secure the kissue portions tightly between the fas~ener strip and the retainer strip. The retainer strip defines frustoco~ical openings for receiving the fastener strip prongs which each include a plurality of spaced-apart, frustoconi~al engaging members for engaging the retainer strip at a desired position relative to the prongs. This provides for the capabilit~ of adjusting the distance be~ween the fastener strip and the retainer ~trip.. Such a fastening device may be fabricated from a biodegradable or absorba~le mater~al~
j ETH-568 ~37~
I .
Although many of the above~discussed types of tissue fastening devices and techniques are satisfactory in vario~s applications ! ~here is a need to prcvide an improved fastening device, especially one compl~tely fabricated from absorbable materials.
Also, i~ would be desirable to provide an j improved fastening device fabricated from absorbable materials that can provide primary approximation of 1 15 the tissue edges to insure that the tissue edges are ¦ in continuous contact. Further, such an improved j ~astener should provide a desired amount of ! hemostatic compression to minimize bleeding, but allow some collater~l blood circulation to the wound or incision edges of the tissue to promote healing.
In addition, such an improved fastener should have the capability to accommodate varying tissue thicknesses and should leave as little tissue ~uff or : margin as possible in effecting the joining of the tissue.
Further, it would be beneficial if such an improved fastener had a configuration tha~, ! consistent with other design considerations, would enable the fastener to be fabricated with 1) as æmall a size as possible to minimize dosage: and 2) ~Ith a minimum of sharp edges or protrusions~. Also, another desirable feature of such an improved fastener would be a fastener configuration that did not form, or : con~ribute to ~he formation of, pockets of infec~ion in the tissue.
:~`
.
37;~q~
Further, such an improved fastener would desirably provide the surgeon with the capability for readjusting the ~ompres~ion after initial application.
Such an improved fastener should have the capability for maintaining the tissue portions in a~proximation and compression for a minimum of 21 days in vivo. Also, such a fastener should desirably be easily adjustable to the length of the two tissue portions beîng joined 50 that a single fastener can be used, ~ather than a pluralitv of shorter fasteners. Further, the fastener should desirably produce a well-distributed clamping force on the tissue ~ortions.
It would also be advantageous to provide such a fastener with a design that would facilitate its application to the tissue portions with a simple yet effective method. It would additionally be desirable if the improved fastener could readily accommodate appli~ation by means of an appropriately designed instrumentO
Summary of the Invention : Improved fasteners are provided to hold together portions of mammalian tissue, su~h as are defined by a wound or in~ision, to facilitate healing 25 of the wound or incision.
:: One fastener includes a fastening member that has a plurali~y of spaced-apart~ serrated le~s adapted to penetrate the tissue portions and that has an elongate clamping member connecting the legs. The fastener further includes an elongate receiver adapted ~o be dis~osed against a ti~sue portion opposite the fastening member for re~eiving the ; fastening member legs. ~he receiver~defines apertures each having a plurality of serrations for cooperating wi~h the serrations on the fasteninq i ~7~33~
member legs to inhibit relative movement of the receiver and fastening member at least in the disengaging directions~
In one form of the fastener, the clamping member and receiver are generally rigid. In another form of the fastener, both ~he clamping member and receiver are flexible strips which can generally conform to the surface contour of one of the tissue portions. ~he fastening member legs and receiver have suitable engaging means which may include serrations or other cooperating structures.
In a modification of this flexible component fastener, the flexible clamping member strip has regions defined between legs where one or more ; 15 shorter lengths of the clamping strip may be separated from the longer clamping strip. The receiYer strip also defines regions between leg receiving means where one or more shorter lengths of ~he receiver strip may be ~eparated.
The above-described flexible, severabl~
forms of the fastener components may be applied to the ti~sue a~ording to a novel method.
~pecifically~ a shorter len~th of a fastening member clamping strip may be separated from the originally provided longer fast~ning member clamping strip. A
shorter length of the receiver strip may be separated from the longer length of the receiver ~trip originally provided. The shorter length of the clamping ~trip is disposed again~t one ti~sue portion. ~he ~horter length of the receiver ~trip is disp~sed against the other of the tissUe p~rtions while conforming the shorter length receiver strip to the surface ~ontour of the other tissue p~rtion.
Then the leg~ of the shorter length of the fastening member ~re insertad through the ti~sue ''' ' .
~ 2~7~
portions and through the shorter length of the receiver strip to conform the clamping strip portion of the shorter length of the fastening member to the surface contour of the one tissue portion with the legs of the fastening member engaged with the shorter length of the receiver strip. .
The above-described method may be used with a flexible fastener wherein the fastening member and receiver are not designed to be severable. In such a case, the fastener is provided in various specific sizes and the user initially selects the appropriate ~ size fastener rather than sever a longer fastener.
; The above described method may be used for applying an elongate, flexible fastening member : 15 clamping strip and an elongate, flexible receiver to conform to the surface contour of the tissue portions even if the fastening member legs are received in receiver structures other than those having serrated apertures. The me~hod may be effectively employed - 20 with fastening members and receivers baving other forms of engaging ~tructures for holding the legs of the fastening member within the receiverO
~ n s~ill another form of the fastener, a astening member is provided with a clamping member ~onnecting a plurality of legs that each have a plurality of barbs angled rearwardly away from the leg distal end. ~he fas~ener also in~ludes a - receiver in ~he orm of a mesh of flexible filaments adapted to receive the fastening member legs after : 30 the legs ha~e been inserted through ~he ti~ue ; ~ port;ons with ~he barbs engaging the ~oth mesh and one of ~he tissue portions so as to inhibit relative movement of the receiver and fastening member at lea~t in the dlsengaging dire~tion~. According to the method for applying this type of f~s~ener, the ~TH-568 receiver is dispo~ed against one of the ~issue portions and the fastening member is dispossd against the other of the two tissue portions so that the legs of the fastening member penetrate the tissue portions and the receiver mesh.
In yet another form o~ the fas~ener, at least first and second ident;cal fastening members are provided. Each fastening member comprises a plurality of spaced-apart legs with di~tal ends and each fastening member also includes a mesh of flexible filaments extending around each of the legs. Accordin~ to a method for applying the fastener, the first fastening member is disp3sed ~gainst one of the tissue portions and the second fastening member is disposed against the other of the tissue portions. The tissue portions are penetrated by the legs of each fastening member so that the legs of each fastening member engage ~he mesh of the other fastening member to prevent disengagement and to hold the tissue portions together.
According to a further broad aspect of the present invention there is provided a fastener adapted to hold together, in conjunction with one or more other similar fasteners, two portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision. The fastener comprises a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions. Each leg defines on its exterior along at least a portion of iîS length a plurality of barbs angled rearwardly away from the leg distal end. A mesh of flexible filaments, the mesh having a generally tri-angular configuration, extends between adjacent legs and the mesh extends outwardly from, and generally normal to, each of the legs to define a leg receiving area wherehy the legs of one of the fastening members may be passed ~.~
-7a-~337%~3 through the tissue portions from one side of the wound or incision with the mesh being disposed against one of the tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of the wound or incision with the mesh of the other fastening member lying substantially against the other of the tissue por-tions so that at least one leg of each of the fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative move-ment of the fastening members at least ln the disengaging directions.
Numerous other features of vari~us embodiments of the novel tissue fasteners and application methods will be apparent from the Çollowing detailed description and accompanying drawings.
Brief Description of the Drawin~
. In the accompanying drawings forming part of : the specification, and in which like numerals are employed to desginate like parts throughou~ the same, Figure 1 i~ a perspective view of a fastening member and receiver which together : 25 constitute a first embodiment of the fastener of the present invention;
Figure 2 is a greatly enlarged, fragmentary~
side view of one of the fastening mem~er legs taken generally along the plane 2-2 in Fi~ure 1, .
~3~g Figure 3A is a greatly enlarged, cross-sectional view of the receiver taken generally along the plane 3A~3A in Figure l;
Figure 3B is a ragmentary, cross-sectional view taken generally along the plane 3B-3B in Figure 3A;
Figure 3C is a fragmentary, bottom view taken generally along the plane 3C-3C in Fi~ure 3B;
Figure 4 is a view of the fastener of Fi~ures 1-3C shown applied ~o tissue por~ions with part of the tissue portions cut away to better illustrate interior detail;
Figure 5 is a fragmentary, c~oss-sectional view of a second embodiment of a fastener shown holding together two portion~ of tis~ue;
lS Figure 6 is a rag~entary, perspective view : of a third embodiment of a fastener shown assembled in the absence of tissue;
Figure 7 is a perspective view of a fourth embodiment of a fastener;
Fi~ure 8 is a perspective view of a fifth .~ embodiment of a fastener;
Figure 9 is a greatly enlarged, fragmentary view of the fastener of Figure 8 ~hown applied to tissue portions to hold together tissue p~rtions with parts o~ ~he tissue portions cut away ~o be~ter illustra~e interior detail;
Figure lO i5 a perspective view ~f three fasteners that each have the form of a sixth : embodiment of a fastener;
: 30 Figure 11 is a view of the fastener~ of Figure lO shown applied ~o ho~d together two tissu~
portions with parts of the tissue portions cut away ~o better illustr~te interior deta11: and Figure l~ is a per~ective view of three fasteners that ea~h have the ~orm of a seventh embodiment of a fastener.
, :
~L~33~ 3 Descrietion of the Preferred Embodiments This invention may be used in many different forms. The specification and accompanying drawings disclose only a few specific forms as an example of the use of the invention. The precise shapes and sizes of the components herein de cribed are not essential to the invention unless otherwise indicated. The invention is not intended to be limited to the embodiments of the method and article illustrated, and the scope of the invention will be pointed out in the appended claims.
FI RST EMBODI~IENT OF THE FASTENER
A first embodiment of the fastener is illustrated in Figures 1-4 and is designated generally therein by reference numeral 50A.
The fastener 50A is illustrated in Figure 4 in the fully assembled, "set" configuration wherein it is shown holding together two portions 52 and 54 of mammalian tissue, such as are defined by a wound : 20 or incision in an organ, to fa~ilitate healing of the wound or incision.
The fastener 50A includes two co~ponents, a ; fastening member 60A and a receiver 62A, which are initially separated as illustrated in Figure 1 and which are adapted to cooperate to c~mpress or hold be~ween them the ~issue portions as illus~rated in Figure 4.
As i~ best illustrated in Figure 1, the fastening member 60A includes 1) a plurality of ~paced-apar~ leqs 66A adapted to penetrate ~he tissue portions and 2) an elongate cl~mping ~ember 68A whi~h ~onnects the legs 6~A and which is adapted to lie substantially ~gains~ one of the tissue portions (e.g., tissue portion 54 in ~igure 4)~ The legs 66~
of the fas~ening member 60~ are generally parallel to ET~-568 ~33~o~3 ~10--each other and are generally perpendicular to the clamping member 68A. Preferably, each leg 66A has a solid, generally cylindrical configuration with a conical distal end 70A to facilitate or aid in the penetration of the tissue portions. The clamplng membex 68A may be cylindrical (as illustrated) or may have any other suitable shape (such a~ that of a regular parallelpiped, for example~.
The fastener 50A is provided ~ith unique means for effecting engagement between the fastening member 60A and the receiver 62A and for holding the fastening member 60A and receiver 62A in a desired relationship t~ compress between them the two tlssue portions S4 and 52 as illustrated in Figure 4. To this end, as best illustrated in Figures 1 and 2, ~ each leg 66A of the fastening member 60A defines on ; its exterior along at least a portion of its length a plurality o~ small teeth or serrations 80A.
Further, as best illustrated in Figure 4,
DESCRIPTION
_ Technical Field This invention relates, in general, to the fastening together of portions of tissue in surgical procedures.
Background of the Invention In various surgical procedures, fa~teners in the form of staples or the like are employed for holding tissue portions together ~o facilitate healing of a wound or incision. ~or example, a locking staple, having a tongue and groove structure by which the staple is locked, is disclosed in U.S.
15 Patent No. 2,881,762. A metal staple especially adapted for ligating blood vessels is disclosed in U.S. Patent No.
3,079,608. International Patent Application No. PCT/SU79/00049, ich is available to the public discloses a variety of . fastening devices and instruments for performing : 20 circular anastomoses on the large i ntestine. The aforementioned disclosures serve to illustrate the wide variety of tissue fastening devices and technique~ that may be employed in general and/or specific surgical ~ituations.
One common type of fastening device for joining or holding together soft tissue portions is the generally nU~-shaped staple whi~h is typically fabricated from a suitable metal. Such staples, although generally aescr~bed as having two legs ~oined to define a "~-shape when unclin~hed, may also be regarded a~ having a configurat~on o~ an ~open" loop when unclinched. The legs need not necessar~ly be parallel but are typically adapted for penetrating the tissue portions and ~or receiving between them some of the tissue material.
3~
Other examples of U shaped or open loop staples, as well as of methods and instruments for applying such staples to tissue, are disclosed in U.S. patent Nos. 3,252,~43, 3,482,428, 3,692,2~4, 3,790,057, 3,795,034, 3,88~,683, 4,198,982, 4,316,468, and 4,319,576.
Other tissue fastening devices have been - proposed and differ from staples ~ in that these other devices may have a plurality of components and do not have to be clinched in the manner used ~o set ~ staple. One such device is disclosed in U.S, ; Patent No. 4,060,089 and includes a fastener strip provided with a plurality of longitudinally spaced, parallel prongs which are adapted to penetrate two overlapped tissue portions from one side so that the distal ends of the prongs project frvm the ~ther side of the tissue p~rtions.
! Th~ fast~ner device further includes a retainer strip which is adapted to be placed on the other side of the tissue portions opposite the fastener strip to engage the ends of the projecting fastener strip prongs and thus secure the kissue portions tightly between the fas~ener strip and the retainer strip. The retainer strip defines frustoco~ical openings for receiving the fastener strip prongs which each include a plurality of spaced-apart, frustoconi~al engaging members for engaging the retainer strip at a desired position relative to the prongs. This provides for the capabilit~ of adjusting the distance be~ween the fastener strip and the retainer ~trip.. Such a fastening device may be fabricated from a biodegradable or absorba~le mater~al~
j ETH-568 ~37~
I .
Although many of the above~discussed types of tissue fastening devices and techniques are satisfactory in vario~s applications ! ~here is a need to prcvide an improved fastening device, especially one compl~tely fabricated from absorbable materials.
Also, i~ would be desirable to provide an j improved fastening device fabricated from absorbable materials that can provide primary approximation of 1 15 the tissue edges to insure that the tissue edges are ¦ in continuous contact. Further, such an improved j ~astener should provide a desired amount of ! hemostatic compression to minimize bleeding, but allow some collater~l blood circulation to the wound or incision edges of the tissue to promote healing.
In addition, such an improved fastener should have the capability to accommodate varying tissue thicknesses and should leave as little tissue ~uff or : margin as possible in effecting the joining of the tissue.
Further, it would be beneficial if such an improved fastener had a configuration tha~, ! consistent with other design considerations, would enable the fastener to be fabricated with 1) as æmall a size as possible to minimize dosage: and 2) ~Ith a minimum of sharp edges or protrusions~. Also, another desirable feature of such an improved fastener would be a fastener configuration that did not form, or : con~ribute to ~he formation of, pockets of infec~ion in the tissue.
:~`
.
37;~q~
Further, such an improved fastener would desirably provide the surgeon with the capability for readjusting the ~ompres~ion after initial application.
Such an improved fastener should have the capability for maintaining the tissue portions in a~proximation and compression for a minimum of 21 days in vivo. Also, such a fastener should desirably be easily adjustable to the length of the two tissue portions beîng joined 50 that a single fastener can be used, ~ather than a pluralitv of shorter fasteners. Further, the fastener should desirably produce a well-distributed clamping force on the tissue ~ortions.
It would also be advantageous to provide such a fastener with a design that would facilitate its application to the tissue portions with a simple yet effective method. It would additionally be desirable if the improved fastener could readily accommodate appli~ation by means of an appropriately designed instrumentO
Summary of the Invention : Improved fasteners are provided to hold together portions of mammalian tissue, su~h as are defined by a wound or in~ision, to facilitate healing 25 of the wound or incision.
:: One fastener includes a fastening member that has a plurali~y of spaced-apart~ serrated le~s adapted to penetrate the tissue portions and that has an elongate clamping member connecting the legs. The fastener further includes an elongate receiver adapted ~o be dis~osed against a ti~sue portion opposite the fastening member for re~eiving the ; fastening member legs. ~he receiver~defines apertures each having a plurality of serrations for cooperating wi~h the serrations on the fasteninq i ~7~33~
member legs to inhibit relative movement of the receiver and fastening member at least in the disengaging directions~
In one form of the fastener, the clamping member and receiver are generally rigid. In another form of the fastener, both ~he clamping member and receiver are flexible strips which can generally conform to the surface contour of one of the tissue portions. ~he fastening member legs and receiver have suitable engaging means which may include serrations or other cooperating structures.
In a modification of this flexible component fastener, the flexible clamping member strip has regions defined between legs where one or more ; 15 shorter lengths of the clamping strip may be separated from the longer clamping strip. The receiYer strip also defines regions between leg receiving means where one or more shorter lengths of ~he receiver strip may be ~eparated.
The above-described flexible, severabl~
forms of the fastener components may be applied to the ti~sue a~ording to a novel method.
~pecifically~ a shorter len~th of a fastening member clamping strip may be separated from the originally provided longer fast~ning member clamping strip. A
shorter length of the receiver strip may be separated from the longer length of the receiver ~trip originally provided. The shorter length of the clamping ~trip is disposed again~t one ti~sue portion. ~he ~horter length of the receiver ~trip is disp~sed against the other of the tissUe p~rtions while conforming the shorter length receiver strip to the surface ~ontour of the other tissue p~rtion.
Then the leg~ of the shorter length of the fastening member ~re insertad through the ti~sue ''' ' .
~ 2~7~
portions and through the shorter length of the receiver strip to conform the clamping strip portion of the shorter length of the fastening member to the surface contour of the one tissue portion with the legs of the fastening member engaged with the shorter length of the receiver strip. .
The above-described method may be used with a flexible fastener wherein the fastening member and receiver are not designed to be severable. In such a case, the fastener is provided in various specific sizes and the user initially selects the appropriate ~ size fastener rather than sever a longer fastener.
; The above described method may be used for applying an elongate, flexible fastening member : 15 clamping strip and an elongate, flexible receiver to conform to the surface contour of the tissue portions even if the fastening member legs are received in receiver structures other than those having serrated apertures. The me~hod may be effectively employed - 20 with fastening members and receivers baving other forms of engaging ~tructures for holding the legs of the fastening member within the receiverO
~ n s~ill another form of the fastener, a astening member is provided with a clamping member ~onnecting a plurality of legs that each have a plurality of barbs angled rearwardly away from the leg distal end. ~he fas~ener also in~ludes a - receiver in ~he orm of a mesh of flexible filaments adapted to receive the fastening member legs after : 30 the legs ha~e been inserted through ~he ti~ue ; ~ port;ons with ~he barbs engaging the ~oth mesh and one of ~he tissue portions so as to inhibit relative movement of the receiver and fastening member at lea~t in the dlsengaging dire~tion~. According to the method for applying this type of f~s~ener, the ~TH-568 receiver is dispo~ed against one of the ~issue portions and the fastening member is dispossd against the other of the two tissue portions so that the legs of the fastening member penetrate the tissue portions and the receiver mesh.
In yet another form o~ the fas~ener, at least first and second ident;cal fastening members are provided. Each fastening member comprises a plurality of spaced-apart legs with di~tal ends and each fastening member also includes a mesh of flexible filaments extending around each of the legs. Accordin~ to a method for applying the fastener, the first fastening member is disp3sed ~gainst one of the tissue portions and the second fastening member is disposed against the other of the tissue portions. The tissue portions are penetrated by the legs of each fastening member so that the legs of each fastening member engage ~he mesh of the other fastening member to prevent disengagement and to hold the tissue portions together.
According to a further broad aspect of the present invention there is provided a fastener adapted to hold together, in conjunction with one or more other similar fasteners, two portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision. The fastener comprises a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions. Each leg defines on its exterior along at least a portion of iîS length a plurality of barbs angled rearwardly away from the leg distal end. A mesh of flexible filaments, the mesh having a generally tri-angular configuration, extends between adjacent legs and the mesh extends outwardly from, and generally normal to, each of the legs to define a leg receiving area wherehy the legs of one of the fastening members may be passed ~.~
-7a-~337%~3 through the tissue portions from one side of the wound or incision with the mesh being disposed against one of the tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of the wound or incision with the mesh of the other fastening member lying substantially against the other of the tissue por-tions so that at least one leg of each of the fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative move-ment of the fastening members at least ln the disengaging directions.
Numerous other features of vari~us embodiments of the novel tissue fasteners and application methods will be apparent from the Çollowing detailed description and accompanying drawings.
Brief Description of the Drawin~
. In the accompanying drawings forming part of : the specification, and in which like numerals are employed to desginate like parts throughou~ the same, Figure 1 i~ a perspective view of a fastening member and receiver which together : 25 constitute a first embodiment of the fastener of the present invention;
Figure 2 is a greatly enlarged, fragmentary~
side view of one of the fastening mem~er legs taken generally along the plane 2-2 in Fi~ure 1, .
~3~g Figure 3A is a greatly enlarged, cross-sectional view of the receiver taken generally along the plane 3A~3A in Figure l;
Figure 3B is a ragmentary, cross-sectional view taken generally along the plane 3B-3B in Figure 3A;
Figure 3C is a fragmentary, bottom view taken generally along the plane 3C-3C in Fi~ure 3B;
Figure 4 is a view of the fastener of Fi~ures 1-3C shown applied ~o tissue por~ions with part of the tissue portions cut away to better illustrate interior detail;
Figure 5 is a fragmentary, c~oss-sectional view of a second embodiment of a fastener shown holding together two portion~ of tis~ue;
lS Figure 6 is a rag~entary, perspective view : of a third embodiment of a fastener shown assembled in the absence of tissue;
Figure 7 is a perspective view of a fourth embodiment of a fastener;
Fi~ure 8 is a perspective view of a fifth .~ embodiment of a fastener;
Figure 9 is a greatly enlarged, fragmentary view of the fastener of Figure 8 ~hown applied to tissue portions to hold together tissue p~rtions with parts o~ ~he tissue portions cut away ~o be~ter illustra~e interior detail;
Figure lO i5 a perspective view ~f three fasteners that each have the form of a sixth : embodiment of a fastener;
: 30 Figure 11 is a view of the fastener~ of Figure lO shown applied ~o ho~d together two tissu~
portions with parts of the tissue portions cut away ~o better illustr~te interior deta11: and Figure l~ is a per~ective view of three fasteners that ea~h have the ~orm of a seventh embodiment of a fastener.
, :
~L~33~ 3 Descrietion of the Preferred Embodiments This invention may be used in many different forms. The specification and accompanying drawings disclose only a few specific forms as an example of the use of the invention. The precise shapes and sizes of the components herein de cribed are not essential to the invention unless otherwise indicated. The invention is not intended to be limited to the embodiments of the method and article illustrated, and the scope of the invention will be pointed out in the appended claims.
FI RST EMBODI~IENT OF THE FASTENER
A first embodiment of the fastener is illustrated in Figures 1-4 and is designated generally therein by reference numeral 50A.
The fastener 50A is illustrated in Figure 4 in the fully assembled, "set" configuration wherein it is shown holding together two portions 52 and 54 of mammalian tissue, such as are defined by a wound : 20 or incision in an organ, to fa~ilitate healing of the wound or incision.
The fastener 50A includes two co~ponents, a ; fastening member 60A and a receiver 62A, which are initially separated as illustrated in Figure 1 and which are adapted to cooperate to c~mpress or hold be~ween them the ~issue portions as illus~rated in Figure 4.
As i~ best illustrated in Figure 1, the fastening member 60A includes 1) a plurality of ~paced-apar~ leqs 66A adapted to penetrate ~he tissue portions and 2) an elongate cl~mping ~ember 68A whi~h ~onnects the legs 6~A and which is adapted to lie substantially ~gains~ one of the tissue portions (e.g., tissue portion 54 in ~igure 4)~ The legs 66~
of the fas~ening member 60~ are generally parallel to ET~-568 ~33~o~3 ~10--each other and are generally perpendicular to the clamping member 68A. Preferably, each leg 66A has a solid, generally cylindrical configuration with a conical distal end 70A to facilitate or aid in the penetration of the tissue portions. The clamplng membex 68A may be cylindrical (as illustrated) or may have any other suitable shape (such a~ that of a regular parallelpiped, for example~.
The fastener 50A is provided ~ith unique means for effecting engagement between the fastening member 60A and the receiver 62A and for holding the fastening member 60A and receiver 62A in a desired relationship t~ compress between them the two tlssue portions S4 and 52 as illustrated in Figure 4. To this end, as best illustrated in Figures 1 and 2, ~ each leg 66A of the fastening member 60A defines on ; its exterior along at least a portion of its length a plurality o~ small teeth or serrations 80A.
Further, as best illustrated in Figure 4,
2~ the receiver 62A is adapted to be disposed against the other of the tissue portions opposite the fastening member 60A. The receiver 62A defines means for receiving ~he fastening member legs and means for being engaged by the fastening member legs af~er the ~ 25 legs have been inserted through the tissue portions.
: The means for re~eiving the fastening member legs includes, in this embodiment~ a plurality~of ~pa~ed-apart apertures 76A as illustrated in Figure 1. The ~pertures 76A mày have the form of elongate or oval bores as illustrated.
~ he receiver 62A defines in each aperture 76R a plurality of small ~eeth or ~errations 90A for cooperating with ~he serrations 80A on the ~a~ening member legs so as ~o inhibit relative movement of the receiver 62~ and of the fastening member 60~ in the -E~lJ-568 ~3;3~7~
disengaging directions (in the directions tending to pull the components apart from ~he set position illustrated in Figure 4). The receiver aperture : serrations 90A are functional in one of two directions relative to the leg serrations 80A for a : given orientati~n of the re~eiyer rela~ive to the fastening member. In this respect, as best illustrate~ in Figures 2 and 3A, each receiver serration 90A is defined by a first retaining sur~ace generally normal to the wall of the aperture 76A and by a second camming surface slanting at an angle relative to the first retaining surface.
Each fastening member leg serration 80A has the form of a small frustoconical structure with a first surface generally normal to the cylindrical exterior surface of the legs 66A and with a second surface slanting at an angle relative to the first surface. By orienting the serration slanting surfaces on the leg in a direction opposite to the ~lanting surfaces of the serrations on the receiver, the legs 66A may be inser~ed into the receive~ 62A so that the serration slanting surfaces accommodate rel:ative movement in the direction of the insertion.
However, the normal ~urfaces of the serr~tions of the : ~5 fastening member leg 66A and of the receiver 62A
engage ~o prevent withdrawal of the leg 66A from the rece;ver 62A. This action is enh~nced by~providing a s~mewha~ resilient serration ~truoture, Also~ as best illustrated in Figure 3A, the ~idth of each re~eiver aperture 76A between ~he serrations 90A may be sl~ghtly le~s th~n the d~ameter ~ of the frusto~oni~al serra~ions BOA on the fastening ; member leg 66A. ~his will ensure a temp~rary : deflection or deformation of the ~errations ~0~ as the leg 66A is inserted into an aperture 76A o~ the E~-568 ~;~33~
receiver 6~A. When the leg 66A has been inserted a desired amount, the serrations 80A will tend to spring outwardly of the original, undeformed orientation so as to fully engage the serrations 90A
of the receiver and prevent withdrawal of the fastening ~ember 60A from the ~eceiver 62A.
As best illustrated in Figures 1 and 3C, the receiver 62A may have an enlarqed portion 95A
adjacent or surrounding each aperture 76A. This allows the receiver 62A to be fabricated with a narrow connecting portion 96A (Figure 1). The narrow connecting portion 96A may have a width considerably less than the width of the receiver portion 95A
around each aperture 76A. Indeed, if desired, each portion 96A may have a width less than the width of the aperture 76A. The provision of the enlarged portion ~5A adjacent or around each aperture 76A
provides sufficient material to define each aperture 76A and to provide the necessary structural inkegrity while permitting the use of the very narrow portions 96A to conserve material.
The fastening member 60A and receiver 62A
may be formed from suitable materials, such as thermoplastic polymer materials that are ab~orbable by mammalian tissue. For example, the fastening member and re~eiver may be molded from absorbable polymers or ~opolymers of poly-dioxanone,~lactide, : glycolide and the like. These components may also be molded from a combination of such materials.
The fastener SOA is used to join ~he tissue portions 52 and 54 (Figure 4~ in a novel manner.
~pecifi~ally, the tissue portions 52 and 54 are first approximated in surface-to-surface relationship as best illu~tra~ed in Figure 40 Then the fastening me~ber 60A is positioned on one side of the tissue Elrl~-s68 ~3~72q~
portions with the legs 66A oriented at an appropriate angle to penetrate the ~issue portions. The receiver 62A is held on ~he other slde of the tissue portions opposite the fastening member 60A and generally in alignment with the fastening member legs 66A.
: 5pecifically, the apertures 76A are ali~ned with the fastening member legs 66A.
Next, relative movement between the : fastening member 60A ~nd the receiver 62A i5 effe~ted to urge t~e fastening member and the re~eiver closer together to cause the fastPning member legs 66A to penetrate the tissue portions 52 and 54 and to lo~ate at least portions of the fastening member legs 66A
within the receiver 62A. The relative movement between the fastening member 60A and the receiver 62A
is terminated when the clamping member 68~ is at a desired distance from the receiver 62A t~ secure the tissue portions together. Preferably, this movement is terminated after the tissue portions have been compressed together a desired amount.
At this point, the distal ends o the fastening member legs 66A will typically protrude from the receiver 62A opposite the side of the ; receiver that is contacting one of the tissue 25 portions. ~f de~ired, the protruding ends of the legs 66A may be ~evered flu~h with the bottom of the ~ receiver 62A by a ~uitable means. Preferably, during : the step of severing the protruding portions of the fastening member legs 66A, the protruding portions of : 30 the fastening member legs are ~urrounded with a suitable ~ontainer for catching thC leg protruding portions after they are severed ~o as ~o prevent the severed portions of ~he legs from falling into the surrounding tissue or body cavity.
~:3372~
The above-described method for applying the fastener 50A to the tissue portions 52 and 54 may be effected with a suitable instrument (not illustrated) specifically designed for holding the fastening member 60A and receiver 62A and for driving the fastening member 60A through the tissue portions and into engagement with the receiver 62A. Such an -. instrument may include a pair of pivotally mounted jaws with one of the jaws adapted for holding the receiver 62A on one side of the tissue portions and with the other of the jaws adapted for holding the fastening member 60A on the other side of the tissue portions. A suitable driving member may be provided as part of the instrument for driving the fastening member 60A out of its holding jaw, into the tissue portions, and finally into engagement with the receiver 62A.
The instrument may include a suitable ; mechanism for severing the protruding portions of the fastening member legs 66A after tbe fastening member ; 60A and receiver 6~A have been locked together with the tissue portions under the desired amount of compression. It is to be realized that such an instrument might be preferably provided with means for applying a plurality of ~uch fasteners simultaneously or with ~eans for accommodating longer or shorter fasteners.
SECOND EM~ODIMENT OF TEE ~AST~NER
; ~he second embodiment of the ~as~ener is : 30 illustrated in Figure 5 and is desi~nated 9enerally therein by reference numeral 50B. The fastener 50 includes a fastening ~ember 60B and a receiver 62B.
The fastener 50B is similar to the fir~t embodiment of ~he fastener 50A described above with referen~e to Figures 1-40 The elements o~ the second ~33~72~
embodiment of the fastener 50B that are identical or functionally analogous to tho~e of the first embodiment of the fastener 50A are designated by reference numerals identical to those used for the first S embodiment with the exception that the second emb~diment reference numerals ~re followed by the upper case letter B whereas the first embodi~ent reference numerals are followed by the upper case letter A.
The fastening member 60B is identical to ~he fastening member 60A of the first embodiment of the fastener 50A described above with reference to Figure 1 and has legs 66B joined by a clamping member 68B.
The receiver 62B is somewhat similar to the receiver 62A of the first embodiment of the fastener 50A described above with reference to Figure 1.
: ~owever, rather than being a completely rigid member like recelver 62A, the receiver 62B has at least a central portion around each aperture 76B that is : flexible. This feature can be provided by making the : 20 receiver 62B somewhat thinner than the receiver 62A.
In any case, the apertures 76B of the receiver 62B are provided with serrations and the : legs 6~B of the fastening member 60B are also : provided with serrations. The serration structure is preferably identi~al to that described above with refer2nce to the first embodiment of the f~stener 50A. Thu~, when the fastener is applied to the tissue, the serrat~ons on the fastening member legs : ~ 66B ~re ~ngaged by the serrations on the r~ceiver 62B.
~ach aperture 76B of the Eeceiver 6~B may be elongate or oval as are the apertures 76A of the first embodiment of the Pastener 50A discu~sed above. Al~o, the width of each aperture 76B 15 preferably slightly less than the dia~eter of each of the legs 66~ of the fastening member 60B.
~, ~233~
Owing to the flexible nature of at least the region of the receiver 62B around each aperture 76B, the flexible regions are forced outwardly some amount when the fastening member 60B is inserted through the ti~sue portions and into the receiver 62B as : i.llustrated in Figure 5. The ~utward deflection of the flexible region~ of the receiver 62B facilitate reception of the fastening member legs 66B in the receiver 62B but further inhibit relative movement of the receiver 62B and fastener member 60B in the disengaging directions.
The second embodiment of the fastener 50B
may be fabricated from the same kinds of materials described abov~ for ~abrication of the first embodiment of ~he fastener 50A. Further, a ~uitable instrument for applying the second embodiment of the fastener 50B may be provided to operate in the manner described above with respect to the instrument for applying the first embodiment of the fastener 50A.
THIRD E~IBODIMENT OF T~E FAS'rENER
The third embodiment of the f~s~ener is illustrated in Figure 6 and is designated generally ~herein by reference numeral 50C. The fastener 50C
includes a fastening member 60C and a receiver 62C.
The fastener SOC is similar to the first and second fastener embodi~ents 50A and 50B, respectively, de~cribed above wlth re~ere~ce to Figures 1-5. The elements o~ the third embodiment of the fastener 50C that are identical or fu~c~ionally ~` : 30 analogous to those of the fir~t and ~econ~
embodiments of the fasteners 50A and SOB, respectively, are designated by reference numerals : identical ~o those used for the first and ~econd embodiments with the exception that the third : 3~ embodiment reference numerals are followed by the 33~
upper case letter C whereas the first and second embodiment reference numerals are followed by the upper case letters A and B, respectively.
The fastening member 60C includes a S plurality of legs 66C which are connected together by a clamping member 68C which has a generally right rectangular parallelpiped sha~e.
Similarly, the receiver 62C has a generally right rectangular parallelpiped shape and defines leg receiving apertures 76C. A region around each aperture 76C may be somewhat flexible so that the receiver 62C functions in a manner identi~al to that of the receiver 62B described above with reference to ~igure 5.
The shape of the ~lamping member 68C and the shape of the receiver 62C, both being generally strip-like, may be advantageously used in thos2 applications where it is desired to have larger areas of contact between the fastener 50C and ~he ti sue portions.
The third embodiment of the fastener 50C may be fabricated rom the same kinds of materials described above for ~he first and ~econd embodiments of the fastener 50A and 50B, respe~tively.
The third embodiment of the fastener 50C is applied to the tissue por~ions in a manner generally analogous t~ that described ~bove for the~ir~t and second embodiment~ of ~he fa3tener 50A and 50B, re~pectively. Similarly~ a ~uitable inætrument for : 30 applying the third embodiment of the astener SOC ~ay be provided to opera~e in the manner de~cribed above with respect to the instrument for appiying the first and second embodimen~s of the fasteners 50R and 50B, respectively~
: 35 ~33~
FOURTH EMBODIMENT OF THE_ FASTENER
The fourth embod;ment of the fastener is illustrated in Figure 7 and is designated generally therein by reference numeral 50D. The fastener 50D
S includes a fastening member 60D and a receiver 62D.
The fastener 50D is slmilar ~o the third embodiment of the fastener 50C described above with reference to Figure 6. The elements of the fourth embodiment of the fastener 50D that are identical or unctionally analogous to those of the third embodiment of the fastener 50C are designated by referenee numerals identical to those used for the third embodiment with the exception that the fourth ~ embodiment reference numerals are followed by the : 15 upper case letter D whereas the third embodiment reference numerals are followed by the upper case letter C.
The fastening member 60D is similar to the fastening member 60C of the third embodiment of the ZO fastener 50C described above with reference to Figure 6 and has a clamping member or strip 68D from which project a plurality of spaced-apart legs S6D. ~h~
legs 66D are provided with engaging members or serrations identical to ~hose on the legs 66C of the : 25 third embodiment of the fastener 50C.
The clamping member 68D differ~, however, from the clamping ~ember 68C of the third~mbodi~ent of the fastener in that the ~lamping member 68D is fabricated from a relatively flexible ~ateral. The flexible 1amping member 68D is adapted to lie substantially against one of the ti~sue port~ons and to generally conform to the surface c~ntour of the : one tissue portion.
The receiver or receiver s~rip 62D is similarly ~abri~ated from a relatively flexible . , material~ It is adapted to be disposed against the other of the tissue portions opposi~e the fastening member 60D and to generally conform to the surface contour of the other tissue portion.
The receiver strip 62D defines means for receiving the fastening member legs 66D and means for being engaged by the engaging members (e.g~
serrations) of the legs 66D after the legs have been inserted throu~h the tissue portions. In the illustrated fourth embodiment, the leg receiving means includes apertures 76D. Serrations provided around the apertures 76D function as means for being engaged by the serrations of the fastening member legs S6D.
The fourth embodiment of the fastener SOD
may be fabricated from the same kinds of materials as the first, second, and third embodiments of the fastener described hereinbefore. In addition, the fourth embodiment of the fastener 50D may be fabricated with a reduced amount of material by providing voids or regions in the fasteQer where no material is used.
For example, in the fastening member 60D, the clamping member or clamping strip 68D defines a plurality of apertures 96D. The apertures 96D may be : sguare-shaped as ~llustrated, or may be any other ~: suitable shape. Similarly~ ~he re~eiver or receiver s~rip 62D may be provided with aperture~ 98D whi~h may be square-shaped as illustrated or which may be : 30 any other suitable shape.
In additiony the ~pa~e between each pair of fastening member legs 66D on the clamping ~tr~p 68D
may define a region where one or more ~horter lengths of ~he fastening member ma~ be separated from the
: The means for re~eiving the fastening member legs includes, in this embodiment~ a plurality~of ~pa~ed-apart apertures 76A as illustrated in Figure 1. The ~pertures 76A mày have the form of elongate or oval bores as illustrated.
~ he receiver 62A defines in each aperture 76R a plurality of small ~eeth or ~errations 90A for cooperating with ~he serrations 80A on the ~a~ening member legs so as ~o inhibit relative movement of the receiver 62~ and of the fastening member 60~ in the -E~lJ-568 ~3;3~7~
disengaging directions (in the directions tending to pull the components apart from ~he set position illustrated in Figure 4). The receiver aperture : serrations 90A are functional in one of two directions relative to the leg serrations 80A for a : given orientati~n of the re~eiyer rela~ive to the fastening member. In this respect, as best illustrate~ in Figures 2 and 3A, each receiver serration 90A is defined by a first retaining sur~ace generally normal to the wall of the aperture 76A and by a second camming surface slanting at an angle relative to the first retaining surface.
Each fastening member leg serration 80A has the form of a small frustoconical structure with a first surface generally normal to the cylindrical exterior surface of the legs 66A and with a second surface slanting at an angle relative to the first surface. By orienting the serration slanting surfaces on the leg in a direction opposite to the ~lanting surfaces of the serrations on the receiver, the legs 66A may be inser~ed into the receive~ 62A so that the serration slanting surfaces accommodate rel:ative movement in the direction of the insertion.
However, the normal ~urfaces of the serr~tions of the : ~5 fastening member leg 66A and of the receiver 62A
engage ~o prevent withdrawal of the leg 66A from the rece;ver 62A. This action is enh~nced by~providing a s~mewha~ resilient serration ~truoture, Also~ as best illustrated in Figure 3A, the ~idth of each re~eiver aperture 76A between ~he serrations 90A may be sl~ghtly le~s th~n the d~ameter ~ of the frusto~oni~al serra~ions BOA on the fastening ; member leg 66A. ~his will ensure a temp~rary : deflection or deformation of the ~errations ~0~ as the leg 66A is inserted into an aperture 76A o~ the E~-568 ~;~33~
receiver 6~A. When the leg 66A has been inserted a desired amount, the serrations 80A will tend to spring outwardly of the original, undeformed orientation so as to fully engage the serrations 90A
of the receiver and prevent withdrawal of the fastening ~ember 60A from the ~eceiver 62A.
As best illustrated in Figures 1 and 3C, the receiver 62A may have an enlarqed portion 95A
adjacent or surrounding each aperture 76A. This allows the receiver 62A to be fabricated with a narrow connecting portion 96A (Figure 1). The narrow connecting portion 96A may have a width considerably less than the width of the receiver portion 95A
around each aperture 76A. Indeed, if desired, each portion 96A may have a width less than the width of the aperture 76A. The provision of the enlarged portion ~5A adjacent or around each aperture 76A
provides sufficient material to define each aperture 76A and to provide the necessary structural inkegrity while permitting the use of the very narrow portions 96A to conserve material.
The fastening member 60A and receiver 62A
may be formed from suitable materials, such as thermoplastic polymer materials that are ab~orbable by mammalian tissue. For example, the fastening member and re~eiver may be molded from absorbable polymers or ~opolymers of poly-dioxanone,~lactide, : glycolide and the like. These components may also be molded from a combination of such materials.
The fastener SOA is used to join ~he tissue portions 52 and 54 (Figure 4~ in a novel manner.
~pecifi~ally, the tissue portions 52 and 54 are first approximated in surface-to-surface relationship as best illu~tra~ed in Figure 40 Then the fastening me~ber 60A is positioned on one side of the tissue Elrl~-s68 ~3~72q~
portions with the legs 66A oriented at an appropriate angle to penetrate the ~issue portions. The receiver 62A is held on ~he other slde of the tissue portions opposite the fastening member 60A and generally in alignment with the fastening member legs 66A.
: 5pecifically, the apertures 76A are ali~ned with the fastening member legs 66A.
Next, relative movement between the : fastening member 60A ~nd the receiver 62A i5 effe~ted to urge t~e fastening member and the re~eiver closer together to cause the fastPning member legs 66A to penetrate the tissue portions 52 and 54 and to lo~ate at least portions of the fastening member legs 66A
within the receiver 62A. The relative movement between the fastening member 60A and the receiver 62A
is terminated when the clamping member 68~ is at a desired distance from the receiver 62A t~ secure the tissue portions together. Preferably, this movement is terminated after the tissue portions have been compressed together a desired amount.
At this point, the distal ends o the fastening member legs 66A will typically protrude from the receiver 62A opposite the side of the ; receiver that is contacting one of the tissue 25 portions. ~f de~ired, the protruding ends of the legs 66A may be ~evered flu~h with the bottom of the ~ receiver 62A by a ~uitable means. Preferably, during : the step of severing the protruding portions of the fastening member legs 66A, the protruding portions of : 30 the fastening member legs are ~urrounded with a suitable ~ontainer for catching thC leg protruding portions after they are severed ~o as ~o prevent the severed portions of ~he legs from falling into the surrounding tissue or body cavity.
~:3372~
The above-described method for applying the fastener 50A to the tissue portions 52 and 54 may be effected with a suitable instrument (not illustrated) specifically designed for holding the fastening member 60A and receiver 62A and for driving the fastening member 60A through the tissue portions and into engagement with the receiver 62A. Such an -. instrument may include a pair of pivotally mounted jaws with one of the jaws adapted for holding the receiver 62A on one side of the tissue portions and with the other of the jaws adapted for holding the fastening member 60A on the other side of the tissue portions. A suitable driving member may be provided as part of the instrument for driving the fastening member 60A out of its holding jaw, into the tissue portions, and finally into engagement with the receiver 62A.
The instrument may include a suitable ; mechanism for severing the protruding portions of the fastening member legs 66A after tbe fastening member ; 60A and receiver 6~A have been locked together with the tissue portions under the desired amount of compression. It is to be realized that such an instrument might be preferably provided with means for applying a plurality of ~uch fasteners simultaneously or with ~eans for accommodating longer or shorter fasteners.
SECOND EM~ODIMENT OF TEE ~AST~NER
; ~he second embodiment of the ~as~ener is : 30 illustrated in Figure 5 and is desi~nated 9enerally therein by reference numeral 50B. The fastener 50 includes a fastening ~ember 60B and a receiver 62B.
The fastener 50B is similar to the fir~t embodiment of ~he fastener 50A described above with referen~e to Figures 1-40 The elements o~ the second ~33~72~
embodiment of the fastener 50B that are identical or functionally analogous to tho~e of the first embodiment of the fastener 50A are designated by reference numerals identical to those used for the first S embodiment with the exception that the second emb~diment reference numerals ~re followed by the upper case letter B whereas the first embodi~ent reference numerals are followed by the upper case letter A.
The fastening member 60B is identical to ~he fastening member 60A of the first embodiment of the fastener 50A described above with reference to Figure 1 and has legs 66B joined by a clamping member 68B.
The receiver 62B is somewhat similar to the receiver 62A of the first embodiment of the fastener 50A described above with reference to Figure 1.
: ~owever, rather than being a completely rigid member like recelver 62A, the receiver 62B has at least a central portion around each aperture 76B that is : flexible. This feature can be provided by making the : 20 receiver 62B somewhat thinner than the receiver 62A.
In any case, the apertures 76B of the receiver 62B are provided with serrations and the : legs 6~B of the fastening member 60B are also : provided with serrations. The serration structure is preferably identi~al to that described above with refer2nce to the first embodiment of the f~stener 50A. Thu~, when the fastener is applied to the tissue, the serrat~ons on the fastening member legs : ~ 66B ~re ~ngaged by the serrations on the r~ceiver 62B.
~ach aperture 76B of the Eeceiver 6~B may be elongate or oval as are the apertures 76A of the first embodiment of the Pastener 50A discu~sed above. Al~o, the width of each aperture 76B 15 preferably slightly less than the dia~eter of each of the legs 66~ of the fastening member 60B.
~, ~233~
Owing to the flexible nature of at least the region of the receiver 62B around each aperture 76B, the flexible regions are forced outwardly some amount when the fastening member 60B is inserted through the ti~sue portions and into the receiver 62B as : i.llustrated in Figure 5. The ~utward deflection of the flexible region~ of the receiver 62B facilitate reception of the fastening member legs 66B in the receiver 62B but further inhibit relative movement of the receiver 62B and fastener member 60B in the disengaging directions.
The second embodiment of the fastener 50B
may be fabricated from the same kinds of materials described abov~ for ~abrication of the first embodiment of ~he fastener 50A. Further, a ~uitable instrument for applying the second embodiment of the fastener 50B may be provided to operate in the manner described above with respect to the instrument for applying the first embodiment of the fastener 50A.
THIRD E~IBODIMENT OF T~E FAS'rENER
The third embodiment of the f~s~ener is illustrated in Figure 6 and is designated generally ~herein by reference numeral 50C. The fastener 50C
includes a fastening member 60C and a receiver 62C.
The fastener SOC is similar to the first and second fastener embodi~ents 50A and 50B, respectively, de~cribed above wlth re~ere~ce to Figures 1-5. The elements o~ the third embodiment of the fastener 50C that are identical or fu~c~ionally ~` : 30 analogous to those of the fir~t and ~econ~
embodiments of the fasteners 50A and SOB, respectively, are designated by reference numerals : identical ~o those used for the first and ~econd embodiments with the exception that the third : 3~ embodiment reference numerals are followed by the 33~
upper case letter C whereas the first and second embodiment reference numerals are followed by the upper case letters A and B, respectively.
The fastening member 60C includes a S plurality of legs 66C which are connected together by a clamping member 68C which has a generally right rectangular parallelpiped sha~e.
Similarly, the receiver 62C has a generally right rectangular parallelpiped shape and defines leg receiving apertures 76C. A region around each aperture 76C may be somewhat flexible so that the receiver 62C functions in a manner identi~al to that of the receiver 62B described above with reference to ~igure 5.
The shape of the ~lamping member 68C and the shape of the receiver 62C, both being generally strip-like, may be advantageously used in thos2 applications where it is desired to have larger areas of contact between the fastener 50C and ~he ti sue portions.
The third embodiment of the fastener 50C may be fabricated rom the same kinds of materials described above for ~he first and ~econd embodiments of the fastener 50A and 50B, respe~tively.
The third embodiment of the fastener 50C is applied to the tissue por~ions in a manner generally analogous t~ that described ~bove for the~ir~t and second embodiment~ of ~he fa3tener 50A and 50B, re~pectively. Similarly~ a ~uitable inætrument for : 30 applying the third embodiment of the astener SOC ~ay be provided to opera~e in the manner de~cribed above with respect to the instrument for appiying the first and second embodimen~s of the fasteners 50R and 50B, respectively~
: 35 ~33~
FOURTH EMBODIMENT OF THE_ FASTENER
The fourth embod;ment of the fastener is illustrated in Figure 7 and is designated generally therein by reference numeral 50D. The fastener 50D
S includes a fastening member 60D and a receiver 62D.
The fastener 50D is slmilar ~o the third embodiment of the fastener 50C described above with reference to Figure 6. The elements of the fourth embodiment of the fastener 50D that are identical or unctionally analogous to those of the third embodiment of the fastener 50C are designated by referenee numerals identical to those used for the third embodiment with the exception that the fourth ~ embodiment reference numerals are followed by the : 15 upper case letter D whereas the third embodiment reference numerals are followed by the upper case letter C.
The fastening member 60D is similar to the fastening member 60C of the third embodiment of the ZO fastener 50C described above with reference to Figure 6 and has a clamping member or strip 68D from which project a plurality of spaced-apart legs S6D. ~h~
legs 66D are provided with engaging members or serrations identical to ~hose on the legs 66C of the : 25 third embodiment of the fastener 50C.
The clamping member 68D differ~, however, from the clamping ~ember 68C of the third~mbodi~ent of the fastener in that the ~lamping member 68D is fabricated from a relatively flexible ~ateral. The flexible 1amping member 68D is adapted to lie substantially against one of the ti~sue port~ons and to generally conform to the surface c~ntour of the : one tissue portion.
The receiver or receiver s~rip 62D is similarly ~abri~ated from a relatively flexible . , material~ It is adapted to be disposed against the other of the tissue portions opposi~e the fastening member 60D and to generally conform to the surface contour of the other tissue portion.
The receiver strip 62D defines means for receiving the fastening member legs 66D and means for being engaged by the engaging members (e.g~
serrations) of the legs 66D after the legs have been inserted throu~h the tissue portions. In the illustrated fourth embodiment, the leg receiving means includes apertures 76D. Serrations provided around the apertures 76D function as means for being engaged by the serrations of the fastening member legs S6D.
The fourth embodiment of the fastener SOD
may be fabricated from the same kinds of materials as the first, second, and third embodiments of the fastener described hereinbefore. In addition, the fourth embodiment of the fastener 50D may be fabricated with a reduced amount of material by providing voids or regions in the fasteQer where no material is used.
For example, in the fastening member 60D, the clamping member or clamping strip 68D defines a plurality of apertures 96D. The apertures 96D may be : sguare-shaped as ~llustrated, or may be any other ~: suitable shape. Similarly~ ~he re~eiver or receiver s~rip 62D may be provided with aperture~ 98D whi~h may be square-shaped as illustrated or which may be : 30 any other suitable shape.
In additiony the ~pa~e between each pair of fastening member legs 66D on the clamping ~tr~p 68D
may define a region where one or more ~horter lengths of ~he fastening member ma~ be separated from the
3~ fastening memberO These Useparating~ regions may be ~233~7~
defined by, may be defined in, or may include voids or apertures, such as the apertures 96D.
Similarly, regions may be defined in the receiver or receiving strip 62D between the leg receiving means (e.g., leg receiving apertures 76D) where one or more shorter lengths nf the receiver strip may be separated from the receiver strip. The _ separating regions of the receiver strip 62D may be defined by r may be defined in, or may include voids or apertures, such as the apertures 98D~
A novel method has been developed for applying the fastener 50D in a manner that uses to advantage the flexible nature of the fastener 50D.
Specifically, the fastening member 60D is selected and, if it is too long for the intended application, the desired shorter length of the fastening member is separated by cutting or otherwise severing the fastening member between a selected pair of legs 66D.
Similarly, if the receiver or receiver strip 62~ is too long, a shorter length of ~he ~eceiver strip may be separated by cutting or ~evering the strip between the le~ receiving means or aperture 76D.
Next~ the shortened length of the fastening member 60D is d1sposed against one ti~sue portion and ~he shortened length of the receiver strip is disposed against the other of the tis~ue portions.
~uring this step, the shortened leng~h of~he receiq*r strip i8 manipulated 80 as to conform to the surface contour of the tissue portion again t which it is di~posed.
: ~ext, the legs of the ~hortened length of the fastening member 60D are inserted th~ough the tissue portions and througb the ~hor~ened length of the r~ceiver ~rip 62D to conform the clamping strip 68D of ~he shortened length of the fastening member ~ . . .
~ l~33~2~:J
60D to the surface conto~r of the tissue portion against which it is disposed. Insertion of the legs 66D is effected so that the legs engage ~he shortened length of the receiver strip 62D to prevent relative movement of the shortened length of the receiver strip 62D and of the shortened length of the fastening member 60D at least in the disengaging dire~tions.
A suitable instrument may be provided for applying the fourth embodiment of the fastener 50D
according to the above-described ~ethod.
FIFTH EMBODIMENT OF T~E FASTENER
The fifth embodiment of the fastener is illustrated in Figures 8 and 9 and is designated generally therein by reference numeral 50E. ~he fastener 50~ includes a fastening member 60E and a receiver 62E.
The components of fastener 50E include some basic features which are analogous to those of the first embodiment of the fastener 50A described above with reference ~o Figure 1-4. The elements of the fifth embodiment of the fastener SOE that are functionally analogo~s to those of the first embodiment of the fastener 50A are desi~nated by reference numerals identical to those used for the first embodimen~ with the exception that the fifth e~bodiment refere~ce numerals are followed by ~he upper case le~ter ~ whereas the fir~t embodiment reference numerals are followed by the upper case letter Ao The Pas~ening ~ember 60E has a ~enerally cylindrical clamping member 68E although other ~hapes are suitable for the clampin~ member 68E. The clamping member 68E ~onnects a plurality of ~5 spaced-apart legs 66E that h~ve di~tal ends 70E
~~372~
'~
(Figure 9) adapted to penetrate the tissue portions~
The elongate clamping member 68E is preferably oriented generally perpendicular to the legs 66E.
Each leg 66E defines, on its exterior along at least a portion of its length, a plurality of barbs 80E which are each anqled rearwardly away from the leg distal end 70E. Preferably, each barb 80E
has a generally conical configuratiQn with a distal end portion that is relatively flexible. As best illustrated in Figures 8 and 9, the barbs 80E are - preferably arranged in groups of four barbs at spaced longitudinal locations along the length of each leg 66E with the barbs in each group of four barb~ being equally spaced about the periphery of each leg 66E.
15The receiver 62E includes a flexible filament mesh 76E adapted to receive the fastening member legs 66E after the legs have been înserted through the tissue portions. The mesh 76E has a grid-like arrangement of the filaments. The me~h 76E
extends across, and is secured to, a rigid peripheral frame 78~.
To apply the fastener 50E to hold together ~wo tissue portions, the receiver 62E is disposed against one of the tissue portions (e.g., ti~ue portion 52 as illustrated in Figure 9). The fastening mem~er 60E is disposed against the other of the tissue portions (e.g., ti~sue portion~54 in Fiqure 9) and both the receiver mesh 76~ and the tissue portions are penetrated with the ~as~ening : 30 member legs ~6E. The barbs 80E eng~ge both the ~esh 76E and one tissue ~ortion (e.q., ti~ue p~rtion 52 so as ~o inhibit relative move~ent of ~he receiver 62E and fasteniny ~ember 60~ at lea~t in the disenqaging direc~iuns.
E~ 568 .. . .
~33'7~
The barbs 80E are flexible enough to be bent rearwardly as the fastening member le~s 6~E are pushed through the tissue portions. ~owever, the barbs 80E are resilient enough to assume their original angle after they have passed through the tissue portions. Thus, those barbs 80E which have penetrated and extend beyond the tissue portions will engage ~he mesh 76E and the adjacent tissue portion.
The fastener 50E may be fabricated from the same materials as the first four embodiments of the fastener described above with reference to Figures l 7. Additionally, a suitable instrument for applying the fastener 50E may be provided to apply the fastener 50E to the tissue portions in accordance with the method described above.
SIXTH_EMBODIMENT OF TRE ASTENER
The sixth embodiment of the fastener is illustrated in Figures lO and ll wherein three identical fasteners are each designated generally by ; 20 the reference numeral 50F, The elements of the sixth embodiment of the fastener 50F that are identical or fun~tionally analogous to those of the firs~
embodiment of the fastener 50A are designated by reference numerals identical to those used for the first embodiment with the ex~eption that the sixth embodiment reference numerals are followed by the upper case letter F whereas the first embodiment reference numerals are followed by the upper ~ase letter A.
The fastener 50F includeæ ~ faxtaning member 60F which comprises a plurality of ~paced-apart legs 66~ ~hat each have a distal end 70F adapted ~o pass through tissue portions. The legs 66F ~ay be connected as illustrated by a link member 68F which is generally perpendicular to the legs 66F.
E'1J-568 ~33~
Each leg 66F defines, on its exterior along at least a portion of its leng~h, a plurality of barbs 80F which are angled rearwardly away from the leg distal end 70F. The barbs 80F may have the same general co~figuration and orientation as the barbs 80E of the fastener 50E described above with reference to Figures 8 and 9.
The fastener 50~ further includes a flexible filament mesh 76F which extends outwaraly from, and generallY normal to, each of the legs 66F so as to define a leg receiving area. The mesh 76F may extend in a g~nerally triangular configuration around both of the legs 66F of a fastening member 60F as illustrate~. The mesh 76F may be loosly disposed on ; 15 the fastening member legs 66F between the link member 68F and the leg distal ends 70A as illustrated.
Preferably, the mesh 76F is adjacent the link member 68F and may even be in contact with the link member 68F. Preferably, there is also a generally rigid frame 78F around the periphery of the mesh 76F, and the mesh 76F is secured to the frame 78F.
The mesh 76F and its frame 78F may ~e loosely disposed on the legs 66F adjacent the link member 68F. The mesh 76F and frame 78F need not be immovably secured or fixe~ to the legs 66~ or to the link member 68F~
The fasteners 50F may be fabrica~ed from the : same materials as the first through the fifth embodiments of the fastener described above with reference to Figure 1-9.
The fasteners 50F ~re applied to tissue por'cions in a novel manner to hold ~ogether the tissue portions. Specificall~r at least a first fastening member 60F and the associated mesh 76F are 35 dis~osed against one of the ~issue pQrtions and the E~ lH_568 ~3~
tissue portions are penetrated by the legs 66F of the astening member 60F.
A second fastening member 60F and associated mesh 76F are ~isposed against the other of the tissue portions~ The fastening member legs 66F of the second fastening member 60F are inserted through the tissue portions so as to penetrate both tissue portions. The locations o~ the leg penetrations of both the first and second fastening members 60F are selected so that at least one leg of each fastening member penetrates the mesh around a leg of the other fastening member and so that the barbs of at least one leg of each fastening member engage both the mesh of the other fa~tening member and one of the tissue portions so as to inhibit relative movement of the fastening members in at least the disengaging directions~
In Figure 11, three identical fasteners 50F
are shown holding together the two tissue portions 54 and 52. ~he fastener 50F that is shown inserted from the bottom below tissue portion 52 has its associated mesh penetrated by a leg of each of the other two fasteners 50F which have been inserted from the top over tissue portion 54. Each of these upper fasteners 50F is engaged by one of the two 12gs of the lower astener 50~r With referen~e to Figure 10, it can be seen that the triangular ~hape of the mesh 76F provides a region defined in a vertex (opposite the link member 68F) which ~an recei~e an engaging leg of another fa~tener 50F.
A suitable in~trument ~ay be used for applying the fa~tener~ 50F to hold together the tis~ue portions according to the method d~scribed above.
E~H-568 ~3~
SEVENTH EMBODIMENT OF THE ~ASTENER
A seventh embodiment of the fastener is illustrated in ~igure 12 where it is de~ignated : generally by the reference numeral 50G. Three such fasteners 50G are shown in a typical orientation wherein they would be applied ~o tissue portions.
Each fastener 50G is similar, and functions in an ~- analogous manner, to the sixth embodiment of the fastener 50F described above with reference to Figures 10 and 11. The elements of the seventh embodiment of the fastener 50G that are identical or functionally analogous to those of the sixth embodiment of the fastener 50F are designated by reference numerals identical to those used for the ~ixth embodiment with lS the exception that the seventh embodiment reference numerals are followea by the upper case letter G
whereas the sixth embodiment reference numerals are followed the upper case letter F.
Each fastener 50G includes two spaced-apart legs 66G that each have a distal ena 70G adapted to pass through the tissue Portions. Preferably, the legs 66G are connected by a link memb~r 68G. ~he : legs 66G have bar~s 80G which may be i~entical to the barbs 80F of ~he sixth embodimene of the fastener 50F
described above.
: Rather than have a ~ingle mesh extending around both legs 66G, the f~s~ener 50G in~ludes two separate portions of flexible filament ~esh 76G --one of the portions having a generally cir~ular : 30 ~onfiguration around one of the fa~tening member legs 66G and the other of the portions havlng a generally ~ircular configura~ion around the other of the fasteninq member legs 66G. ~ach portion of mesh 76G
may include a generally r$gid frame 78G. ~ach : 35 portion of megh 76~ may be loosely disposed on a leg E~H-568 ~3~
66G adjacent the link member 68G. A fixed securement of each mesh portion to the fastener 50G is not required.
The fastener~ 50G may be applied to the tissue portions in a manner generally similar and analogous to that used in applying the sixth embodiment of the fasteners 50F described above with reference to Figures 10 and 11.
The fasteners 50G may be fabricated from the same materials as the first through the sixth embodiments of the fasteners described hereinbefore.
FASTENER ADJUSTABILITY
With each of the fastener embodiments described above ~ it is seen that the fastener can accommodate variou~ thicknesses of tissue. The fasteners may be inserted into the tissue and relative movement may be effected until the desired tissue compression is achieved. The fastener components lock together at any of a plurality of closely spaced points along the length of the fastening member legs so that a wide range of . adjustability is conveniently provided.
ALTERNATIVE DESIGN FEATURES
~: .
~: In the embodiments shown in figures 1-6 and 8, the legs of each fastening member are connected by a portion of the fastening member (e~g., the link or clamping member ) which is illustr ted as peing generally straight and extending perpendi~:ular to the legs. The structure need not be limited to such a ~hape however. Instead, all or a portion of the length of the fastening mem~er between any two adjacent le~s may be arched or arcuate or may include an arcuate portion (e.g., an inverted U shaped configuration). This would function to initially provide a free space between the upper ti~sue portion ." .
~3~
and the top of the fastening member to allow for some expansion of the tissue.
However, in those situations where increased initial tissue compression is desired, a modified receiver structure may be provided to cooperate with the above-described arcuate fa$tening member~
Specifically, the receiver need not have a flat upper surface as illustrated. Rather, the upper surface of the receiver may be arcuate (e.~., convex) so as to generally match or correspond with the arcuate shape of the f~stening member This can result in an increased compression of the two tissue portions between the receiver and fastening member.
From the foregoing, it will be observed that numerous variations and modifications may be effected without departing from the true spirt and scope of the novel concept of the invention. It is to be understood that no limitation with respect to the specific articles, instruments, and methods illustrated herein is intended or should be ; inferred~ It is~ of course, intended to cover by the appended claims all such modifications as fall within the scope of the claims.
.
.
E~-568
defined by, may be defined in, or may include voids or apertures, such as the apertures 96D.
Similarly, regions may be defined in the receiver or receiving strip 62D between the leg receiving means (e.g., leg receiving apertures 76D) where one or more shorter lengths nf the receiver strip may be separated from the receiver strip. The _ separating regions of the receiver strip 62D may be defined by r may be defined in, or may include voids or apertures, such as the apertures 98D~
A novel method has been developed for applying the fastener 50D in a manner that uses to advantage the flexible nature of the fastener 50D.
Specifically, the fastening member 60D is selected and, if it is too long for the intended application, the desired shorter length of the fastening member is separated by cutting or otherwise severing the fastening member between a selected pair of legs 66D.
Similarly, if the receiver or receiver strip 62~ is too long, a shorter length of ~he ~eceiver strip may be separated by cutting or ~evering the strip between the le~ receiving means or aperture 76D.
Next~ the shortened length of the fastening member 60D is d1sposed against one ti~sue portion and ~he shortened length of the receiver strip is disposed against the other of the tis~ue portions.
~uring this step, the shortened leng~h of~he receiq*r strip i8 manipulated 80 as to conform to the surface contour of the tissue portion again t which it is di~posed.
: ~ext, the legs of the ~hortened length of the fastening member 60D are inserted th~ough the tissue portions and througb the ~hor~ened length of the r~ceiver ~rip 62D to conform the clamping strip 68D of ~he shortened length of the fastening member ~ . . .
~ l~33~2~:J
60D to the surface conto~r of the tissue portion against which it is disposed. Insertion of the legs 66D is effected so that the legs engage ~he shortened length of the receiver strip 62D to prevent relative movement of the shortened length of the receiver strip 62D and of the shortened length of the fastening member 60D at least in the disengaging dire~tions.
A suitable instrument may be provided for applying the fourth embodiment of the fastener 50D
according to the above-described ~ethod.
FIFTH EMBODIMENT OF T~E FASTENER
The fifth embodiment of the fastener is illustrated in Figures 8 and 9 and is designated generally therein by reference numeral 50E. ~he fastener 50~ includes a fastening member 60E and a receiver 62E.
The components of fastener 50E include some basic features which are analogous to those of the first embodiment of the fastener 50A described above with reference ~o Figure 1-4. The elements of the fifth embodiment of the fastener SOE that are functionally analogo~s to those of the first embodiment of the fastener 50A are desi~nated by reference numerals identical to those used for the first embodimen~ with the exception that the fifth e~bodiment refere~ce numerals are followed by ~he upper case le~ter ~ whereas the fir~t embodiment reference numerals are followed by the upper case letter Ao The Pas~ening ~ember 60E has a ~enerally cylindrical clamping member 68E although other ~hapes are suitable for the clampin~ member 68E. The clamping member 68E ~onnects a plurality of ~5 spaced-apart legs 66E that h~ve di~tal ends 70E
~~372~
'~
(Figure 9) adapted to penetrate the tissue portions~
The elongate clamping member 68E is preferably oriented generally perpendicular to the legs 66E.
Each leg 66E defines, on its exterior along at least a portion of its length, a plurality of barbs 80E which are each anqled rearwardly away from the leg distal end 70E. Preferably, each barb 80E
has a generally conical configuratiQn with a distal end portion that is relatively flexible. As best illustrated in Figures 8 and 9, the barbs 80E are - preferably arranged in groups of four barbs at spaced longitudinal locations along the length of each leg 66E with the barbs in each group of four barb~ being equally spaced about the periphery of each leg 66E.
15The receiver 62E includes a flexible filament mesh 76E adapted to receive the fastening member legs 66E after the legs have been înserted through the tissue portions. The mesh 76E has a grid-like arrangement of the filaments. The me~h 76E
extends across, and is secured to, a rigid peripheral frame 78~.
To apply the fastener 50E to hold together ~wo tissue portions, the receiver 62E is disposed against one of the tissue portions (e.g., ti~ue portion 52 as illustrated in Figure 9). The fastening mem~er 60E is disposed against the other of the tissue portions (e.g., ti~sue portion~54 in Fiqure 9) and both the receiver mesh 76~ and the tissue portions are penetrated with the ~as~ening : 30 member legs ~6E. The barbs 80E eng~ge both the ~esh 76E and one tissue ~ortion (e.q., ti~ue p~rtion 52 so as ~o inhibit relative move~ent of ~he receiver 62E and fasteniny ~ember 60~ at lea~t in the disenqaging direc~iuns.
E~ 568 .. . .
~33'7~
The barbs 80E are flexible enough to be bent rearwardly as the fastening member le~s 6~E are pushed through the tissue portions. ~owever, the barbs 80E are resilient enough to assume their original angle after they have passed through the tissue portions. Thus, those barbs 80E which have penetrated and extend beyond the tissue portions will engage ~he mesh 76E and the adjacent tissue portion.
The fastener 50E may be fabricated from the same materials as the first four embodiments of the fastener described above with reference to Figures l 7. Additionally, a suitable instrument for applying the fastener 50E may be provided to apply the fastener 50E to the tissue portions in accordance with the method described above.
SIXTH_EMBODIMENT OF TRE ASTENER
The sixth embodiment of the fastener is illustrated in Figures lO and ll wherein three identical fasteners are each designated generally by ; 20 the reference numeral 50F, The elements of the sixth embodiment of the fastener 50F that are identical or fun~tionally analogous to those of the firs~
embodiment of the fastener 50A are designated by reference numerals identical to those used for the first embodiment with the ex~eption that the sixth embodiment reference numerals are followed by the upper case letter F whereas the first embodiment reference numerals are followed by the upper ~ase letter A.
The fastener 50F includeæ ~ faxtaning member 60F which comprises a plurality of ~paced-apart legs 66~ ~hat each have a distal end 70F adapted ~o pass through tissue portions. The legs 66F ~ay be connected as illustrated by a link member 68F which is generally perpendicular to the legs 66F.
E'1J-568 ~33~
Each leg 66F defines, on its exterior along at least a portion of its leng~h, a plurality of barbs 80F which are angled rearwardly away from the leg distal end 70F. The barbs 80F may have the same general co~figuration and orientation as the barbs 80E of the fastener 50E described above with reference to Figures 8 and 9.
The fastener 50~ further includes a flexible filament mesh 76F which extends outwaraly from, and generallY normal to, each of the legs 66F so as to define a leg receiving area. The mesh 76F may extend in a g~nerally triangular configuration around both of the legs 66F of a fastening member 60F as illustrate~. The mesh 76F may be loosly disposed on ; 15 the fastening member legs 66F between the link member 68F and the leg distal ends 70A as illustrated.
Preferably, the mesh 76F is adjacent the link member 68F and may even be in contact with the link member 68F. Preferably, there is also a generally rigid frame 78F around the periphery of the mesh 76F, and the mesh 76F is secured to the frame 78F.
The mesh 76F and its frame 78F may ~e loosely disposed on the legs 66F adjacent the link member 68F. The mesh 76F and frame 78F need not be immovably secured or fixe~ to the legs 66~ or to the link member 68F~
The fasteners 50F may be fabrica~ed from the : same materials as the first through the fifth embodiments of the fastener described above with reference to Figure 1-9.
The fasteners 50F ~re applied to tissue por'cions in a novel manner to hold ~ogether the tissue portions. Specificall~r at least a first fastening member 60F and the associated mesh 76F are 35 dis~osed against one of the ~issue pQrtions and the E~ lH_568 ~3~
tissue portions are penetrated by the legs 66F of the astening member 60F.
A second fastening member 60F and associated mesh 76F are ~isposed against the other of the tissue portions~ The fastening member legs 66F of the second fastening member 60F are inserted through the tissue portions so as to penetrate both tissue portions. The locations o~ the leg penetrations of both the first and second fastening members 60F are selected so that at least one leg of each fastening member penetrates the mesh around a leg of the other fastening member and so that the barbs of at least one leg of each fastening member engage both the mesh of the other fa~tening member and one of the tissue portions so as to inhibit relative movement of the fastening members in at least the disengaging directions~
In Figure 11, three identical fasteners 50F
are shown holding together the two tissue portions 54 and 52. ~he fastener 50F that is shown inserted from the bottom below tissue portion 52 has its associated mesh penetrated by a leg of each of the other two fasteners 50F which have been inserted from the top over tissue portion 54. Each of these upper fasteners 50F is engaged by one of the two 12gs of the lower astener 50~r With referen~e to Figure 10, it can be seen that the triangular ~hape of the mesh 76F provides a region defined in a vertex (opposite the link member 68F) which ~an recei~e an engaging leg of another fa~tener 50F.
A suitable in~trument ~ay be used for applying the fa~tener~ 50F to hold together the tis~ue portions according to the method d~scribed above.
E~H-568 ~3~
SEVENTH EMBODIMENT OF THE ~ASTENER
A seventh embodiment of the fastener is illustrated in ~igure 12 where it is de~ignated : generally by the reference numeral 50G. Three such fasteners 50G are shown in a typical orientation wherein they would be applied ~o tissue portions.
Each fastener 50G is similar, and functions in an ~- analogous manner, to the sixth embodiment of the fastener 50F described above with reference to Figures 10 and 11. The elements of the seventh embodiment of the fastener 50G that are identical or functionally analogous to those of the sixth embodiment of the fastener 50F are designated by reference numerals identical to those used for the ~ixth embodiment with lS the exception that the seventh embodiment reference numerals are followea by the upper case letter G
whereas the sixth embodiment reference numerals are followed the upper case letter F.
Each fastener 50G includes two spaced-apart legs 66G that each have a distal ena 70G adapted to pass through the tissue Portions. Preferably, the legs 66G are connected by a link memb~r 68G. ~he : legs 66G have bar~s 80G which may be i~entical to the barbs 80F of ~he sixth embodimene of the fastener 50F
described above.
: Rather than have a ~ingle mesh extending around both legs 66G, the f~s~ener 50G in~ludes two separate portions of flexible filament ~esh 76G --one of the portions having a generally cir~ular : 30 ~onfiguration around one of the fa~tening member legs 66G and the other of the portions havlng a generally ~ircular configura~ion around the other of the fasteninq member legs 66G. ~ach portion of mesh 76G
may include a generally r$gid frame 78G. ~ach : 35 portion of megh 76~ may be loosely disposed on a leg E~H-568 ~3~
66G adjacent the link member 68G. A fixed securement of each mesh portion to the fastener 50G is not required.
The fastener~ 50G may be applied to the tissue portions in a manner generally similar and analogous to that used in applying the sixth embodiment of the fasteners 50F described above with reference to Figures 10 and 11.
The fasteners 50G may be fabricated from the same materials as the first through the sixth embodiments of the fasteners described hereinbefore.
FASTENER ADJUSTABILITY
With each of the fastener embodiments described above ~ it is seen that the fastener can accommodate variou~ thicknesses of tissue. The fasteners may be inserted into the tissue and relative movement may be effected until the desired tissue compression is achieved. The fastener components lock together at any of a plurality of closely spaced points along the length of the fastening member legs so that a wide range of . adjustability is conveniently provided.
ALTERNATIVE DESIGN FEATURES
~: .
~: In the embodiments shown in figures 1-6 and 8, the legs of each fastening member are connected by a portion of the fastening member (e~g., the link or clamping member ) which is illustr ted as peing generally straight and extending perpendi~:ular to the legs. The structure need not be limited to such a ~hape however. Instead, all or a portion of the length of the fastening mem~er between any two adjacent le~s may be arched or arcuate or may include an arcuate portion (e.g., an inverted U shaped configuration). This would function to initially provide a free space between the upper ti~sue portion ." .
~3~
and the top of the fastening member to allow for some expansion of the tissue.
However, in those situations where increased initial tissue compression is desired, a modified receiver structure may be provided to cooperate with the above-described arcuate fa$tening member~
Specifically, the receiver need not have a flat upper surface as illustrated. Rather, the upper surface of the receiver may be arcuate (e.~., convex) so as to generally match or correspond with the arcuate shape of the f~stening member This can result in an increased compression of the two tissue portions between the receiver and fastening member.
From the foregoing, it will be observed that numerous variations and modifications may be effected without departing from the true spirt and scope of the novel concept of the invention. It is to be understood that no limitation with respect to the specific articles, instruments, and methods illustrated herein is intended or should be ; inferred~ It is~ of course, intended to cover by the appended claims all such modifications as fall within the scope of the claims.
.
.
E~-568
Claims (2)
1. A fastener adapted to hold together, in conjunc-tion with one or more other similar fasteners, two portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision, said fastener comprising:
a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions, each said leg defining on its exterior along at least a portion of its length a plurality of barbs angled rearwardly away from the leg distal end;
and a mesh of flexible filaments, said mesh having a generally triangular configuration, said mesh extending between adjacent legs and said mesh extending outwardly from, and generally normal to, each of said legs to define a leg receiving area whereby the legs of one of the fasten-ing members may be passed through the tissue portions from one side of said wound or incision with the mesh being disposed against one of said tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of said wound or incision with the mesh of said other fastening member lying substantially against the other of said tissue portions so that at least one leg of each of said fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative movement of said fastening members at least in the dis-engaging directions.
a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions, each said leg defining on its exterior along at least a portion of its length a plurality of barbs angled rearwardly away from the leg distal end;
and a mesh of flexible filaments, said mesh having a generally triangular configuration, said mesh extending between adjacent legs and said mesh extending outwardly from, and generally normal to, each of said legs to define a leg receiving area whereby the legs of one of the fasten-ing members may be passed through the tissue portions from one side of said wound or incision with the mesh being disposed against one of said tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of said wound or incision with the mesh of said other fastening member lying substantially against the other of said tissue portions so that at least one leg of each of said fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative movement of said fastening members at least in the dis-engaging directions.
2. A fastener adapted to hold together, in conjunc-tion with one or more other similar fasteners, two portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision, said fastener comprising:
a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions, each said leg defining on its exterior along at least a portion of its length a plurality of barbs angled rearwardly away from the leg distal end; and each of said legs having a mesh of flexible filaments extending around said leg, said mesh having a generally circular configuration, said mesh extending outwardly from, and generally normal to said leg to define a leg receiving area whereby the legs of one of the fasten-ing members may be passed through the tissue portions from one side of said wound or incision with the mesh being disposed against one of said tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of said wound or incision with the mesh of said other fastening member lying substantially against the other of said tissue portions so that at least one leg of each of said fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative.
movement of said fastening members at least in the dis-engaging directions.
a fastening member with at least two spaced-apart legs each having a distal end adapted to pass through the tissue portions, each said leg defining on its exterior along at least a portion of its length a plurality of barbs angled rearwardly away from the leg distal end; and each of said legs having a mesh of flexible filaments extending around said leg, said mesh having a generally circular configuration, said mesh extending outwardly from, and generally normal to said leg to define a leg receiving area whereby the legs of one of the fasten-ing members may be passed through the tissue portions from one side of said wound or incision with the mesh being disposed against one of said tissue portions and whereby the legs of another of the fastening members may be inserted through the tissue portions from the other side of said wound or incision with the mesh of said other fastening member lying substantially against the other of said tissue portions so that at least one leg of each of said fastening members penetrates the mesh of the other fastening member with the leg barbs engaging both the mesh and the adjacent tissue portions so as to inhibit relative.
movement of said fastening members at least in the dis-engaging directions.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US506,142 | 1983-06-20 | ||
US06/506,142 US4548202A (en) | 1983-06-20 | 1983-06-20 | Mesh tissue fasteners |
Publications (1)
Publication Number | Publication Date |
---|---|
CA1233720A true CA1233720A (en) | 1988-03-08 |
Family
ID=24013363
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA000456845A Expired CA1233720A (en) | 1983-06-20 | 1984-06-18 | Strip tissue fasteners, mesh tissue fasteners, and application methods therefor |
Country Status (7)
Country | Link |
---|---|
US (1) | US4548202A (en) |
EP (1) | EP0130037B1 (en) |
JP (1) | JPS6012048A (en) |
AU (1) | AU565018B2 (en) |
CA (1) | CA1233720A (en) |
DE (1) | DE3467693D1 (en) |
ZA (1) | ZA844642B (en) |
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- 1983-06-20 US US06/506,142 patent/US4548202A/en not_active Expired - Lifetime
-
1984
- 1984-06-18 JP JP59123889A patent/JPS6012048A/en active Granted
- 1984-06-18 CA CA000456845A patent/CA1233720A/en not_active Expired
- 1984-06-19 EP EP84304133A patent/EP0130037B1/en not_active Expired
- 1984-06-19 ZA ZA844642A patent/ZA844642B/en unknown
- 1984-06-19 AU AU29526/84A patent/AU565018B2/en not_active Ceased
- 1984-06-19 DE DE8484304133T patent/DE3467693D1/en not_active Expired
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AU2952684A (en) | 1985-01-03 |
EP0130037A1 (en) | 1985-01-02 |
ZA844642B (en) | 1986-02-26 |
AU565018B2 (en) | 1987-09-03 |
JPH041626B2 (en) | 1992-01-13 |
DE3467693D1 (en) | 1988-01-07 |
US4548202A (en) | 1985-10-22 |
EP0130037B1 (en) | 1987-11-25 |
JPS6012048A (en) | 1985-01-22 |
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