Note: Descriptions are shown in the official language in which they were submitted.
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BACKGROUND OF THE INVENTION
The present invention relates to therapeutic and pro-
phylactic devices, and more particularly to devices for applying
compressive pressures against a patient's limb.
It is known that the velocity of blood flow in a
patient's extremities, particularly the legs, markedly decreases
during confinement of the patient. Such pooling or stasis of
blood is particularly pronounced during surgery, immediately
after surgery, and when the patient has been confined to bed for
extended periods of time. It is also known that stasis of blood
is a significant cause leading to the formation of thrombi in
the patient's extremities, which may have a severe deleterious
effect on the patient, iAcluding death. Additionally, in certain
patients it is desirable to move fluid out of interstitial spaces
in extramity tissues, in order to reduce swelling associated with
edema in the extremities.
Devices have been disclosed in U.S. patents 4,013,069
and 4,030,488 which develop and apply the desired compressive
pressures against the patient's limbs. Such devices comprise a
pair of sleeves which envelop the patient's limbs, and a con-
troller for supplying fluid pressure to the sleeves through con-
duits which are connected in fluid communication with chambers
in the sleeve. However, in certain patients it is necessary to
place the sleeve over an open wound of the patient, and the
sleeve is inadequate for covering such a limb on the patient.
SUMM~RY OF THE INVENTION
.
A principal feature of the present invention is the
provision of a device for applying compressive pressures against
a patient's limb with an open wound.
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The device of the present invention comprises, a
sleeve comprising a pair of flexible sheets of fluid impervious
material, and means for connecting the sheets together along
lines defining inflatable chamber means between the sheets.
A feature of the present invention is the provision of
an absorbent dressing for the sleeve which extends laterally
across at least a portion of the sleeve.
Another feature of the invention is that the dressing
is releasably attached to an inner surface of the sleeve.
Still another feature of the invention is that the
dressing may be readily attached to the inner surface of the
sleeve.
Yet another feature of the invention is that the dress-
ing may be located on the sleeve to contact the patient's wound.
Further features will become more fully apparent in
the following description of the embodiments of this invention
and from the appended claims.
DESCRIPT ION OF THE DRAWINGS
In the drawings:
Fig. l is a fragmentary perspective view of a compres-
sion device of the present invention;
Fig. 2 is a front plan view, partly broken away, of a
compression sleeve for the device of Fig. l;
Fig. 3 is a back plan view, partly broken away, of the
sleeve of Fig. 2;
Fig. 4 is a front plan view on page 2 of the drawings
of fluid impervious sheets defining chambers in the sleeve of
Fig. 2;
Fig. 5 is a back plan view of the fluid impervious
sheets of Fig. 4;
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Fig. 6 is a fragmentary sectional view taken substanti-
ally as indicated along the line 6-6 of Fig. 4;
Fig. 7 is a fragmentary sectional view taken substanti-
ally as indicated along the line 7-7 of Fig. 4;
Fig. 8 is a fragmentary sectional view on page 1 of
the drawings taken substantially as indicated along the line 8-8
of Fig. 4;
Fig. 9 is a perspective view on page 3 of the drawings
illustrating the sleeve during placement on a patient's leg;
Fig. 10 is an outer plan view of a dressing for the
sleeve; and
Fig. 11 is a sectional view taken substantially as
indicated along the line 11-11 of Fig. 10.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to Fig. 1, there is shown an intermit-
tent compression device generally designated 20 having a con-
troller 22, and a pair of elongated compression sleeves 26 for
enclosing a length of the patient's extremities, such as the
legs as shown. The controller 22 is connected through a tube 28
to a source S of pressurized gas, and to an exhaust tube 30.
Also, the controller 22 is connected to the separate sleeves 26
through separate sets of conduits 34 and 35. The controller may
be of any suitable type, such as the controllers described in
U.S. patents 4,013,069 and 4,030,488.
With reference to Figs. 2 and 3, the sleeve 26 has an
outer cover sheet 36 covering the entire outer surface of an
outer fluid impervious barrier sheet 38. Also, the sleeve 26
has an inner cover sheet 40 covering an inner surface of an inner
fluid impervious barrier sheet 42. The outer cover sheet 36 may
comprise a relatively inelastic fabric with a brushed matte or
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napped finish of nylon or polyester, such as a fabric sold under
the trademark Flannel/Flannel II, No. 11630, by Guilford Mills,
Greensboro, North Carolina, which provides an attractive outer
surface for the sleeve, and also defines brushed or napped fibers
across the entire outer surface of the sleeve for a purpose which
will be described below. In suitable form, the fabric of the
sheet 36 may be warp knit from polyester yarns on a tricot
machine, after which the fabric is dyed to a suitable color, and
the fabric is brushed or napped on a suitable machine to raise
loops from the fabric. The inner cover sheet 40 may comprise a
suitable nonwoven material which provides a comfortable inner
surface of the sleeve for the patient. The barrier sheets may
be formed from a suitable flexible plastic material, such as
polyvinylchloride. If desired, a segment of the brushed nylon
fabric may be formed into a tube 44 to cover the conduits which
extend from the sleeve to the controller. As shown, the conduits
and covering tube 44 may extend through an opening 46 in the
inner cover sheet 40.
The sleeve 26 may have a pair of side edges 48a and
48b, and a pair of end edges 50a and 50b connecting the side
edges 48a and b, with the side edges 48a and b being tapered
toward a lower end of the sleeve. The sleeve 26 may also have
an elongated opening 52 extending through a knee region 53 of
the sleeve, and defined by peripheral edges 54 extending around
the opening 52. In addition, the sleeve 26 has an elongated
opening or cut-out 56 in the knee region 53 extending from the
side edge 48a toward a lateral central portion of the sleeve,
with the opening 56 being defined by peripheral edges 58 extend-
ing from the side edge 48a around the opening 56. As shown, the
inner end of the opening 56 is spaced from the opening 54, and
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the opening 56 defines an upper flap 60 and a lower flap 62 of
the sleeve which are separated by the openlng 56. Further, the
sleeve 26 may have a pair of lower fastening strips 61, such as
a hook material sold under the trademark Velcro, secured to the
inner cover sheet 40 along the side edge 48b.
With reference to Figs. 4-8, the inner and outer fluid
impervious barrier sheets 38 and 42 have a plurality of later-
ally extending lines 64, such as lines of sealing, connecting
the barrier sheets 38 and 42 together, and longitudinally extend-
ing lines 66, such as lines of sealing, connecting the sheets 38and 42 together and connecting ends of the lateral lines 64, as
shown. The connecting lines 64 and 66 define a plurality of
longitudinally disposed chambers 68a, 68b, 68c, 68d, 68e, and
68f, which for convenience will be termed contiguous. As shown,
the chambers 48 extend laterally in the sheets 38 and 42, and
are disposed in the longitudinal arrangement between the end
edges 50a and 50b. When the sleeve is placed on the patient's
leg, the lowermost chamber 68a is located on a lower part of the
leg adjacent the patient's ankle, while the uppermost chamber
68f is located on an upper part of the leg adjacent the midthigh.
As shown, the longitudinal line 66 nearest the side
edge 48b is separated intermediate the chambers 68b and c, 68c
and d, and the chambers 68e and f. The lateral lines 64 define
ventilation channels 70a, 70b, and 70c extending laterally in
the sleeve from the longitudinal line 66 adjacent the side edge
48a toward the longitudinal lines 66 adjacent the side edge 48b,
with the ventilation channels 70 being positioned at spaced loca-
tions longitudinally along the sleeve intermediate different
pairs of adjoining chambers. Thus, the ventilation channel 70a
is located intermediate the chambers 68b and 68c, the ventila-
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tion channel 70b is located intermediate the chambers 68c and68d, and the ventilation channel 70c is located intermediate the
chambers 68e and 68f. Moreover, the ventilation channels 70
have a width substantially less than the width of the chambers
68 such that the channels 70 do not detract from the size and
volume required for the compression chambers 68. The inner and
outer barrier sheets 38 and 42 also have a longitudinally extend-
ing line 72 which defines a connecting channel 74 intermediate
the line 72 and the adjacent longitudinal line 66. As shown,
the connecting channel 74 extends along the sides of the cham-
bers 68c, 68d, and 68e, and communicates with the ventilation
channels 70a, b, and c, such that the channel 74 connects the
spaced ventilation channels 70. Further, the inner barrier sheet
42 has a plurality of openings or apertures 76 which communicate
lS with the channels 70. Thus, when the sleeve 26 is placed on the
patient's leg, the openings 76 face toward the leg.
With reference to Figs. 4-7, the longitudinal lines 66
and 72 adjacent the side edge 48b define a pair of flaps 78a and
78b of the barrier sheets 38 and 42 which extend between the
respective lines and the side edge 48b. As shown, the sheets 38
and 42 have a longitudinally extending line 79 which defines a
directing channel 80 intermediate the lines 79 and 72, with the
opposed longitudinal ends of the channel 80 being open. The
sleeve 26 has a first connecter 82a which is commonly connected
in fluid communication to the two lowermost chambers 68a and 68b,
and which is connected to a conduit 34a in the illustrated con-
duit set 34. As shown, the conduit 34~ passes through an opening
84a in the upper barrier sheet flap 78a which retains the conduit
34a at the desired position in the sleeve 26. The sleeve 26 also
has a second connecter 82b which is commonly connected in fluid
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communication to the second pair of adjoining chambers 68c and
68d, and which is connected to a second conduit 34b in the con-
duit set 34. The conduit 34b passes through an opening 84b in
the upper flap 78a which retains the conduit 34b at the desired
position. The sleeve 26 has a third connecter 82c which is com-
monly connected in fluid communication to the uppermost chambers
68e and 68f, and which is connected to a third conduit 34c in
the conduit set 34. As shown, the conduit 34c passes through an
opening 84c in the upper flap 78a, with the conduit 34c extend-
ing through the directing channel 80 in order to retain the thirdconduit 34c at the desired position in the sleeve. The sleeve
26 also has a fourth connecter 82d which is connected in fluid
communication to the connecting channel 74 in order to permit
passage of air to the ventilation channels 70. As shown, the
connecter 82d is connected to a fourth conduit 34d in the conduit
set 34, with the conduit 34d passing through an opening 84d in
the upper barrier flap 78a. Thus, the conduits 34a, 34b, and
34c are separately connected to pairs of adjoining chambers,
while the conduit 34d is connected to the connecting channel 74.
Of course, the other sleeve associated with the conduits 35 may
be constructed in a similar manner. It will be apparent that
the barrier flaps 78a and 78b, the directing channel 80, and the
openings 84 cooperate to retain the conduits at the desired posi-
tion within the sleeve. Further, the sleeve 26 has suitable
securing means 86, such as regions of heat sealing or adhesive,
bonding the flaps 78a and 78b to opposed sides of the conduits
34 adjacent the opening 46. Thus, in the event that forces are
applied to the conduits 34 exterior the sleeve 26, the forces
are transmitted to the flaps 78a and b rather than the connec-
ters 82a, b, and c, in order to relieve possible strain from the
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connecters and prevent severance of the connecters from the
sleeve.
In use, the sleeve 26 may be placed below the patient's
leg preparatory to securement about the limb, as illustrated in
Fig. 9. Next, the upper flap 60 and lower flap 62 may be inde-
pendently passed around the patient's leg at locations above and
below the knee, respectively. Thus, the opening 56 separates
the flap portions of the sleeve in the region of the knee to per-
mit independent wrapping of the upper and lower portions of the
sleeve about the leg and simplify placement of the sleeve, as
well as provide an improved fit. After both the upper and lower
flaps 60 and 62 have been suitably wrapped about the patient's
limb, the remaining part of the sleeve adjacent the side edge
48b may be wrapped over the flaps 60 and 62, and the fastening
strips 61 may be pressed against the outer cover sheet 36. Thus,
the hook fastening strips 61 engage with the brushed fibers of
the outer cover sheet 36, such that the strips 61 and sheet 36
interengage and retain the sleeve in the wrapped configuration.
Since the sheet 36 extends entirely across the outer surface of
the sleeve 26, the sleeve may be readily adjusted as necessary
for the desired fit according to the size of the patient's leg.
Thus, the sleeve 26 may be placed in a simplified manner while
accomplishing an improved fit on patients having varying leg
sizes. In addition, the openings 52 and 56 greatly reduce the
a~ount of material and bulk for the sleeve in the region of the
patient's knee. Accordingly, the sleeve provides flexibility in
the knee region in order to prevent binding and permit flexation
of the knee during the extended periods of time while the sleeve
is secured about the leg.
After placement of the sleeves on the patient's limbs,
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the controller 22 may be initiated in order to supply air to the
sleeves 26. The controller 22 intermittently inflates the cham-
bers 68 during periodic compression cycles, and intermittently
deflates the chambers 68 through the exhaust tube 30 during
periodic decompression cycles intermediate the compression
cycles. The inelastic cover sheet 36 of the placed sleeve
restricts the size of the inflated chambers, and greatly enhances
the compressive action of the chambers to permit lower fluid vol-
umes during the compression cycles. Further, the controller 22
supplies air through the conduits to the connecting channels 74
in the two sleeves. The air then passes from the common connect-
ing channels 74 to the spaced ventilation channels 70 and through
the openings 76 onto the patient's legs. In this manner, the
device 20 ventilates a substantial portion of the patient's legs
to prevent heat buildup and provide comfort for the patient dur-
ing extended periods of time while the sleeves are retained in a
wrapped condition about the patient's limbs. In a preferred
form, the controller 22 supplies air to the ventilation channels
70 during the periodic decompression cycles. Also, the con-
troller 22 may have suitable means, such as a switch, to selec-
tively permit passage of air to the ventilation channels 70 or
prevent passage of air to the ventilation channels 70, as
desired. In addition, the switch may be utilized to control the
quantity of air which ventilates the patient's limbs for maximum
patient comfort.
At certain times it is necessary to place the sleeves
26 over the open wound on a patient's limb. With reference to
Figs. 3, 10, and 11, the device 20 of the present invention has
a dressing generally designated 90 comprising a sheet of absorb-
ent material having a pair of tapered side edges 92a and g2b,
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and a pair of spaced end edges 94a and 94b connecting the sideedges 92a and b. The dressing 90 has an inner surface 96 for
contacting the patient's wound, and an opposed outer surface 98
which faces away from the patient's limb when the dressing is
placed against the limb. The dressing 90 may be constructed
from any suitable material, such as a washed gauze sponge dis-
closed in U.S. Patent 3,190,289.
As best shown in Fig. 10, the dressing 90 has a pair
of hook fastening strips lOOa and lOOb extending along the side
edges 92a and b of the dressing 90, and a pair of hook fastening
strips 102a and 102b extending along the end edges 94a and b of
the dressing 90. As shown in Fig. 3, the inner cover sheet 40
has a plurality of loop fastening strips 104a and 104b extending
along the length of the side edges 48a and b of the sleeve 26.
The sleeve 26 also has a plurality of spaced rows 106a, 106b,
106c, 106d, and 106e of loop fastening strips extending later-
ally across the cover sheet 40 between the fastening strips 104a
and b at longitudinally spaced locations on the sleeve. As
shown, the rows 106a and 106e of loop fastening strips are
located adjacent the end edges 50a and b, respectively, while
the rows 106b and 106c of fastening strips are located on opposed
sides of the opening 52 and cut-out 56 in the knee region, and
the row 106d of fastening strips is located intermediate the
rows 106c and e.
The dressings 90 are made of suitable width and length
such that the hook fastening strips lOOa and b and 102a and b
may be releasably attached to a portion of the loop fastening
strips on the inner cover sheet 40. Thus, with reference to Fig.
3, a dressing 90 is illustrated as partially attached to the
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sleeve 26, with the hook fastening strips 100a and b being
attached to a longitudinal portion of the loop fastening strips
104a and b, and with the hook fastening strips 102a and b being
attached to the laterally extending loop strips 106c and 106d.
Of course, the dressing may be made of suitable length such that
the end hook strips 102a and b of the dressing may be attached
to the loop strips 106d and 106e, or the dressing hook strips
102a and b may be attached to the laterally extending loop
strips 106a and 106b. Thus, in this manner, a dressing of suit-
able length may be attached at different longitudinal positionson the inner surface of the sleeve 26. Alternatively, a dress-
ing of suitable width and length may have the hook end strips
102a and b attached to the laterally extending loop strips 106c
and 106e, such that the dressing extends substantially across
the lower longitudinal portion of the sleeve 26.
It will be apparent that hook and loop fastening strips
on the dressing 90 and sleeve 26 permit easy attachment of the
dressing to the inner surface of the sleeve 26. Once attached,
the sleeve and dressing may be wrapped around the patient's limb,
as shown in Fig. 9, such that the dressing covers the open wound
on the patient's limb, after which the compression device may be
initiated to sequentially inflate and deflate the sleeve 26 with
the dressing 90 in place. The sleeve 26 may be unwrapped at
intervals in order to replace the dressing 90 with a new dress-
ing, if desired, after which the sleeve may be wrapped about thelimb once again to sequentially inflate and deflate the chambers
in the sleeve.
The foregoing detailed description is given for clear-
ness of understanding only, and no unnecessary limitations should
be understood therefrom, as modifications will be obvious to
those skilled in the art.
