Note: Descriptions are shown in the official language in which they were submitted.
~ ~8~5
-
Field of Invention
This invention relates to a skin clip and applier
for use in joinder of skin, as for closing wounds, inci-
sions and the like.
Background of Invention
When lacerations and incisions of the skin layer
occurs in wounds, surgical operations and the like, it has
been the practice to stitch the separated portions of the
skin together for the purpose of reducing scar formation
and to accelerate healin~. Such stitching operation con-
! stitutes a surgical operation wherein the separated sections
of the skin are brought together and then stitched by needle
and thread to hold the separated sections together until
the wound has healed. 11hen sufficient time has elapsed,
such as three to six days, the stitches are removed by
pulling the stitches from the wound after the thread has
been severed.
Such stitching operatlon constitutes a painful
procedure which lasts over a considerable period of time.
In addition, it requires the services of both hands of one
or more physicians to hold the separated sections of the
skin togeth~r, thread the needle, pass the needle throu~
the adjacent edge sections of the skin layer, tie the
` thread with the desired tension to close the wound, and
, then to sever the loose ends of the thread when the stitch
`, has been completed, all of which takes considerable time
coupled with the interference of the bleeding wound.
The art has turned more recently to the use of
metal clips which are applied by clip applicators which
3 operate more or less in the fashion of a stapler to clip
1 ~ 6245~ ~
the free edges of the skin in a manner to hold the edges
together until the wound has healed. The use of clips in
clip applicators has materially reduced the time required
to close a wound and it has been effective to reduce the
amount of effort and the amount of assistance required to
effect skin closure.
In U.S. Patent No. 733,723, U.S. Patent No.
816,026, U.~. Patent ~o. 3,273,562 and U.S. Patent No.
3,775,825, description is made of surgical skin clips
and clip applîcators wherein preformed clips are indi-
¦ vidually applied by a suitable applicator for skin
closure. Such prior devices have found little acceptance
in the medical field for any number of reasons including
cost, ease of apnlication, ease of removal, and exposure
while in position of use to inadvertent engagements, with
resultant pain and/or dLsengagement of the clip.
Objects of the Invention
It is an object ofAthisP~invention to produce a
new and improved skin clip which is capable of low cost
manufacture of readily available materials; which is Pre-
formed to enable use in skin closure by en~agement of the
clip between actuating jaws; which reduced to a skin clip
that engages the skin to a predetermined depth with little
of the clip protruding above the skin, and in which the clip
enables control as to the shape to which it is deformed for
skin closure, and it is a related object to provide a new
and improved applier for use with skin clips of the type
described to effect closure of the clip for bringing the
edges of the skin together, which is simple in construction
3 and easy in operation, which can be formed of readily
1 ~ 62455
available and 'ow cost materials to provide a throw away
applier when the last of the clips have been dispensed
therefrom, which is automatic in operation, and which is
adapted to receive a multiplicity of clips to enable
sequential application of the clips in rapid succession
for wound closure, which allows for visualization of the
areas where the clip is applied to insure proper applica-
tion of the clip, and which requires the use of only one
hand thereby to relieve the surgeon in his operative
0 procedures.
An aspect of the invention is as follows:
In combination:
a preformed skin clip designed to reduce tissue
trauma during and after application to vertically disposed
portions of skin tissue which are to be joined in abutting
relation comprising a deormable wire-like member initially
configured to include a concave bail portion and arms
initially extending angularly downwardly and outwardly
from the bail portion and finally downwardly and inwardly
in an end portion remote from the bail por-tion, the ends
of the arms being formed to piercing points;
and means for applying said clip to said tissue
solely by lateral deformation of the arms of said clip
such that the end portions describe arcs of less than 70
degrees during engagement and entry into the tissue
thereby significantly limiting trauma to said tissue.
'~?
I ~ 62455
The foregoing and other objects and advantages
of this invention will hereinafter appear and for purposes
of illustration, but not of limitation, an embodiment of
the invention is shown in the accompanying drawings in
S which:
Figure 1 is a perspective view o~ the clip applier
embodying the features of this invention, showing the shape
of the clip upon release from the applier;
Figure 2 is a perspective vi~w of the elements
making up the clip applier shown in their relative posi-
tions of assembly;
Figure 3 is a top plan view of the applier of
figure l;
Figure 4 is a plan view of the applier of figure
lS 1 ta]cen from the bottom side;
Figure 5 is an elevational view of the preformed
clip embodying the features of this invention;
Figure 6 is a sectional view taken partially
along the line 6-6 of figure 1 showing the clip as
received in the applieri
~3a~
~6245~
~.
Figure 7 is a perspective view illustrating a
means for removal of the applied CliP; and
Figure 8 is an elevational view showing the
configuration of the clip removed by the means shown in
; 5 figure 7.
Detailed Description of Preferred
Embodiment of the Invention
In the practice of this invention, use is made
of a clip 10 formed of tantalum, titanium, stainless steel
or the like deformable metal wire which retains the shape
to which it is deformed. The clip is preformed to a U-
shaped member having a bail..portion 12 and ar~s 14 extend-
ing from the ends of the bail portion, with each arm being
formed of an upper portion 16 and a lower free end portion
18 extending at about 90 - 10 from the upper portion 16
with the upper portion extending angularly outwardly at a
contained angle of.about 135 - 15 from the ends of the
bail portion 12. The bail portion is preferably, though
~ not necessarily, formed with a concave curvature for
i 20 purposes which will hereinafter be described in applying
the clip. The ends of the clip, which are spaced one from
the other by an amount generally corresponding to the length
~ of the bail portion, are reduced to a relatively sharp
j point 20 for piercing the skin.
r 25 Referring now to figures 1-4 of the drawings,
the applier comprises a pair of jaw plates 22 and 24
disposed between a top plate 26 and a bottom plate 28
~ with the top and bottom plates secured one to the other
.- for relative rotational movement about a connecting screw
bolt 30 or rivet which extends through an opening 32 in
. -4
1 ~ ~2~55
the top plate 26 for engagement with a threaded post 34
rigid with the bottom plate 28. The top plate has an
integral handle portion 36 extending rearwardly thereof
in spaced relation from the rearward extension 38 of the
bottom plate 28. The handle portion is constan~ly urged
in the direction away ~rom the bottom plate to open posi-
tion, as by means of a coil spring 40 disposed between
the handle portion and the adjacent side wall of the bottom
plate, witll one end of the coil spring 40 anchored to the
handle portion while the other end seats within a recess
44 provided in the side wall of the bottom plate, whereby
the coil spring is retained therebetween. Means are pro-
vided to block movement of the handle portlon beyond open
position. In the illustrated modification, such blocking
means comprises a curvilinear finger 46 extending inwardly
from the forward end portion of the handle 36, forwardly
of the pivot 30 and in crosswise alignment with the side
wall of the bottom plate for~engagement therewith when the
~ handle portion is rocked about its pivot to open position.
i 20 The bottom side o~ the bottom plate 28 forms the
top wall of an elongate enclosure 48 having a slot 50
j extending therethrough and shaped to define a cross section
corresponding generally to the cross section of the clip
~! members whereby the enclosure is in the form of a cartridge
~ 25 in which a plurality (20-lOO) of clips 10 can be preloaded
; for use. In the illustrated modification, the slot is
designed with a flat top wall 52 and facing V-shaped side
walls 54 contoured to correspond with the contour of the
: side arms of the clips 10 and .spaced one from the other by
3 an amount for retaining the clips 10 in fitting relation
therein.
!
1 1 62a~5~
The jaw plates 22 and 24 are formed with jaw
members 56 and 58 which project downwardly from the forward
ends thereof immediately adjacent the forward end of the
bottom plate 28 and to a level of and preferably below the
apex of the V-shaped side walls of the slot with the jaw
members being spaced one from the other laterally by an
amount less t~an the spaced relation between the apex
portions forming the side walls of the slot and preferably
by an amount corresponding to the spaced relation between
the apex portions of the clip arms less the thickness of
the clips in the side arm portions. The inner edge of éach
jaw member is formed with a recessed portion 60 having a
width and depth corresponding to the thickness or cross
section of a single clip so that the side walls of the
recessed portions will be spaced one from the other by an
amount corresponding to and preferably slightly in excess
of the distance between the apices of the side arms of the
clip so that only a single clip will be capable of being
received in fitting relation within the crosswise aligned
recessed portion of the jaw members.
The jaw members 56 and 58 are adapted to be
displaced laterally in the direction towards and away from
each other between closed and open positions respectively
in response to actuation of the handle 36 between closed
and open positions, with a type of linear-rolling action
as derived from remote pivots. As illustrated in the
drawing, each of the jaw plates 22 and 24 is provided with
: a pivot pin 62 which depends from a rearward end portlon
of the plate into relative laterally spaced apart openings
3 64 in the bottom plate 28 to define the pivotal axes of
-6-
-
~ ~ ~24~5
the jaw plates 22 and 24. In order to provide ~or move-
ment of the jaws 56 and 58 in opposite directions in
response to actuation of the handle portion, one jaw plate
24 is pivotally connected to the top plate rearwardly of
the connection between the top and bottom plates w~ile the
other is pivotally connected to the top plate forwardly
of the pivot. Such pivotal connections are effected by
pivot pins 66 and 68 extending forwardly from the jaw
plates 24 and 2~ into aligned openings 70 and 72 respect-
~ 10 ively in the top plate. The openings 70 and 72 are dimen-
j sioned to have a width corresponding to the width of the
~ pivot pins 66 and 68 for transmission of movement of the
! top plate to the jaw plates, and the openings are dimen-
sioned to have a length slightly greater than the cross
section of the pivot pins to enable relative movement of
j the pivot pins in the openings to accommodate the relative
movement therebetween during actuation of the top plate,
by reason of the differences in the radii from their
respective pivots.
The bottom plate 28 is provided with a rela-
tively flat, horizontally disposed portion 74 which extends
forwardly from the forward edge of the bottom plate for a
distance corresponding to the thickness of the skin clip
within the enclosure. Thus the extension projects beyond
~` 25 the inner surfaces of the jaw members 56 and 58 and, to
enable lateral displacement of the jaw members are each
provided with a horizontally disposed slot 76 dimensioned
to receive the extension therein for relative sliding
movement.
~ 30
i -7-
i ~ ~2~5
A slide plate 78, having a width and len~th
dimensioned to span the open bo-ttom of the enclosure, is
formed with side flanges 80 having an inturned upper edge
for sliding engagement within slide grooves 82 in the
outer side walls of the housing to enable the slide plate
to be secured in sliding engagement with the bottom plate
to seal the enclosure.
Means are provided constantly to urge the stack
of clips within the enclosure toward the jaw members. For
this purpose, there is provided a pusher block 84 contoured
to correspond with the shape of the passage 50 through the
housing and dimensioned slideably to be received therein.
Means are provided constantly to urge the pusher block 84
in the direction towards the jaws ~or displacement of the
stac~ of clips to push the foremost clip in the stack into
the slotted portion between the jaw members 56 and 58.
Such means ~or constantly urging the pusher block lS illUg-
~' trated in the drawing as a compression spring 88 confined
between a rear plate 90 and the pusher block wherein the
rear plate 90 is retained within a rearward portion o~ theenclosure as by means of a blocking nut 92.
To insure return of the jaw plates 22 and 24 to
open position, means are provided constantly to urge the
forward end portion of the jaw plates ln a direction away
from each other. Such means are illustrated as coil spring
members 92 and 94 seated at their opposite ends in cross-
~` wise aligned slots 96 and 98 in the jaw plates.
In use, the cartridge housing 48 is filled with acolumn of clips. In normal position, the jaws 56 and 58
3 are spread by the coil springs 92 and 94 to thelr open posi-
tion.
-8-
1 ~ ~2~55
q
Under these conditions, the pusher ~ has
displaced the stack of clips lO forwardly in the cartridge
until the foremost clip ln the stack is displaced into
the recessed portion 60 between the jaws with the apices
of the clip arms in the path of the jaw members with the
bail 12 of the cIip underlying the anvil-extension 74 from
the bottom plate. Thus the foremost clip is retained in
position of use between the jaws.
In applying the clip, the edges of the skin 100
are broughttogether with one hand and with the other hand,
the applier is positioned in lengthwise alignment with
t'ne line 102 of skin separation with the jaws 56 and 58 on
opposite sides of the line and at rest on the top surface
of the skin 100. In response to squeezing of the handle
36 for displacement from open position to closed position,
the jaw members 56 adn 5~ are displaced in the direction
towards each other into engagement with the apex portions
of the side walls of the clip members located therebetween.
In response to actuation by the jaw members for displace-
ment of the arms in the direction towards each other, the
arms of the clip members are caused to bend about their
ends of the bail portion as a fulcrum whereby the downwardly
and inwardly extending end portions 18 of the clip are
caused to move downwardly and inwardly along an arc~ate
path to engage the portion of the skin 100 immediatel~
; adjacent the edges to be joined, and to enter the skin
layer to a predetermined depth whereby the skin portions
are drawn together to establish an abutting relation. By
the time that the jaw movement is completed, open movement
3 to closed position, the clip 10 has been defor~ed into a
_g_
~ 1 62~5~
substantially rectangular shape with the lower arm portions
18 embedded in the skin layer and extensions substantially
horizontally while the upper arm portion 16 extends verti-
cally therefrom firmly to clip the skin layers adjacent
the wound. The overlying extension 74 serves as a backup
which permits the bail portion 12 to straighten out during
rotation of the arm portions about the ends of the bail as
a fulcrum, thereby to facilitate deformation of the clip
but only to the extent limited by the extension thereby to
form the clip into a substantially rectangular section.
! In the applied relation, the bail por~ion 12 is
a short distance from the grippin~ end portion to pro~ject
a calculated distance from the surface of the joined skin
sections.
When the jaws are returned via the coil springs
92 and 94 to their initial spread or open position, the
freed recessed portions return into alignment with the
~ stack of clips in the cartridge whereby, upon clearance,
; the foremost clip in the stack is automatically displaced
by the pusher 8~ into the recessed portion between the jaw
members readying the applier for immediate reuse. Thus
¦ the clip can be applied in a rapid sequence to close the
wound in minimum time.
Because of the location of the jaws 56 and 58
at the forward end of the applier, and by reason of the
openness at the jaw end portion, visibility is greatly
increased for accurate and rapid position of the applier
for correct insertion of the clip members.
The applier is intended to be discarded when
3 the stack of clips has been used. ~Iowever, it will be
.
-10-
.
9 ~ 6~
understood that instead of loading the clips directly
into the applier, use can be made of a replaceable cart-
ridge in which clips are prepackaged for use in reloading
the applier, in which event the cartridge is in the form
of the described housing adapted replaceably to be secured
to the bottom plate in the position corresponding to the
housin~.
General Description
While it is preferred ~o make use of a clasp in
which ~he upper and lower arm portions extend in angular
relation as described, the desired results can be achieved
when the arm portions have a coniguration other than
angular, such that the arms may constitute curvilinear
sections in which the portion extending from the ends of
the bail portion are inclined downwardly and outwardly
from the ends thereof while the lower, pointed free end
portion is inclined downwardly and inwardly at an angle
; whereby said end portion extends substantially horizon~all~
or parallel to the bail portion when the clip is deformed
to embed the end portion in the skin layer. One require~
ment in the construction of the clip is that a portion
intermediate the ends of the arms extend outwardly beyond
the remainder to define an apex portion engaged by the jaws
for bending the arms about the ends of the bail portion as
a fulcrum, during displacement of the jaws in the direction
t towards each other to closed position.
While it is preferred that the recessed portion
. 60 be dimensioned to have a depth corresponding to the
thickness of a clip so as to accommodate only ~he foremost
3 clip in the stack, the desired results can be achieved
.
-11-
l ~ 6~55
when the depth of the recessed portion 60 is less than
the thickness of the clip but more than one-half the
thickness of the clip so that the major portion of the
clip member will be received in the recessed portion and
lie in the path to b~ engaged by ~he jaws for bending of
the arms during displacement of the jaws in the direction
towards each other to closed position. The depth of the
recessed portion should not exceed the thickness of the
clip otherwise more than the outermost clip will lie in
the path to be engaged by the jaws during, movement to
closed position.
The spaced relation between the jaws in open
position is designed to be greater than the combined
movement of the jaws between open and closed positions.
Means are provided for limiting the movement of the Jaws
in the direction towards each other upon reaching closed
'5 position. In the illustrated modification, such means
comprises abutments 10~ in adjace.nt inner surfaces of the
jaw plates. In the alternative, such means may comprise
the dimensioning of the length of the slot 76 for engage-
ment with the extension 7~ when the jaw members have been
displaced to closed position thereby to prevent movernent
beyond closed position.
While the force constantly urging the stack of
clips forwardly in the direction of the jaws is ordinarily
sufficient to retain the outermost clip in position of use
within the recessed portion of the jaws, retention of the
outermost clip in the recessed portion can be further
benefited by inclining the lower side walls of the slots
3 in an inwardly direction by an amount whereby the spaced
-12-
!
1 1 62~55
relation therebetween, when the jaws are in open position,
is less than the spaced relation between the outermost,
portions of the clip arms so as to militate against inad-
i~ vertent dropping of the clip from between the jaws when
displaced from the cartridge.
Removal of the clips can be easily and quickly
effected as by a removing means such as a pair of lever
arms 110 and 112 pivoted one on the other adjacent one end
with the end portion of one arm beyond the pivot 114
being formed of laterally space'd prongs 116, while the
end portion of the other arm is in the form of a single
prong 118 which extends in vertical alignment with a midway
portion between the spaced prongs 116. In use, the spaced
prongs 116 are inserted into the space between the s~in
surface and the bail portion 12 of the clip 10 while the
single prong 118 is positioned above the'bail. In response
to rotation about the pivot 114 to displace the single
prong 118 into the area between the spaced prongs 116, an
s
, intermediate portion of the bail will be deformed into
the area between the spaced prongs whereby the lateral
portions of the bail will rotate about the single prong
as a fulcrum to swing the clip arms outwardly and upwardly
through an arc to withdraw the clip end portions from the
' skin. The withdrawn clip will have the configuration shown
in figure 8.
t It will be apparent that the clips can be applied
one after the other in close sequence along t~e length of
the wound as illustrated in figure 1 whereby the adjacent
edges of the skin are 'held in abutting relation. It will
3
also be apparent that substantially full visibility is
13
~ ~ 624~5
available at the application zone so that the device can
be accurately positioned for optimum utilization in the
skin clipping operation. The depth of penetration of the
pointed end portion of the clip arms is sufficient for
1 5 engagement of the skin for displacement and for holding
the skin in abutting relation but insufficient to pierce
the skin to cause bleeding.
It will be understood that changes may be made
in the details of construction, arrangement and operation
without department from the spirit of the invention,
¦ especially as defined in the following claims.
.
3o
-14-
