The present invention generally relates to surgical instruments, and more specifically to a combination multi-purpose instrument for subcutaneous use.
Perhaps the most frequent and most annoying complication of abdominal surgery is the wound which is commonly known as "spitting" silks. The presence of infected sinuses with non-absorbable sutures at their bases resulting in recurrent abscess formation is a painful and messy problem for the patient which often persists for months to years after the operation. The foreign body is finally extruded by the body or, preferably, extracted by the surgeon. After the suture is removed, the draining sinus closes permanently.
If the infected sutures cannot be removed from the sinuses, it may be necessary to excise the entire scar. This procedure in itself may not be entirely benign since the granuloma sinus may extend very close to the bowel, which is adherent to the scar on the peritoneal surface. Intestinal fistulas have been noted following excision of infected scars.
The extraction of sutures from granuloma sinuses has been accomplished traditionally by "fishing" for the suture in the infected sinus with either a hemostat or better with a small crochet-type hook. When the suture is hooked, it is drawn to the surface. Unfortunately, the suture may be deeply imbedded in the fascial layers and it cannot be extracted without first dividing it so that it can be pulled through the tissues. In order to divide it, the suture must be elevated to the skin surface to be visualized. This pulling may be quite painful for the patient. Also, when the crochet hook brings the suture to the surface for cutting, it must be grasped with, for example, a hemostat to prevent losing it back into the sinus after it is cut. Thus, three instruments are required to remove the embedded suture: a hook, a clamp, and a scissors or knife, and often two people are required to remove the suture from the sinus. It is often a very uncomfortable procedure for the patient, and if the patient is somewhat obese so that there are several centimeters of fat between the suture at the base of the sinus and the skin surface, it becomes impossible to remove the suture by this technique. Thus, surgical excision of the infected scar may be necessary.
Various surgical instruments have been proposed for solving some of the above problems. Examples of some of these instruments are disclosed in the following U.S. Pat. Nos. 3,328,876; 3,364,573; 3,443,313; 2,865,099; 2,127,190; 3,287,751; 2,041,521; 3,739,784; 3,791,387; 3,828,790. An examination of these patents reveals that most of these relate to hemostats or combination surgical instruments which are intended to cut and remove sutures. However, most of these are in the form of scissors or tweezers which have cutting and gripping portions so that a portion of the suture may be retained after cutting the same. Typical of the scissors-type instruments are disclosed in U.S. Pat. Nos. 2,127,190; 2,865,099; and 3,443,313. Typical of the tweezer-like instruments are disclosed in U.S. Pat. Nos. 3,328,876 and 3,364,573.
A common characteristic and disadvantage of the prior art suture removers is that the cutting and clamping is performed by portions of the instrument which move in directions generally normal to the axial or length direction of the instrument. Because of this requirement that the opposing tips or ends of the scissors or tweezers move laterally during fishing for the suture, the instruments could not be used in the smaller sinuses where there is insufficient space for such lateral movements. For this reason, as well as because the prior art instruments are not generally slender at the probing ends thereof, the prior art suture extractors are not normally used for subcutaneous procedures. As with the conventional procedures, the prior art instruments could be utilized when the sutures are near the skin surface or once the sutures are brought near that surface.
In U.S. Pat. No. 3,328,876, there is also disclosed a surgical suture extractor which includes a hook and a tubular member which is slideably mounted along the longitudinal axis of the instrument. The tubular member carries both a knife, which sweeps in the region of the hook, and a shoulder, which abuts against a side extension of the hook once the knife has been moved to the cutting position. However, since the cutting element and the clamping element are mounted for simultaneous movement on the same tubular member, positive locking is not possible so that even small axial movements of the tubular member subsequent to cutting of the suture results in release of the same. Additionally, the suture extractor being described is not in the nature of a slender probe which can be inserted through a narrow sinus to effect subcutaneous procedures.
Additionally, the proposed suture extractors of the prior art typically are limited in their usefulness to extracting sutures. In this respect, the prior art suture extractors do not include means for modifying the instruments so that they can be used for different purposes and possibly related procedures.
The instrument of the present invention is a multi-purpose combination surgical instrument for subcutaneous use which combines the hooking, clamping and cutting of the suture into one manipulation. Of even greater importance, the entire operation is done at the base of the sinus rather than on the skin surface, so that the sutures ten to twelve centimeters deep can be retrieved. This avoids the pain caused by pulling the sutures to the surface as has previously been required with the prior art instruments. Accordingly, the instrument of the present invention is an extremely useful item for a surgeon's office and may avoid the possible necessity of excising a scar with multiple infected granulomas.
By removing one or more of the elements of the combination surgical instrument of the present invention, the instrument can perform different functions to permit different subcutaneous procedures with basically the same instrument. The primary functions of the combination tool are as a subcutaneous suture remover, biopsy sampler and syringe.