Surgery – Instruments – Means for removal of skin or material therefrom
Reexamination Certificate
1998-01-26
2001-07-24
Buiz, Michael (Department: 3731)
Surgery
Instruments
Means for removal of skin or material therefrom
C606S002000, C606S009000, C606S201000, C606S132000, C606S134000, C606S204350, C604S257000, C433S084000, C433S088000, C433S089000
Reexamination Certificate
active
06264666
ABSTRACT:
BACKGROUND OF THE INVENTION
This invention relates generally to cosmetic surgery and more particularly to treatment of dermatological conditions.
Within cosmetic surgery, dermatological treatments remain one of the largest problems. The current modalities available for skin resurfacing include chemical peeling, dermabrasion, and laser resurfacing.
Chemical peeling involves the application of a variety of chemicals to the skin with the intent of producing a chemical burn of a predictable depth. Depending on the agent applied, the skin responds as a chemical burn. Necrotic tissue peels off and is scavenged by macrophages eventually leading to a healing wound. Depending on the depth of the wound new collagen fibers are produced resulting in a thicker more elastic (youthful) appearing skin. At the same time, surface irregularities such as pigmentation problems or textural problems are removed by the peeling and new smoother skin of a more even color replaces it.
Dermabrasion involves removing layers of skin through an abrasive process. Either a diamond fraise or a wire brush is attached to a motor driven rotating device which allows the operator to “sand” down the skin to a given depth. This is different than chemical peeling in that an abrasive wound begins to heal immediately after the injury. There is no delay in wound healing for tissue to peel off or for macrophage to clean up necrotic cells. Abraded wounds depending on the depth also result in improved texture and skin color as well as the deposition of new collagen fibers for thicker more youthful skin. Motorized dermabrasion has also been used for almost a century for smoothing facial scars.
Laser resurfacing is the newest skin resurfacing modality. Currently, ultra pulsed lasers are used to vaporize skin. This extremely precise process burns away tissue to a specific depth. Thermal damage to the remaining tissue is kept at a minimum because the laser pulses at an extremely rapid rate. Similar to dermabrasion, the skin is removed at the time of surgery but somenecrotic tissue is left behind which must be scavenged by macrophage before wound healing can ensue. Laser resurfacing also results in even color and texture to skin as well as the deposition of new collagen fibers.
The three current modalities for skin resurfacing are able to be used interchangeably. Each has its own specific advantages according to the pathology involved and the location of the skin being treated.
None of these modalities provides the ideal method of skin resurfacing. Dermabrasion comes most close to the ideal in that wound healing is able to begin immediately after the surgery. Thus the potential for infection from bacteria and viruses is reduced over chemical peeling and especially laser resurfacing. However, dermabrasion results in brisk bleeding during surgery. This has been suggested to present a danger to both the surgeon and assistants. In aerolized form, the bleeding can also contaminate other individuals in the vicinity of the ventilation system. Also patients are unhappy with the appearance of abrasive wounds and are naturally fearful of bleeding surgical sites.
It is clear from the foregoing that there is a need for an efficient and safe mechanism for the treatment of dermatological conditions.
SUMMARY OF THE INVENTION
The present invention creates a system for the removal of epidermal and dermal skin through the use of a pressurized stream of water. Water, or another stream of liquid, is directed against the skin layer to abrade the surface cells of the epidermis.
The abrasion process involves repeatedly passing the stream of pressurized water against a site to selectively remove successive cell layers until the proper effect is obtained.
In this task, the surgeon chooses the pressure of the water to obtain the desired abrasive affect. The key is to obtain the desired water pressure that removes the layer without cutting the skin too deeply. In this context, a pressure of fifty pounds per square inch is desired although other pressures are also useable.
The pressure chosen must also be tempered with the width of the water spray being used. A wider diameter spray, even at a high pressure is less likely to cut than a thinner spray. In the preferred embodiment, the tip of the probe is equipped with replaceable nozzles which direct the spray in varying bands and which can be adjusted by the surgeon to have a particular orientation (from horizontal to a vertical orientation).
In this context, a water jet dissector is modifiable for skin abrasion.
In another embodiment of the invention, a benign abrasive is added to the water to assist in the removal of the surface cells of the skin. This abrasive is chosen so that any fragments which may remain embedded in the skin after the treatment, do not have any adverse affects upon the patient and are naturally removed by the patient's own immune system.
Some such abrasive include rock salt, ice, and hardened starch. Often such abrasives react with water and are softened by prolonged exposure to the water. In this case, the abrasive is applied to the water as proximate in time to use of the abrasive as possible to keep the abrasive from losing its ability to abrade the skin.
In other embodiments, a variety of medications are added to the water such as: anesthetics to anesthetisize the skin being abraded; coagulants to minimize bleeding in the abraded area; and antiseptics to combat infection after treatment has been applied.
Those of ordinary skill in the art readily recognize a variety of medications which serve the above functions and other medications which can be used in this context.
Note that the medications are forced into the epidermis due to the water pressure applied during application and as such form a layer of medicated skin after the surgical procedure has been completed.
While in most applications the waste water and debris the procedure generates is removed using a catch reservoir positioned around the site being treated to collect and withdraw the spent liquid and removed cells.
The preferred catch reservoir is a generally circular shaped mechanism which is placed around the surgical site and is then connected to a vacuum pump. The vacuum pump draws air through a channel within the catch reservoir with strategically placed portals so that the waste water and debris is pulled away from the surgical site for appropriate disposal.
This attribute assists in keeping the surgical site clear of water so that the pressurized spray from the surgeon has optimal effectiveness and also assures a clear site for viewing by the surgeon.
In the preferred embodiment, the apparatus is a water driven device with various sized skin probes. The probe both delivers water at high speeds and at the same time suctions away debris and contaminated water. In this manner, the device removes the epidermis and upper dermis. The depth of skin removal is controlled by the rate of water delivery.
Through the use of various sized probes, local skin removal or large areas of skin removal is easily and effectively accomplished.
Water resurfacing is highly advantageous since a clean wound is created while at the same time avoiding the potential for blood splatter and contamination is significantly reduced. The clean wound created by the water resurfacing is much less prone to bacterial and viral infections and more rapidly heals than any of the other resurfacing modalities.
The invention, together with various embodiments thereof, will explained in more detail by the accompanying drawings and following description.
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Coleman William P.
Tsai Ren-Yeu
Buiz Michael
Ho (Jackie) Tan-Uyen
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