Surgery – Instruments – Means for removal of skin or material therefrom
Reexamination Certificate
2001-02-13
2003-03-11
Lewis, Aaron J. (Department: 3761)
Surgery
Instruments
Means for removal of skin or material therefrom
C606S131000, C606S167000
Reexamination Certificate
active
06530931
ABSTRACT:
FIELD OF THE INVENTION
This invention relates to dermatomes, useful for surgical operations such as skin grafting and tangential excision, particularly to dermatome wherein the cutting blade may also be actuated for a reciprocal motion by mechanical means, usually comprising electrical motor means.
BACKGROUND OF THE INVENTION
Dermatomes, used for surgical operations and particularly for skin-grafting purposes, are known in the art. They comprise a cutting blade, which reciprocates in a direction essentially perpendicular to the direction of advancement of the dermatome, and handle means or the like for controlling and displacing the dermatome as required. The blade may be actuated in its reciprocating motion, either manually or by mechanical means, which are usually electrical or gas turbine motor means. A suitable electrical power or gas supply source is provided, and usually is a central source connected to said motor means by cables or tubes, as the case may be.
U.S. Pat. No. 2,579,029 describes a dermatome with a manually reciprocated knife coupled with suction means for drawing the skin to be cut closely against the cutting blade, the length of the cut being limited by the width of the suction means and the blade. The dermatome is provided with a handle by which the dermatome is maneuvered and advanced in the desired direction of the surface on which the skin may be cut, which handle is also used for actuating the knife in its reciprocating motion.
U.S. Pat. No. 3,428,045 is intended to be an improvement on the aforesaid U.S. Pat. No. 2,457,772. It is constituted by a frame, comprising a pair of opposite side members connected by a foot plate riding on the skin, a pressure plate mounted between the side members forwardly on the footplate, an oscillatory cutting element having its cutting edge forwardly off the foot plate and rearwardly off the pressure plate, for adjusting the pressure plate vertically for determining the depth of the cut, and assuring exact parallelism of the pressure plate with the forward edge of the foot plate. The dermatome further comprises means for actuating the blade in its oscillating movement. They are not described, and are stated to be any suitable means which form no part of the invention of the said patent. The width of the skin section to be taken is controlled by means of adjustable guide plates, one on either side of the dermatome, which underlie the blade and the foot plate and are slidably mounted on supporting rods. The dermatome is maneuvered by means of a handle which is fitted on an axial plane of the instrument, the plane being parallel to the motion of the dermatome and perpendicular to the blade edge.
DAS 2916268 describes a dermatome, characterized by the presence of swingable guide plates transversely juxtaposed of the cutting blade, which can be raised to expose the skin to the cutting blade or lowered to prevent contact of the skin with said blade. This patent does not describe a handle nor means for actuating the cutting blade. However, it does not have the features described in this application nor in the art, manufactured by Aesculap-Werke RG, the applicant of the aforesaid application, DAS 2916268, and they have a motor actuated cutting blade and a handle situated in an axial plane perpendicular to the cutting blade. The cut is limited in this dermatome, as well as in the dermatome described in the aforesaid DAS, by cutting elements located laterally of the cutting blade edges.
U.S. Pat. No. 4,690,139 is a hand-actuated dermatome with a guard for controlling the cutting depth and an adjusting mechanism for effecting an angular displacement between the guard and the cutting depth, the guard extending the complete length of the cutting edge of the blade and being rounded at its opposite end, enabling the full blade length to be used. The dermatome includes a handle which is offset from the plane on the head of which the cutting blade is mounted, and is pivoted from the first position overlying said head to a second position extending laterally of, but offset from, said head.
All the powered dermatomes known in the art have blades that are rather short (e.g., 10 cm of less), and thus the width of the incision and the resulting width of the graft is limited to narrow strips. The manual dermatomes have longer blades (more than 14-15 cm) with a resulting, potential, wide cutting front and wide graft. The dermatomes in which the blade is manually actuated are problematic. They require a considerable physical effort and technical skill on the part of the operator to produce a desired cutting, permit to use the central length of the blade in the cutting operation, except for the dermatome described in U.S. Pat. No. 4,690,139, in which the entire length and even the corners can be used. On the other hand, the dermatomes in which the blade is mechanically actuated may be much more efficient in their cutting operation but are so constructed that they can be advanced by pushing forward over the treated area of the skin substantially only in a direction perpendicular to the cutting blade, which makes it very difficult to operate over small skin areas or areas having a complex shape and renders the treated skin areas not as fully visible to the operator as they should be. Another drawback, common to all the dermatomes (except that of U.S. Pat. No. 4,690,139) is the geometry of the blades' ends, which are complex, have sharp angles, protrusions or ridges, and do not allow sidewise movement when the blade touches the skin.
Furthermore, said mechanically actuated dermatomes have sterility problems which exist practically in all surgical instruments which comprise an actuating electrical motor, and other electrical components, of non-stainless metals and other non-metallic materials. Absolute sterility of all the surgical instruments is required and any danger of pollution, no matter how minimal, must be avoided. For this purpose, the instrument is sterilized and is used in a completely sterile environment. However, the electrical motor, as well as the batteries, if it is battery-operated, cannot be subjected to the standard, “flash” autoclaving, sterilizing operation, which requires high temperatures and vapor pressures. For this reason most dermatomes are connected to a main electrical or gaz source by a flexible line. These lines cannot be autoclaved and should be gaz-sterilized, a method that demands time (24-48 hours) and means. It is possible, of course, to introduce the motor, and the batteries, if any, into the housing of the surgical instrument, which housing can be closed hermetically. However, contact between the non-sterilized motor and batteries can occur while it is introduced into the housing. Transitory contact of this kind is sufficient to destroy the absolute sterility that is required of the instrument and of the environment. In order to prevent this problem from arising, in one instrument (sold under the trade name Aesculap™) a separate plastic tunnel is provided to ensure a safe and non-contaminating passage of the non-sterile motor and batteries into the sterile housing. This tunnel has to be kept for use and discarded afterwards.
It is therefore a purpose of this invention to provide a mechanically-actuated dermatome which can be used over skin areas that are small or of complex shape.
It is another purpose of this invention to provide such a dermatome which allows the operator full visibility of the treated skin areas and access thereto.
It is a further purpose of this invention to provide such a dermatome which can be maneuvered by the operator most easily straight forward and sidewise, and with a minimum effort, on any skin surface.
It is a still further purpose of this invention to provide such a dermatome that can incise and excise tangentially very thin or thicker layers of skin or other tissues.
It is a still further purpose of this invention to provide a mechanically actuated dermatome that can be used as a hand actuated dermatome, in case of power failure.
It is a still further purpose of this inventio
Anderson Kill & Olick
L.R.R. & D. Ltd.
Lewis Aaron J.
Lieberstein Eugene
Meller Michael N.
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