US2524750A - Surgical appliance for use with draining wounds - Google Patents

Description

Oct. 10, 1950 M. J. BELLINGER 2,524,750

SURGICAL APPLIANCE FOR USE WITH DRAINING WOUNDS' Filed April 23, 1947 12 l 10 3 E- 3 a I INVENTOR.

// MART/N d. BELL/NGER RTTORNEV Patented Oct. 10, 1950 SURGICAL APPLIANCE FOR USE WITH DRAINING WOUNDS Martin J. Bellinger, Boston, Mass.

Application April 23, 1947, Serial No. 743,288

4 Claims. (01. 128-283) The present invention relates to surgical appliances and particularly to an appliance suitable for wear by the patient during early convalescence from surgical operations resulting in draining wounds. The appliance is particularly suitable for use with ileostomy cases, in which it serves to protect the wound and surrounding tissue and carry away the ileal discharge.

In an ileostomy operation an incision is made into the abdomen, the intestine is transected and the proximal open end of the ileum, for example, is brought out through the incision, where it may remain for some time, or possibly permanently. In the care of patients with ileostomies, particularly those with profuse or watery discharge, the physician and nurse are beset with many problems. Among these, may be mentioned the prodigious nursing care necessary in the frequent changing of dressings, clothing and bed linen because of soilage. More importantly, serious irritation, maceration and erosion of the surrounding skin are almost invariably sequellae, even after careful and frequent applications of metallic powderspa stes, resins, etc., designed for protection of the skin. Such skin damage prolongs the required hospitalization period, and, since many of these patients are in a debilitated physical and mental state as a result of the pathologic condition demanding ileostomy, the

added insults to the psyche resulting from prolonged hospitalization and mounting expense contribute further anguish, retarding convalescence and rehabilitation.

An object of the invention is to provide an apparatus which may be worn by the patient during the early convalescent period following ileostomy, which will assure prompt removal of irritative discharge and obviate the need for surgical dressings and, generally, will contribute to the patients comfort and peace of mind and shorten the hospitalization period.

A further object is to provide such an appliance which will permit the use of an indwelling catheter, if such is indicated for a particular case.

A further object is to provide such an apparatus, which Will admit air to the wound, which will permit irrigation of the wound, which will permit dilation of the stoma, and which will allow the patient limited ambulation.

Other features, objects and advantages of the invention will be apparent from the following description whenread in connection with the accompanying drawings, which show an illustrative embodiment of. the invention. In the drawings:

Fig. 1 is a perspective view of the appliance as applied to the patient;

Fig. 2 is a vertical mid-sectional view of the apparatus of Fig. 1; and

Fig. 3 is a plan view.

Referring to the drawings, the appliance comprises a cup member 2, having a cylindrical side wall 4 and being closed at one end by a flat end plate 6. This culp member may be blown or drawn from sheet plastic material, or it may be fabricated from standard tubular stock by cutting to the appropriate length and cementing a flat circular disk to one end to form the end plate 6. I prefer to form the cup member 2 from a transparent material, such as a plasticized methyl methacrylate resinous composition, so that the ileostomy may be observed without removal of the appliance.

The side wall 4 is provided with a short drainage connection 8 and the end plate 6 is provided with an air inlet 9, which is shielded by a baflie arrangement indicated generally at A.

The part of the apparatus so far described is held in position over the wound by means of the base member 10, which comprises a generally circular, thin, flat sheet l2 and a cylindrical flange l4 secured at one end to the upper surface of the sheet l'2, as shown. The sheet is made of a flexible material and the flange of a flexible and elastic material. Both preferably are formed from soft sterilizable rubber. By the term rubber I mean synthetic elastomers as well as natural rubber. The sheet i2 is provided with an opening l6, disposed approximately centrally of the sheet, and within the cylindrical flange IA. The sheet I2 is cemented to the intact skin l5 surrounding the ileostomy and the cylindrical flange 14 is so shaped and proportioned as to receive and tightly embrace the cylindrical side wall 4 of the cup 2. The flange [4 is provided,

with a side tube !8 cemented thereto and having its bore communicating with the interior of the flange I4. This side tube is of such a size as to receive snugly the drainage connection 8 of the plate 20 which completely surrounds the air inlet 9 except at one side, as shown. The plate 20 may be formed integrally with the end plate 6 by a molding operation, or it may be separately formed from a sheet material of the proper thickness and then cemented in place during the assembly of the apparatus.

verlying the plate is a circular disk 22 which is free to slide on the plate 20 about a pivot pin 24. The pivot pin 26 passes freely through the disk '22 and is anchored in the plate 20. The disk 22 is provided with an aperture 26, which may be of approximately the same size as the air inlet 9 in the end plate 6 and may be similarly bevelled or chamfered. The aperture is located eccentrically of the disk 22, and is so spaced from the pivot pin 24 as to be aligned with the air inlet 9 in one adjusted position of the disk 22.

Means for locking the disk 22 in various positions of adjustment about the pivot pin 24 is provided, comprising an arcuate slot 28 which is circularly curved about a center lying in the axis of the pivot pin 24. A knurled locking screw 3!] passes freely through the arcuate slot 28 and is threaded into the disk 28. The head of the locking screw 30 is sufiiciently large to bear on the disk 22 at each side of the slot 28, so that the disk 22 may be quickly and conveniently locked in adjusted position, and unlocked, by rotation of the locking screw 36. The arcuate slot 28 is of such a length and is so positioned in the disk 22 that when one end of the slot 28 is in engagement with the stem of the locking screw til, the

aperture 26 will be in alignment with the air inlet 9 in the top disk 6. When the plate 22 is moved to its other extreme position, with the opposite end of the slot in engagement with the stem of the locking screw 30, the aperture 26 is completely out of alignment with the airinlet 9, as appears to best advantage in Fig. 3.

In using the appliance, the cup member 2 is assembled with the base member M by stretching the flange M of the latter about the cylindrical wall 4 of the cup and the sheet i2 is then cemented to the intact skin surrounding the wound, with the ileum 36 projecting through the opening IS. The surfaces of the sheet l2 and the skin should first be cleansed with benzine, ether, acetone, or carbon tetrachloride, and then be allowed to dry. A non-irritative sterile rubber cement 33 is then spread on the lower side of the sheet !2 by use of a'throat stick or other suitable instrument, and a similar layer is applied 'to the cleansed and dried skin over an area the size of the sheet 12. In coating the skin, I have found that it is advisable to begin at the periphery of the area and work inwardly, to minimize the risk of wetting the cement; it is helpful to hold a rolled sponge over the stoma during this operation to prevent soilage of the prepared skin. The rubber cement should be allowed to dry, and the base member then gently but firmly pressed onto the skin with the side tube iii in dependent position. If the apparatus is being applied to a newly-created ileostomy, as will normally be the case, aseptic precautions must be observed to prevent infection of the wound.

The sheet l2 may be trimmed with scissors by the surgeon to the size he deems desirable, and the opening I 6 likewise may be trimmed to fit' the particular ileostomy. It is preferred that the opening I6 fit the ileostomy rather closely to minimize the area of tissue which is left exposed to the destructive action of the discharge.

If indwelling tube drainage of the ileostomy is preferred for the immediate post-operative period, the disk 22 may be adjusted into its position in which the air inlet 9 and the aperture 26 are in alignment and the catheter may be led out through these openings. When loosening of the catheter occurs, it can be easily removed from the ileostomy by gentle traction, without removing the appliance from the patient.

If a catheter is not employed, the disk 22 will normally be adjusted into its position, shown in Fig. 3, in which the openings 9 and 26 are out of alignment. In this case, the side tube l8 will be connected to any suitable source of suction, through a waste receiver 38 if necessary. The modern hospital is equipped with wall suction connections which are suitable for the purpose. If such connections are not available, a vacuum pump, or any of the well known units employed for intestinal decompression, will serve satisfactorily as a substitute.

When the suction connection is completed, a. current of air will be drawn into the air inlet 9 through the notch in the plate 20 and between the outer disk 22 and the end plate 6. Any discharge from the ileostomy will be carried into the side arm 8 and out of the apparatus through the side tube 58. The openings 9 and 26 are of such a size, and the spacing of the disk 22 from the end plate 6 is such, in relation to the vacuum applied to the side tube I 8, that no significant lowering of the pressure within the cup 2 occurs. This is an important consideration, inasmuch as even a slight tenting of the stoma and surrounding skin into the cup under the influence of suction would give rise to discomfort and eventually to edema of the projecting ileum.

When it is desired to irrigate the ileostomy, the locking screw 30 may be loosened and the disk 22 swung to its position in which the openings 6 and 26 are aligned. The neck of a syringe may then be introduced through the openings and the ileostomycoated or irrigated as desired. A viscous suspension of aluminum hydroxide gel, for example, has been found to have a soothing effect when placed around the stoma, and. this surfacing provides protection of the adjacent tissue from the corrosive discharge, and, reportedly, tends to inactivate pepsin and trypsin. I have found that most patients are able to perform this lavage for themselves, and are glad to do so when the purpose is described to them.

When the patient is permitted ambulation, the suction tube may be disconnected from the side tube It and the latter clamped in any suitable manner, as with a metal clamp, or by bending it upon itself and securing it with a rubber band 3 as shown in Fig. 2. Then the locking screw 30 is loosened. the disk 22 moved to align the openings 9 and 26 and a stopper 40, which may be an ordinary rubber laboratory stopper, passed through the openings so that it seats firmly in the air inlet 9. The patient is then free to walk about and the apparatus serves the function of an ileostomy bag, such as those customarily worn after convalescence when the dejecta has solidified. At intervals the patient can remove the stopper 4!), re-attach the suction tube, and drain the cup.

The attachment of the appliance by cementing of the sheet [2 to the skin is ordinarily adequate, even when a patient may walk about. However, an all rubber belt with a doughnutshaped enlargement to fit around the cup has been found helpful in supporting the appliance when it is worn after the patient is ambulant. The baffle arrangement A, comprising the disk 22 and the disk 20, permits a, steady flow of air into the cup when the suction connection is in use, yet without permitting escape of ileal discharge. This arrangement also prevents sheets and clothing'from being drawn against the air inlet and interfering with the flow of air.

The cups have the properties of transparency. lightness, ruggedness, and durability. The entire appliance may be made of a material sterilizable in the conventional autoclaves. If the cup member 2 is made of a composition which, in order to obtain special physical properties, such as transparency, does not permit boiling it may be sterilized by cleansing with warm soapy water and subsequent immersion in alcohol.

If it is desired to dilate the ileostomy after the apparatus has been applied and is in operation,

the cup may be removed from the rubber base, the desired procedure efiected, and the cup then replaced, all without removing the sheet [2 from the patient.

When the base member ID is applied with care, I have found that there will be no leakage for five to eight days, or occasionally longer. When leakage does occur, the rubber sheet l2 may be peeled off the skin with the aid of gauze saturated with benzine, and cleansed and reapplied.

While the apparatus described is particularly useful for wear with newly-created ileostomies during the early convalescent period, it has also been used with success in cases of fistula of the small bowel and of the biliary tract. It should perform equally well with other types of fistulae such as pancreatic or uretenal fistulae and also with draining suprapubic wounds.

I claim:

1. A surgical appliance suitable for wear by a patient during early convalescence from surgical operations resulting in draining wounds, comprising a base member including a sheet of flexible soft rubber with an opening therein adapted to be cemented to the patients skin in the area surrounding the incision, with the opening overlying the incision, and an upstanding cylindrical elastic flange secured to one side 'of said sheet about said opening, a hollow cupshaped member having an open end and an end wall opposite said-open end with an air inlet therein, said cup being gripped by said flange with its open end inside said flange, a drainage connection on said cup member'to which an air suction line may be connected, and a baffle member supported on said endwall for preventing obstruction of said air inlet by clothing and the like while permitting free flow of air into said cup-shaped member.

2. A surgical appliance suitable for Wear by a patient during early convalescence from surgical operations resulting in draining wounds, comprising a base member including .a sheet of flexible soft rubber with an opening therein adapted to be cemented to the intact skin in the area surrounding the incision with the opening overlying the incision, a hollow cup-shaped member 1 having an open lower end and an end wall op- LSU posite said open end with an air inlet therein, means for connecting said cup to said sheet with its open end adjacent said sheet and surrounding the opening therein, a drainage connection on said cup member to which an air suction line may be connected, and an apertured plate pivotally supported on said end wall for movement selectively into and out of a position in which the aperture therein is aligned with said air inlet.

3. A surgical appliance suitable for Wear by a patient during early convalescence from surgical operations resulting in draining wounds, comprising a base member including a sheet of flexible soft rubber with an opening therein adapted to be cemented to the patients skin in the area surrounding the incision, with the opening overlying the incision, and an upstanding cylindrical elastic flange secured to one side of said sheet about said opening, a side tube connected to said flange with its bore in communication with the inside of the flange, a hollow cupshaped member having an open lower end, a drainage opening and a Wall with an air inlet therein, said cup being embraced by said flange with its open end inside said flange and said drainage opening aligned with the bore of said side tube, and a baffle member supported on said end wall for preventing obstruction of said air inlet by clothing and the like.

4. A surgical appliance suitable for wear by a patient during early convalescence from surgical operations resulting in draining wounds, comprising a base member including a sheet of soft flexible material with an opening therein adapted to be cemented to the patients skin in the area surrounding the incision, with the opening overlying the incision, and an upstanding cylindrical flexible and elastic flange secured to one side of said sheet about said opening, a hollow cup-shaped member having an open end and a wall with an air inlet therein, said cup being gripped by said flange with its open end inside said flange, a drainage connection on said cup member to which an air suction line may be connected, and a baffle member supported on said end wall for preventing obstruction of said air inlet by clothing and the like, while permitting free flow of air into said cup-shaped member.

' MARTIN J. IBELLINGER.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 1,656,328 Le Cras Jan. 1'7, 1928 2,025,492 Aird Dec. 24, 1935 2,154,202 Gricks- Apr. 11, 1939 2,223,566 Koch Dec. 3, 1940 2,280,915 Johnson Apr. 28, 1942 2,331,226 Pritchard Oct. 15, 1943 2,438,073 Saur Mar. 16, 1948 FOREIGN PATENTS Number Country Date 114,754 Great Britain Apr. 18, 1918

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