阅读说明：本技术 负压伤口封闭装置以及用于以负压处理伤口的系统和方法 (Negative pressure wound closure device and system and method for treating a wound with negative pressure ) 是由 R.M.邓 E.Y.哈特维尔 J.K.希克斯 E.M.哈德尔斯顿 C.萨克斯比 于 2014-03-12 设计创作，主要内容包括：这里所述的某些实施例涉及一种伸长的材料层和唇缘、它们的使用方法和包含它们的系统,唇缘放置在与伤口接触的位置,并且伸长的材料层缠绕在伤口填料周围,其中伤口填料唇缘配置成定位在筋膜的下面。另外,这里所述的某些实施例涉及伤口的封闭和在伸长层及唇缘上使用附连机构以附连到伤口表面上。(Certain embodiments described herein relate to an elongated material layer and lip, methods of their use, and systems containing them, the lip being placed in contact with a wound, and the elongated material layer wrapped around a wound filler, wherein the wound filler lip is configured to be positioned beneath fascia. In addition, certain embodiments described herein relate to the closure of wounds and the use of attachment mechanisms on the elongate layer and lip to attach to the wound surface.)

1. An apparatus for wound treatment, comprising:

an annularly shaped layer of material configured to be placed in contact with a wound of a patient, the annularly shaped layer of material having an annular opening to receive a wound filler positioned within the wound; and

a lip extending outwardly from the annularly shaped layer of material, wherein the lip is custom shaped and sized for positioning beneath tissue surrounding the wound of the patient; and

wherein the wound filler and the annularly shaped layer of material transmit negative pressure to remove fluid from the wound.

2. The device of claim 1, wherein the annularly shaped layer is made of porous foam formed as a single piece with the lip.

3. The device of claim 1, wherein the lip is made of foam, fabric, or a rigid material.

4. The device of claim 1, wherein the annular shaped layer has an inner surface and an outer surface and a thickness therebetween, wherein the thickness of the annular shaped layer is less than the height of the inner surface and the outer surface.

5. The apparatus of claim 1, wherein the ring-shaped layer surrounds the wound filler having an elliptical shape.

6. The apparatus of claim 1, wherein the wound filler is configured to compress horizontally when negative pressure is applied and cause the wound edges to draw closer together and is further configured to be relatively rigid in a vertical direction, thereby preventing vertical collapse of the wound cover.

7. The apparatus of claim 1, wherein the wound filler comprises a porous open-cell foam that contacts underlying tissue, foam layers, or organ protective layers.

8. The apparatus of claim 1, further comprising an organ protection layer configured to be positioned on underlying tissue beneath the wound filler and the lip.

9. The apparatus of claim 1, further comprising one or more foam layers configured to be positioned at least one of above and/or below the wound filler.

10. The apparatus of claim 1, wherein the wound filler is configured to preferentially contract in a first direction in the plane of the wound relative to a second direction in the plane of the wound.

11. The apparatus of claim 1, further comprising a wound cover configured to be placed over and seal the wound, and a connector for connecting the wound cover to a negative pressure source.

12. The apparatus of claim 11, further comprising a negative pressure source configured to be connected to the wound cover to provide negative pressure to the wound.

13. The apparatus of claim 1, wherein the wound filler and wound filler, the annularly shaped layer and lip are formed as a single piece.

14. The apparatus of claim 13, wherein an inner surface of the annular shaped layer is configured to be attached to a wound filler and the inner surface has an attachment mechanism for attaching the inner surface of the annular shaped layer to the wound filler.

15. The device of claim 14, wherein the attachment mechanism is selected from the group consisting of barbs, adhesives, hooks, mushroom hooks, and any combination thereof.

16. The apparatus of claim 1, wherein an outer surface of the annularly shaped layer is configured to be attached to a wound surface.

17. The apparatus of claim 16, wherein the outer surface has means for attaching the outer surface of the annularly shaped layer to the wound surface.

18. The apparatus of claim 17, wherein the means for attaching the outer surface of the ring-shaped layer to the wound surface is selected from the group consisting of barbs, adhesives, tissue grabbers, glue, sutures, and any combination thereof.

19. The apparatus of claim 1, wherein the lip has means for attaching the lip to the surrounding tissue including fascia.

20. The apparatus of claim 19, wherein the means for attaching the lip to fascia comprises an attachment mechanism selected from the group consisting of barbs, adhesives, tissue claws, glue, sutures, and any combination thereof.

21. The apparatus of claim 19, wherein the outer surface of the ring-shaped layer has means for attaching the outer surface of the ring-shaped layer to the wound surface that is different from the means for attaching the lip to the fascia.

22. The device of claim 1, further comprising a plurality of fingers extending outwardly from the lip.

23. The device of claim 22, wherein the fingers are covered with a fractured organ protection layer.

24. The device of claim 22, wherein the fingers comprise a foam material that is different from a material of the lip.

25. The device of claim 24, wherein the foam material for the fingers comprises foam having a porosity of between 200ppi and 60 ppi.

26. The apparatus of claim 1, wherein the annular shaped layer and the lip form a generally L-shaped cross-section, the lip having a top surface, a bottom surface, and a thickness, wherein the lip has a length between about 5mm to about 60mm to extend from the bottom of the annular shaped layer to a position below the wound edge.

27. The apparatus of claim 1, wherein the ring-shaped layer has a first end and a second end and means for attaching the first end and the second end together.

28. A method of treating a wound using the apparatus of claim 1, comprising: applying negative pressure to the wound through a wound cover positioned over the wound and a wound filler positioned within the wound, wherein the wound filler is surrounded by the annularly shaped layer of material and the lip is positioned below surrounding tissue.

29. The method of claim 28, wherein the wound is an abdominal wound.

30. The method of claim 28, further comprising positioning an organ protection layer over at least a portion of the wound and then positioning the wound filler within the wound.

Technical Field

Embodiments described herein relate to devices and methods that may be used to treat wounds with negative pressure. Particular embodiments may also be used to aid in wound closure, such as in abdominal wounds or following fasciotomy procedures.

Disclosure of Invention

In general, the embodiments described herein may be used to assist in treating a wound with negative pressure. These embodiments may be particularly effective in treating large wounds, such as abdominal wounds, and/or for fasciotomy procedures, where closure and access of the wound margins is challenging. Certain embodiments described herein relate to an elongated material layer and lip, methods of their use, and systems containing them, the lip being placed in contact with a wound, and the elongated material layer wrapped around a wound filler, wherein the wound filler lip is configured to be positioned beneath fascia. In addition, certain embodiments described herein relate to the closure of wounds and the use of attachment mechanisms on the elongate layer and lip to attach to the wound surface.

In one embodiment, an apparatus for wound treatment includes an elongated layer of material configured to be placed in contact with a wound. The elongated layer can be shaped into a toroidal shape. When the layers are disposed in an annular shape, a lip extends outwardly from the elongate layer, wherein the lip is capable of being positioned beneath the fascia of a patient.

In certain embodiments, the elongate layer may be made of foam. The lip may be made of foam. The elongated layer may have an inner surface and an outer surface and a thickness therebetween, wherein the thickness of the layer is less than the height of the inner and outer surfaces. The inner surface of the elongate layer may be configured to attach to a wound filler. The inner surface of the layer may have means for attaching the inner surface of the layer to the wound filler. The outer surface of the layer may be configured to attach to a wound surface. The outer surface may have means for attaching the outer surface of the layer to the wound surface. The lip may have means for attaching the lip to the fascia. The outer surface of the layer may have means for attaching the outer surface of the layer to the surface of the wound, as opposed to means for attaching the lip to the fascia.

In some embodiments, a plurality of fingers may extend outwardly from the lip. The fingers may be covered with a cracked organ protection layer. The fingers may comprise a foam material different from the material of the belt. In certain embodiments, the foam material for the fingers may comprise a foam having a porosity of between 200ppi and 60 ppi.

In certain embodiments, the layer and the lip may form a generally L-shaped cross-section. The layer may have a first end and a second end and means for attaching the first end and the second end together.

In certain embodiments, the device for wound treatment may further comprise a wound filler, wherein the elongate layer described above may surround the wound filler. The wound filler may comprise foam. The organ protection layer may be configured to be positioned over the wound under the wound filler. One or more foam layers may be configured to be positioned above and/or below the wound filler. The wound cover may be configured to be placed over a wound. The device may further comprise a connector for connecting the wound covering to a source of negative pressure. A negative pressure source may be configured to be connected to the wound cover to provide negative pressure to the wound.

In one embodiment, a method of treating a wound with the apparatus may include applying negative pressure to the wound through a wound cover positioned over the wound. The wound filler may be positioned in the wound, wherein the wound filler is surrounded by the elongated layer of material and a lip positioned below the fascia. In certain embodiments, the wound may be an abdominal wound. In certain embodiments, the organ protection layer is positioned over the wound, and then the wound filler is positioned within the wound.

In one embodiment, an apparatus for wound treatment includes a wound filler configured to collapse horizontally within a wound. The fixation material may be configured to surround the wound filler, the fixation material including an elongate layer configured to be in contact with the wound and a lip extending outwardly from the elongate layer. The lip can be positioned under the fascia of the patient. The elongate layer and the lip are integrated into a single piece and form a generally L-shaped cross-section. The apparatus also includes a wound cover configured to be placed over the wound.

In certain embodiments, the inner surface of the layer may be configured to attach to a wound filler. In certain embodiments, the inner surface may have means for attaching the inner surface of the layer to the wound filler. In certain embodiments, the means for attaching the inner surface of the layer to the wound filler comprises an attachment mechanism selected from the group consisting of barbs, adhesives, Velcro (Velcro @ cohesive fastening), hooks of Velcro, mushroom-shaped hooks of Velcro, hooks, staggered barbs, and any combination thereof.

In certain embodiments, the outer surface of the layer may be configured to be attached to a wound surface. The outer surface may have means for attaching the outer surface of the layer to the wound surface. The means for attaching the outer surface of the layer to the wound surface is selected from the group consisting of barbs, adhesives, velcro, hooks of velcro, mushroom hooks of velcro, hooks, staggered barbs, and any combination thereof.

In certain embodiments, the lip may have means for attaching the lip to the fascia. The means for attaching the lip to the fascia is selected from the group consisting of barbs, adhesives, velcro hooks, velcro mushroom hooks, hook shapes, staggered hooks, staggered barbs, and any combination thereof. The means for attaching the lip to the fascia includes a lateral attachment mechanism extending outwardly from an anterior surface of the lip.

In certain embodiments, the apparatus for wound treatment further comprises a plurality of fingers extending outwardly from the lip. In certain embodiments, the apparatus for wound treatment may further comprise an organ protection layer configured to be positioned over the wound under the wound filler. In certain embodiments, the device for wound treatment may further comprise one or more foam layers configured to be positioned above and/or below the wound filler. In certain embodiments, the apparatus for wound treatment may further comprise a connector for connecting the wound cover to a negative pressure source. In certain embodiments, the apparatus for wound treatment further comprises a negative pressure source configured to be connected to the wound cover to provide negative pressure to the wound.

In another embodiment, a method of treating a wound with the apparatus of any one of the preceding claims, comprising applying negative pressure to the wound through a wound cover positioned over the wound and a wound filler positioned within the wound, wherein the wound filler is surrounded by the elongate layer and the lip is positioned below the fascia; wherein the wound filler collapses horizontally under negative pressure.

Drawings

FIG. 1 illustrates one embodiment of a negative pressure processing system.

Fig. 2A shows one embodiment of a wound securing material comprising an elongate layer.

Fig. 2B shows a cross-sectional view of the wound securing material of fig. 2A showing the elongate layer having a lip with an L-shaped cross-section.

Fig. 2C is a perspective view of the wound securing material of fig. 2A arranged in an angular shape.

Fig. 2D-2E show side views of the wound securing material of fig. 2A arranged in a ring shape, showing a slit.

Fig. 3A shows one embodiment of a wound securing material having an elongated layer of material, a lip, and a plurality of fingers extending outwardly from the lip.

Fig. 3B shows one embodiment of a wound securing material having an elongate layer, a lip, and fingers surrounded by an organ protective layer.

Fig. 4 shows a top view of one embodiment of a wound securing material.

Fig. 5 shows a top view of one embodiment of a wound securing material with fingers.

Fig. 6A shows a partial cross-sectional view of one embodiment of a negative pressure wound therapy system including a wound securing material having an elongate layer and a lip.

Fig. 6B shows a partial cross-sectional view of one embodiment of a negative pressure wound therapy system including a wound securing material having an elongate layer, a lip, and fingers.

Fig. 6C shows a partial cross-sectional view of another embodiment of a negative pressure wound therapy system in which the wound securing material includes an attachment mechanism.

Fig. 6D is an enlarged view of one embodiment of a wound securing material including an attachment mechanism positioned within a wound.

FIG. 7 illustrates a top view of one embodiment of a wound filler and wound securing material placed within a wound.

Fig. 8A-H show partial cross-sectional views of an embodiment of a negative pressure wound therapy system including a wound securing material having an elongate layer and a lip.

Fig. 8I-K are enlarged views of one embodiment of a wound securing material including various attachment mechanisms positioned within a wound.

Fig. 9A shows a cross-sectional view of a pad and wound filler in a surgical site, according to a preferred embodiment of the present invention.

Fig. 9B shows a top view of the wound filler and tissue attachment device.

Fig. 9C shows a detailed perspective view of a surgical drainage system according to a preferred embodiment of the present invention.

FIG. 10 shows a cross-sectional view of a wound drainage and closure system for surgically treated pressure ulcers, in accordance with a preferred embodiment of the present invention.

Fig. 11A shows an enlarged view of one embodiment of the tissue anchoring system.

Fig. 11B is a cross-sectional view of a tissue gripping surface of a wound closure device.

FIG. 11C is a side view of the tissue gripping surface showing the gripping surface for different types of tissue (T)₁，T₂) And corresponding force profiles for the same, including the maximum force (F) applied during vacuum sealing₁) And the force (F) required to remove the anchor from the tissue without damaging the tissue₂)。

Fig. 11D shows a different design for the tissue anchor of the present invention.

Fig. 11E shows an enlarged view of the tissue anchoring elements on the peripheral surface of the oval wound closure device.

Fig. 12A is a schematic view of a wound closure device positioned within a wound showing different force distributions around the wound edge, according to one embodiment.

Fig. 12B shows the wound closure device of fig. 12A after a wound closure and recovery cycle, wherein the wound and the wound closure device are in their original configuration represented by dashed lines.

Fig. 13A-B show a wound closure device for closing a wound.

FIG. 14 illustrates one embodiment of a negative pressure processing system.

Fig. 15A-F show various views of one embodiment of a stabilization construct.

Fig. 15G-15I show various views of another embodiment of a stabilization construct.

Fig. 16 shows an embodiment of a ring that may enclose a stabilization structure.

FIG. 17 illustrates one embodiment of a stabilization construct having a surrounding anchoring layer and a foam layer.

Fig. 18A-D illustrate another embodiment of a stabilization construct having a surrounding anchoring layer and a foam layer.

Figure 19 shows an example of an open abdominal wound.

Fig. 20 shows one embodiment of steps in a method of treating a wound.

Fig. 21 shows one embodiment of steps in a method of treating a wound.

Figures 22A-C illustrate one embodiment of method steps for treating a wound.

Figures 23A-C illustrate one embodiment of method steps for treating a wound.

FIG. 24 illustrates one embodiment of method steps for treating a wound.

Fig. 25A-G show one embodiment of method steps for treating a wound.

Detailed Description

Various embodiments that may be used for wound treatment will now be described with reference to the following drawings and the accompanying specification. It will be understood that various omissions and substitutions and changes in the form and details of the embodiments illustrated may be made without departing from the spirit of the disclosure. In addition, the various features and processes described above may be used independently of one another or may be combined in different ways. All possible combinations and sub-combinations are intended to fall within the scope of the present disclosure. Many of the embodiments described above include similar components and thus these similar components may be interchanged in different embodiments.

Embodiments disclosed in this section or elsewhere in this specification relate to apparatus and methods for treating wounds with reduced pressure, including pumps and wound dressing members and apparatus. In general, embodiments described herein that include a wound filler may be used in conjunction with a negative pressure system that includes a drape or wound cover placed over the filler. A vacuum source, such as a pump, may be attached to the cover, such as through one or more conduits that are attached to apertures or ports made in or below the cover. These devices and components include wound coverings and fillers, which are sometimes referred to collectively herein as wound dressings if desired. Further details of methods and apparatus that may be used with embodiments described herein are found in fig. 14-25G and accompanying text, and in the following applications, which are incorporated herein by reference in their entirety: application No.11/919,355, published as US2009/0306609, entitled "wound treatment device and method", filed on 26.10.2007; U.S. patent No.7,753,894 entitled "wound cleansing apparatus with stress" published on 13/7/2010; filed on 20/9/2010 under the title "system and method for negative pressure wound therapy to manage open abdominal wounds," application No.12/886,088 published as US 2011/0213287; application No.13/092,042, published as US2011/0282309, entitled "wound dressing and method of use", filed on 21/4/2011; application No.13/365,615, published as US2012/0209227, entitled "negative pressure wound closure device", filed on 3/2/2012; and international application No. pct/US2013/050698 entitled "negative pressure wound closure device" filed on 2013, 7, 16.

It should be understood that reference is made to wounds throughout this specification. It should be understood that the term "wound" is to be broadly construed and includes both open and closed wounds in which the skin is torn, cut or punctured, or any other surface condition or other condition or defect on the patient's skin or elsewhere that would benefit from reduced pressure treatment. A wound is thus broadly defined as any damaged tissue region that may or may not produce fluid. Examples of such wounds include, but are not limited to, acute wounds, long-term wounds, surgical incisions and other incisions, subacute and dehiscent wounds, traumatic wounds, flaps and skin grafts, lacerations, abrasions, contusions, burns, diabetic ulcers, pressure ulcers, stomata, surgical wounds, venous ulcers, and the like. In certain embodiments, the components of the negative pressure treatment systems described herein may be particularly suitable for incision wounds that exude small amounts of wound exudate.

The reduced or negative pressure level used in this section of this specification or elsewhere, e.g., -X mm hg represents a pressure level below standard atmospheric pressure, which corresponds to 760mm hg (or 1 atmosphere, 29.93 inches hg, 101.325kPa, 14.696psi, etc.). Therefore, the negative pressure value of-XmmHg reflects an absolute pressure lower than 760mmHg by XmmHg, or in other words, an absolute pressure of (760-X) mmHg. In addition, a negative pressure "less" or "small" than XmmHg corresponds to a pressure closer to atmospheric pressure (e.g., -40mmHg less than-60 mmHg). A negative pressure that is "more" or "greater" than XmmHg corresponds to a pressure that is further from atmospheric pressure (e.g., -80mmHg is more than-60 mmHg).

For certain embodiments of the present disclosure, the negative pressure may range from about-80 mmHg, or between about-20 mmHg to-200 mmHg. Note that these pressures are relative to the standard ambient atmospheric pressure. Thus, 200mm Hg would actually be about 560 mm Hg. In certain embodiments, the pressure may range between about-40 mmHg to-150 mmHg. Alternatively, pressure ranges of up to-75 mmHg, up to-80 mmHg, or above-80 mmHg may be used. Pressure ranges below-75 mmHg may also be used in other embodiments. Alternatively, the negative pressure device may provide a pressure range of about-100 mmHg, or even above 150 mmHg.

In some embodiments, the negative pressure range may be as small as about-20 mm Hg or about-25 mm Hg, which may be used to reduce flaccid vessels. In certain embodiments of the wound closure devices described herein, increased wound contraction may result in increased tissue expansion in the surrounding wound tissue. This effect may be increased by varying the force applied to the tissue, for example by varying the negative pressure applied to the wound over time, possibly in combination with increasing the tension applied to the wound by embodiments of the wound closure device. In some embodiments, the negative pressure may vary over time, such as with a sine wave, a square wave, and/or in synchronization with one or more patient physiological indicators (e.g., heart beats). Examples of such applications that may find supplementary disclosure in relation to the foregoing include application No.11/919,355, filed on 10/26, 2007 under the title "wound treatment apparatus and method", published as US 2009/0306609; and U.S. patent No.7,753,894 entitled "wound cleansing apparatus with stress" filed on 13/7/2010. Both of these applications are incorporated herein by reference in their entirety. Other applications may contain teachings for use with the embodiments described in this section of this specification or elsewhere, which may include application No.12/886,088, published as US2011/0213287, entitled "system and method for using negative pressure wound therapy to manage open abdominal wounds," filed on 20/9/2010; application No.13/092,042, entitled "wound dressing and method of use", published as US2011/0282309, filed at 2011, month 4, 21; and application No.13/365,615, published as US2012/0209227, filed on 3/2/2012, entitled "negative pressure wound closure device," the entire contents of which are incorporated herein by reference.

Turning to fig. 1, in certain embodiments the wound is treated with negative pressure using a negative pressure treatment system 101 schematically illustrated herein. In this embodiment, the wound site 110, shown here as an abdominal wound site, may benefit from the treatment of negative pressure. Such abdominal wound sites may be the result of, for example, an accident or as a result of surgical intervention. In some cases, medical conditions such as abdominal compartment syndrome, abdominal hypertension, sepsis or edema of body fluids may require surgical incision of the abdominal wall to depressurize the abdomen in order to expose the peritoneal space, after which the opening may need to remain open accessible until the condition is resolved. Other conditions may also necessitate the opening, particularly the abdominal cavity, remaining open, for example if multiple surgical procedures are required (possibly with attendant trauma), or there may be symptoms of clinical conditions such as peritonitis or necrotizing fasciitis.

In conditions where wounds exist, particularly in the abdomen, control is necessary regarding the complications that may arise from exposure of the organs and peritoneal space, whether the wound remains open or it will be closed. Treatment, preferably with negative pressure, serves the purpose of minimizing the risk of infection, while promoting tissue viability and removal of toxic substances from the wound site. It has been found that the application of reduced pressure or negative pressure to a wound site promotes rapid healing, increases blood flow, reduces bacterial burden, increases the rate of granulation tissue formation, thereby stimulating proliferation of, inter alia, fibroblasts, stimulating proliferation of endothelial cells, closing long-term open wounds, inhibiting burn penetration, and/or enhancing attachment of flaps and grafts, among other things. Wounds that exhibit positive responses to negative pressure application treatment have been reported to include infected open wounds, bed wounds, dehiscent incisions, partial thickness burns, and various injuries to flaps or grafts that have been attached. Thus, the application of negative pressure to the wound site 110 may be beneficial to the patient.

Thus, certain embodiments provide an organ protection layer 105 that can be cut to size for placement over a wound site 110. Organ protective layer 105 may preferably be a material that does not adhere to exposed internal organs at or near the wound site. In one embodiment, the organ protection layer is permeable. For example, organ protection layer 105 may be provided with openings, such as holes, slits, or channels, to allow for removal of fluids from wound site 110 or to transmit negative pressure to wound site 110. Additional embodiments of organ protection layer 105 are described in further detail below.

In certain embodiments, a tissue protective layer may also be used to protect surrounding tissue near the wound site in order to replace or supplement the organ protective layer. For example, if the wound closure device is used on a non-abdominal wound, the tissue protective layer may be used in place of the organ protective layer. Additionally, in certain embodiments, a tissue protective layer may be used with the organ protective layer to protect surrounding organs and tissues.

Certain embodiments of the negative pressure treatment system 101 may also use one or more foam layers 102 and 104 that may be cut to an appropriate size (e.g., oval) to fit within a wound. As shown in fig. 1, a foam layer 104 may be disposed on an organ protection layer 105. Foam layer 104 may be configured to be positioned below wound filler 103 and above the organ protective layer. In certain embodiments, one or more foam layers may be configured to be positioned above and/or below the wound filler 103. In such embodiments, such as shown in fig. 6A and 6B, wound filler 103 is positioned on foam layer 104, and foam layer 102 is positioned on wound filler 103. In other embodiments, one or both of these foam layers are optional and may not be used at all.

A layer of foam located above and/or below wound filler 103 may protect the wound cover and facilitate fluid flow. In certain embodiments, the foam may have a thickness in the range of 1mm to 20mm (or about 1mm to about 20mm), such as between 5mm to 15mm (or about 5mm to about 15 mm).

Certain embodiments of the negative pressure treatment system 101 may also use a wound filler 103, which may be disposed on the wound contact layer 105 and/or the foam layer 104. Wound filler 103 may be cut into a suitable shape, such as an oval, that fits in the wound. The wound filler shown in fig. 1 has portions that can be removed to provide a suitable size for fitting in a wound. Such wound filler 103 may be composed of a porous material, such as foam, that is soft, resilient, and generally conforms to the wound site 110. Such foams may include, for example, open-cell reticulated foams made from polymers. Suitable foams include foams composed of, for example, polyurethane, silicone, and polyvinyl alcohol. Such wound filler 103 preferably can direct wound exudate and other fluids through itself when negative pressure is applied to the wound. Some wound fillers 103 may include preformed channels or openings for such purposes.

In certain embodiments, the wound filler may comprise a material that is more compressible in the horizontal plane than in the vertical dimension. Such material may compress horizontally upon application of negative pressure to cause the wound edges to draw closer together while remaining relatively rigid to prevent vertical collapse of the wound cover 107 described below. An example of a wound filler that may be used is described in application No.13/365,615, published as US2012/0209227, filed on 3/2 2012 entitled "negative pressure wound closure device," which is incorporated herein by reference. Additional wound packing materials and features may be used as described in international application No. pct/US2013/050698 entitled "negative pressure wound closure device" filed on 2013, 7, 16, which is incorporated herein by reference. Wound closure devices and methods of treatment of horizontally compressed materials and/or stabilizing structures to be incorporated into wound closure devices are described in further detail below with reference to fig. 14-25G.

Additionally, certain embodiments of the negative pressure treatment system 101 may include supplemental wound filler material 200 that facilitates the fixation of the wound filler 103 on the wound. Such a material 200 will hereinafter be referred to as a wound securing material 200. As shown and described in further detail below, the wound securing material 200 may include an elongated strip of material 210 that may be shaped into a loop shape and sized to fit over the outer dimensions of the wound filler 103. Wound fixation material 200 may be placed in the wound prior to or together with placement of wound filler 103. The wound securing material 200 may be configured to be placed in contact with the wound edge such that the wound securing material is located between the wound edge and the wound filler material 103. The wound securing material 200 may have a lip 216 that extends outward when the wound securing material is in the shape of a ring. In certain embodiments, the wound securing material 200 may have a plurality of fingers 217 projecting outwardly from the lip. In certain embodiments, the lip and fingers may be positioned under the fascia of the patient, thereby securing the wound filler in the wound. Additional embodiments of wound securing material 200 are described in further detail below.

Wound cover 107 is preferably used to seal wound site 110. The wound cover 107 may be at least partially liquid impermeable such that at least a partial negative pressure may be maintained at the wound site. Suitable materials for wound covering 107 include, but are not limited to, synthetic polymeric materials that do not significantly absorb aqueous fluids, including polyolefins such as polyethylene and polypropylene, polyurethanes, silicones, polyamides, polyesters, and other copolymers and mixtures thereof. The material used for the wound cover may be hydrophobic or hydrophilic. Examples of suitable materials include those available from DeRoyal corporationAnd may be selected from Smith&From Nephew IncTo aid patient comfort and avoid skin maceration, the wound covering member is in some embodiments at least partially breathable so that water vapor evaporatesVapor can pass through without remaining under the wound dressing. An adhesive layer may be provided on at least a portion of the lower side of the wound cover 107 to secure the wound cover to the skin of the patient, although certain embodiments may alternatively use a separate adhesive or adhesive tape. Optionally, a release layer may be provided on the adhesive layer to protect it prior to use and facilitate handling of the wound cover 107; in some embodiments, the release layer may be comprised of multiple sections.

The negative pressure system 101 may be connected to a source of negative pressure, such as a pump 114. One example of a suitable pump is the Renasys EZ pump available from Smith & Nephew corporation. The wound cover 107 may be connected to a negative pressure source 114 via a conduit 112. The conduit 112 may be connected to a port 113 located on the aperture 109 in the wound cover 107, or the conduit 112 may be connected directly through the aperture 109 without the use of a port. In a further alternative, the conduit may pass under the wound cover and extend out from the side of the wound cover. U.S. patent No.7,524,315 discloses other similar aspects of a negative pressure system and is incorporated herein by reference in its entirety and to be considered a part of this specification.

In many applications, a container or other storage unit 115 may be inserted between the negative pressure source 114 and the conduit 112, allowing wound exudate and other fluids removed from the wound site to be stored without entering the negative pressure source. Some types of negative pressure sources, such as peristaltic pumps, may also allow the container 115 to be placed after the pump 114. Certain embodiments may also use filters to prevent fluids, aerosols, and other microbial contaminants from exiting the container 115 and/or entering the negative pressure source 114. Further embodiments may also include a shut-off valve or a hydrophobic and/or oleophobic filter for plugging to prevent spillage; other embodiments may include a sensing device, such as a capacitive sensor or other fluid level sensor, for stopping or turning off the negative pressure source when the fluid level in the container approaches capacity. At the pump discharge, an odor filter, such as an activated charcoal canister, may also preferably be provided.

Fig. 2A-2E illustrate an embodiment of a wound securing material 200 having lips that may be used with the negative pressure systems and methods described herein. In contrast to fig. 1, the securing material 200 in fig. 2A-2E does not include the fingers shown in the embodiment of fig. 3A-3B. Fig. 2A shows one embodiment of a securing material 210 as an elongated layer or strip 210 that may have a straight or substantially straight length between ends 214 and 215 prior to use, and that may be severed to an appropriate length around wound filler 103. The ends 214,215 may be connected to form an angular shape and may be attached by an attachment mechanism, such as an adhesive, a catch or barb, velcro, a hook of velcro, a mushroom hook of velcro, or other attachment mechanisms known in the art. For example, after the elongate strip is cut to an appropriate length, its ends 214 and 215 may be placed together and attached to form a loop shape, as shown in fig. 2C. In other embodiments, the wound securing material may be pre-formed into an annular shape to fit different sizes of wound filler.

As shown in fig. 2A-2E, wound securing material 200 may have a lip 216, an inner surface 211, and an outer surface 212, and a thickness 213 therebetween. In certain embodiments, the elongated layer 210 may have a height of the inner and outer surfaces 211,212 that is greater than its thickness 213. The inner surface of the elongate layer 211 may be configured to attach to the wound filler 103. The wound securing material 200 includes a lip 216 and the elongated layer 210 may stabilize the wound filler and/or wound closure device in place in the wound.

In certain embodiments, the elongate layer may have a lip that forms an L-shaped cross-section as may be shown in fig. 2A-E. FIG. 2B shows a cross-sectional view of one embodiment of an elongated layer, wherein the lip 216 has an L-shaped cross-section. In certain embodiments, the elongate layer may take the form of a strip without a lip. In such embodiments, the elongate layer may be used in the same manner as described herein with reference to the elongate layer having a lip, however a portion of the elongate layer is not disposed beneath the fascia.

Fig. 2D-2E illustrate one embodiment of an elongated layer 220 that is disposed in a ring shape, with cracks shown. The lip 216 may have slits or cuts 221 that allow the elongate layer to bend into an angled shape, as shown in fig. 2A-2E.

In certain embodiments, the wound securing material 200 of fig. 2A may be made of foam. In other embodiments, wound securing material 200 may be formed of any material that can transmit negative pressure and/or fluids. In certain embodiments, the material may be a bonded open-mesh foam having a porosity in the range of 60ppi (or about 60ppi) or less, 50ppi (or about 50ppi) or less, 40ppi (or about 40ppi) or less, 30ppi (or about 30ppi) or less, 20ppi (or about 20ppi) or less, or 10ppi (or about 10ppi) or less. The foam is compressed with heat and/or pressure to form a more rigid, cohesive foam. For example, in certain embodiments, the material may be a bonded 10-60ppi (or about 10 to about 60ppi) open mesh foam, such as a bonded foam that has been compressed with heat and/or pressure to form a more rigid. Such foam may offer few barbs, which may help to better attach the material to the tissue. In certain embodiments, bonding may be important to increase the stiffness of the foam, but retains the structure that can still be used as a manifold for exudates and vacuum. In certain embodiments, the result of the bonding is a tighter structure and thus the resulting surface may be less open for tissue ingrowth. In certain embodiments, the foam may have a finer pore size, such as 60ppi to 200ppi (or about 60ppi to about 200ppi), or greater than 60ppi (or about 60ppi), to minimize the formation of granulation tissue.

In certain embodiments, the wound securing material 200 may be made of a material that does not adhere to the wound site. The non-adhesive material may aid in wound closure without adhering to the tissue of the wound site. The non-adhesive material may prevent damage to the wound tissue when the wound closure device is removed from the wound site. In addition, the wound securing material 200 may be a porous or non-porous material.

In one embodiment, the wound securing material 200 may be a flexible covering layer, such as a mesh film, that is secured to the peripheral surface of the wound filler 103 and may expand and contract as the wound filler 103 expands and contracts. At one endIn one embodiment, wound securing material 200 may be a mesh film or a composite polyester mesh film, such as Parietex (Paietex) from Covidien corporation (Mansfield, MA)^TMAnd (3) a net.

In certain embodiments, the inner surface 211 may be configured to attach to the wound filler by any suitable attachment mechanism, such as, for example, an adhesive, a catch or barb, velcro, hooks of velcro, mushroom-shaped hooks of velcro, or other attachment mechanisms known in the art. In certain embodiments, the elongate layer 210 is provided with attachment means integrated in the inner surface 211. In some embodiments, the inner surface 211 may be prepared prior to insertion into a body cavity using an attachment device.

The elongate layer 210 may also have an outer surface 212 configured to be attached to a wound surface. In certain embodiments, the outer surface 212 may be configured to be attached to the wound surface by any suitable tissue attachment mechanism, such as adhesives, catches or barbs, tissue grabbers as known in the art, glue, sutures, Parietex (Parietex surgical patch), or other tissue attachment mechanisms as known in the art. For example, in certain embodiments, the outer surface 212 may have barbs that may facilitate attachment to tissue, such as rearwardly facing barbs that may anchor into tissue when the barbs are pulled in a direction closing the wound cavity, but may be released when pushed in the opposite direction and may provide a sealing force on the wound. In certain embodiments, the barbs may be polymeric, glass, metal, fine hair-like structures, and/or other barbs known in the art. In some embodiments, the barbs may be smooth, rod-like projections. Alternatively, in certain embodiments, the barbs may have a roughened surface or a peaked surface to increase the attachment force. In certain embodiments, the length of the barbs may be in the range of 0.1mm to 5mm (or about 0.1mm to about 5mm), such as 5mm (or about 5mm), 4mm (or about 4mm), 3mm (or about 3mm), 2mm (or about 2mm), or 1mm (or about 1 mm). In certain embodiments, the spacing of the barbs may be in the range of 0.1mm to 10mm (or about 0.1mm to about 10mm), such as 10mm (or about 10mm), 8mm (or about 8mm), 6mm (or about 6mm), 4mm (or about 4mm), 2mm (or about 2mm), or 1mm (or about 1 mm). In certain embodiments, the elongate layer 210 is provided with attachment means integrated in the outer surface 212. In certain embodiments, the outer surface 212 of the elongate layer 210 may be prepared prior to insertion into a body lumen using an attachment device.

In certain embodiments, the lip 216 may be attached to the base 232 of the outer surface 212 or form the elongate layer 210, forming a generally L-shaped cross-section as shown in FIG. 2B. In certain embodiments, the lip 216 may be made of the same or different foam materials as described above. In other embodiments, the lip may be formed of other materials known in the art that are suitable for contacting a wound or fascia of a patient. In certain embodiments, the lip 216 may be formed of a material capable of transmitting negative pressure and/or fluid. In certain embodiments, the lip 216 may be a non-porous material. In certain embodiments, the lip 216 may be a porous material. In certain embodiments, the lip may be made of a material that does not adhere to the wound site. The non-adhesive material may aid in wound closure without adhering to the tissue of the wound site. The non-adhesive material may prevent damage to the wound tissue when the wound closure device is removed from the wound site.

Additionally, in certain embodiments, the lip 216 may be a flexible material, such as a flexible polymeric material. The lip 216 may have varying stiffness as it extends outwardly from the wound filler, for example, the lip 216 may be rigid near the wound filler, and the lip material may increase in flexibility and/or decrease in strength as the lip extends radially outwardly. As shown in fig. 2B, the lip 216 may have a top surface 218, a bottom surface 219, and a thickness therebetween. In addition, the lip 216 may have a front or outer surface 231.

The lip 216 may have an upper surface 218 that may be configured to attach to a wound site. In certain embodiments, the lip may have means for attaching the lip to the fascia. In certain embodiments, the upper surface 218 may be configured to be attached to the wound site by any suitable tissue attachment mechanism, such as adhesives, catches or barbs, tissue grabbers known in the art, glue, sutures, paritex, or other tissue attachment mechanisms known in the art. In some embodiments, the barbs may be smooth, rod-like projections. Alternatively, in certain embodiments, the barbs may have a roughened surface or a peaked surface to increase the attachment force. For example, in certain embodiments, the lip 216 may have barbs, such as rearwardly facing barbs, that may aid in attachment to tissue or anchoring the lip into fascia when the barbs are pulled in a direction that closes the wound cavity, but may be released when pushed in the opposite direction and may provide a closing force on the wound. In certain embodiments, the barbs may be polymeric, glass, metal, fine hair-like structures, and/or other barbs known in the art. In certain embodiments, the length of the barbs may be in the range of 0.1mm to 5mm (or about 0.1mm to about 5mm), such as 5mm (or about 5mm), 4mm (or about 4mm), 3mm (or about 3mm), 2mm (or about 2mm), or 1mm (or about 1 mm). In certain embodiments, the spacing of the barbs may be in the range of 0.1mm to 10mm (or about 0.1mm to about 10mm), such as 10mm (or about 10mm), 8mm (or about 8mm), 6mm (or about 6mm), 4mm (or about 4mm), 2mm (or about 2mm), or 1mm (or about 1 mm).

In some embodiments, the lip 216 is provided with an attachment feature integrated into the upper surface 218. In certain embodiments, the upper surface 218 of the lip 216 may be prepared prior to insertion into a body cavity using an attachment device. The surface of the lip from which the barbs project may be smooth to limit the formation of granulation tissue on the fascia. The tissue attachment mechanism on the lip 216 may be the same tissue attachment mechanism as used on the other components of the device. In other embodiments, the tissue attachment mechanism on the lip 216 may be of a different type than that used on other components of the device. For example, different types of tissue attachment mechanisms may be used to attach the lip surface 218 to the fascia than to attach the outer surface 212 of the elongate layer to fat or other tissue.

Alternatively, in certain embodiments, the wound securing material may comprise an elongate layer, such as an adhesive tape with or without a lip. The tape may surround the wound filler when in use. In certain embodiments, the tape may include adhesive, barbs, velcro, hooks of velcro, mushroom hooks of velcro, or other attachment mechanisms known in the art on both sides. In other embodiments, the tape may have adhesive, barbs, velcro hooks, velcro mushroom hooks, or other attachment mechanisms known in the art on the tissue-facing side, and adhesive or other attachment mechanisms known in the art on the side facing the wound filler. In some embodiments, the barbs may be smooth, rod-like projections. Alternatively, in certain embodiments, the barbs may have a roughened surface or a peaked surface to increase the attachment force. In certain embodiments, the length of the barbs may be in the range of 0.1mm to 5mm (or about 0.1mm to about 5mm), such as 5mm (or about 5mm), 4mm (or about 4mm), 3mm (or about 3mm), 2mm (or about 2mm), or 1mm (or about 1 mm). In certain embodiments, the spacing of the barbs may be in the range of 0.1mm to 10mm (or about 0.1mm to about 10mm), such as 10mm (or about 10mm), 8mm (or about 8mm), 6mm (or about 6mm), 4mm (or about 4mm), 2mm (or about 2mm), or 1mm (or about 1 mm). In some embodiments, the barbs on the tape may be of different sizes and shapes. In some embodiments, the barbs on the tape may be of the same size and shape.

Fig. 3A shows one embodiment of a wound securing material 200 having an elongated material layer 210 with a lip and a plurality of fingers 217 extending outwardly from the lip. The lip may have one or more outwardly extending fingers 217 protruding from the end of the lip 216. In certain embodiments, a plurality of outwardly extending fingers 217 may protrude from the end of the front surface 231 of the lip 216, as shown in fig. 3A. In some embodiments, the fingers 217 may each have a distal end 240 and a proximal end 241 and a length extending from the distal end 240 to the proximal end 241. In certain embodiments, the proximal end 241 of each finger 217 may be attached to the front surface 231 of the lip 216. In certain embodiments, the lip 216 forms a finger 217 that protrudes from the front surface 231 of the lip 216. In certain embodiments, the fingers 217 may be a foam material. In certain embodiments, the fingers 217 may comprise a different foam material than the material used for the elongate layer, the lip, and/or other components of the device. In other embodiments, the fingers may comprise a foam material similar or identical to the material used for the elongate layer, lip, and/or other components of the device, or any other foam described herein. In certain embodiments, the foam for the fingers may be compressed as described herein. In certain embodiments, the foam material for the fingers 217 may be a foam having a porosity, for example, in the range of 60ppi to 200ppi (or about 60ppi to about 200ppi), or greater than 60ppi (or about 60ppi), to minimize the formation of granulation tissue.

In some embodiments, the fingers or even a portion of the wound securing material, such as lip 216, may be made of a 3D fabric rather than foam, such as a knitted or woven spacer fabric (e.g., a knitted polyester 3D fabric, a polyester fabric, a polyurethane, or a polyurethane, a,Or) Or a non-woven fabric. In certain embodiments, the finger or wound securing material may comprise other materials that may remain porous when compressed, including non-woven materials and/or other materials described herein or known in the art. In some embodiments, the fingers 217 may be formed of a non-porous material. Additionally, in certain embodiments, the fingers 217 may be a flexible material, such as a flexible polymeric material. In certain embodiments, as the finger 217 extends outwardly from the lip 216, the finger 217 may have varying stiffness, e.g., proximate the lip 216, at the proximal end 241 the finger 217 may be rigid, but as the finger 217 extends radially outwardly from the lip 216, the finger 217 may increase in flexibility and/or decrease in strength, and the distal end 240 may be flexible. In some embodiments, the fingers 217 may have a varying thickness as the fingers 217 extend outwardly from the lip 216, e.g., the thickness of the fingers may decrease along the length of the fingers 217, and the proximal end 241 may be thicker than the distal end 240. Additionally, in certain embodiments, the fingers may be bifurcated and/or include intersectionsA member, such as a cross member, may extend from one finger to the other, thereby connecting the fingers together. Further, in certain embodiments, the fingers 217 may vary in width, for example the fingers 217 may widen as they extend radially outward from the lip 216, and the distal end 240 may be wider than the proximal end 241. The widening of the fingers allows for more fluid to be removed.

In certain embodiments, the fingers 217 may facilitate abdominal drainage as they contact the wound site and/or extend into the back of the abdomen. In certain embodiments, the fingers 217 can help secure the lip 216 during use, as the fingers 217 can be inserted between the fascia and the internal organs, as further described below. In some embodiments, the fingers 217 may extend to the rear of the abdomen, thereby draining fluid from the majority of the abdominal cavity. For example, fluid may move along the length of the fingers toward the point of application of negative pressure, thereby evacuating fluid from the abdominal cavity.

Additionally, the surface of the finger 217 may be in contact with the wound site and the interior of the body cavity. This interaction of the surface of the fingers 217 with the interior of the body may cause the formation of granulation tissue. In certain embodiments, the fingers 217 may be formed of foam having a porosity in the range of 60ppi to 200ppi (or about 60ppi to about 200ppi) to prevent granulation of the tissue. Fig. 3B shows an embodiment of a wound securing material having the fingers described with reference to fig. 3A, but the fingers as shown in fig. 3B may be surrounded by an organ protective layer 305. In certain embodiments, fingers 217 may be sealed by an organ protection layer 305 having a plurality of fluid drainage openings or crevices that prevent granulation tissue and other unwanted interactions between the fingers and the interior of the body cavity. In certain embodiments, the organ protective layer 305 surrounding the fingers 217 may be microporous or semi-permeable, such as a dialysis membrane. In certain embodiments, the organ protection layer 305 may serve to increase the strength of the fingers 217 and thus reduce the chance of the component remaining in the body due to tearing during removal.

Fig. 4 shows a top view of an embodiment of a wound securing material 200 similar to that of fig. 2C, including an elongate layer 210 shaped or having a ring shape, the elongate layer 210 having an outwardly extending lip 216 and a slit 221. Fig. 5 shows a top view of an embodiment of a wound securing material 200 similar to that of fig. 3A-3B formed or having an annular shape with fingers 217 extending outwardly from a lip 216. In certain embodiments, when the elongate layer 210 of fig. 2A including the lip 216 is bent into an angled shape and the first end 214 and the second end 215 are attached, the elongate layer can form a loop shape, as shown in the top view shown in fig. 4. In certain embodiments, when the elongate layer 210 including the lip 216 and the outwardly projecting fingers 217 in fig. 3A-3B is bent into an angled shape and the first end 214 and the second end 215 are attached, the elongate layer may form a loop shape, as shown in the top view shown in fig. 5.

Fig. 6A-6C show cross-sectional views of a negative pressure system 101 having the components described with reference to fig. 1 applied to a wound. Fig. 6A shows a cross-sectional view of a wound securing material 200 similar to the embodiment of fig. 2A-E in the wound area. In certain embodiments, organ protection layer 105 may be positioned in a wound site, as shown in fig. 6A. In some embodiments, the organ protection layer 105 may extend radially beyond the foam layer 104, and the outer end 602 of the organ protection layer may be inserted below the abdominal wall 601. In certain embodiments, the organ protection layer may have a length in the range of 900mm (or about 900mm) or less, 800mm (or about 800mm) or less, 700mm (or about 700mm) or less, and 600mm (or about 600mm) or less.

In certain embodiments, a foam layer 104 may be provided over the organ protection layer 105. The foam layer 104 may be the foam described herein or other foams known in the art. In certain embodiments, the foam may have a thickness in the range of 1mm to about 20mm (or about 1mm to about 20mm), such as 15mm (or about 15mm) or less, 10mm (or about 10mm) or less, or 5mm (or about 5mm) or less. In some embodiments, the outer perimeter or boundary of the foam 104 will not extend beyond the front surface 231 of the lip 216 of the wound securing material 210. In certain embodiments, the foam layer 104 will extend to the front surface 231 of the lip 216. In certain embodiments, the foam 104 will not protrude below the tissue 600 of the wound site. In some embodiments, the foam 104 may extend beyond the front surface 231 of the lip 216, as shown in fig. 8A. In certain embodiments, the foam layer 104 may be at least partially surrounded by the elongate layer 210 and/or the lip 216 of the wound securing material 200, as shown in fig. 6C-6D.

In certain embodiments, wound filler 103 may be placed on top of foam layer 104 and below foam layer 102. In certain embodiments, the wound filler can be a wound filler as described herein or other foams known in the art. In certain embodiments, the wound filler may have a thickness in the range of 5mm to 40mm (or about 5mm to about 40mm), such as 40mm (or about 40mm) or less, 30mm (or about 30mm) or less, or 10mm (or about 10 mm). In certain embodiments, the wound filler may have a thickness for a lower limit within the neonatal application range. In addition, the wound filler 104 may be used in conjunction with other wound fillers stacked in the wound site for larger or deeper wounds. In such embodiments, such additional wound filler may also be surrounded by additional wound securing material as described herein. In certain embodiments, the additional wound securing material surrounding the wound filler stacked on top of the underlying wound filler may be an elongated layer without finger-like protrusions. In certain embodiments, the additional elongated layer surrounding the wound filler stacked on top of the underlying wound filler may be an elongated layer without lips.

In some embodiments, the wound filler may be surrounded by an elongate layer 210. The elongate layer 210 may have a lip 216. The elongate layer 210 and lip 216 may be any embodiment of the elongate layer and/or lip described herein. The lip 216 of the elongate layer 210 may extend under the tissue 600. In certain embodiments, the lip 216 may be inserted beneath a layer of tissue 600 in which a closing force is required to close the wound cavity. In certain embodiments, the lip may extend under the deep fascia, sub-serosal fascia, serosa, peritoneum, or any other layer located between the superficial layer and the viscera. For example, in one embodiment, for an abdominal wound, the lip may preferably be placed under the peritoneum. The use of a lip may thus facilitate the retention and retention of wound filler at the correct vertical height in the wound. In certain embodiments, the lip may have a length of between 5mm to 60mm (or about 5mm to about 60mm), such as 60mm (or about 60mm) or less, 50mm (or about 50mm) or less, 40mm (or about 40mm) or less, 30mm (or about 30mm) or less, or 10mm (or about 10mm) or less. The attachment mechanism on the lip 216 may thus be used to facilitate movement of the fascia when the wound is closed.

During use in a wound cavity, the elongate layer 210 and lip 216 surround the wound filler 103. In certain embodiments, wound filler 103 may be wrapped with elongated layer 210 and attached to elongated layer 210 with lip 216 before the unit is inserted into the body cavity. Additionally, the elongate layer 210 with the lip 216 and wound filler 103 may be a unitary piece of material. Alternatively, in certain embodiments, the elongate layer 210 with the lip 216 may be cut and sized to fit the wound site 110 and then placed in the wound site. n wound filler 103 may be placed and attached in the inner surface 211 of the elongate layer 210 with lips 216. The inner surface 211 of the elongate layer 210 may be in contact with the wound filler 103 and the outer surface of the elongate layer 212, and the lip may contact the interior of the wound site. The inner surface 211 and wound filler 103 may be attached by the attachment means described herein as well as other attachment means known in the art.

In certain embodiments, a foam layer 102 may be provided over the wound filler 103. The foam layer 102 may comprise the foam described herein or other foams known in the art. In certain embodiments, the foam may have a thickness in the range of 1mm to about 20mm (or about 1mm to about 20mm), such as 15mm (or about 15mm) or less, 10mm (or about 10mm) or less, or 5mm (or about 5mm) or less. In some embodiments, the outer boundary of the foam 102 will not extend beyond the outer surface 212 of the elongate layer 210. In certain embodiments, the foam 102 will extend to the outer surface 212. In certain embodiments, the foam 102 may extend beyond the outer surface 212, as shown in fig. 8A. In certain embodiments, the foam 102 may be at least partially surrounded by the elongate layer 210 and/or the lip 216, as shown in fig. 6C-6D.

In certain embodiments, foam layer 102 is covered by wound cover 107. Wound cover 107 may include all embodiments of the wound covers described herein as well as other wound covers known in the art. Port 113 and conduit 112 may be used to connect the wound cover to the negative pressure source described above.

FIG. 6B shows a cross-sectional view similar to that described in FIG. 6A, however, FIG. 6B shows the elongate layer 210 having fingers 217 that protrude outward from the lip as described with reference to FIG. 3. In some embodiments, the fingers 217 may have a length in the range of 100mm to about 300mm (or about 100mm to about 300mm), such as 250mm (or about 250mm) or less, 200mm (or about 200mm) or less, or 150mm (or about 150mm) or less. In certain embodiments, the lip 216 and finger 217 may be inserted beneath a layer of tissue 600 in which a closing force is required to close the wound cavity. In certain embodiments, the lip and fingers 217 may extend under the deep fascia, sub-serosal fascia, serosa, peritoneum, or any other layer located between the superficial layer and the viscera. For example, in one embodiment, for an abdominal wound, the lip may preferably be placed under the peritoneum.

FIG. 6C shows an alternative embodiment of a cross-sectional view of an elongated layer in the wound area, similar to that described with reference to FIG. 6A. Fig. 6C further shows the elongate layer 210 having an attachment mechanism 700 for attaching the elongate layer to the wound filler material. Attachment mechanism 700 may be implemented by any of the means described herein as well as other attachment mechanisms known in the art. Additionally, fig. 6C further shows an attachment mechanism 701 for attaching the outer surface 212 of the elongate layer to the wound site. Attachment mechanism 701 may be implemented by any of the means described herein as well as other attachment mechanisms known in the art.

Fig. 6D shows the elongate layer 210 with an attachment mechanism 702. In certain embodiments, the outer surface 212 of the elongate layer can be attached to the wound site by tissue attachment means described herein, as well as other tissue attachment means known in the art. In certain embodiments, the upper surface 218 of the lip can be attached to the wound site by tissue attachment means described herein, as well as other tissue attachment means known in the art. Attachment mechanism 702 may be implemented by any of the means described herein as well as other attachment mechanisms known in the art. In some embodiments, attachment mechanisms 700,701, and 702 may utilize the same attachment means. Alternatively, in certain embodiments, attachment mechanisms 700,701, and 702 may utilize different attachment means.

In certain embodiments, the lip 216 may extend outwardly into the wound cavity. The top surface of lip 216 may be located below the patient's peritoneum or fascia. In certain embodiments, lip 216 may be inserted into wound site 110 by a medical professional or user manipulating lip 216 with his or her fingers, such that lip 216 reaches beneath the peritoneum. An optional tissue attachment mechanism on the top surface of the lip may adhere the lip to the wound site and secure the lip 216, as shown in fig. 6D. The secure connection of the elongate material 210 by the secure connection of the lip 216 to the wound site 110 may ensure the positioning of the wound filler 103 attached to the inner surface 211 of the elongate material 210. In certain embodiments, the lip 216 can help provide structural stability to the device and prevent the wound filler or device from walking out of the wound site. Additionally, barbs or catches on the lip 216 may also create a pulling force to draw the bottom of the wound together.

In some embodiments, the bottom surface of lip 216 may be in contact with bottom foam layer 104 and/or organ protection layer 105, depending on the components used and the dimensions of those components. In certain embodiments, it may be preferred that the lip 216 and/or fingers 217 not be in direct contact with the organ itself, and/or that the lip 216 and/or fingers 217 be surrounded by an organ protective layer, or that an organ protective layer be placed between the lip 216 and/or fingers 217 and the internal organ.

Fig. 7 shows a top view of wound filler 103 inserted into wound 110, wherein wound securing material 200 described in fig. 3A-3B surrounds the wound filler. Anterior surface 231 lip 216 and finger 217 are shown in phantom to depict lip 216 and finger 217 positioned radially outward of the wound edge and positioned beneath the fascia.

Fig. 8A-H show partial cross-sectional views of an embodiment of a negative pressure wound therapy system including a wound securing material having an elongate layer and a lip. The negative pressure wound therapy system is similar to the system described with reference to fig. 6A, including the wound securing material shown in fig. 8A-B. Fig. 8A-B further illustrate the foam 102 extending beyond the elongate layer 210 and contacting the top surface of the tissue. Additionally, fig. 8B shows an embodiment comprising two wound packing materials 103 separated by an additional foam layer 160. In certain embodiments, two wound filler materials 103 and additional foam 160 may be surrounded by the elongate layer 210 and the lip 216.

Fig. 8C-D show an embodiment of a negative pressure wound therapy system including a wound securing material similar to that described with reference to fig. 6A. Fig. 8C-D further illustrate the foam layers 102,104 at least partially surrounded by the elongate layer 210 and/or the lip 216. Furthermore, fig. 8B shows an embodiment comprising two wound packing materials 103, which are separated by an additional foam layer 160. In certain embodiments, two wound filler materials 103 and additional foam 160 may be surrounded by the elongate layer 210 and the lip 216.

Fig. 8E-F show an embodiment of a negative pressure wound therapy system including a wound securing material similar to that described with reference to fig. 8A-B. Fig. 8E-F further illustrate the use of the gripper and/or attachment mechanisms 700,701 described with reference to fig. 6C.

Fig. 8G-H show an embodiment of a negative pressure wound therapy system that includes a wound securing material similar to that described with reference to fig. 8C-D. Fig. 8G-H further illustrate the use of the gripper and/or attachment mechanisms 700,701 described with reference to fig. 6C.

Fig. 8I-K are enlarged views of an embodiment of a wound securing material positioned in a wound, including attachment mechanism 701,700. In certain embodiments, the attachment mechanism 701 may be a mushroom-shaped gripper, as shown in fig. 8I. In certain embodiments, the attachment mechanism 701 may be a q-tilt gripper, as shown in fig. 8J. In certain embodiments, the attachment mechanism 701 may be a hook-shaped gripper, as shown in fig. 8K.

In certain embodiments, the elongate material 210 may take the form of a strip without a lip. The elongate layer without the lip may have fingers that extend directly from the outer surface 212 of the elongate material 210. These fingers, which extend directly from the elongate layer, may contact the tissue and be placed beneath the fascia and/or any other layer or structure described herein. In certain embodiments, fingers 217 extending directly from the elongate layer 210 without a lip can support and secure the wound securing material 200 and provide the functionality of an elongate layer with a lip as described herein.

In certain embodiments, the elongate material 210 may have more than one lip 216 extending outwardly from the elongate material. In one embodiment, the elongate layer may have two separate lip regions extending outwardly from an outer surface of the elongate layer, which may be positioned at different depths in the wound. For example, one lip may extend laterally from the elongate layer and may be positioned between the abdominal cavity and the fascia, while a second lip may be positioned between the fascia and overlying tissue.

In the embodiments described above, the elongate material 210 and lip 216 are preferably integrally formed or attached to each other such that the elongate material and lip are integrated into a single piece for simultaneous placement in a wound. The elongate material may also be pre-attached to any wound filler described herein such that the wound filler, elongate material and lip are placed in the wound simultaneously. Figures 9A-9C illustrate another embodiment of treating a wound 1900 with a wound filler in the negative pressure region 1918, the wound filler being a separate element from the underlying pad 1925 that extends laterally beyond the edges of the wound filler 1918. In fig. 9A, pads 1925 are shown positioned between the fascia and overlying tissue, but in other embodiments pads 1925 may be positioned below the fascia. Pad 1925 also need not be a separate element from padding 1918 and may be attached to or integral with the padding. It should be further appreciated that features of pad 1925, such as drains, apertures, and tissue anchors, described further below, may also be included in lip 216, which may be integral with the elongate material 210 described above.

In fig. 9A, a wound incision 1900 is shown in which tissue region 1906,1908 has been separated to access underlying tissue region 1902 for treatment. Lateral displacement of region 1906,1908 from its corresponding location of upper layer region 1902 causes further separation between displaced region 1906,1908 and the underlying structure. In the case of an open abdominal wound, the underlying structure may be the large and small intestines, which may be subject to infection and/or elevated fluid pressure.

In addition, there may be a space between fascia 1909,1911 and abdominal muscles and the superior subcutaneous tissue 1906,1908. Thus in fig. 9A, the system optionally includes three components, namely, a pad 1907, a pad 1925, and a wound filler 1918, the pad 1907 being positioned between the abdominal cavity 1902 and the fascia, which can be used to allow sliding movement and use negative pressure, and the pad 1925 being described in more detail below, which is positioned between the fascia and the overlying tissue. The negative pressure region of the wound filler 1918 may be in fluid communication with the lower layer of the pad 1925, with the pad 1925 extending laterally to the sections 1914 and 1916 between the upper tissue 1906,1908 and the lower abdominal muscle and fascia structure 1911,1909, respectively. As described herein, one or both sides of the segments 1914,1916 may have tissue anchors. Dashed line 1921 indicates the area through which negative pressure is applied to all three layers.

After insertion of pad 1925, compressible wound filler 1918 is inserted, followed by wound cover 1905 and port 1940 and conduit 1942. The pads 1907 operate to evacuate fluid 1910 from the abdominal cavity by negative pressure through pads 1925 and wound filler 1918.

In certain embodiments, the wound filler 1918 can be integrated or attached to the lower layer. For example, the wound filler 1918 can be integrated onto the pad 1925. In certain embodiments, wound filler 1918 can be integrated with or attached to pads 1925 and 1907. In some embodiments, the system does not include pads 1925. In such embodiments, the wound filler 1918 may be integrated or attached to the backing 1907, which may be positioned between the abdominal cavity 1902 and the fascia. For example, in certain embodiments, the liner 1907 may be positioned on top of the peritoneal layer of the viscera.

In one embodiment, as wound filler 1918 collapses horizontally under negative pressure as described herein, attached pads 1907 and/or pads 1925 will also collapse horizontally. Horizontal collapse may cause pads 1907 and/or pads 1925 to slide relative to the tissue layer upon which pads 1907 and/or pads 1925 are positioned. For example, in certain embodiments, the wound filler 1918 is attached to the liner 1907, and the liner 1907 is positioned on the peritoneal layer of the viscera. As the wound filler 1918 collapses horizontally under the application of negative pressure, the horizontal collapse may thus cause the attached liner 1907 to slide over the peritoneal layer of the viscera.

In some embodiments, the wound filler 1918 may be attached to the underlying pad at substantially all points of contact between the wound filler 1918 and the underlying pad in other embodiments, the wound filler 1918 may be attached to the underlying pad 1925 and/or pad 1907 at one or more points of attachment. In one embodiment, the wound filler 1918 may be attached to the underlying pad 1925 and/or pad 1907 only at the central attachment point. As the wound filler 1918 collapses horizontally, the wound filler 1918 will slide horizontally relative to the underlying pad 1925 and/or pad 1907 due to the central attachment point. In certain embodiments, the wound filler 1918 may be attached to the underlying pad 1925 and/or pad 1907 by one or more ribs extending along the center of the wound filler 1918. One or more ribs may extend downward from the center of the wound filler 1918 and connect to the pads 1925 and/or pads 1907. Additionally, in certain embodiments, wound filler 1918 can be attached to pads 1925 and/or pads 1907 by an adhesive.

In the event that adjacent tissue requires treatment with negative pressure or stabilization by, for example, pads 1925, the wound treatment system may be used in conjunction with the systems and methods described herein. A top view of a system utilizing a wound filler 1918 and a pad 1925 substantially as described herein is shown in fig. 9B. The pad 1925 may also be circular in shape and devoid of holes or tissue anchors, for example. The number of drains may be in the range of 6-10, which extends in radial direction according to a uniform angular spacing between the drain elements.

Thus, a preferred embodiment provides a pad or surgical drainage device 1925 for facilitating drainage of a surgical wound and wound closure. The drainage device can include a plurality of drainage tubes 1935 disposed on a substrate referred to as an "adhesive matrix" designed to promote tissue adhesion in the wound space. The adhesive matrix has a suitable configuration and is made of a flexible material with a flat surface that can be bent to fit the shape of the wound space.

In a preferred embodiment, the adhesive matrix comprises a plurality of apertures 1927 or gaps in the matrix that allow tissue contact across the matrix to promote adhesion and wound closure. Thus, the tissue surface on a first side of the matrix may be in direct contact with the tissue surface on a second or opposite side of the matrix, thereby promoting rapid healing and stabilization of the wound. The number, size, and distribution of the holes 1927 through the matrix can be selected based on the geometry of the wound. For abdominal wounds, for example, the drains may be positioned in a fan-shaped array having a plurality of three or more tubes extending from a manifold. The matrix and/or tubing may be cut or custom shaped by the user to conform to the shape of the wound. The matrix may also serve as a drug carrier to aid the patient in administering the drug. The substrate optionally includes a layer of adhesive on at least a portion of any of its surfaces. Once the drainage flow is sufficiently reduced, the drain tube can be removed from the device and the adhesive matrix can remain in the body where it will be broken down and absorbed over time, remaining in place to optimize healing of the tissue. The matrix may comprise a porous biodegradable polymeric material. With multiple tubes extending distally spaced from a single exit site into the wound, a user can easily remove all of the tubes from the wound simultaneously.

As shown in more detail in fig. 9C, pad 1925 may include a tissue anchoring system whereby the device is mechanically attached to the surrounding tissue by an array of surface barbs or hooks 1926,1928 or other attachment mechanisms described herein. These surface structures may be positioned on any exposed surface of the adhesion matrix. When the device is implanted, the surrounding tissue may be compressed over the barbs or hooks, thereby embedding them in the tissue and anchoring the device. The use of surface barbs or hooks can be used in conjunction with surgical adhesives to provide a much stronger bond between tissue layers than the adhesive alone and to provide a temporary bond as the adhesive cures. The structure of the hooks can have various shapes depending on the tissue they are intended to engage. Longer hooks may be used for loosely bound tissue, such as fat or connective tissue, while shorter hooks may be used for tight tissue, such as muscle. Anchors with stiffer handles may be used to penetrate tighter tissues.

Another aspect of the invention is a system for negative pressure wound therapy. The system includes a drainage device or pad coupled to the wound filler 1918 as generally described herein and a vacuum source, such as a pump, and tubing connecting the vacuum source to a drainage tube of the drainage device or pad. The system may optionally further comprise a fluid trap that collects the drained fluid and a control unit that monitors and controls the application of the vacuum and the collection of the fluid. Other components of the system may include vacuum or pressure gauges, flow meters, and computers to monitor vacuum and flow, and adjust vacuum or flow. The pressure measurement may be used to control the applied pressure level using a feedback control circuit. The wound filler 1918 may comprise an endoskeleton structure as described in international application No. pct/US2013/050698, and may comprise a stabilizing structure, such as described with reference to fig. 14-25G, having external ribs and flexible arms or beams extending from an outer surface with an inherent restoring force that varies depending on the position of the respective flexible elements. Different flexible elements may have different restoring forces depending on their position in the structure. The endoskeleton adapts to expand to fill the wound cavity and will collapse in a well-defined manner in response to the wound collapsing under negative pressure. As described herein, foam or other filler material may be used in the flexible system. The endoskeleton may have a multi-layered structure in which the different layers collapse in the wound along separate planes of a three-dimensional structure without tilting the structure. Any other embodiment of a collapsible wound filler described in international application No. pct/US2013/050698 entitled "negative pressure wound closure device" filed on 7, 16, 2013 or elsewhere in this specification may also be utilized.

Fig. 10 shows another embodiment in which a wound closure element 1007 is positioned below the wound filler 1020, the wound closure element extending laterally beyond the wound filler 1020 such that the wound filler 1020 extends above or below the fascia. The wound closure element 1007 may be integral with, attached to, or a separate element from the wound filler 1020. In addition, features of the wound closure element may be incorporated into the lip 216 described above. The wound shown in fig. 10 has a wound opening 1001, which may have a generally circular or oval shape. The surgeon may use this opening to access tissue that must be removed, thereby forming a laterally extending cavity 1005. The wound closure element 1007 extends laterally to regions 1012,1015 which can include tissue anchors 1014,1016 for attaching the regions 1012,1015 to tissue flaps 1004,1006 above the regions 1012,1015, respectively, and to underlying tissue 1026. The anchor 928 may also extend in a lateral direction. The wound filler 1020 is in fluid communication with the wound closure element 1007 and allows negative pressure to be applied to the channels of the regions 1012,1015 as may be used in the embodiment of fig. 10. The closure elements may include holes 927 that allow tissue contact to be achieved through regions 1012 and 1015 when the elements are compressed under negative pressure.

Tissue anchors or attachment mechanisms 1014,1016 may be provided on the top and bottom surfaces 218, 219, respectively, of the lip to secure the wound securing material 200 to tissue. The bottom surface 218 of the lip faces the wound cavity and/or viscera, while the top surface 218 of the lip is opposite the bottom surface 219 and is closest to the surface layer. In some embodiments, the lip may extend below the fascia and be interposed between the fascia and the underlying peritoneal layer. The peritoneal layer is generally associated with and lies below the abdominal fascia. When the lip is placed between the fascia and the peritoneal layer, the tissue anchor 1014 on the underside 218 of the lip may extend into the peritoneal layer as the tissue anchor 1016 on the top side 218 of the lip may extend into the fascia. In certain embodiments, the lip may be placed under the fascia and peritoneal layer. The tissue anchor 1016 on the top surface 218 of the lip may be passed through the peritoneal layer into the fascia, thereby gripping the fascia and peritoneal layer and securing the lip to the wound cavity. In certain embodiments, the tissue anchor 1016 on the top surface 218 of the lip may be attached to the peritoneal layer and secure the lip to the peritoneal layer. In certain embodiments, the lip, elongated layer, and/or fingers may extend under the deep fascia, sub-serosal fascia, serosa, peritoneum, or any other layer located between the superficial layer and the viscera as described herein.

The attachment mechanism (e.g., 701,702 described above) may be provided on the entire peripheral surface of the wound securing material 200, or on a surface of the lip 216, wound filler, pad 925, or wound closure element 1007, as described above, or other surfaces. For example, referring to the embodiment of FIGS. 1-8J, when the filler material 103 is placed in the wound, the attachment mechanisms 701,702 are embedded in the tissue at the wound margin and secure the device 101 in the wound opening. The attachment mechanisms 701,702 may be spread over the entire surface of the wound edge to provide sufficient strength in terms of gripping force. The wound securing material 200 may be designed to allow the wound closure device 101 to be easily placed and also easily removed and replaced with a new device 101 or other wound dressing (e.g., after 2-7 days) as needed. The wound securing material 200 may be configured to have a high gripping strength over at least a portion of its surface, but may also be easily removed by, for example, pulling on the edge. Wound securing material 200 may be designed to be removed from a wound without damaging surrounding tissue. Attachment mechanisms 701,702 may be designed to accommodate various tissue applications, such as muscle, fat, skin, and cementum scleroprotein, and various combinations of these. In certain embodiments, the attachment mechanisms 701,702 may also be designed to securely attach to a particular tissue for a selected period of time. The attachment mechanisms 701,702 may also be formed using a resorbable material.

As shown in the cross-sectional view of fig. 11A, for example, wound securing material 200 may comprise an elongate member having two sets of attachment mechanisms as described herein. The wound fixation material 200 may have a first set 910 of outwardly facing tissue gripping elements or attachment mechanisms 912 that are designed to protrude into tissue. These tissue gripping elements are located on the tissue gripping surface of the wound fixation material 200. The second set 904 of elements 906 protrude into the filler material to secure the wound securing material 200 to the filler material. The second anchor element or attachment mechanism 904 may be shaped to grip the filler material, such as with a distal hook shape 906. Because the material 200 must be attached to the padding with a certain gripping strength in order to apply sufficient tension to the tissue, a prescribed force level F must be applied in order to remove the hooks from the padding material, which exceeds the tension applied to the tissue. Similarly, because the tissue to be grasped by the material 200 has different structural characteristics than the filler material, the first set of anchor elements 910 adapted to grasp tissue may have a different shape and grasping force than the second anchor elements. In this embodiment, barbs 912 may have bilateral prongs that tend to collapse when inserted into tissue and yet expand when pulled in the opposite direction so that some pulling force may be applied to the tissue. However, the bifurcated or conical shape of the anchoring element has a release force such that the barbs can be manually pulled away from the tissue without causing injury.

FIG. 11B is an edge view of the device 101 showing the attachment mechanism 926 protruding from the tissue gripping surface 924 at the perimeter of the wound filler material 103. In certain embodiments, the wound filler material 103 may be integrally formed with the wound securing material 200, which includes a tissue gripping surface 924 having an anchoring element or attachment mechanism 926. In other embodiments, the wound packing material does not contain wound securing material 200, and the tissue gripping surface 924 with the anchoring element or attachment mechanism 926 is formed from the wound packing surface. The attachment mechanisms 926 may be provided on the entire peripheral surface of the filler material 103, spread over the entire surface of the wound edge, to provide sufficient strength in terms of gripping force. The tissue gripping surface and/or the attachment mechanism may also be formed using a resorbable material. The filler material 103 containing the attachment mechanism 926 may include all of the features and details of the attachment mechanism as described herein with reference to the attachment mechanism on the wound securing material 200.

FIG. 11C is a side view of the tissue gripping surface of wound fixation material 200, showing the application to different types of tissue (T)₁，T₂) 601,602,603, 604. Also shown in the figures are examples of corresponding force profiles for the anchoring or attachment mechanisms, including the maximum force (F) applied to the tissue during vacuum sealing₁) And at homeThe force required to remove the anchor from the tissue in conditions of damage to the tissue (F)₂). In one embodiment, the characteristics of the tissue anchoring mechanisms or attachment mechanisms may be varied to provide different force profiles across the interface between the wound closure device and the surrounding tissue. For example, for the upper tissue layer, T₁The anchor 601 is designed for attachment to a cementous material, for example, in the dermis. Anchor 601 is in the upper tissue layer T₁Having different force profiles (F)₁And F₂) As shown in fig. 11C. In the lower tissue layer T₂In the upper, anchors 602,603,604 are designed for attachment to subcutaneous fat tissue. In general, a smaller force distribution is required to secure the anchor to this tissue.

The characteristics of the anchoring or attachment mechanisms and their resultant force profiles may be varied by a number of parameters, such as the length of the anchor, the shape of the attachment mechanism, the configuration of the gripping features, the material used for the attachment mechanism, the relative flexibility/stiffness of the attachment mechanism, and the spacing/density of the attachment mechanism. For example, in fig. 11C, anchor 601 is significantly longer than anchors 602,603, and anchors 602,603 are longer than anchor 604. Fig. 11C also shows the variation in anchor density, as shown for example at 602,603 and 604. Fig. 11D shows examples of three different types of gripping features, including a barb configuration 605, a staggered hook configuration 606, and a staggered barb configuration 607. Other suitable gripping features may be utilized such as anchor element 620 shown in the enlarged perspective view of fig. 11E. The anchoring or attachment process may be enhanced by suturing the filler material or supporting endoskeleton to the tissue. The force distribution may also be varied by controlling the vacuum force distribution in the filler material, for example by varying the pore size and/or pore density of the filler.

The wound closure devices of the present invention may be provided in kits for closing different types of wounds (e.g., abdominal, fasciotomy, etc.). The tissue gripping surface may be optimized for different types of tissue, such as cementum scleroprotein, adipose tissue, and muscle, depending on the tissue structure at the wound site.

As the filler material shrinks, the tissue gripping surface grasps and pulls on the adjacent tissue, which is preferably the tissue surrounding the wound margin, causing the tissue to shift, thus facilitating closure of the wound.

In certain embodiments, the force distribution of the wound closure device varies around the perimeter of the wound. An exemplary embodiment showing the force distribution (f) applied to the wound edge at multiple locations around the wound perimeter is shown in FIG. 12A₁). In this embodiment, the maximum f₁In the central region of the wound filler 102, where the wound opening is widest and the wound closure force is completely or almost completely in the X-axis direction. Moving towards the top and bottom areas of the wound, a closing force (f)₁) It will be much smaller. One reason for this is because the wound opening is much smaller in these areas and requires much less force to re-approximate the tissue. In addition, the inward forces applied in these regions include components in the X and Y directions. Thus, a smaller force profile may be used to avoid inward collapse of tissue in the Y direction. As shown in fig. 12B, when the wound is closed and heals from an initial state (shown by the dashed line) to a posterior state (shown by the solid line), it may become elongated in the Y-direction. Thus, displacement of the tissue anchoring or attachment mechanisms 701a and 701b in the X direction and the closing force (f)₁) Is repulsive while displacement of the tissue anchoring or attachment mechanisms 703a,703b is inward in the X-direction (the direction of the sealing force) and outward in the Y-direction (opposite to the direction of the sealing force). Thus, smaller f₁Is preferred in these areas to provide greater "play" between the attachment mechanism and the surrounding tissue. In other embodiments, the wound closure device may be configured such that it does not elongate, but does not change its length along the long axis 720.

The variation in force distribution around the perimeter of the wound closure device may be accomplished in various ways, such as varying the spacing/density of the tissue attachment mechanisms, the type of attachment mechanism, the length of the attachment mechanism or its configuration, and so forth. For example, in fig. 10A and 10B, attachment or anchoring mechanisms 701a, 701B are longer and penetrate deeper into tissue than attachment or anchoring mechanisms 703a, 703B. The force distribution may also be varied by controlling the vacuum force distribution in the filler material, for example by varying the pore size and/or pore density of the filler.

In fig. 13A, the wound closure device 101 is placed in the wound opening such that the tissue gripping surface 1104 with the attachment mechanism 1106 is in contact with the wound edge 203.

Fig. 13B shows the wound 1200 after negative pressure is applied to the wound closure device 101. The tissue anchoring elements 1106 grasp the tissue edge 203 and cause the tissue edge 203 to displace as the filling material 1102 collapses. As seen in fig. 13B, the filler material 1102 collapses in the X and Y directions such that tissue is re-approximated at the wound edge 203. In certain embodiments, as shown in fig. 13A and 13B, stabilizer elements 1108 may be included in the wound filler material 1102 in a cross-hatched configuration to help control the direction of tissue displacement during collapse. In this embodiment, the greatest amount of tissue displacement is in the central region of the wound 1200, where the opening is widest, and this displacement is primarily inward along the X-direction. Away from the central region (e.g., at the top and bottom of the wound as shown in fig. 13A and 13B), where the wound edges are closer together, less displacement in the X-direction is required in order to re-approximate the tissue.

In one embodiment, the internal stabilizer element 1108 promotes collapse of the filler material in a manner that provides re-access to the wound. In one embodiment shown in fig. 13B, the cross-hatched stabilizer elements 1108 straighten out relative to each other, similar to a collapsible door, for example, during packing collapse. The largest displacement is in the central region of the padding 1102, along the X-direction. Stabilizer 1108 may inhibit inward collapse along the Y-direction. When the stabilizers 1108 are straightened, they may also promote elongation of the wound in the Y-direction to allow proper tissue re-approximation.

In certain embodiments, inward collapse of the fill material along the Y-direction is undesirable. For example, during re-approximation of tissue, when the wound edges are closed in the X-direction, the wound 1200 will tend to elongate in the Y-direction.

In certain embodiments, the wound filler may include a peripheral stabilizer element on the wound filler. The peripheral stabilizer element may be configured to expand and contract as needed with the expansion and contraction of the wound filler material. Thus, in one embodiment, the stabilizer elements are sufficiently flexible to contract and expand in the X and Y directions (i.e., along the perimeter of the filler material 103), but have the appropriate stiffness in the Z direction (i.e., along the height of the filler) to inhibit collapse or tilt in this direction. A tissue gripping anchor element or attachment mechanism may be included on the peripheral stabilizer element and project from the periphery of the filler material. This may alternatively or additionally provide anchoring elements or attachment mechanisms on the separate wound securing material 200.

In any of the embodiments described herein, the wound securing material may be formed of a material that is sufficiently rigid to hold the wound securing material and wound filler surrounded by the wound securing material in place when placed in a wound. In certain embodiments, the wound filler and surrounding wound securing material do not comprise an attachment mechanism. For example, the wound securing material may be formed of a sufficiently rigid material that allows the wound securing material to be secured to the underside of fascia or other tissue without the need for an attachment mechanism.

In any of the embodiments described herein, the edges of the wound securing material may be rounded edges to avoid tissue trauma when inserted into the wound site. For example, the elongate layer and lip may have edges that are not sharp, but rounded. Wound fixation materials having rounded edges may contact and act on surrounding tissue in contact with the material, similar to embodiments described herein without rounded edges. In certain embodiments, a wound securing material having rounded edges may aid in wound closure as effectively as a wound closure device comprising a material having non-rounded edges.

Further embodiments of wound treatment devices and methods

Fig. 14-25G show further embodiments of wound treatment devices and methods that may incorporate any of the devices and methods previously described. For example, the wound securing materials described above may be applied to the wound filler, wound roller, and/or stabilizing structure described above to aid in positioning such devices in a wound. In certain embodiments described below, the wound closure device is surrounded by a porous layer, such as a foam and/or anchoring layer, which may be replaced with or incorporate features of the wound securing material described above.

Fig. 14 shows one embodiment of a negative pressure treatment system 4100 including a wound roller 4102 inserted into a wound 4101. The wound roller 4102 may comprise a porous material, such as foam, and in certain embodiments may comprise one or more embodiments of a wound closure device, which are described in further detail in this section of the specification or elsewhere. In certain embodiments, the perimeter or top of any wound closure device inserted into the wound 4101 may also be covered with foam or other porous material. A single drape 4104 or multiple drapes may be placed over the wound 4101 and preferably adhered or sealed to the skin at the perimeter of the wound 4101, thereby creating a fluid seal. Apertures 4106 may be made through the drape 4104, which may be manually made or pre-formed into the drape 4104, thereby providing a fluid connection from the wound 4101 to a source of negative pressure, such as a pump 4110. The flow connection between the bore 4106 and the pump 4110 is preferably formed by a conduit 4108. In certain embodiments, the catheter 4108 may comprise a catheter made of Smith @&Manufactured by Nephew corporationSoft Port^TM. Of course, in certain embodiments, the curtain 4104 may not need to include an aperture 4106, and fluid connection to the pump 4110 may be achieved by laying a conduit 4108 underneath the curtain. In certain wounds, particularly larger wounds, multiple conduits 4108 may be used, fluidly connected by one or more apertures 4106.

In certain embodiments, the curtains 4104 may be provided with one or more grooves or corrugations. The grooves are preferably aligned along the longitudinal axis of the wound and may therefore support closure of the wound by collapsing, preferably in a direction perpendicular to the longitudinal axis of the wound. Such channels may facilitate the application of contractile forces parallel to the wound surface and in the direction of wound closure. An example of such a curtain can be found in application No.12/922,118 entitled "vacuum enclosure" filed on 17.11.2010 (published as US 2011/0054365), which is incorporated herein in its entirety by reference.

During use, the wound 4101 is prepared and cleaned. In some cases, such as abdominal wounds, a non-adhesive or minimally adhesive organ protection layer (not shown) may be applied to any exposed viscera. The wound roller 4102 is then inserted into the wound and covered with the drape 4104, thereby forming a fluid seal. The first end of the conduit 4108 is then placed in fluid communication with the wound, such as through the aperture 4106. A second end of conduit 4108 is connected to pump 4110. Pump 4110 may then be activated to supply negative pressure to wound 4101 and evacuate wound exudate from wound 4101. As will be described in additional detail below with reference to previous embodiments of wound closure devices, negative pressure may also help facilitate closure of the wound 4101, such as by accessing opposing wound margins.

With respect to certain wound fillers and stabilizing structures described herein, it should be understood that reference to an elongated or longitudinal strip is made throughout certain embodiments of the present description. It should be understood that these terms are to be broadly construed and refer in some embodiments to an elongated material having two parallel or substantially parallel faces, wherein in cross-section, the thickness of the material measured perpendicular to the faces is relatively small compared to the height of the material measured parallel to the faces. While in some embodiments the belt may be constructed of discrete lengths of material, in other embodiments the belt may simply refer to an elongate portion of a unitary structure having two parallel or substantially parallel faces. In certain embodiments, the strip has rectangular or substantially rectangular faces, wherein the length of the faces is longer than the height of the faces. In certain embodiments, the length of the face may be 2, 4, 6, 8, or 10 times greater than the height of the face.

The word "horizontal" as used in this portion of the specification or elsewhere in reference to a wound means a direction or plane generally parallel to the skin surrounding the wound. The term "vertical" when referring to a wound generally means a direction extending perpendicular to a horizontal plane. The word "longitudinal" when referring to a wound generally refers to the direction in the horizontal plane taken along the longest direction of the wound. The term "transverse" when referring to a wound generally means a direction perpendicular to the longitudinal direction in a horizontal plane. The words "horizontal", "vertical", "longitudinal" and "transverse" may also be used to describe the stabilizing structure and wound closure device described throughout this specification. When describing these structures or devices, these terms should not be construed as requiring that the structures or devices must be placed in a certain orientation into a wound, but in certain embodiments, it may be preferable to do so.

15A-18D stabilizing structure and wound closure device

Fig. 15A-F show an embodiment of a stabilization structure 4200. The stabilizing structure may include a plurality of parallel disposed elongated strips 4202, the longitudinal length of which may be aligned with the longitudinal axis when placed in a wound. The stabilization structure may also include a plurality of intervening components 4204 that are connected to elongated strip 4202 by joints 4206. In certain embodiments, stabilization structure 4200 may collapse with and without the application of negative pressure in any manner described in this section of this specification or elsewhere. For example, the stabilizing structure may collapse more significantly in one plane than in another plane. In certain embodiments, the stabilizing structure may be comprised of any of the materials described in this section of this specification or elsewhere, including: flexible plastics (e.g., silicone, polyurethane), rigid plastics (e.g., polyvinyl chloride), semi-rigid plastics, semi-flexible plastics, biocompatible materials, synthetic materials, metals, and foams.

Stabilizing structure 4200 and all of the stabilizing structures and wound closure devices described in this section or elsewhere in this specification may collapse in a dynamic manner according to various time scales. In certain embodiments, most of the collapse may occur within the first few minutes when negative pressure is applied. However, after the initial collapse, the stabilizing structure or wound closure device may continue to collapse at a much slower rate, thereby applying increased longitudinal tension over a long period of time and drawing the edges of the wound closer together. By slowly pulling the wound edges closer together over time, the stabilizing structure or wound closure device allows the surrounding healing tissue to be reconstructed in concert with the closure device or stabilizing structure. Slow dynamic wound closure may allow surrounding tissue to heal at an accelerated rate because the collapsed structure or device slowly pulls the edges of the wound closer together without stressing the newly formed or weakened tissue too quickly.

In certain embodiments, the stabilizing structure described in this section of the specification or elsewhere herein may be placed into the wound for a certain period of time and then removed or replaced with another stabilizing structure. For example, the stabilizing structure may be inserted into the wound for a period of time to promote closure of the wound by pulling the edges closer together. After a certain period of time, the stabilizing structure may be replaced with a stabilizing structure of a different size or slump, such as a smaller size or reduced density stabilizing structure. This process may be repeated iteratively, continuously drawing the edges of the wound together over time, and allowing for continuous repair and reconstruction of the surrounding tissue.

In certain embodiments, the stabilizing structure is configured to remain in the wound for at least about less than 1 hour, at least about 2 hours, at least about 4 hours, at least about 6 hours, at least about 8 hours, at least about 12 hours, at least about 24 hours, at least about 2 days, at least about 4 days, at least about 6 days, at least about 1 week, at least about 2 weeks, at least about 3 weeks, or more than 3 weeks.

In certain embodiments, up to 90% collapse of the stabilizing structure or wound closure device may occur during the first few minutes when negative pressure is applied, while the remaining 10% collapse may occur slowly over a period of many minutes, hours, days, weeks, or months. In other embodiments, a collapse of up to about 80%, up to about 70%, up to about 60%, up to about 50%, up to about 40%, up to about 30%, up to about 20%, up to about 10%, or about 0% will occur immediately the first few minutes upon application of negative pressure, while the remaining collapse occurs at a slowed rate, such as over a period of many minutes, hours, days, weeks, or months. In other embodiments, the stabilizing structure may collapse at a variable rate.

In certain embodiments, the entire collapse occurs at a slowed rate, while in other embodiments, the entire collapse occurs almost immediately within the first few minutes. In further embodiments, the collapsing may occur at any rate, and the rate may change over time. In certain embodiments, the rate of collapse may be varied in a variable manner by adding and/or removing portions of the structure, or by controlling the application of negative pressure and irrigation fluid.

As shown in the perspective view of fig. 15A and the top view of fig. 15B, the intersection of the intervening component 4204 and the elongate strip 4202 may define a plurality of cells 4210. In certain embodiments, cells 4210 may have any shape and size described in this section or elsewhere in this specification. For example, the cells may take the shape of squares, diamonds and rectangles, ovals and/or parallelepipeds.

Joint 4206 is configured to allow intervention component 4204 to collapse. The joint 4206 may be configured to allow the intervening component to collapse in any manner described in this section of this specification or elsewhere with reference to other embodiments. For example, joint 4206 may be configured to permit or preferably cause first row of intervening components 4204 to collapse in one direction while permitting or preferably causing adjacent rows to collapse in another direction.

Elongated strap 4202 may include alternating curved segments 4212 and support segments 4214. In a preferred embodiment, the flexure section 4212 may be constructed of a flexible or semi-flexible material, such as silicone and/or polyurethane. However, any flexible or semi-flexible material may be suitable. The curved section 4212 may curve in any direction, allowing the stabilization structure to collapse more easily in any direction, but particularly in the horizontal plane. In a preferred embodiment, the support section 4214 may be constructed of a rigid or semi-rigid material, such as polyvinyl chloride (PVC). However, any rigid or semi-rigid material may be suitable. In the illustrated embodiment, elongate strip 4202 includes an elongate strip of a first material, such as silicone and/or polyurethane, having a plurality of elongate inserts 4214 of a more rigid second material, with elongate inserts 4214 embedded in the first material. Thus, curved section 4212 is a region within elongate strip 4202 that lacks a relatively rigid insert.

As shown in fig. 15A-D, the support section 4214 may be larger than the flexure section 4212. In one embodiment, the support section 4214 may be about three times as large as the flexure section 4212 (e.g., by spanning three cells 4210). In other embodiments, the support section 4214 may have the same dimensions as the curved section 4212. In further embodiments, the curved section 4212 may be larger than the support section 4214. Alternatively, the length and width of the individual segments of elongate strip 4202 may vary. For example, the height of support segment 4214 may be reduced so that it does not extend substantially from the top to the bottom of stabilization structure 4200. In some embodiments, the smaller support section may encompass about half the height of elongate strip 4202. In certain embodiments, the support segment 4214 may be positioned in an upper or lower portion of the elongate band. Such an embodiment may be achieved by utilizing an insert of a second material having a height that is less than the height of the first material forming elongate strips 4202.

In some embodiments, the support sections do not alternate with flexion sections 4212, rather, elongate strip 4202 is composed entirely of support sections 4214 (e.g., a silicon strip or other material with an embedded more rigid insert extending throughout its length, or simply, a more rigid material itself). Alternatively, the entire elongate band 4202 may consist of only the curved section 4212 (e.g., the band is made of only silicon or other more flexible material).

Elongated strip 4202 may be made of a female mold, which may further surround the entire stabilization structure 4200. Support segment 4214 may be inserted into the female mold, followed by injection of a flexible polymer, such as silicone and/or polyurethane, thereby encapsulating support segment 4214 in a flexible polymer frame. The support sections 4214 may be inserted into the mold in any desired manner or number, taking into account the many potential variations of the stabilization device.

In further embodiments, support segments 4214 may be inserted and/or removed from elongate band 4202, and may be inserted and/or removed to change the slump of stabilization structure 4200. After the stabilization structure has been placed in the wound, support segments 4214 may be inserted and/or removed from stabilization structure 4200 in order to variably control the collapse of stabilization structure 4200. In such an embodiment, elongate strip 4202 may form a cavity that opens from one side (e.g., the top) to allow insertion and removal of support segment 4214.

Fig. 15C-D show one embodiment of the individual support segments 4214 in more detail. The support member 4214 may be a flat plate-like structure having a rectangular shape with a length greater than its height and two parallel faces. The support section may comprise at least one groove 4220, preferably located on an upper edge of the support section. In other embodiments, the grooves may be located on the bottom or sides of the support sections. In further embodiments, the top grooves may have corresponding bottom grooves, or the grooves may be semi-randomly positioned on the top and bottom of the stabilization structure. In some embodiments, the groove may be configured to allow the support section to tear according to a transverse line across the support section. The groove 4220 may advantageously provide flexibility to the structure. The groove 4220 may allow the stabilization structure to more easily bend in a horizontal or vertical plane. The indentation 4220 may further allow the stabilization structure to twist in multiple planes. The grooves 4220 may also improve fluid flow in the stabilization structure 4200. In certain embodiments, the support section does not contain a groove and the uppermost edge is flat. The groove 4220 may be positioned at other locations on the support section, such as the bottom edge or side. The shape of the grooves may be rounded triangles as in fig. 15C-D or any other similar shape.

In certain embodiments, the intervention component 4204 may comprise a first material 4216 having a built-in insert 4218 made of a more rigid material. One embodiment of a built-in insert is shown in fig. 15E-F. In certain embodiments, the insert 4218 is placed in a female mold and a flexible polymer, such as silicone and/or polyurethane, is injected around the insert, thereby embedding the insert 4218 in the flexible polymer frame. The inserts 4218 may be inserted into the mold in any desired manner or number, taking into account the many potential variations of the stabilization device. In other embodiments, the first material 4216 may take the form of a sleeve configured to accept the insert 4218. Further, the sleeve 4216 may be configured to allow removal of the insert 4218 by, for example, providing an opening at the top of the sleeve. In a preferred embodiment, the first material 4216 is comprised of a flexible or semi-flexible material, such as silicone and or polyurethane. However, any flexible or semi-flexible material may be suitable. In a preferred embodiment, the insert 4218 is constructed of a rigid or semi-rigid material, such as polyvinyl chloride. However, any rigid or semi-rigid material may be suitable.

Fig. 15E shows a front view of the insert 4218, while fig. 15F shows a side view of the insert 4218. In one embodiment, the insert may be a flat plate-like structure having a rectangular shape with a height greater than its length and two parallel faces. The insert may include a recess 4222. The recess is preferably located in the upper portion of the insert, however, the recess 4222 may be located on either side or bottom of the insert. The notches 4222 may be configured such that they help to allow fluid to flow through the stabilization structure by providing a flow path. Notches 4222 may improve the flexibility of stabilization structure 4200 and be configured to allow more efficient collapse of stabilization structure 4200.

In certain embodiments, the stabilization structure 4200 of fig. 15A-B can be configured to include a perforated or removable portion that allows a portion of the device to be separated from the remainder of the device. For example, perforations may be incorporated into the joint 4206 between various cells, the joint 4206 being incorporated into the stabilization structure 4200, thereby allowing individual rows or cells to be removed in order to change the shape of the stabilization structure 4200. In certain embodiments, these segments may be separated along perforations or lines in the elongate strip corresponding with the indentations 4220, as described above with respect to fig. 15C-D.

In certain embodiments, the insert 4218 may be embedded in the first material 4216 of a variable number of intervening components 4204, thereby controlling the shape and collapse of the stabilization structure 4200. In other embodiments, insert 4218 may be inserted directly into a sleeve comprised of first material 4216 in the intervening component 4204, thereby controlling the shape and collapse of the stabilization structure 4200.

For example, the insert 4218 may be present in the intervention component at least about 5%, in the intervention component at least about 10%, in the intervention component at least about 15%, in the intervention component at least about 20%, in the intervention component at least about 25%, in the intervention component at least about 30%, in the intervention component at least about 35%, in the intervention component at least about 40%, in the intervention component at least about 45%, in the intervention component at least about 50%, in the intervention component at least about 55%, in the intervention component at least about 60%, in the intervention component at least about 65%, in the intervention component at least about 70%, in the intervention component at least about 75%, in the intervention component at least about 80%, in the intervention component at least about 85%, at least about 90% in the intervening component, at least about 95% in the intervening component, or about 100% in the intervening component.

In certain embodiments, a variable number of support segments 4214 may be embedded in elongate strip 4202 to control the collapse of stabilization structure 4200. In other embodiments, a variable number of support sections may be inserted into the cavities contained in elongate strip 4202 to control the collapse of the stabilizing structure. For example, the support segment 4214 may be present for at least about 5%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, or about 100% of the total length of the elongated strap.

In certain embodiments, insert 4218 or support section 4214 may be inserted and/or removed over time, thereby variably controlling the collapse of stabilization structure 4200. For example, while all available sleeves 4216 of the initial stabilization structure may contain inserts, after the stabilization structure in the wound has undergone an initial displacement, additional inserts 4218 may be removed over time, thus causing stabilization structure 4200 to collapse even further. An insert may also be attached to the stabilizing structure after the stabilizing structure is inserted into the wound, thereby reducing the slump of the stabilizing structure 4200. Thus, the addition and/or removal of insert 4216 or support section 4214 allows for variable control of the collapse of stabilization structure 4200. In a similar manner, support segments 4214 may be inserted and removed from the elongated strip over time, thereby providing variable control over the collapse of stabilization structure 4200.

In certain embodiments of the stabilization structures described in this section of the specification or elsewhere, such as in stabilization structure 4200 described in fig. 15A, the flexibility of various segments of the stabilization structure is enhanced by thinning of that segment. For example, in certain embodiments, rather than using a flexible material for the curved section 4212 of the elongate band 4202, the curved section 4212 may be constructed of similar materials used to construct the support section 4214. In this embodiment, because the support section 4212 is thicker than the bending section 4212, it will not bend to the extent that the bending section 4212 may experience. In some embodiments, the entire stabilization structure 4200 may be constructed of a single rigid or semi-rigid material, but made with different rigid and flexible portions by thinning certain areas of the stabilization structure 4200. In a further embodiment, the joint 4206 may be thinned to allow for greater flexibility as compared to surrounding segments. In certain embodiments, thinning of the sections of the stabilization structure 4200 may allow thinner portions to more easily disengage from the structure.

Fig. 15G-15I show another embodiment of a stabilization structure 4200 similar to the stabilization structure described above with reference to fig. 15A-15F. In this and other embodiments, the stabilizing structure may have a length L and a width W that extend parallel to a horizontal plane, and a thickness T that may extend vertically and perpendicular to the horizontal plane. As shown, the length L and width W may be greater than the thickness T such that the stabilization structure forms a generally flat or planar object having an upper surface 4230 and a lower surface 4232 that may be parallel to each other. The thickness T of the structure may be constant between the upper and lower surfaces, or it may vary. The stabilizing structure of fig. 15G-15I may further include grooves 4242 and 4244 in the upper surface 4230 and lower surface 4232, respectively. These grooves may extend through elongate strip 4202 and support section 4214.

The stabilizing structure of fig. 15G may define an outer perimeter that is generally rectangular in shape, although other shapes are contemplated. In one embodiment, the stabilizing structure has a first side 4234 and a second side 4236 opposite the first side. Fig. 15H shows a side view of the first side 4234. The side portions 4234 and 4236 may be straight in shape and parallel to each other. The sides also need not be parallel and may have other shapes, such as curved. The stabilizing structure may also have a third side 4238 and a fourth side 4240 opposite the third side. Fig. 15I shows a side view of the third side 4238. The third and fourth sides may have a zigzag shape as shown, but may also have other shapes, such as straight and curved.

For all of the stabilization structures or wound closure devices described in this section of this specification or elsewhere, a soft polymer may be molded over the entire stabilization structure 4200 in order to soften the tactile feel of the device to protect surrounding organs and/or other tissue. In other embodiments, a soft polymer may be molded only to the bottom portion of stabilization device 4200, while in certain embodiments, a softer polymer may be molded on the top and/or sides of the device. In certain embodiments, soft polymers may be molded on specific edges of stabilization structure 4200, such as those on the bottom, sides, and/or top. In certain embodiments, a soft polymer may be molded on any side or combination of sides of stabilization structure 4200. The soft polymer may act like a softened rim that surrounds the hard edges of the stabilization structure 4200.

Fig. 16 shows one embodiment of an anchoring layer 4800 that can encompass the stabilizing structure described in this section or elsewhere in this specification. Ring 4800 can include a layer of tissue anchors 4802 configured to grip the peripheral edge of a wound. For example, the tissue anchor may be a hook, barb, prong, or other structure for attachment to the tissue of a wound. In certain embodiments, the tissue anchor comprises a hook and loop fastener, such as those used in velcro technology. In certain embodiments, the ring 4800 can be composed of foam, such as those previously described, or the ring can include a combination of a foam layer and a tissue anchoring layer 4802. Lip 4804 may extend inwardly from ring 4800 and, as described in this section or elsewhere in this specification, serve to overlap the top and/or bottom of the stabilization structure, thereby securing ring 4800 around the stabilization structure.

Fig. 17 is a photograph of a wound closure device 4900 that includes a stabilizing structure 4902, such as described in this section or elsewhere in this specification, a foam layer 4904, such as described in this section or elsewhere in this specification, and an anchoring layer 4906 that includes tissue anchors similar to the loops shown in fig. 16. In certain embodiments, the wound closure device 4900 can be placed in a wound and sealed with a drape. Similar to the embodiment shown in fig. 15A-F, the stabilizing structure 4902 may collapse in any manner described in this section or elsewhere in this specification.

The stabilizing structures and/or wound closure devices described in this section or elsewhere in this specification may be used in conjunction with methods or systems for wound closure. In certain embodiments of methods of use for wound closure, one or more stabilizing structures or wound closure devices of any of the embodiments described in this section of this specification or elsewhere are placed in a wound. In certain embodiments, an organ protective layer may be provided in the wound prior to placement of the stabilizing structure. In certain embodiments, foam or other porous material may be placed in the wound with the stabilizing structure or wound closure device, either below, on, or surrounding the stabilizing structure or wound closure device. The foam or other porous material may also surround the perimeter of the stabilizing structure or wound closure device. The stabilizing structure or wound closure device may be configured to collapse in accordance with any of the methods described in this section or elsewhere in this specification, such as by having a particular size and shape, or by including a volume of foam or other porous material in the cells of the structure. The stabilizing structure or wound closure device may be further modified in any manner described in this section or elsewhere in this specification to better accommodate the shape of the wound. After placement in the wound, the stabilizing structure or wound closure device may be sealed by a fluid-tight curtain. The sealed curtain may include a port configured for application of negative pressure. A source of negative pressure can then be connected to the port and negative pressure can be applied to the wound. The stabilizing structure or wound closure device may be replaced over time with stabilizing structures or wound closure devices of various shapes and sizes as desired to best promote wound healing.

Fig. 18A-D are photographs of a wound closure device 5000 according to another embodiment. Wound closure device 5000 includes a stabilizing structure 5002, which may be similar to the structures described in fig. 15A-I, or may include any of the stabilizing structures described elsewhere in this specification. The stabilizing structure 5002 is surrounded by a porous layer 5004, e.g., a foam layer, and the porous layer is surrounded by an anchoring layer 5006, which includes tissue anchors, such as those produced by the velcro industry, various barbs, and/or various hooks. In certain embodiments, the tissue anchor is similar to the loop depicted in fig. 16-17. In certain embodiments, the porous layer may take the form of a tape. The stabilizing structure 5002, porous layer 5004 and anchoring layer 5006 may be provided as separate members for attachment by a practitioner at the time of use, or they may be previously attached to one another.

Similar to the embodiment shown in fig. 15A-I, the stabilizing structure 5002 may be collapsed in any manner described elsewhere in this specification, such as horizontally. When the wound closure device 5000 is implanted, the surrounding tissue may be compressed over the tissue anchors so as to embed them in the tissue and anchor device. In certain embodiments, the wound closure device 5000 can be placed in a wound and sealed with a curtain. Although the embodiments further described in this section include an anchoring layer surrounding a porous layer, other embodiments may omit the porous layer such that the anchoring layer directly surrounds or is attached to the stabilization structure.

In certain embodiments, the anchoring layer 5006 comprises an elongated strip of material comprising a plurality of tissue anchors extending from the bottom layer 5007, wherein the tissue anchors can have different shapes and sizes as described elsewhere in this specification. The tissue anchor may extend from a first flat side of the elongate strip, and a second flat side of the elongate strip may include adhesive covered by an adhesive backing layer. The structure of the anchors may have various shapes depending on the tissue they are intended to engage. Longer anchors may be used for loosely bound tissue, such as adipose or connective tissue, while shorter hooks may be used for tight tissue, such as muscle. In other embodiments, depending on the shape of the anchor, shorter anchors may be more suitable for softer adipose tissue, while longer anchors are used for tighter tissue. Anchors with stiffer handles may be used to penetrate tighter tissues. In some embodiments, the anchor may have a bilateral bifurcation that tends to collapse when inserted into tissue and yet expand when pulled in the opposite direction so that some tension may be applied to the tissue. The characteristics of the anchor or attachment mechanism and their resultant force profile may be varied by a number of parameters, such as the length of the anchor, the shape of the attachment mechanism, the configuration of the gripping features, the material used for the attachment mechanism, the relative flexibility/stiffness of the attachment mechanism, and the spacing/density of the attachment mechanism.

The anchor may have various lengths for optimal penetration of the surrounding tissue. For example, the length of the anchor may be at most about 0.01mm, at most about 0.1mm, at most about 0.2mm, at most about 0.5mm, at most about 1mm, at most about 2mm, at most about 3mm, at most about 5mm, at most about 10mm, at most about 20mm, at most about 30mm, at most about 40mm, at most about 50mm, at most about 75mm, at most about 100mm, or greater than 100 mm.

Fig. 18B is a photograph of an enlarged view of the anchoring layer 5006 of the wound closure device 5002 depicted in fig. 18A. The anchor layer may be composed of a first, longer anchor 5008 and a second, shorter anchor 5010, the anchor 5008 being configured to surround the porous layer 5004 and the stabilizing structure 5002, and the anchor 5010 being configured to surround the porous layer 5004 and the stabilizing structure 5002. As shown, the first band 5008 can be disposed above the second band 5010. In some embodiments, there may be additional alternating series of bands that are relatively perpendicular to each other. As disclosed in this section and elsewhere in this specification, in further embodiments, different bands may have different anchoring lengths and shapes. For example, in addition to 2 types of straps having 2 types of anchors, there may be 3 types of straps having 3 types of anchors, or 4 types of straps having 4 types of anchors. The anchor is preferably selected for the appropriate tissue type. For example, returning to fig. 18B, the first band 5008 can include longer anchors, suitable for penetration into the more compact fascia, and thus can be positioned at the bottom of the device. Similarly, the second band 5010 includes shorter clasps, suitable for penetration into tighter tissue. Other suitable tissue anchors, as described elsewhere in this specification, include velcro's hook and loop structures, barbs, hooks, prongs, pegs, arrows, or any suitable shape. Further surface examples include textured surfaces, such as roughened sandpaper-like surfaces or nanofabricated surfaces, which can facilitate tissue attachment.

In some embodiments, the use of surface anchors may be used in conjunction with surgical adhesives to provide a much stronger bond between tissue layers than the adhesive alone and to provide a temporary bond when the adhesive cures. In certain embodiments, the surgical adhesive may be attached to the anchor itself. In certain embodiments, the surgical adhesive may simply be applied between the anchors to cover at least a portion of the anchoring layer. In further embodiments, the anchor may be replaced with a surgical adhesive, and the surgical adhesive may be used to anchor the device to the surrounding wound.

In certain embodiments, the anchor may be constructed of various materials, including any of the materials disclosed elsewhere in this specification, such as: synthetic or natural polymers, metals, ceramics or other suitable materials. The anchor may be constructed of a biodegradable material, such as a biodegradable synthetic polymer or a natural polymer. Non-limiting examples of biodegradable synthetic polymers include: polyesters such as polylactic acid or polyglycolic acid, polyanhydrides, and linear polymers with biodegradable linkages. Furthermore, the anchors may be constructed of biodegradable biomaterials, such as autografts, allografts and/or xenografts.

Fig. 18C is a photograph of an embodiment of a wound closure device 5000, which is similar to the wound closure device of fig. 18A-B. However, in this orientation, the first band 5008 of the anchor is toward the bottom of the device, while the second band 5010 of the anchor is toward the top. As described above, the anchors may be arrayed in any desired manner. Fig. 18D is a top view of one embodiment of a wound closure device 5000, which is similar to the wound closure device of fig. 18A-C.

In view of the anchoring layer of fig. 18A-D, the shape of the anchoring layer is not limited to the annular shape of fig. 17-18D. In certain embodiments, the anchoring layer wraps around the entire stabilization device, i.e., the top, bottom, and sides. In other embodiments, the anchoring layer surrounds only a portion of the perimeter of the stabilization structure. In certain embodiments, the anchoring layer is attached to discrete portions of the stabilization structure only as needed. In certain embodiments, the anchoring layer covers up to about 5%, up to about 10%, up to about 20%, up to about 30%, up to about 50%, up to about 75%, and up to about 100% of the outer face of the stabilizing structure.

In some embodiments, the different tissue anchor strips may be organized in a vertical direction, while in other embodiments they may be organized in a horizontal direction. They may also organize in horizontal and vertical directions when considered in the xy plane, i.e. facing downwards towards the wound.

In some embodiments, different types of anchors may fan out of each other rather than being organized into discrete strips of a particular type of anchor. For example, a longer anchor may be surrounded by a smaller anchor, and vice versa. In certain embodiments, the anchors may be randomly organized across the anchoring layer or in other suitable patterns.

In particular embodiments, the anchoring layer may be disposed on an inner surface of the stabilization structure. For example, the anchoring layer may cover up to about 5%, up to about 10%, up to about 20%, up to about 30%, up to about 50%, up to about 75%, and up to about 100% of the inner surface of the stabilizing structure.

In further embodiments, the entire anchoring layer may include only one anchor type, for example the entire anchoring layer may be comprised of longer hooks 5008 or shorter hooks 5010, as shown in fig. 18B. Some embodiments may require that the anchor be color coded. For example, the bottom anchor may be made in one color while the top anchor may be in another color to identify the correct orientation of the stabilizing structure in the wound.

19-25G wound closure and treatment methods

Fig. 19-23D are photographs and illustrations depicting an embodiment of a method for treating a wound with a wound closure device that includes a stabilizing structure described in this section and elsewhere in this specification. To better illustrate a non-limiting example of the method, numbers are added in each step of FIGS. 23A-D to allow the reader to follow the method steps more easily. However, the steps may be performed in any order, and any numbering system is for clarity purposes only. Moreover, in some embodiments, various steps of this method may be eliminated. In other embodiments, additional steps may be added to the method based on the methods described in this section and elsewhere in this specification. The porous layers and structures described in this section may be of any material or structure described elsewhere in this specification, such as foam.

Fig. 19 depicts one embodiment of an open wound 5100 prior to treatment with a wound closure device, which will be described in more detail below. The open wound of fig. 19 is similar to the wounds described elsewhere in this specification, particularly with respect to fig. 14. In some cases, such wounds may be created by surgical incision or other means, as described elsewhere in this specification.

Fig. 20 depicts one embodiment of the initial steps of a method of treating an open wound 5100 with a wound closure device. Prior to treatment, the wound may be cleaned using the pad 5502 and the skin 5504 is prepared for application of a wound closure device, for example as described with reference to fig. 15A-18D and 23A-23C.

Fig. 21 depicts one embodiment of an earlier step of a method for treating an open wound 5100. In certain embodiments, the tissue protection layer 5506 may be placed over a wound to protect underlying tissue from shivering or other potential damage from negative pressure wound therapy. Thus, certain embodiments provide a tissue protective layer 5506 that may be cut to size for placement on the wound site 5100. The tissue protective layer 5506 may preferably be a material that does not adhere to exposed internal organs at or near the wound site. Such a tissue protective layer may be comprised of any suitable material, such as a biocompatible polymer. For example, by Smith&Manufactured and marketed by Nephew corporationOrgan protection layers are sold for use as tissue protection layers and are placed over the abdominal cavity and/or wound bed 5100 and wrapped over the peritoneal groove. In a further example, materials such as fluoropolymer Polytetrafluoroethylene (PTFE) are applicable because these materials are generally non-tacky and are used in surgical implants. In one embodiment, the tissue protective layer is permeable. For example, the tissue protection layer 5506 may be provided with openings, such as holes, slits, or channels, to allow for the removal of fluid from the wound site 5100 or the transfer of negative pressure to the wound site 5100. In further embodiments, the tissue protective layer may be applied to non-abdominal wounds in other areas of the body, such as the legs, arms, shoulders or back.

Fig. 22A-C show an example of possible initial steps in a method for treating an open wound. However, as noted above, the steps need not be performed in this order, and may be performed in any order. In fig. 22A, two porous materials, e.g., foam, a bottom piece 5102 and a top piece 5116 are selected to approximate the size of a wound 5100. In certain embodiments, the top part and the bottom part have the same thickness. However, in certain embodiments, and vice versa, the top part 5116 can be at least twice as thick, at least four times as thick, at least 10 times as thick, or more than 10 times as thick as the bottom part 5102. Fig. 22B shows one embodiment of additional steps of a method for treating an open wound. The bottom piece 5102 may be shaped by cutting or other suitable means into the shape of a wound and subsequently placed into a wound 5100, as shown in fig. 22C and further depicted in fig. 23A below.

Starting with steps 1 and 2 of fig. 23A, after shaping, a foam layer 5102 (e.g., a 15mm foam layer) is placed in the wound 5100. In steps 3-4, the stabilizing structure 5104 is similar to the stabilizing structure disclosed in fig. 15A-I or any other stabilizing structure described elsewhere in this specification, which is customized to the size of the wound by cutting or other suitable means. In certain embodiments, the substrate may be custom shaped in this manner, ensuring that the substrate has flat longitudinal sides. As shown in step 4, the stabilizing structure 5104 may be placed in the wound to determine the accuracy of the custom shape step. Preferably, when the stabilizing structure of fig. 15A-I is utilized, the stabilizing structure is placed so that the grooves or flutes described elsewhere in this specification face downward. However, in certain embodiments, grooves or recesses may be present at the top and bottom of the stabilization structure. In step 5-6 of fig. 23B, a tape-shaped foam layer 5106 is attached to the outer edge of the stabilizing structure 5104 by an adhesive backing or other suitable means. A foam layer 5106 may be used to partially or completely surround the perimeter of the stabilizing structure 5104. Excess strap can simply be removed from the harness and discarded. To allow the brace layer to properly adhere to the stabilizing structure, the foam layer may remain in place for more than 30 seconds.

Step 7 of fig. 23B shows the next step of one embodiment of the method, where an anchor layer 5108 is attached to a foam layer 5106, which includes a first longer anchor 5110 and a second shorter anchor 5112. The anchoring layer 5108 may be sized to the perimeter dimensions of the stabilizing structure 5104 and adhered to the foam layer 5106 by removing an adhesive backing layer covering the adhesive surface on the side of the elongated layer opposite the anchor. The anchoring layer may partially or completely surround the foam layer. To allow the anchoring layer to properly adhere to the stable structure, the anchoring layer may remain in place for a period of time, such as over 30 seconds. Once the anchoring layer has been applied to the foam layer 5106 and the stabilizing structure 5104, the entire wound closure device 5114 can be placed onto the wound 5100, as shown in step 8 of fig. 23B. To assist in insertion of the device into the wound, the device may be deformed slightly inwardly or horizontally to facilitate access into the wound site. In certain embodiments, the device may be slightly compressed during insertion and then released upon contact with the wall of the wound. In certain embodiments, the wound closure device 5114 can be placed such that the longitudinal sides of the matrix are aligned with the longitudinal axis of the wound 5100.

In some embodiments, it may be preferable to orient the shorter second anchors 5112 in a direction toward the top of the wound and the longer first anchors 5110 in a direction toward the bottom of the wound so that the shorter anchors 5112 can engage the adipose tissue of the wound. However, in other embodiments, depending on the shape of the anchor, it may be desirable to orient the combination in the opposite orientation so that the longer anchor 5110 engages the adipose tissue. The anchors may also have the same length. In some embodiments, the anchor may have a color code to guide to a particular orientation of the stabilization construct. The anchor also needs to not cover the entire outer perimeter of the stabilization construct. In certain embodiments, anchors are provided only on the first and second sides 4234, 4236 of the stabilization structure (e.g., one embodiment shown in fig. 15G).

Figure 23C contains photographs of steps 9 and 10 of the wound closure and treatment method. In step 9, another layer of foam 5116 (e.g., a 10mm layer of foam) is placed on top of the wound closure device 5114. As shown in step 10, a bridging portion of the foam 5118 may be placed over the wound edge in intimate contact with the foam layer 5116. The bridging portion of the foam 5118 can extend over the intact skin with a curtain 5120 disposed between it and the intact skin. In addition, the suction inlet 5122 can be connected to the bridge portion 5118 with a length of curtain 5120 therebetween. In an alternative embodiment, as shown in fig. 23A, the bridge portion 5118 and the suction opening 5122 may be placed over the wound during different steps, such as during steps 1 and 2.

In fig. 24, the device can be covered by one or more curtains 5120, as shown in steps 11-14. An aperture may be made in the curtain covering the foam bridge portion and the suction inlet 5122 may be placed over the aperture. The protective layer 5124 on the top surface of one or more curtains can be removed after application of the curtains 5120. Once the curtain 5120 is applied and the port is in place, negative pressure can be applied to the wound from a vacuum source through the curtain. As described elsewhere in this specification, negative pressure may cause the stabilizing structure to collapse horizontally. Tissue anchors adhered to the stabilizing structure by the porous layer engage the wound tissue and may facilitate closure of the wound.

Fig. 25A-25C further provide an upper foam layer 5116 for placement in a wound, followed by placement of a bridge 5118, and placement of one or more curtains or wound coverings 5120. Fig. 25D-25G show one embodiment of several steps in a method for treating and closing a wound. As shown in fig. 25D, the suction port 5122 drains the tubing 5126 separately and is applied to the wound at the rear, as shown in fig. 23A-24. Fig. 25E shows a canister 5128 inserted into a negative pressure wound therapy device 5130 ready to collect wound exudate. Fig. 25F shows a snap-fit connection between the tubing connected to the suction inlet and the tubing connected to the negative pressure wound therapy device 5130. Once the connection has been made, the negative pressure wound treatment can be started as shown in fig. 25G.

Further details regarding wound closure devices, stabilizing structures, related devices, and methods of use that may be incorporated or incorporated in any of the embodiments described herein will be found in international application No. pct/US2013/050698 filed on 7, 16/2013, which is incorporated herein in its entirety by reference.

Features, materials, characteristics, or combinations described in connection with a particular aspect, embodiment, or example are to be understood as applicable to any other aspect, embodiment, or example described herein, unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. The patent protection is not restricted to the details of any of the foregoing embodiments. This protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

While certain embodiments have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of patent protection. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the form of the methods and systems described herein may be made. Those of skill in the art will understand that in certain embodiments, the actual steps taken in the illustrated and/or disclosed flows may differ from those shown in the figures. Depending on the embodiment, some of the steps described above may be removed and other steps may be added. Moreover, the features and attributes of the specific embodiments disclosed above can be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure.

While the disclosure includes certain embodiments, examples, and applications, it will be understood by those skilled in the art that the disclosure extends beyond the disclosed embodiments to other alternative embodiments and/or methods of use and obvious modifications and equivalents thereof, including embodiments that do not provide all of the features and advantages set forth herein. Accordingly, the scope of the present disclosure is not limited to the specific disclosure of the preferred embodiments herein, and may be defined by the claims presented herein or presented in the future. For example, the following embodiments are intended to be included within the scope of the present disclosure, in addition to any claims presented herein.

1. An apparatus for wound treatment, comprising:

a wound filler configured to collapse horizontally within a wound;

a fixation material configured to surround the wound filler, the fixation material comprising:

an elongate layer configured to be in contact with the wound; and

a lip extending outwardly from the elongate layer, wherein the lip is positionable beneath the fascia of a patient;

wherein the elongate layer and the lip are integrated into a single piece and form a generally L-shaped cross-section; and

a wound cover configured to be placed over a wound.

2. The apparatus of embodiment 1, wherein an inner surface of the layer is configured to be attached to the wound filler.

3. The apparatus of embodiment 2, wherein the inner surface has means for attaching the inner surface of the layer to the wound filler.

4. The apparatus of embodiment 3, wherein the means for attaching the inner surface of the layer to the wound filler comprises an attachment mechanism selected from the group consisting of barbs, adhesives, Velcro, hooks of Velcro, mushroom hooks of Velcro, hooks, staggered barbs, and any combination thereof.

5. The apparatus of any of preceding claims embodiments 1-4, wherein an outer surface of the layer is configured to be attached to a wound surface.

6. The apparatus of embodiment 5, wherein the outer surface has means for attaching the outer surface of the layer to the wound surface.

7. The apparatus of embodiment 6, wherein the means for attaching the outer surface of the layer to the wound surface is selected from the group consisting of barbs, adhesives, Velcro's hooks, Velcro's mushroom hooks, staggered barbs, and any combination thereof.

8. The device of any of embodiments 1-7, wherein the lip has means for attaching the lip to the fascia.

9. The apparatus of embodiment 8, wherein the means for attaching the lip to the fascia is selected from the group consisting of barbs, adhesives, velcro hooks, velcro mushroom hooks, hook shapes, staggered hooks, staggered barbs, and any combination thereof.

10. The apparatus of embodiment 9, wherein the means for attaching the lip to the fascia comprises a lateral attachment mechanism extending outwardly from an anterior surface of the lip.

11. The device of any of embodiments 1-10, further comprising a plurality of fingers extending outwardly from the lip.

12. The apparatus of any of embodiments 1-10, further comprising an organ protection layer configured to be positioned over the wound under the wound filler.

13. The apparatus of any of embodiments 1-12, further comprising one or more foam layers configured to be positioned above and/or below the wound filler.

14. The apparatus of any of embodiments 1-13, further comprising a connector for connecting the wound cover to a source of negative pressure.

15. The apparatus of any of embodiments 1-15, further comprising a negative pressure source configured to be coupled to the wound cover to provide negative pressure to the wound.

16. A method of treating a wound with the apparatus of any of embodiments 1-15, comprising applying negative pressure to the wound through a wound cover positioned over the wound, a wound filler positioned within the wound, wherein the wound filler is surrounded by an elongate layer and the lip is positioned below the fascia; and wherein the wound filler collapses horizontally under negative pressure.

The present application also relates to the following items.

1. An apparatus for wound treatment, comprising:

an elongated layer of material configured to be placed in contact with a wound, the elongated layer capable of forming an annular shape; and a lip extending outwardly from the elongate layer when the layer is disposed in the annular shape, wherein the lip is positionable beneath a fascia of a patient.

2. The device of item 1, wherein the elongated layer is made of foam.

3. The device of any one of the preceding items, wherein the lip is made of foam.

4. The device of any one of the preceding items, wherein the elongated layer has an inner surface and an outer surface and a thickness therebetween, wherein the thickness of the layer is less than the height of the inner and outer surfaces.

5. The apparatus of any one of the preceding items, further comprising a wound filler, wherein the layer surrounds the wound filler.

6. The apparatus of item 5, wherein the wound filler comprises a material configured to compress horizontally when negative pressure is applied and cause the wound edges to draw closer together and configured to be relatively rigid, thereby preventing vertical collapse of the wound cover.

7. The apparatus of item 5, wherein the wound filler comprises foam.

8. The apparatus of any of items 5-7, further comprising an organ protection layer configured to be positioned over the wound under the wound filler.

9. The apparatus of any of items 5-8, further comprising one or more foam layers configured to be positioned above and/or below the wound filler.

10. The apparatus of any one of the preceding items, further comprising a wound cover configured to be placed over a wound.

11. The apparatus of item 10, further comprising a connector for connecting the wound cover to a source of negative pressure.

12. The apparatus of item 10 or 11, further comprising a negative pressure source configured to be connected to the wound cover to provide negative pressure to the wound.

13. The apparatus of any one of the preceding items, wherein an inner surface of the layer is configured to be attached to a wound filler.

14. The apparatus of the preceding item, wherein the inner surface has means for attaching the inner surface of the layer to the wound filler.

15. The apparatus of item 14, wherein the means for attaching the inner surface of the layer to the wound filler comprises an attachment mechanism selected from the group consisting of barbs, adhesives, velcro hooks, velcro mushroom hooks, and any combination thereof.

16. The apparatus of any one of the preceding items, wherein an outer surface of the layer is configured to be affixed to a wound surface.

17. The apparatus of item 16, wherein the outer surface has means for attaching the outer surface of the layer to the wound surface.

18. The apparatus of item 17, wherein the means for attaching the outer surface of the layer to the wound surface is selected from the group consisting of barbs, adhesives, tissue grabbers, glue, sutures, paritex, and any combination thereof.

19. The apparatus of any one of the preceding items, wherein the lip has means for attaching the lip to the fascia.

20. The apparatus of item 19, wherein the means for attaching the lip to the fascia is selected from the group consisting of barbs, adhesives, tissue claws, glue, sutures, Parietex, and any combination thereof.

21. The apparatus of item 19, wherein the outer surface of the layer has means for attaching the outer surface of the layer to the wound surface that is different from the means for attaching the lip to the fascia.

22. The device of any one of the preceding items, further comprising a plurality of fingers extending outwardly from the lip.

23. The device of item 19, wherein the fingers are covered with a cracked organ protection layer.

24. The device of item 22, wherein the fingers comprise a foam material that is different from the material of the band.

25. The device of item 24, wherein the foam material for the fingers comprises foam having a porosity of between 200ppi and 60 ppi.

26. The device of any one of the preceding items, wherein the layer and the lip form a generally L-shaped cross-section.

27. The apparatus of any of the preceding items, wherein the layer has a first end and a second end and means for attaching the first end and the second end together.

28. A method of treating a wound with the apparatus of any one of the preceding items, comprising applying negative pressure to the wound through a wound cover positioned over the wound and a wound filler positioned within the wound, wherein the wound filler is surrounded by an elongate layer and the lip is positioned below the fascia.

29. The method of item 28, wherein the wound is an abdominal wound.

30. The method of item 28 or 29, further comprising positioning an organ protection layer over the wound and then positioning the wound filler within the wound.