Surgical methods using one-way suture

Abstract

Methods are disclosed for binding together human or animal tissue using one-way sutures having barbs on their exterior surfaces, allowing passage of a needle-drawn suture in one direction through tissue, but not in the opposite direction. In closing a wound, the sutures are passed through tissue at each of the opposed sides of the wound, forming suture pairs in which trailing ends of the sutures are juxtaposed in the wound. The number of suture pairs is selected in accordance with the size of the wound. The wound is closed and ends of the sutures of each suture pair are secured together, which may be by heat bonding or surgical knots. In a variation of this procedure double-armed sutures are used. In another variation detachable needles are used to leave the barbed sutures below the skin. The invention avoids loop stitching, minimizing scarring. In addition to wounds at the skin surface, the method is useful in binding together severed tendons or other internal tissue of a patient, providing considerable tensile strength with a minimum of suturing and locating the tensile support precisely where needed. In facelifts and other cosmetic operations, the sutures are used to provide lines of tissue support beneath the skin.

I claim: 
     
       1. A method for bringing together and holding closed an open wound in human or animal flesh to allow healing and regrowth together of the two sides of the wound, comprising:
 (a) in the open wound, inserting a surgical needle into flesh at one side of the wound, penetrating into the flesh wall at the one side, the needle having a base or trailing end secured to a one-way suture which has a series of exterior barbs providing for gripping of the flesh in one direction only, the barbs permitting movement of the suture through the flesh in the direction the needle is inserted, 
 (b) pushing the needle to extend out of the flesh at a point laterally spaced from the wound, then gripping the needle from the point end and pulling the needle out of the flesh, leaving a trailing end of the suture in the open wound, 
 (c) severing the suture from the needle, 
 (d) repeating the procedure of step (a) at the opposite side of the open wound, at a position to form a suture pair of two sutures located across the wound from one another, 
 (e) repeating steps (b) and (c) at said opposite side of the open wound, 
 (f) repeating steps (a) through (e) to form additional suture pairs as necessary at further locations along the wound depending on the size of the wound, 
 (g) bringing the two sides of the wound together, and 
 (h) connecting together trailing ends of the two sutures of each suture pair to bind the wound in a closed position. 
 
     
     
       2. The method of  claim 1 , wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion. 
     
     
       3. The method of  claim 2 , wherein the suture is formed of nylon. 
     
     
       4. The method of  claim 1 , wherein the suture is formed of nylon. 
     
     
       5. The method of  claim 1 , wherein the suture has a periphery and has said barbs oriented at progressively staggered positions around the periphery of the suture. 
     
     
       6. The method of  claim 1 , wherein the surgical needle is a detachable needle and wherein the step of severing the suture from the needle comprises, while conducting the step of pulling the needle out of the flesh, restraining the trailing end of the suture and pulling the needle with sufficient force to detach it from the suture at a position wherein the leading end of the suture is well below the surface of the flesh, thereby leaving the leading end of the suture within the flesh. 
     
     
       7. The method of  claim 6 , wherein the base end of the detachable needle has metric markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching the needle at a desired depth by reference to the metric markings. 
     
     
       8. The method of  claim 1 , wherein the suture has a leading end region free of barbs, and wherein the step of pulling the needle out of the flesh comprises pulling the barb free leading end of the suture to the flesh, leaving the barbs well below the flesh so as to avoid downward tension at or near the surface of the skin. 
     
     
       9. A surgical method for bringing and holding together two tissue portions in a living patient or animal, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:
 (a) at the tissue separation, inserting a surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted, the surgical needle being a part of a double-armed suture which includes first and second such surgical needles oriented in opposite directions and a single suture extending between the trailing ends of the two surgical needles, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a remaining, second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted,   (b) pushing the first surgical needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the needle from its point end and pulling the needle out of the tissue, leaving said second portion of the suture extending in the tissue separation,   (c) repeating the procedure of step (a) at the opposite side of the open wound, using the second surgical needle, at a position located across the tissue separation from the position in which the first needle was inserted,   (d) repeating step (b) at said opposite side of the tissue separation, to the extent that said second portion of the suture is drawn through tissue at said opposite side of the separation, with the second surgical needle,   (e) bringing the two tissue portions together, while drawing one or both of the surgical needles outwardly from the wound until the two portions of the suture are located substantially in respective tissue portions at opposed sides of the separation and the suture is drawn substantially tight so as to bind the two tissue portions together in a substantially closed position, and   (f) severing the suture from the two surgical needles.   
     
     
       10. The surgical method of  claim 9 , wherein the surgical needles are detachable needles, detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from the two surgical needles comprises, while conducting the step of pulling the needle out of the tissue, pulling each needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue. 
     
     
       11. The surgical method of  claim 10 , wherein the two tissue portions comprise two sides of an open wound at the skin of a patient. 
     
     
       12. The surgical method of  claim 9 , wherein the suture is formed of nylon. 
     
     
       13. The surgical method of  claim 9 , wherein the suture is formed of a resorbable material. 
     
     
       14. The surgical method of  claim 9 , wherein the two tissue portions are portions of a tendon which is at least partially severed. 
     
     
       15. The surgical method of  claim 9 , wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, wherein the suture includes leading end regions free of barbs, adjacent to the trailing end of each surgical needle, and including leaving the barb free regions of the suture just below the skin to avoid pulling in of the skin. 
     
     
       16. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:
 selecting one or more paths through the patient's facial tissue on which lines of facial tissue support are desired, 
 selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the facial tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the facial tissue in one direction only, the barbs permitting movement of the suture through the facial tissue in the direction the needle is inserted, 
 pushing the needle into the facial tissue, below the skin and along the selected path for the desired line of facial tissue support, until the needle extends out through the skin at a distal end of the selected path, 
 gripping the needle from its point end and pulling the needle out of the patient's facial tissue, leaving the one-way suture lying within the facial tissue along the selected path, 
 severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of facial tissue support, to place additional one-way sutures below the skin at said additional desired lines of facial tissue support, 
 applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of facial tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired facial tissue support. 
 
     
     
       17. The surgical method of  claim 16 , wherein the trailing end of each suture is secured to facial tissue of the patient. 
     
     
       18. The surgical method of  claim 16 , A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:
 selecting one or more paths through the patient's tissue on which lines of tissue support are desired, 
 selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted, 
 pushing the needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the needle extends out through the skin at a distal end of the selected path, 
 gripping the needle from its point end and pulling the needle out of the patient's tissue, leaving the one-way suture lying within the tissue along the selected path, 
 severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of tissue support, to place additional one-way sutures below the skin at said additional desired lines of tissue support, 
 applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired tissue support, wherein the trailing end of each suture is secured to a trailing end of another one-way suture which extends in essentially an opposite another direction. 
 
     
     
       19. The surgical method of  claim 16 , wherein the surgical needle is a detachable needle which detaches from the suture under a prescribed degree of pulling force, and wherein the step of severing the sutures from the surgical needle comprises, while conducting the step of pulling the needle out of the facial tissue, restraining the trailing end of the suture and pulling the needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is at a selected depth below the surface of the skin, thereby leaving the suture at said selected depth. 
     
     
       20. The surgical method of  claim 19 , wherein the surgical needle has near its trailing end metric markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching the needle at a desired depth by reference to the metric markings. 
     
     
       21. A surgical method for bringing and holding together two tissue portions in a living patient, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:
 (a) at the tissue separation, inserting a surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted, 
 (b) pushing the needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the needle from its point end and pulling the needle out of the tissue, leaving a trailing end of the suture in the tissue separation, 
 (c) severing the suture from the needle, 
 (d) repeating the procedure of step (a) at the opposite side of the tissue separation, in the other tissue portion, at a position to form a suture pair of two sutures located across the tissue separation from one another, 
 (e) repeating steps (b) and (c) at said opposite side of the tissue separation, in said other tissue portion, 
 (f) repeating steps (a) through (e) to form additional suture pairs as necessary at further locations in the tissue separation depending on the size of the tissue separation, 
 (g) bringing the two tissue portions together, and 
 (h) connecting together trailing ends of the two sutures of each suture pair to bind the tissue separation in a closed position to facilitate regrowth together of the two tissue portions. 
 
     
     
       22. The surgical method of  claim 21 , wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion. 
     
     
       23. The surgical method of  claim 21 , wherein the two tissue portions comprise sections of a tendon of the patient. 
     
     
       24. The surgical method of  claim 23 , wherein the step of securing together trailing ends of the sutures comprises binding together the two trailing ends by means of heat fusion. 
     
     
       25. The surgical method of  claim 21 , wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, and wherein the step of severing the sutures comprises severing the sutures below the skin surface. 
     
     
       26. The surgical method of  claim 21 , wherein the surgical needle is a detachable needle, detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from the surgical needle comprises, while conducting the step of pulling the needle out of the tissue, pulling the needle with sufficient force to detach it from the suture at a position wherein the trailing end of the needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue. 
     
     
       27. A surgical needle and suture combination, comprising:
 a surgical needle,   a one-way suture having a series of exterior barbs providing for gripping of tissue in one direction only, the barbs permitting movement of the suture through tissue in the direction the needle is inserted,   a detachable connection means securing the trailing end of the needle to a leading end of the suture, for releasing the needle from the suture when the needle pulls the suture with a prescribed amount of tension, and   the needle having near its trailing end metric markings as a visual reference indicating distance from the trailing end of the needle, whereby a surgeon can predetermine a depth at which the needle is released from the suture by reference to the markings.   
     
     
       28. The surgical method according to claim 16 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture. 
     
     
       29. The surgical method according to claim 17 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture. 
     
     
       30. The surgical method according to claim 19 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture. 
     
     
       31. The surgical method according to claim 20 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, wherein: the one-way suture is a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture. 
     
     
       32. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:
 selecting one or more paths through the patient's tissue on which lines of tissue support are desired,   selecting a surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the surgical needle having a trailing end secured to a one-way suture which has a multiplicity of exterior barbs providing for gripping of the tissue in one direction only, the barbs permitting movement of the suture through the tissue in the direction the needle is inserted,   pushing the needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the needle extends out through the skin at a distal end of the selected path,   gripping the needle from its point end and pulling the needle out of the patient's tissue, leaving the one-way suture lying within the tissue along the selected path,   severing the suture from the surgical needle, at a point below the skin, leaving a leading end of the one-way suture hidden beneath the skin at said distal end of the selected path, as needed for the particular facelift operation, inserting a needle in additional selected paths for additional desired lines of tissue support, to place additional one-way sutures below the skin at said additional desired lines of tissue support,   applying tension to the trailing end of each suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, and securing the trailing end of each suture, in the tensioned condition, such that the desired line of support is placed in tension to provide the desired tissue support for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, said method further including providing tissue support in the facelift operation from the sutures themselves.   
     
     
       33. The surgical method according to claim 32 for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, said method comprising: the one-way suture being a double-armed suture having a length and having barbs oriented in one direction for a first portion of the length of the suture and in a direction opposite to the one direction for a remaining second portion of the length of the suture. 
     
     
       34. A surgical method for supporting skin and adjacent subcutaneous tissue of a patient in a facelift operation, comprising:
 selecting one or more paths through the patient's skin and adjacent subcutaneous tissue on which lines of tissue support are desired;   selecting a first surgical needle of sufficient length to be inserted through a first of such selected paths in the tissue, the first surgical needle having a trailing end wherein a double armed suture extends between and has its ends secured to the trailing ends of the first surgical needle and a second such surgical needle, the two needles oriented in opposite directions, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted;   pushing the first needle into the tissue, below the skin and along the selected path for the desired line of tissue support, until the first needle extends out through the skin at a distal end of the selected path;   pulling the first needle out of the patient's tissue, leaving the first portion of the suture lying within the tissue along the selected path;   as needed for the particular facelift operation, inserting the second needle in an additional selected path through the patient's skin and adjacent subcutaneous tissue for an additional desired line of tissue support, to place the second portion of the suture below the skin at said additional desired line of tissue support, until the second needle extends out through the skin at a distal end of the additional selected path;   pulling the second needle out of the patient's tissue, leaving the second portion of the suture lying within the tissue along the additional selected path;   applying tension to the suture, to engage the barbs against the internal tissue along said one or more desired lines of tissue support, in the tensioned condition, such that the desired lines of support are placed in tension to provide the desired tissue support, and   severing the suture from each needle.   
     
     
       35. The surgical method of claim 34, wherein the surgical needles are detachable needles which detach from the suture under a prescribed degree of pulling force, and wherein the step of severing the sutures from the needles comprises, while conducting the step of pulling each needle out of the tissue, restraining the suture and pulling each needle with sufficient force to detach each needle from the suture at a position wherein the trailing end of each needle is at a selected depth below the surface of the skin, thereby leaving the suture at said selected depth. 
     
     
       36. The surgical method of claim 34, wherein each surgical needle has near its trailing end markings as a visual reference for a surgeon, and including the surgeon's predetermining the depth of needle-suture severing by detaching each needle at a desired depth by reference to the markings. 
     
     
       37. The method of claim 34, wherein the barbs extend outwardly somewhat on the suture. 
     
     
       38. The method of claim 34, wherein the suture has said barbs at staggered positions along the suture. 
     
     
       39. The method of claim 34, wherein the suture has barbs at helical positions along the suture. 
     
     
       40. The method of claim 34, wherein the suture has barbs at opposing positions on either side along the suture. 
     
     
       41. The method of claim 34, wherein the suture is about 100 to about 500 microns in diameter. 
     
     
       42. The method of claim 34, wherein the suture is formed of non-absorbable material. 
     
     
       43. The method of claim 34, wherein the suture is formed of bioabsorbable material. 
     
     
       44. A surgical method for bringing and holding together two tissue portions in a living patient, to allow healing and regrowth together of the two tissue portions on either side of a tissue separation, comprising:
 (a) at the tissue separation, inserting a first surgical needle into tissue at one side of the separation, penetrating into the one tissue portion, the first surgical needle having a trailing end wherein a double-armed suture extends between and has its ends secured to the trailing ends of the first surgical needle and a second such surgical needle, the two needles oriented in opposite directions, the suture having said exterior barbs oriented in one direction for a first portion of the length of the suture and in the opposite direction for a second portion of the length of the suture, each portion having the barbs oriented so as to allow movement of that portion of the suture through the tissue in the same direction in which the needle secured to that portion of the suture is inserted,   (b) pushing the first needle to extend along an intended line of support and then out of the tissue at a point spaced from the tissue separation, then gripping the first needle from its point end and pulling the first needle out of the tissue, leaving the first portion of the suture in the tissue separation,   (c) repeating the procedure of steps (a) and (b) at the opposite side of the tissue separation, in the other tissue portion, with the second needle at a position located across the tissue separation,   (d) repeating steps (a), (b) and (c) using additional double-armed sutures as necessary at further locations in the tissue separation depending on the size of the tissue separation,   (e) bringing the two tissue portions together to bind the tissue separation in a closed position to facilitate regrowth together of the two tissue portions, and   (f) severing the suture from each needle.   
     
     
       45. The surgical method of claim 44, wherein the two tissue portions comprise sections of a tendon of the patient. 
     
     
       46. The surgical method of claim 44, wherein the two tissue portions comprise two sides of an open wound at the skin of a patient, and wherein the step of severing the sutures comprises severing the sutures below the skin surface. 
     
     
       47. The surgical method of claim 44, wherein each surgical needle is a detachable needle detachable from the suture with a prescribed pulling force, and wherein the step of severing the suture from each needle comprises, while conducting the step of pulling each needle out of the tissue, pulling each needle with sufficient force to detach it from the suture at a position wherein the trailing end of each needle is well below the surface of the tissue, thereby leaving the suture well below the surface of the tissue. 
     
     
       48. The method of claim 44, wherein the barbs extend outwardly somewhat on the suture. 
     
     
       49. The method of claim 44, wherein the suture has said barbs at staggered positions along the suture. 
     
     
       50. The method of claim 44, wherein the suture has barbs at helical positions along the suture. 
     
     
       51. The method of claim 44, wherein the suture has barbs at opposing positions on either side along the suture. 
     
     
       52. The method of claim 44, wherein the suture is about 100 to about 500 microns in diameter. 
     
     
       53. The method of claim 44, wherein the suture is formed of non-absorbable material. 
     
     
       54. The method of claim 44, wherein the suture is formed of bioabsorbable material.