Surgical tools and methods for their use

Abstract

Surgical tools and kits for performing methods include a grommet with cylindrical shaft, cutting tip, annular flange with suture retaining anchoring fixture; a grommet jig for extending between adjacent grommets and guiding a needle therebetween; a family of needles with single and double pointed ends, reinforced eyelets, stops to limit inadvertent exiting, double shaft construction with a longitudinal gap and sharpened, slicing ends, including a “J” shape embodiment; a bone anchor with ring to secure sutures about a patient's clavicle; a tissue dissector having radially extending cones to nick taut connecting tissues; a tissue rasp having a series of crisscrossing grooves along an end; a tissue mesher comprising one or more blocks having a matrix of holes for clamping a plurality of needles and a supporting framework; and a kit device and a method of surgically inserting an internal mesh brassiere under the breast skin.

1 - 39 . (canceled) 
     
     
         40 . A surgical method, comprising:
 cutting, at a first location, a plurality of anchoring fibers that restrict movement of a tissue region without excising the tissue region from a body, wherein the plurality of anchoring fibers are cut along multiple planes; and   relocating at least a portion of the tissue from the first location to a second location, different than the first location, without excising the portion of the tissue region from the body.   
     
     
         41 . The method of  claim 40 , wherein cutting the plurality of anchoring fibers includes cutting a plurality of cutaneous perforator nerves. 
     
     
         42 . The method of  claim 40 , wherein cutting the plurality of anchoring fibers expands the tissue region. 
     
     
         43 . The method of  claim 40 , wherein the first location is an abdomen of a mammal. 
     
     
         44 . The method of  claim 40 , wherein the second location is a breast of a mammal. 
     
     
         45 . The method of  claim 40 , wherein relocating at least a portion of the tissue region includes stretching the portion of the tissue region from the first location to the second location. 
     
     
         46 . The method of  claim 45 , wherein the first location is an abdomen of a mammal and the second location is a breast of a mammal. 
     
     
         47 . The method of  claim 40 , wherein cutting the plurality of anchoring fibers includes inserting a plurality of needles into the tissue region at least twice. 
     
     
         48 . The method of  claim 40 , wherein cutting the plurality of anchoring fibers includes inserting a plurality of needles into the tissue region. 
     
     
         49 . The method of  claim 48 , wherein the plurality of needles are inserted percutaneously. 
     
     
         50 . The method of  claim 48 , wherein the plurality of needles are part of a disposable needle array. 
     
     
         51 . The method of  claim 50 , wherein the disposable needle array is mounted on a cartridge. 
     
     
         52 . The method of  claim 50 , wherein the disposable needle array includes at least 3 needles and fewer than 20 needles. 
     
     
         53 . The method of  claim 40 , further comprising augmenting a breast of a mammal. 
     
     
         54 . The method of  claim 40 , further comprising placing the tissue region under tension before cutting the plurality of anchoring fibers. 
     
     
         55 . The method of  claim 40 , further comprising cutting the plurality of anchoring fibers to produce a plurality of gaps approximately 2 mm in diameter in the tissue region. 
     
     
         56 . The method of  claim 55 , further comprising grafting at least one of tissue droplets, fat, platelet rich plasma, growth factors, tumescent fluid, or stem cells into at least one of the gaps. 
     
     
         57 . The method of  claim 40 , wherein the plurality of anchoring fibers in the tissue region are cut to a ratio of up to about 20% with respect to uncut anchoring fibers in the tissue region. 
     
     
         58 . The method of  claim 40 , wherein the plurality of anchoring fibers in the tissue region are cut to a ratio of between about 20-30% with respect to uncut anchoring fibers in the tissue region. 
     
     
         59 . A method of cutting tissue in a body of a patient, comprising:
 applying tension to the tissue;   at least partially inserting an array of needles into the tissue;   selectively cutting a plurality of fibers that are configured to hold the tissue in place;   at least partially pulling the array of needles out of the tissue; and   re-inserting the array of needles into the tissue,   wherein the fibers are cut at different depths to expand the tissue, and wherein inserting and re-inserting the array of needles creates a region of tissue with a plurality of punctures.   
     
     
         60 . The method of  claim 59 , wherein each of the plurality of punctures is approximately 2 mm in diameter. 
     
     
         61 . The method of  claim 59 , wherein only tensioned fibers are cut. 
     
     
         62 . The method of  claim 59 , wherein inserting the array of needles includes inserting the array of needles into the region of tissue such that the needles do not pass completely through the tissue. 
     
     
         63 . The method of  claim 59 , further comprising relocating at least a portion of the region of tissue with the plurality of punctures to augment a breast. 
     
     
         64 . The method of  claim 59 , wherein the array of needles is mounted on a disposable cartridge. 
     
     
         65 . The method of  claim 59 , wherein the array of needles is inserted percutaneously into the region of tissue. 
     
     
         66 . The method of  claim 59 , wherein the array of needles is mounted on a handling device. 
     
     
         67 . The method of  claim 59 , wherein the plurality of anchoring fibers are cut to a ratio of at least about 20% with respect to uncut anchoring fibers in the region of tissue. 
     
     
         68 . The method of  claim 59 , wherein the plurality of anchoring fibers are cut to a ratio of between about 20-30% with respect to uncut anchoring fibers in the region of tissue. 
     
     
         69 . A surgical method, comprising:
 percutaneously inserting a needle array into body tissue to cut a plurality of anchoring fibers in a region of the body tissue without excising the region of tissue, wherein the plurality of anchoring fibers are configured to restrict movement of the region of tissue;   at least partially pulling the needle array out of the region of tissue;   re-inserting the needle array into the region of tissue to cut the plurality of anchoring fibers along multiple planes to create a plurality of offset punctures in the region of tissue; and   relocating at least a portion of the region of tissue from the first location to a second location, different than the first location, while the region of tissue remains attached to the body.   
     
     
         70 . The method of  claim 69 , wherein the first location is an abdomen and the second location is a breast. 
     
     
         71 . The method of  claim 69 , wherein the needle array is mounted on a handling device and includes at least 3 needles. 
     
     
         72 . The method of  claim 69 , wherein each of the plurality of offset punctures created is approximately 2 mm in diameter. 
     
     
         73 . The method of  claim 69 , wherein the method further comprises grafting at least one of tissue droplets, fat, platelet rich plasma, growth factors, tumescent fluid, or stem cells into at least one of the plurality of offset punctures. 
     
     
         74 . A method of augmenting a breast, comprising:
 percutaneously inserting a needle array into abdominal tissue to cut a plurality of anchoring fibers that restrict movement of the abdominal tissue without excising the abdominal tissue from a patient's body;   at least partially pulling the needle array out of the abdominal tissue;   re-inserting the array needle array into the abdominal tissue to cut the plurality of anchoring fibers along multiple planes to create a plurality of offset punctures in a region of the abdominal tissue;   relocating at least a portion of the region of abdominal tissue to the breast, while the region of abdominal tissue remains attached to the body; and   augmenting the breast with at least a portion of the relocated abdominal tissue.