Mechanical method and apparatus for bilateral tissue fastening

Abstract

A mechanical system for bilaterally securing skin tissue preferably utilizes a tissue manipulator apparatus to approximate a portion of an interior surface of each of two pieces of living dermis tissue along a vertical interface below an exterior surface without overlapping either interior surface across the vertical interface. An applicator apparatus includes a driving head portion positioned in the vertical interface and at least partially below the exterior surface and a handle portion positioned at least partially above the exterior surface. The applicator apparatus bilaterally drives at least one portion of the fastener through each piece of the living dermis tissue behind the interior surface of that piece of tissue such that the fastener is positioned below the exterior surface and a portion of the fastener is positioned generally transverse to the vertical interface.

1 - 8 . (canceled) 
     
     
         9 . A method of deploying a bioabsorbable fastener into two sides of an incision or wound in skin tissue, comprising:
 everting each of the two sides of the incision or wound to present an inner surface of each of the two sides is generally vertical relative to an external surface of the skin tissue;   inserting a bioabsorbable fastener into the exposed inner surfaces by simultaneously inserting each of a pair of legs of the fastener into one of the two exposed inner surfaces from above and generally vertical relative to the external surface of the skin tissue; and   releasing the two sides of the incision or wound to leave the bioabsorbable fastener below the external surface of the skin tissue,   whereby the two sides of the incision or wound are maintained in approximation by the bioabsorbable fastener as the bioabsorbable fastener transitions in response to wound stress from an insertion disposition in which the pair of legs reside in parallel relation to each other and in a substantially perpendicular orientation relative to the external surface of the skin tissue to a subsequent disposition in which the pair of legs reside in non-parallel relation to each other.   
     
     
         10 . A mechanism for deploying a bioabsorbable fastener into skin tissue having an incision or wound, comprising:
 a tissue manipulation assembly having:
 a first tissue form configured to contact an external surface of the skin tissue on a first side of the incision or wound; and 
 a second tissue form configured to contact the external surface of the skin tissue on a second side of the incision or wound, 
   the tissue manipulation assembly configured to evert the skin tissue on the first side and the second side relative to the external surface of the skin tissue to expose a dermal layer of each of the first side and the second side of the incision or wound;   a generally U-shaped bioabsorbable fastener having a first leg connected to a second leg by a cross member; and   an applicator assembly configured to deploy the bioabsorbable fastener into the incision or wound, the applicator assembly having:
 a first piercing member adapted to releasably hold the first leg; and 
 a second piercing member adapted to releasably hold the second leg, 
   the applicator assembly configured to simultaneously deploy the first leg into the dermal layer of the first side of the incision or wound and the second leg into the dermal layer of the second side of the incision or wound from above and generally obliquely downward relative to the external surface of the skin tissue,   whereby the sides of the incision or wound are maintained in approximation by the bioabsorbable fastener for a period of time after the bioabsorbable fastener is deployed.   
     
     
         11 . A method of deploying a bioabsorbable fastener into two sides of an incision or wound in skin tissue, comprising:
 everting each of the two sides of the incision or wound to expose a dermal layer of each of the sides such that the dermal layers face in a direction generally vertical relative to an external surface of the skin tissue;   simultaneously inserting each of a pair of legs of the bioabsorbable fastener into the corresponding dermal layer exposed on each of the two sides; and   releasing the everted sides of the incision or wound to leave the bioabsorbable fastener below the external surface of the skin tissue,   whereby the sides of the incision or wound are maintained in approximation by the bioabsorbable fastener for a period of time after the bioabsorbable fastener is deployed.   
     
     
         12 . A method of closing an incision or wound using bioabsorbable fasteners, the method comprising:
 everting each of two sides of skin tissue on opposed sides of the incision or wound to expose a dermal layer of each of the sides at a first location along the incision or wound;   inserting each of a pair of legs of a first bioabsorbable fastener into the corresponding dermal layer exposed at the first location such that a backspan on the first bioabsorbable fastener extends across a an interface defined between the two sides at the first location, whereby the first bioabsorbable fastener resides entirely below an external surface of the skin tissue in a substantially vertical orientation relative to the external surface;   everting each of two sides of skin tissue on opposed sides of the incision or wound to expose the dermal layer of each of the sides at a second location along the incision or wound; and   inserting each of a second pair of legs of a second bioabsorbable fastener into the corresponding dermal layer exposed at the second location such that a second backspan on the second bioabsorbable fastener extends across an interface defined between the two sides at the second location, whereby the second bioabsorbable fastener resides entirely below an external surface of the skin tissue in the substantially vertical orientation relative to the external surface.