Methods and devices for the prevention of incisional surgical site infections

Abstract

A surgical access device for facilitating access through an incision to a surgical site in a patient's body has a pliable membrane which is configured to engage and expand the incision. The pliable membrane includes a base layer, a permeable membrane attached to the base layer, and a fluid channel disposed between the layers. The fluid channel is fluidly coupled to a fluid source. The fluid is delivered to the surgical site via the permeable membrane. The surgical access device may also have a locking mechanism for holding the device in a desired configuration.

1 . (canceled) 
     
     
         2 . A surgical access device for facilitating access through an incision to a surgical site in a patient's body, said device comprising:
 a radially expandable and collapsible retention ring having a collapsed configuration, an expanded configuration, and a plurality of configurations therebetween, the retention ring comprising:   a plurality of links pivotably coupled to one another; and   a locking mechanism having a locked position and an unlocked position, the locked position configured to hold the retention ring in a desired configuration, the unlocked position configured to allow radial expansion and radial collapsing of the retention ring,   wherein the locking mechanism maintains a distance between any two points on any two links in the plurality of links when the locking mechanism is in the locked position, or   wherein the locking mechanism maintains an angle between any two links in the plurality of links when the locking mechanism is in the locked position.   
     
     
         3 . The device of  claim 2 , wherein the locking mechanism comprises a ratchet and a pawl, and engagement of the ratchet and pawl prevent pivoting of adjacent links amongst the plurality of links relative to one another, and disengagement of the ratchet from the pawl allow pivoting of the adjacent links relative to one another. 
     
     
         4 . The device of  claim 2 , wherein the locked position is configured to hold the retention ring in the desired configuration when a collapsing force is applied to the retention ring. 
     
     
         5 . The device of  claim 2 , wherein the retention ring forms a closed ring having a desired size in between the collapsed configuration and the expanded configuration, and wherein the locking mechanism holds the closed ring in the desired size. 
     
     
         6 . The device of  claim 2 , wherein the plurality of configurations comprises between 2 and 20 configurations. 
     
     
         7 . The device of  claim 2 , wherein the plurality of configurations comprises an infinite number of configurations. 
     
     
         8 . The device of  claim 2 , wherein adjacent links in the plurality of links are pivotably coupled together with a pin. 
     
     
         9 . The device of  claim 8 , wherein a distance between two adjacent pins is minimized in the collapsed configuration, and wherein the distance is maximized in the expanded configuration. 
     
     
         10 . The device of  claim 8 , wherein an angle between the adjacent links is minimized in the collapsed configuration, and wherein the angle is maximized in the expanded configuration. 
     
     
         11 . The device of  claim 3 , wherein the ratchet comprises one or more teeth and the pawl comprises one or more teeth, the one or more teeth of the ratchet engage the one or more teeth of the pawl in the locked configuration. 
     
     
         12 . The device of  claim 11 , wherein the one or more teeth of the ratchet or the one or more teeth of the pawl are angled to one another so as to bias engagement therebetween when a collapsing force is applied to the adjustable ring. 
     
     
         13 . The device of  claim 3 , further comprising a torsion spring coupled to the pawl and configured to provide a torque in a direction that biases the pawl to engage the ratchet. 
     
     
         14 . The device of  claim 3 , further comprising an interface surface coupled to the pawl, the interface surface configured to allow a user to apply a torque thereto thereby disengaging the pawl from the ratchet and allowing the retention member to expand and collapse. 
     
     
         15 . The device of  claim 3 , wherein the ratchet comprises a continuous curved element frictionally engaged with the pawl, and
 wherein frictional engagement of the continuous curved element and pawl prevents pivoting of the adjacent links relative to one another, and   wherein disengagement of the continuous curved element from the pawl allows pivoting of the adjacent links relative to one another to form an infinite number of configurations sized between the expanded and the collapsed configurations.   
     
     
         16 . The device of  claim 15 , further comprising a torsion spring coupled to the pawl and configured to provide a torque in a direction that biases the pawl to frictionally engage the continuous curved element. 
     
     
         17 . The device of  claim 15 , further comprising a cam surface coupled to the pawl, the cam surface configured to control rotation of the pawl by engagement with a portion of the adjustable ring. 
     
     
         18 . The device of  claim 2 , further comprising a pliable membrane coupled to the retention ring. 
     
     
         19 . The device of  claim 18 , further comprising an inferior resilient retention ring coupled to the pliable membrane opposite of the retention ring.