Devices and methods for wound closure

Abstract

The present disclosure provides methods and devices for wound closure. In some exemplary embodiments, a tissue approximation device is provided. In some embodiments, the tissue approximation device includes a first scissors arm having a proximal end and a distal end and a second scissors arm having a proximal end and a distal end. In some embodiments, the second scissors arm is connected to the first scissors arm at a pivot point. In some embodiments, the tissue approximation device further includes a first rake member connected to the distal end of the first scissors arm via a first articulating joint. In some embodiments, the first rake member includes a plurality of hooks configured to grip tissue.

1 . A tissue approximation device to place tissue under tension comprising:
 a first arm having a proximal end and a distal end;   a second arm having a proximal end and a distal end, the second arm being connected to the first arm;   a first rake member connected to the distal end of the first arm, the first rake member comprising a first plurality of curved or bent tissue engaging members configured to grip tissue without slicing through tissue; and   a second rake member connected to the distal end of the second arm, the second rake member comprising a second plurality of curved or bent tissue engaging members configured to grip tissue.   
     
     
         2 . (canceled) 
     
     
         3 . The tissue approximation device of  claim 2 , wherein the first rake member and the second rake member move towards each other in parallel as the distal ends of the first arm and the second arm approximate. 
     
     
         4 . The tissue approximation device of  claim 1 , wherein movement of the first and second arms move the first and second rake members, the first and second rake members staying parallel to each and perpendicular to the direction of approximation during such movement. 
     
     
         5 . The tissue approximation device of  claim 1 , wherein the first and second tissue engaging members comprise curved hooks, and at least a portion of the hooks has an elongated body curved to penetrate tissue at an oblique angle without slicing through tissue. 
     
     
         6 . The tissue approximation device of  claim 1 , wherein the distal end of the first arm is in the same plane as the other portions of the first arm. 
     
     
         7 . The tissue approximation device of  claim 6 , further comprising a vertical extension member attached to the distal end of the first arm that positions the first rake member below a plane of the first arm. 
     
     
         8 . The tissue approximation device of  claim 1 , wherein the distal end of the first arm is in a different plane than other portions of the first arm. 
     
     
         9 . A system for closing a wound, the system comprising:
 a) a tissue approximation device configured to apply tension to tissue in an area of interest for closing the wound, the tissue approximation device including:
 a first arm having a proximal end and a distal end; 
 a second arm having a proximal end and a distal end, the second arm being connected to the first arm; 
 a first rake member connected to the distal end of the first arm, the first rake member having a plurality of hooks configured to grip tissue; and 
 a second rake member connected to the distal end of the second arm, the second rake member having a plurality of hooks configured to grip tissue; 
   b) a meshing device including at least one puncturing device configured to puncture the tissue.   
     
     
         10 . (canceled) 
     
     
         11 . The system of  claim 9 , wherein the first rake member is connected to the distal end of the first arm via a first articulating joint and the second rake member is connected to the distal of the second arm via a second articulating joint, wherein the first and second articulating joints are configured to cause the first rake member and the second rake member to move towards each other in parallel as the distal ends of the first arm and the second arm approximate. 
     
     
         12 .- 17 . (canceled) 
     
     
         18 . The system of  claim 9 , wherein the meshing device further comprises a supporting framework for mounting the at least one puncturing device. 
     
     
         19 - 20 . (canceled) 
     
     
         21 . The tissue approximation device of  claim 3 , wherein the first and second tissue engaging members penetrate tissue at an angle to a plane of the first and second arms to prevent penetration of tissue perpendicularly. 
     
     
         22 . The tissue approximation device of  claim 3 , further comprising a retaining structure to retain the first and second arms in a position with the first and second rake members approximated. 
     
     
         23 . The tissue approximation device of  claim 1 , wherein the first and second tissue engaging members have a cross-section without a sharp edge. 
     
     
         24 . The tissue approximation device of  claim 1 , wherein first and second tissue engaging members have a cross-section with a curved circumference. 
     
     
         25 . The tissue approximation device of  claim 1 , wherein the first and second tissue engaging members have a thickened portion to limit penetration of the first and second tissue engaging members into tissue. 
     
     
         26 . The tissue approximation device of  claim 1 , wherein the first rake member is removably and replaceably connected to the first arm. 
     
     
         27 . The tissue approximation device of  claim 1 , wherein the first and second tissue engaging members having a curved or bent elongated body provide a cupping effect to grip tissue. 
     
     
         28 . The tissue approximation device of  claim 1 , wherein the first and second tissue engaging members comprise hooks have curved distal ends to position the hooks in a plane between 1.5 cm and 4 cm below the plane of the first arm. 
     
     
         29 . The tissue approximation device of  claim 1 , wherein the first rake member is positioned below a plane of the first arm.