Devices and methods for wound closure

Abstract

A tissue approximation device for wound closure having 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 connected to the first arm. A first rake member is connected to the distal end of the first arm and has a first plurality of tissue engaging members extending therefrom to engage tissue. A second rake member is attached to the distal end of the second arm, the second rake member having a second plurality of tissue engaging members extending therefrom to engage tissue. A transverse bar can extend through the first and second rake members such that the first and second rake members movable along the transverse bar. Systems and methods for wound closure are also disclosed.

1 - 20 . (canceled) 
     
     
         21 . A tissue approximation device for enhancing wound closure 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 connected to the first arm;   a first rake member connected to the distal end of the first arm, the first rake member having a first plurality of tissue engaging members extending therefrom to engage tissue;   a second rake member attached to the distal end of the second arm, the second rake member having a second plurality of tissue engaging members extending therefrom to engage tissue, the first and second rake members movable toward each other to place tissue under tension.   
     
     
         22 . The tissue approximation device of  claim 21 , 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 end of the second arm via a second articulating joint. 
     
     
         23 . The tissue approximation device of  claim 21 , wherein the first rake member and the second rake member are movable towards each other in parallel to move tissue edges closer together and place tissue under tension as the distal ends of the first arm and the second arm approximate. 
     
     
         24 . The tissue approximation device of  claim 21 , wherein the first and second plurality of tissue engaging members comprise a plurality of hooks having an elongated body and at least a portion of the elongated body is curved. 
     
     
         25 . The tissue approximation device of  claim 21 , wherein the first and second plurality of tissue engaging members comprise a linear portion extending toward an opposing rake member, a first portion extending in a first direction at an angle to the linear portion and a second portion extending in a second direction different than the first direction. 
     
     
         26 . The tissue approximation device of  claim 21 , further comprising a transverse bar extending through the first and second rake members, the first and second rake members movable along the transverse bar. 
     
     
         27 . The tissue approximation device of  claim 26 , wherein the first rake member includes a first channel and the second rake member includes a second channel, the transverse bar extending through the first and second channels and maintaining a parallel orientation of the first and second rake members as the first and second rake members slide along the transverse bar toward each other to approximate tissue. 
     
     
         28 . The tissue approximation device of  claim 27 , further comprising a coating within the first and second channels engageable by the transverse bar. 
     
     
         29 . The tissue approximation device of  claim 26 , further comprising a plurality of roller members engageable with the transverse bar to constrain the transverse bar. 
     
     
         30 . The tissue approximation device of  claim 26 , further comprising a plurality of spring elements engageable with the transverse bar to constrain the transverse bar. 
     
     
         31 . The tissue approximation device of  claim 26 , further comprising a second transverse bar, wherein the second transverse bar is spaced from tips of the plurality of hooks to provide a stop for tissue penetration of the plurality of hooks. 
     
     
         32 . The tissue approximation device of  claim 31 , wherein the second transverse bar is parallel to the transverse bar. 
     
     
         33 . The tissue approximation device of  claim 31 , further comprising a transverse bar extending through the first and second rake members, the first and second rake members movable along the transverse bar, wherein the second transverse bar distributes tension on the hooks. 
     
     
         34 . The tissue approximation device of  claim 21 , wherein the first and second plurality of tissue engaging members are shaped to have a cupping effect. 
     
     
         35 . The tissue approximation device of  claim 21 , wherein the first and second plurality of tissue engaging members have an oblique angle. 
     
     
         36 . A system for closing a wound comprising:
 a) a tissue approximation device configured to apply tension to tissue in an area adjacent the wound, the tissue approximation device 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 and having a first plurality of tissue engaging members extending therefrom configured to grip tissue on a first side of the wound; and   a second rake member connected to the distal end of the second arm and having a second plurality of tissue engaging members extending therefrom configured to grip tissue on a second side of the wound;   wherein the first and second arms are movable to move the first and second rake members toward each other to adjust a distance between the first and second rake members to approximate tissue; and   b) a meshing device having a plurality of puncturing devices extending therefrom and configured extending to puncture the tissue, the meshing device puncturing tissue outside a region of tissue defined between the first and second rake members.   
     
     
         37 . The tissue approximation device of  claim 36 , wherein the first rake member and the second rake member are movable towards each other in parallel to move tissue edges closer together and place tissue in tension as the distal ends of the first arm and the second arm approximate. 
     
     
         38 . The tissue approximation device of  claim 36 , further comprising a transverse bar extending through the first and second rake members, the first and second rake members movable along the transverse bar. 
     
     
         39 . The tissue approximation device of  claim 36 , wherein the first and second plurality of tissue engaging members comprise a plurality of hooks having an elongated body and at least a portion of the elongated body is curved. 
     
     
         40 . The tissue approximation device of  claim 36 , wherein the first and second plurality of tissue engaging members comprise a linear portion extending toward an opposing rake member, a first portion extending in a first direction at an angle to the linear portion and a second portion extending in a second direction different than the first direction