Abstract:
Light is directed between the arms of a forceps to illuminate an area under debridement of foreign material with a color selected to enhance contrast of foreign material that needs to be removed. The light comes from a multicolor source such as an LED chip having RGBW dies and is transmitted by a light transmitting element such as an elongated waveguide or a light pipe to illuminate the area under examination. The color is selectable so as to obtain a color that has good contrast for the foreign material. The apparatus has a docking station to install the forceps so that it is properly located with respect to the illumination. A camera can be part of the apparatus to transmit imagery to a display.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     U.S. provisional application Ser. No. 61/318,147 filed on Mar. 26, 2010 priority of which is claimed and which is incorporated herein by reference. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     This invention was made with Government support under contract number 1R43RR031895-01 from the NIH (National Institute of Health)—NCRR (National Center for Research Resources). The Government may have certain rights in this patent. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to the field of debridement of wounds and surgical openings in particular for foreign material and in particular to illumination in a manner to provide contrasting color for the objects to be removed. It also relates to such illumination accompanied by forceps to implement the removal. 
     BACKGROUND 
     Traumatic wounds contain devitalized tissue, bacteria and associated bodies, grass, soil and bone fragments depending on how and where the injury occurred. Wounds caused by blast impact are usually more severe, and are contaminated with an even greater variety of foreign bodies. The debris can include weapon shells, fabric, gravel, ceramic shards and shrapnel. The wound also will contain devitalized skin and muscle tissue The speed and quality of wound debridement in the initial treatment stage are crucial to prevent the type of infections that lead to mortality and morbidity. 
     A surgeon tending to such wounds, as a rule, presently uses visual observation and mechanical methods (hand, forceps and scalpel) to identify and remove the objects and devitalized tissue. Although ceiling and head mounted lights are often used for illumination, the light scattered from wet tissue and shadows from the surgical instruments dramatically reduce the visual contrast necessary for locating and removing such objects. 
     SUMMARY 
     The invention resides in methods and apparatus for enhancing the ability to visualize foreign bodies (also referred to as materials) in a wound or other body opening by illuminating the operational field with one or more selected colors to match hues of specific material, thereby enhancing contrast with the surrounding body parts. The method can be implemented in a multicolor illuminator that can be attached to any type of surgical forceps. In accordance with the principles of this invention, an illuminator is provided for attachment to surgical forceps. The illuminator is provided with a controller and a light-emitting diode (LED) chip, the controller being user operated to select different portions of the light spectrum for the illumination of a wound. In one embodiment, a red, green, blue, and white LED chip is provided. In another embodiment ultra violet light is also provided. The illuminator is configured to provide a dock for the head of a forceps and light pipes are provided to carry light from the LED chip(s) to the distal end of the forceps. a microminiaturize camera can be incorporated in the illuminator to provide a magnified image that can be displayed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of an embodiment of the present invention. 
         FIG. 2  is a side view of the embodiment of  FIG. 1 . 
         FIG. 3  is a top view of the embodiment of  FIG. 1 . 
         FIG. 4  is a view showing the interior of the embodiment of  FIG. 1 . 
         FIG. 5  is a perspective view with the covers removed of the embodiment of  FIG. 1 . 
         FIGS. 6   a ,  6   b  and  6   c  are printed circuit board (PCB) diagrams for the LEDs, the LED driver and the power supply for the embodiment of  FIG. 1 . 
         FIG. 7  is a view of an LED chip having red, blue, green and white dies. 
         FIG. 8  is an illustration of an LED chip with RGBW and violet dies. 
         FIG. 9  is a circuit diagram of an embodiment of the invention. 
         FIGS. 10   a  and  10   b  are alternative embodiments of the invention. 
         FIG. 11  is an illustration of the invention in use along with remoter displays 
     
    
    
     DETAILED DESCRIPTION 
     The invention resides in an apparatus and method of use for enhancing the ability to locate and remove foreign objects from physiological/anatomical surroundings such as a wound (such as debris or blast shrapnel) or from a surgery (such as an article mistakenly left in) by enhancing the visual contrast of the objects that must be removed from the other things being observed such as anatomical parts that produce complicated visual background. 
     Exemplary applications of the invention are: (1) in surgical wound debridement; (ii) in open surgical procedures for designating and removal of missed or lost medical supply; (iii) in forensic sciences for investigating evidence or in interpreting complicated mixtures; (iv) in life sciences research and laboratory tests for designating and separating objects in slurries and solutions. 
     The invention can be implemented in a number of ways. 
     The invention in one embodiment is a multicolor light source apparatus to which a forceps can be attached. The light source is combined with a waveguide or lightguide that projects the light to a favored position with respect to operation of the forceps such that the light illuminates an area that is being worked on. In one embodiment, the light color is selectable from a multicolored light source so that by the selection a useful contrast can be made of the foreign material relative to normal material. In one embodiment, the illumination device is an LED chip with a plurality of differently colored dies. A selection control allows selection of a desired one of the dies. A trigger switch can be used to sequentially turn on the dies in order to find the color that provides the most useful contrast. In another embodiment, the dies can be mixed and the mixture can be varied to provide incremental or graduated spectral variation in order to find the best color mix for good contrast. Also, certain light mixtures can be stored in a preprogrammed set for specific objects for which preferred contrasting illumination is known. 
     An exemplary light source is the multicolor LED chip. The chip may include dies of blue, green, red, white and UV LEDs (the UV LED is useful for the designation of highly luminescent objects). Optional simplified LED chip configurations are: (i) RGB without UV, and white light may be produced by mixing these colors in certain proportions using the CIE chart; (ii) RBGW without UV where white is produced by the white die. Specific image enhancing additive colors can be preset in the memory of a preprogrammed chip for known objects common to a specific usage, such as foreign objects in combat wounds. 
     In various embodiments, the light source and its controls are provided in a head portion which also has an element allowing attachment of a forceps whereby the illumination is directed relative to clamping elements of the forceps such that the area being worked on is most directly illuminated. 
     Also, in various embodiments, the light from the light source in the head portion is directed to the desired area of illumination by waveguides such one or more optical fibers or by one or more rigid light pipes. The light will delivered to a point at or near the tips of the forceps, such a 1 to 1½ inches beyond the tips. One goal is to provide shadowless illumination of the examined area in between the tips of the forceps. In one embodiment the light is projected so as to be centralized between the arms of the forceps 
     The type of forceps commonly called tweezers forceps (historically called dissecting forceps) has an opposed pair of arms or clamps with a spring joint biasing the arms open, at the proximal end and clamping tips at the distal end, usable by pressing the arms together against the spring force. 
     In the present invention, the illumination head has a docking element into which the proximal end of the forceps is placed. 
     Now, various embodiments of the invention will be described with reference to the figures. 
       FIGS. 1 ,  2  and  3  show an illuminator  10  in accordance with the principles of this invention. The illuminator comprises a head  12  comprising a battery compartment  14  and an electronics compartment  16  and an extension leg  20 . A control switch for color selection is shown at  18  mounted on the extension leg  20  that places the switch  18  conveniently for a user of the forceps. An on-off switch  22  is located at the rear of the battery compartment  14 . Waveguides in the form of light pipes  24   a  and  24   b  extend from the electronics compartment  16  and can be seen to be spaced apart from one another in a plane orthogonal to the arms  28   a  and  28   b  of an illustrative forceps  26  which has been docked to the illuminator  10 , as will be described below. The light pipes  24   a  and  24   b  are secured to the cover  30  of the electronics compartment  16  in apertures  32   a  and  32   b  such as by set screws (not shown) or press fitting or other securing mean. 
       FIG. 4  is a view of the illuminator with the interiors of the electronics compartment  16  and the battery compartment  14  shown. Also,  FIG. 5  shows a view of the interior of the electronics compartment  16  and of the battery compartment  14  with their covers removed. In these views and with further reference to  FIGS. 6   a ,  6   b  and  6   c  there is shown the electronics of the apparatus in which there is an LED PC board  36  ( FIG. 6   a ), a driver PC board  38  ( FIG. 6   b ) and a power supply PC board  40  ( FIG. 6   c ). Both sides of each of the three PC boards are shown in  FIGS. 6   a ,  6   b  and  6   c . The exemplary circuit diagram is shown in  FIG. 9  and is outlined to show the circuitry for each of the three PC boards. On the front of the LED PC board  36 , a pair of LED chips  42  are mounted, each one having a lens  44 . 
     The LED chip  42  is also shown in  FIG. 7 . Exemplary of these chips is the Cree X Lamp MC-E LED (RGBW) of Cree. Inc. of Durham, N.C. which has red, green, blue and white LED dies. 
     The apertures  32   a  and  32   b  are in registry with lenses  44  and thus with the LED chips  40  so that the light pipes  24   a  and  24   b  are in the right place for receiving and transmitting light from the LED chips. 
     Also, in  FIG. 8  there is shown an exemplary LED chip that has dies of RGBW and UV. 
     The forceps  26  is shown in  FIG. 4  inserted and held on the illumination head  10 . It passes loosely through openings in the cover  30  and the LED boards  36  and  38  having its proximal end slid into place in a slot or docking portal  46  in the battery compartment  14  by a fit made tight enough to hold it in place during use but to allow it to be pulled out by hand. While the forceps proximal end passes through the cover  30  and the PC boards  36  and  38 , that is a loose fit. Generally, other ways of holding the forceps in place can be configured such as a positive detent in which a bump or hole is in the forceps and an opposite element in the illuminator. 
     The illuminator  10  is adapted to receive forceps with arms of varying length and light pipes  24   a  and  24   b  may be replaced by light pipes of differing lengths to adjust to the lengths of the forceps arms. The light pipes are chosen to be of lengths to deliver light ahead of the distal ends of the forceps in order to illuminate the area being worked on to provide illumination and by reason of selected colors, contrast to identify foreign bodies. As shown the light pipes end short of the ends of the forceps arms so as to not interfere with use of the forceps. 
     In  FIG. 9  the electronics of the apparatus is shown. The Driver Board portion contains the switch  18  connected to the flip-flop triggers so that sequential pressing of the switch  18  will be processed through the multiplexer/demultiplexer chip to command sequential selection of the dies of the LED chips, a pair of four die chips (the LED chips  42 ) being illustrated in the circuit in the LED Board portion of the circuit diagram. The Power Supply portion shows the battery and the on-off switch  22 . 
     In use, the forceps is fitted into the docking portal where it is held sufficiently tightly to use the device but allowing it to be removed. The user can start with any selected color of the RBGW chips by pressing the switch  18  which sequentially cycles illumination of the RGBW dies. It is anticipated that with experience for a particular use, the user will start with a color known to give good contrast for the anticipated foreign material. This will be especially the case for combat wounds where the contrasting color for foreign bodies from combat wounds will be known by the user. In some cases, the user may start with white light in order to assess the general condition, and then cycle to the best color for contrast. 
     The embodiment described above has a selection functioning mode of sequential selection of specific colors from a multicolor source, in this embodiment that source being the LED chip and the selections in one embodiment being in sequence, red, green, blue and white. Other selection functioning modes are available such as graduated or universally adjustable selection from a color range such as from red to blue, or from red to the ultra violet or preprogrammed color mixes which are described in the embodiments following. Using one or more of the selection functioning modes allows the apparatus and method to be used for enhancing light in surgical debridement most conveniently for selecting the best contrast. In the case of the sequential selection mode, each of a sequence of colors is available from an LED chip in which each die of the chip is one of the sequential selections. But also, special mixtures of light from the dies can be programmed into the electronics, for example a particular light mixture might be optimal for enhancing contrast of foreign material found in combat wounds. 
     Other embodiments of the invention are shown in  FIGS. 10A and 10B . In these embodiments the illuminator  50  has an extended arm  52  aligned with one side of a forceps  54 . This allows easy access to varying the light by operating switches in the extended arm  52 . The embodiment of  FIG. 10A  has self supported light transmitting waveguides that are slightly curved light pipes  56   a  and  56   b . The embodiment of  FIG. 10B  has light transmitting means that are secured to each arm of the forceps, and it is anticipated that optical fibers  58   a  and  58   b  (not shown) will be used. The light sourcing and selection can be as described above. But, each of these embodiments show a version of the invention in which color mixing from a single LED chip of multiple dies is enabled by varying the current to each die so as to vary the intensity of light from each die to provide a color mix, in that way allowing a universal adjustment of color. The extended arm  52  has a three position switch  60  having an off position and two active positions, one for color mixed light and one for white light. When in the position for color mixed light, the wheel  56  which is wired into the circuitry for the LED chip, can be rotated to cause color mixing. Also, there is shown a micro video camera  62  which can transmit the scene at the wound to a display.  FIG. 11  illustrates an exemplary view of a doctor and patient with displays available to the doctor. 
     The method of the invention using the embodiments described above is to insert the forceps into the illuminator. The mounting and dismounting of the forceps contemplates that the forceps will be sterilized for reuse. 
     Then the user turns on the illuminator and commences to position it to illuminate the area under treatment. To begin, a white light might be used to get a general appraisal of the situation. Then a contrast illumination will be selected. In the case of sequential illumination, the activating button or other means is used to cycle through the selections which can be simply the illumination of each die in turn. Then the forceps are used to pick out the foreign bodies/objects. Alternatively the electronics can be configured to allow universal adjustment through the spectral range given by the dies. Also, it is possible to provide selected color mixes based on experience for expected foreign bodies. 
     What has been described herein is considered merely illustrative of the principles of this invention. Accordingly, it is well within the purview of one skilled in the art to provide other and different embodiments within the spirit and scope of the invention as encompassed by the following claims. 
     The foregoing Detailed Description of exemplary and preferred embodiments is presented for purposes of illustration and disclosure in accordance with the requirements of the law. It is not intended to be exhaustive nor to limit the invention to the precise form or forms described, but only to enable others skilled in the art to understand how the invention may be suited for a particular use or implementation. The possibility of modifications and variations will be apparent to practitioners skilled in the art. No limitation is intended by the description of exemplary embodiments which may have included tolerances, feature dimensions, specific operating conditions, engineering specifications, or the like, and which may vary between implementations or with changes to the state of the art, and no limitation should be implied therefrom. This disclosure has been made with respect to the current state of the art, but also contemplates advancements and that adaptations in the future may take into consideration of those advancements, namely in accordance with the then current state of the art. It is intended that the scope of the invention be defined by the Claims as written and equivalents as applicable.