Abstract:
A dressing delivery system comprises an applicator for holding and positioning a wound dressing. The applicator comprises a sleeve having a distal spreading portion. The wound dressing is disposed on or adjacent the spreading portion. The applicator urges the dressing into contact with the wound. The sleeve is advanced to actuate the spreading portion, which increases the diameter of the applicator and preferably deploys the dressing.

Description:
RELATED APPLICATIONS 
     This application is based on and claims priority to U.S. Provisional Application No. 60/500,764, which was filed on Sep. 5, 2003. The entirety of the priority application is hereby incorporated by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to a wound closure device, and more specifically to a device and method for applying a dressing onto a wound during a surgical procedure. 
     2. Description of the Related Art 
     In an effort to minimize patient trauma, many types of surgeries are typically performed through as small of an incision as possible. Such minimally invasive surgical procedures can be used to treat various types of internal wounds. These wounds can be, for example, surgical incisions, accident-caused injuries, bleeding tumors or ulcers, tumor beds from which a tumor has been surgically removed, or any other tissue area requiring treatment. However, closure of internal wounds using minimally invasive procedures may be problematic and difficult. If blood flow from such a subcutaneous wound cannot be effectively and confidently arrested, the clinician must convert from laparoscopic or endoscopic surgery to open surgery in order to gain sufficient access to the tissue to enable closure of the wound through traditional open-surgery techniques such as suturing or clips. 
     Endoscopic surgery typically involves a cannula or trocar inserted through a relatively small incision through the patient&#39;s outer tissue layers to provide access to the patient&#39;s internal organs. Access to the surgical field during endoscopic surgery is limited. Thus, a limitation of endoscopic surgery is that it is relatively difficult to use multiple tools to effect wound closure. As a result, surgical instruments may be called upon to perform tasks without the aid of other instruments. However, consistent and reliable closure of a wound using only a single instrument is difficult to achieve. Further, surgical tools must fit through a narrow trocar of cannula. 
     SUMMARY OF THE INVENTION 
     Accordingly, there is a need in the art for a single surgical instrument that can access internal wounds through a confined space, and apply a suitable dressing to the wound. 
     In accordance with one embodiment, a wound closure device is provided. The device can be a dressing applicator having an elongate body with inner and outer lumens. First and second connectors provide access to the inner and outer lumens, respectively. The lumens each have distal openings and the inner lumen distal opening is distal of the outer lumen distal opening. In some embodiments, the inner and outer lumens are arranged concentrically. 
     In one embodiment, a vacuum source may be removably connected to one of the first and second connectors. The vacuum source is preferably configured to releasably hold a dressing disposed at the distal opening of the lumen of said connector while the closure device is advanced to the wound location to deploy the dressing. The dressing can be deployed by pressing the dressing onto the wound location with the applicator. Further, a distal portion of the applicator preferably spreads the dressing onto the wound. In another embodiment, an adhesive source may be removably connected to another of the first and second connectors, wherein the adhesive source is configured to deliver a flowable adhesive over and around the dressing once the dressing is deployed over the wound. 
     In another embodiment, a dressing applicator comprises a sleeve having a body and a lumen extending about an axis between a proximal end and a distal end. The distal end of the body defines at least one foldable portion configured to pivot between an orientation generally parallel to the axis of the lumen and an orientation generally orthogonal to the axis. For example, the at least one foldable portion can pivot about a junction in the body wall, such as a hinge. 
     In one embodiment, the distal end of the body is configured to releasably hold the dressing while the sleeve is advanced to the wound location or field area. Once the dressing is at the wound location, the at least one foldable portion may be pivoted into an orientation generally transverse to the axis, and preferably generally parallel to the dressing and wound location. In one embodiment, a clinician using the applicator may continue to advance the sleeve toward the wound location, causing the at least one foldable portion to pivot upon coming in contact with the wound. 
     In another embodiment, a locking or actuation mechanism is configured to hold the at least one foldable portion generally parallel to the axis. The locking mechanism can be actuated to allow the at least one foldable portion to pivot into an orientation generally transverse to the axis. The at least one foldable portion can then be used to compress and/or hold the dressing against the wound and/or the field area surrounding the wound. Optionally, a flowable adhesive may be delivered over and around the dressing, as described above. In one embodiment, the flowable adhesive can be delivered via at least one aperture formed on the body of the dressing applicator. 
     In still another embodiment, the dressing may be disposed circumferentially about the at least one foldable portion of the sleeve. The dressing thus extends about the axis as the sleeve is advanced to the wound location or field area. In one embodiment, the sleeve can have apertures formed at a distal end thereof for applying a vacuum therethrough to hold the dressing on the sleeve. Once the distal end of the sleeve is proximal the wound location, the at least one foldable portion is pivoted, as discussed above, to push the dressing onto the wound. The at least one foldable portion can then be used to compress and/or hold the dressing against the field area surrounding the wound. 
     In one embodiment, the sleeve having foldable portions can define a lumen configured to slidably receive an elongate body of a dressing applicator therein. The applicator is configured to removably hold a dressing generally orthogonal to an axis of the applicator, as the applicator and dressing are advanced to the wound location. In one embodiment, a vacuum source, as discussed above, can be used to hold the dressing. In another embodiment, the dressing is held by an adhesive. Once the dressing is positioned at the wound location, the sleeve can be advanced about the body toward the dressing. In one embodiment, the foldable portions of the sleeve can pivot upon contacting the dressing to expand the diametrical cross section of the applicator and to compress and/or hold the dressing on the wound. In another embodiment, the foldable portions can pivot upon contacting a catch at the distal end of the applicator body. 
     In another embodiment, the elongate body of a dressing applicator, as described above, can have foldable portions at a distal end of the applicator. Upon deployment of the dressing over the wound location, the foldable portions can be pivoted generally orthogonal to an axis of said body, via for example contact with the wound location, to compress and/or hold the dressing over the wound location. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side view of one embodiment of a dressing applicator. 
         FIG. 2  is a cross-sectional view of the dressing applicator of  FIG. 1 . 
         FIG. 3  is a sectional side view of a dressing applicator according to another embodiment, the applicator having a sleeve with a spreading portion. 
         FIG. 4  is a partial perspective view of the dressing applicator of  FIG. 3  with the spreading portion in an unfolded state. 
         FIG. 5  is a partial perspective view of the dressing applicator of  FIG. 3  with the spreading portion in an intermediate state. 
         FIG. 6  is a partial perspective view of the dressing applicator of  FIG. 3  with the spreading portion in a fully deployed state. 
         FIG. 7  is a cross-sectional partial side view of another embodiment of a dressing applicator, wherein the dressing is removably held about a distal end of a sleeve. 
         FIG. 8  is a partial perspective view of the arrangement of  FIG. 7  with the spreading portion in an unfolded state. 
         FIG. 9  is a partial perspective view of the arrangement of  FIG. 7  with the spreading portion in an intermediate state. 
         FIG. 10  is a partial perspective view of the arrangement of  FIG. 7  with the spreading portion in a fully deployed state. 
         FIG. 11  is a longitudinal cross-section of another embodiment of a dressing applicator having a catch for operatively contacting a sleeve. 
         FIG. 12  is a cross-sectional view of another embodiment of a dressing applicator having a dressing removably held at a distal end of a tubular main body. 
         FIG. 13  is a cross-sectional view of another embodiment of a dressing applicator, having a tubular main body movable relative to a tubular inner body. 
         FIG. 14  is a cross-sectional view of a sleeve having a locking mechanism. 
         FIG. 15  is a cross-sectional view of another embodiment of a dressing applicator, having a locking mechanism configured to lock a sleeve longitudinally relative to a tubular main body. 
         FIG. 16  is a partial perspective view of another embodiment of a dressing applicator. 
         FIG. 17  is a cross-sectional side view of the dressing applicator of  FIG. 16  with the spreading portion in an unfolded state. 
         FIG. 18  is a partial perspective view of the dressing applicator of  FIG. 16  with the spreading portion in a deployed state. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       FIG. 1  shows a side view of one embodiment of a dressing applicator  18 . The applicator  18  preferably comprises a tubular main body  20  having a generally cylindrical wall  20   a  (see  FIG. 2 ) extending between a proximal end  22  and a distal end  24 . The cylindrical wall  20   a  defines a lumen  26  therein that extends between the proximal end  22  and a distal opening  28  at the distal end  24  of the tubular main body  20 . The applicator  18  also preferably comprises a tubular inner body  30  having a generally cylindrical inner wall  30   a  that extends between a proximal end  32  and a distal end  34 . The inner wall  30   a  defines a lumen  36  extending between the proximal end  32  and a distal opening  38  at the distal end  34  of the tubular inner body  30 . In the illustrated embodiment, the tubular main body  20  and the tubular inner body  30  are concentric about a major axis Y. It is to be understood that other configurations may desirably be employed. 
     As shown in  FIGS. 1 and 2 , a first connector  40  is connected to the proximal end  22  of the tubular main body  20  via a first neck  42 . Additionally, a second connector  44  is connected to the cylindrical wall  20   a  of the tubular main body  20  via a second neck  46 . As shown in  FIG. 2 , the inner lumen  36  can extend through the first neck  42  and the first connector  40  to the proximal end  32  of the lumen  36 . Additionally, another lumen  48  may extend from the main body  20  through the second neck  46  and the second connector  44 . The lumen  48  preferably communicates with the outer lumen  26 . 
     Each of the connectors  40 ,  44  preferably is adapted to be selectively connected to a variety of medical devices. For example, in one embodiment one of the connectors  40 ,  44  can be connected to a vacuum source  50  (shown schematically). In another embodiment, one of the connectors  40 ,  44  can be removably connected to a fluid source  52  (not shown) that supplies a fluid such as an irrigation liquid, a hemostatic agent, medication, or the like. In still another embodiment, one of the connectors  40 ,  44  can be removably connected to a source of flowable adhesive  54  (shown schematically). Further details concerning some embodiments of a dressing applicator can be found in Applicants&#39; U.S. Pat. No. 6,589,269, the entirety of which is hereby incorporated by reference. 
     With reference next to  FIGS. 3-4 , another embodiment of a dressing applicator  18  additionally comprises a tubular sleeve  60  having a wall  60   a  that defines a lumen  66 . The lumen  66  is configured to sidably receive the tubular main body  20  of the applicator  18  therethrough. The tubular inner body  30  removably holds a dressing  70  at its distal end  34  via, for example, a vacuum pulled through the inner lumen  36 . 
     The tubular sleeve  60  preferably comprises a generally rigid portion  72  and at least one spreading portion  74  disposed between the rigid portion  72  and a distal end  76  of the sleeve  60 . In the illustrated embodiment the tubular sleeve  60  comprises a plurality of upper segments  78  each connected to the generally rigid portion  72 , and a corresponding plurality of lower segments  80  connected to respective upper segments  80  and extending to the distal end  76  of the sleeve  60 . With reference also to  FIGS. 5 and 6 , the segments  78 ,  80  are preferably configured to moveably pivot between an orientation generally parallel to the major axis Y and an orientation generally orthogonal to the axis Y. 
     Each upper segment  78  pivotably connects to the generally rigid portion  72  via a proximal joint  82  so as to define a pivoting edge  84  between the upper segment  78  and the generally rigid portion  72 . In one embodiment, the proximal joint  82  allows the upper segment  78  to pivot in a direction away from the major axis Y. Preferably, the proximal joint  82  comprises a hinge. It is to be understood that the proximal joint  82  can include any structure allowing the upper segments  78  to pivot relative to the major axis Y. For example, in one embodiment the proximal joint  82  can be a scored section extending about the circumference of the sleeve  60 , where the scored section is preferentially bendable to allow the upper segments  78  to pivot relative to the rigid portion  72 . In another embodiment, the proximal joint  82  can be a circumferential section of the sleeve wall  60   a  having a reduced thickness, where the section of reduced thickness is preferentially bendable to allow the upper segments  78  to pivot relative to the rigid portion  72 . 
     With continued reference to  FIGS. 3-6 , each lower segment  80  preferably is pivotally connected to the respective upper segment  78  via an intermediate joint  86  so as to define a pivoting edge  87  between the upper segment  78  and the lower segment  80 . In one embodiment, the intermediate joint  86  can allow the lower segment  80  to pivot away from the major axis Y. As with the proximal joint  82 , the intermediate joint  86  can comprise any structure configured to allow the lower segments  80  to pivot relative to the major axis Y and the upper segments  78 , such as a hinge, scored section, or section of reduced thickness. 
     Each of the upper segments  78  comprises side edges  88  extending from the proximal joint  82  to the intermediate joint  86 . Similarly each of the lower segments  80  comprises side edges  90  that extend from the intermediate joint  86  to a distal joint  92 . In the illustrated embodiment, the side edges  88  of adjacent upper segments  78  generally engage each other when the segments are oriented generally parallel to the major axis Y, as shown in  FIG. 4 . Similarly the side edges  90  of the adjacent lower segments  80  generally engage each other when the segments are oriented generally parallel to the major axis Y. Accordingly there is generally no gap between the segments when in this position. It is to be understood that, in other embodiments, the segments can be arranged so that there are gaps between the side edges  88 ,  90  of adjacent segments  78 ,  80  when the segments are oriented generally parallel to the major axis Y. 
     Each lower segment  80  preferably is pivotally connected to a distal joint  92  at or adjacent to the distal end  76  of the sleeve  60 . The lower segment  80  pivots at the distal joint  92 . As with the proximal and intermediate joints  82 ,  86 , the distal joint  92  can comprise any structure configured to allow the lower segment  80  to pivot relative to the major axis Y. With particular reference to  FIG. 5 , preferably the lower segments  80  are configured so that each distal joint  92  generally maintains its radial distance from the major axis Y, and the distal joints  92  of successive segments  80  are immediately adjacent another. Preferably, the distal joints  92  are linked so as not to separate them from one another. 
       FIGS. 4-6  illustrate an embodiment of a dressing applicator  18  having a tubular sleeve  60  in operation deploying a dressing  70  upon a wound W. The wound W depicted in  FIG. 3  simulates a tumor bed from which a tumor has been surgically removed. Such a wound W tends to ooze and bleed slowly over a relatively large area. If the oozing is not controlled, open surgery techniques may be required to properly dress the wound W and arrest the bleeding. Of course, one of ordinary skill in the art will understand that other types of wounds are also amenable to the embodiments disclosed herein, such as wounds to internal organs and vasculature. 
       FIG. 4  shows the sleeve  60  in an unfolded position, in which the segments  78 ,  80  are generally aligned with the major axis Y.  FIG. 5  shows the sleeve  60  in a partially folded orientation in which the segments  78 ,  80  are positioned generally transverse to the major axis Y.  FIG. 6  shows the sleeve  60  in a completely folded orientation in which the segments  78 ,  80  are positioned generally orthogonal, or generally perpendicular, to the major axis Y. 
     With continued reference to  FIGS. 3-6 , in one embodiment the dressing  70  is applied to the distal end  34  of the inner body  30  and a vacuum is drawn therethrough in order to hold the dressing  70  in place. The device is then advanced toward the wound W as shown in  FIG. 4 . After the device has been advanced so that the dressing  70  has contacted the wound W, the clinician preferably applies a force to the sleeve  60  so as to advance the sleeve distally relative to the main tubular body  20 . The generally rigid portion  72  of the sleeve  60  preferably is sufficiently rigid to push distally without buckling. The distal end  76  of the sleeve  60  contacts the wound W through the dressing  70 . Upon continued application of force, the upper and lower segments  78 ,  80  buckle or pivot about the joints  82 ,  86 ,  92 , as shown in  FIG. 5 . The upper segment  78  pivots outward relative to the major axis Y so that its outer surface faces generally away from a surgical field F surrounding the wound W. The lower segment  80  pivots outwardly relative to the major axis Y so that its outer surface generally faces toward the field F. As the segments  78 ,  80  pivot, the edge  84  between the upper and lower segments  78 ,  80  displaces radially outwardly from the major axis Y. 
     As the sleeve  60  continues to move distally relative to the main body  20 , the segments  78 ,  80  continue to fold and the pivoting edge  84  continues to move radially outwardly from the major axis Y. Eventually, as shown in  FIG. 6 , the segments  78 ,  80  are substantially completely folded. The lower segments  80  are in contact with the dressing, and a compression force from the sleeve  60  is translated through the segments  80  to the dressing  70 . As such, in the fully deployed state, the effective circumference of the applicator is increased, and compression force urging the dressing  70  against the wound W is distributed across a larger area than is provided when the dressing applicator  18  is in a non-folded arrangement. A more secure placement of the dressing  70  on the wound W is thus achieved. Additionally, in some embodiments, the present device and method can be used to compress the dressing  70  against the field F surround the wound W as well as the wound itself. After the dressing  70  is suitably deployed and spread, the sleeve  60  may be moved proximally to return the segments  78 ,  80  to the unfolded state. 
     In the embodiment shown in  FIGS. 3-6 , at least one aperture  94  preferably is formed on the generally rigid portion  72  of the sleeve  60  and communicates with the lumen  66  of the sleeve  60 . The at least one aperture  94  is configured to allow, for example, a flowable adhesive therethrough onto and about the dressing  70 . Other substances, such as a medication, hemostatic agent, irrigation fluid, or the like can also or alternatively be supplied through the at least one aperture  94  to the field F around a wound W. 
     In the illustrated embodiment, a length  95  of the upper segments  78  is substantially equal to a length  96  of the lower segments  80 . In other embodiments, the lengths can be different. For example, in another embodiment, the length  95  of the upper segments  78  is greater than the length  96  of the lower segments  80 . As such, when the lower segments  80  are deployed generally perpendicular to the sleeve  60 , the upper segments  78  are still somewhat angled, and efficiently communicate compression force to the intermediate joint  86  and throughout the lower segments  80 . Still further, in such an embodiment the lower segments  80  can be deployed and angled beyond an angle perpendicular to the sleeve  60 , and thus may be used in applications involving convex wound application surfaces. 
     With reference next to  FIGS. 7-10 , another embodiment of an applicator  98  comprises a main body  20  having a distal end  24  and comprising a tubular sleeve  60  that is slidable relative to the main body  20 . In the illustrated embodiment, the main body defines a lumen  26 , and the distal end  24  of the main body  20  comprises a distal wall  100 . Preferably, the distal wall  100  is substantially solid. In other embodiments, the distal wall may include at least one aperture, and may comprise a mesh, netting, or the like. Preferably, the sleeve  60  is similar to the sleeve discussed above in connection with  FIGS. 3-6 . 
     With particular reference to  FIG. 7 , the main body  20  preferably comprises one or more apertures  102  formed through a side wall  20   a . One or more of the lower segments  80  of the sleeve  60  additionally comprises an aperture  104 . Preferably, the sleeve  60  has a lumen  66  that is configured to maintain a vacuum so that a vacuum drawn through the main body lumen  26  further draws a vacuum through the apertures  102 ,  104 . 
     As shown in  FIG. 7 , the dressing  70  preferably is disposed circumferentially about the distal ends  24 ,  76  of the main body  20  and sleeve  60 , and is at least partially wrapped thereabout so as to be about at least portions of the lower segments  80 . As such, the vacuum through the apertures  104  holds the dressing  70  in place on the distal end of the device  98  in a generally compact arrangement before and while the device  98  is introduced into the patient. 
     With continued reference to  FIGS. 7-10 , in operation, a clinician preferably inserts the applicator  98  through a minimally invasive incision and advances the dressing  70  toward the field F of the wound W. Once the distal end  24  of the body  20  contacts the wound W, the clinician moves the sleeve  60  distally relative the body  20  so as to pivot the segments  78 ,  80  into a fully or partially deployed state. As the segments  78 ,  80  pivot into a deployed state, the dressing  70  is unwrapped from the sleeve  60  and deployed onto the wound W. The lower segments  80  communicate pressure to urge the dressing  70  securely onto the wound W. 
     In a preferred embodiment, the vacuum being pulled through the at least one aperture  104  is terminated prior to deploying the dressing  70 . Thus, the dressing is more easily is removed from the sleeve  60 . In another embodiment, the vacuum is not terminated; however, as the upper and lower segments  78 ,  80  fold, gaps between the side edges  88 ,  90  of the segments defeat the vacuum so that the dressing  70  is no longer held securely onto the segments  80  by the vacuum. In another embodiment, the vacuum is also drawn through an aperture or series of openings through the distal wall  100  of the main body  20 . 
     In still another embodiment, instead of or in addition to using a vacuum, the dressing  70  is removably attached to the lower segments  80  via a light adhesive such that the dressing  70  can be detached from the lower segments  80  via the application of a mild force, such as by twisting the applicator once the dressing is deployed. In yet another embodiment, the dressing  70  is removably attached to the lower segments  80  by mechanical means such as, for example, a plurality of hooks or the like. The dressing  70  can be detached from the lower segments  80  by unhooking said hooks via, for example, the application of a rotational force to the sleeve  60 . 
     The dressing  70  can comprise any material suitable for treatment of internal wounds, such as incisions, or oozing tissues, such as ulcers, tumors, or tumor beds from which tumors have been surgically removed. In one embodiment, the dressing  70  comprises a fibrous or sponge-like material infused with a hemostatic agent configured to arrest the flow of blood from the wound W. The dressing  70  can also be made of, for example, PTFE, biovascular material, collagen, Gore-Tex®, Dacron™, etc. The dressing is preferably made of materials that will dissolve over time within the patient&#39;s body. Further, the dressing is also preferably hydrophilic so that the dressing  70  will readily adhere to the wound W. 
     In a particularly preferred embodiment, the dressing comprises a woven or non-woven fabric comprising a hemostatic agent. The hemostatic agent preferably comprises a starch such as bioabsorbable microporous polysaccharide microspheres (e.g., TRAUMADEX™ marketed by Emergency Medical Products, Inc. of Waukesha, Wis.). The microspheres have micro-replicated porous channels. The pore size of the microspheres facilitates water absorption and hyperconcentration of albumin, coagulation factors, and other protein and cellular components of the blood. The microspheres also affect platelet function and enhance fibrin formulation. In addition, the microspheres are believed to accelerate the coagulation enzymatic reaction rate. When applied directly, with pressure, to an actively bleeding wound, the particles act as molecular sieves to extract fluids from the blood. The controlled porosity of the particle excludes platelets, red blood cells, and serum proteins larger than 25,000 Daltons, which are then concentrated on the surface of the particles. This molecular exclusion property creates a high concentration of platelets, thrombin, fibrinogen, and other proteins on the particle surface, producing a gelling action. The gelled, compacted cells and constituents accelerate the normal clotting cascade. The gelling process initiates within seconds, and the resulting clot, while exceptionally tenacious, breaks down normally along with the microparticles. Such microporous polysaccharide microspheres, and additional hemostatic agents, are discussed in more detail in Applicants&#39; copending application entitled “Deployable Multifunctional Hemostatic Agent,” U.S. application Ser. No. 10/868,201, filed Jun. 14, 2004, the entirety of which is hereby incorporated by reference. 
     Any suitable hemostatic substrate can be employed as a support for the hemostatic agents of preferred embodiments. However, in a particularly preferred embodiment the hemostatic substrate comprises chitosan. Chitosan is obtained from chitin, a biopolymer obtained principally from shrimp and crab shell waste. Chitosan is the main derivative of chitin, and is the collective term applied to deacetylated chitins in various stages of deacetylation and depolymerization. Chitosan exhibits anti-inflammatory and analgesic effects, and promotes hemostasis and wound healing. Chitosan has also been used as a hemostatic agent in surgical treatment and wound protection. The hemostatic effect of chitosan has been described in U.S. Pat. No. 4,394,373. 
     A single hemostatic substrate or combination of hemostatic substrates of different forms and/or compositions can be employed in the devices of preferred embodiments. Different substrate forms can be preferred, for example, fibrous puff, fleece, woven or non-woven fabric, sheet, suture, or powder. A homogeneous mixture of different substrate-forming materials can be employed, or composite substrates can be prepared from two or more different formed substrates. Additional details concerning chitosan and other suitable substrates are discussed in more detail in Applicants&#39; copending application “Deployable Multifunctional Hemostatic Agent.” 
     The applicators  18 ,  98  illustrated and discussed in connection with  FIGS. 1-9  can be made of any biocompatible material suitable for use in surgical procedures for treating subcutaneous wounds. Preferably, the applicator  18 ,  98  is made of a sterilized and hypoallergenic material. For example, the applicator can be made of a sterilized metal, such as stainless steel or aluminum. In other embodiments, the applicator can be made of a sterilized plastic, such as polyurethane or polypropylene. 
     In another embodiment, shown in  FIG. 11 , a catch  110  is disposed at the distal end  24  of the tubular main body  20 . In the illustrated embodiment, the catch  110  comprises a lip extending radially outward from the body  20 . The catch  110  is configured to contact and limit the translation of the distal end  76  of the sleeve  60  as the sleeve is advanced over the tubular main body  20  and toward the wound. The distal end  76  of the sleeve  60  will contact the catch  110  as the clinician applies force to the sleeve  60  to advance the sleeve to the wound. Once the distal end  76  is in contact with the catch  110 , continued application of said force will cause the segments  78 ,  80  to buckle or pivot relative to the major axis Y into an orientation generally transverse to the axis Y. The segments  78 ,  80  are thus deployed to compress and/or hold the dressing  70  on the wound without necessitating the distal end  76  of the sleeve  60  contacting with the wound. 
     With reference next to  FIG. 12 , another embodiment of an applicator  120  comprises a main body  20  having a distal end  24  and comprising a tubular sleeve  60  that is slidable relative to the main body  20 . In the illustrated embodiment, the main body defines a lumen  26 , and the distal end  24  of the main body  20  comprises a distal opening. Preferably, a vacuum is drawn through the lumen  26 , and the vacuum through the distal opening releasably holds a dressing  70  onto the distal end  24 . In operation, a clinician advances the body  20  to the wound to dispose the dressing  70  on the wound W. Once the dressing  70  is disposed on the wound, the vacuum is terminated to detach the dressing  70  from the distal end  24  of the body  20 . The sleeve  60  is advanced toward the wound to operatively contact the wound W and deploy the dressing  70  thereon. 
       FIG. 13  shows yet another embodiment of an applicator  130 . In the illustrated embodiment, the applicator  130  comprises a tubular main body  140  having a generally cylindrical wall  140   a  that defines a lumen  146  therein. The applicator  130  also preferably comprises a tubular inner body  150  having a generally cylindrical inner wall that defines a lumen  156  extending between a proximal end and a distal opening  158  at a distal end  154  of the tubular inner body  150 . A connector is connected to the cylindrical wall  140   a  of the tubular main body  140  via a neck  160 . Both the inner lumen  156  and outer lumen  146  can be connected to a source of vacuum, fluid or the like. 
     The tubular main body  140  preferably comprises a generally rigid portion  172  and at least one spreading portion  174  disposed between the rigid portion  172  and a distal end  176  of the body  140 . In the illustrated embodiment, the spreading portion  174  comprises a plurality of upper segments  178  and a corresponding plurality of lower segments  180 . The respective upper and lower segments  178 ,  180  preferably are pivotable relative to the rigid portion  172  and each other. 
     With continued reference to  FIG. 13 , the tubular main body  140  preferably is movable relative to the tubular inner body  150 . As shown, a dressing  70  preferably is removably held at the distal end  154  of the inner body  150  via, for example, a vacuum pulled through the inner lumen  156 . In use, the applicator  130  is advanced to a wound so as to position the dressing  70  adjacent the wound W. The main body  140  is then advanced relative to the inner body  150  so that its distal end operatively contacts the wound. Once in contact with the wound W, further application of the force causes the segments  178 ,  180  to pivot relative to the major axis Y so as to deploy the dressing  70  from the applicator  130  to the wound. 
     In accordance with another embodiment, a locking mechanism can be used to maintain the segments  78 ,  80  generally parallel to the major axis Y. In the embodiment illustrated in  FIG. 14 , the proximal and intermediate joints  82 ,  86  are maintained in a locked position via a locking mechanism  190  when the segments  78 ,  80  are in an unfolded state. The locking mechanism  190  comprises a rod  192  within the sleeve  60  and extending generally parallel to the axis Y. The rod  192  is configured to slidably extend through at least one locking member  194  connected to the segments  78 ,  80 . In the illustrated embodiment, the at least one locking member  194  consists of two loops. However, the at least one locking member  194  can have other shapes, such as a hook. In a locked position, the rod  192  extends through the at least one locking member  194  to substantially prevent the segments  78 ,  80  from pivoting relative to the axis Y. To unlock the mechanism  190 , the rod  192  is withdrawn from the at least one locking member  194 , allowing the segments  78 ,  80  to pivot relative to the axis Y. 
     In another embodiment, shown in  FIG. 15 , a locking mechanism  196  configured to lock a sleeve  60  relative to a tubular main body  20  includes at least one protrusion  197  formed on an inner wall of the sleeve  60  and contacting the body  20 . The at least one protrusion  197  is preferably configured to operatively engage a corresponding receiving portion  198  formed in or on the tubular main body  20 . In the illustrated embodiment, the protrusion  197  and receiving portion  198  comprise a ball and detent. When the protrusion  197  is disposed in the receiving portion  198 , the locking mechanism  196  substantially prevents movement of the sleeve  60  relative to the body  20 . However, the protrusion  197  disengages from the receiving portion  198  upon application of a releasing force. Once disengaged, the sleeve  60  is free to move relative to the tubular main body  20 . In another embodiment, the sleeve and body are partially threaded onto one another. 
     With reference next to  FIGS. 16-18 , another embodiment of a dressing applicator  200  comprises a main body  202  and a sleeve  210  that is movable longitudinally relative to the main body  202 . The sleeve  210  comprises a generally rigid portion  212  and a spreading portion  214  distal of the rigid portion  212 . Preferably the spreading portion  214  is disposed at or adjacent a distal end  216  of the sleeve  210 . The spreading portion  214  comprises a plurality of upper segments  218  and a corresponding plurality of lower segments  220 . In the illustrated embodiment, the upper segments  218  are coformed with the rigid portion  212 , and are defined by side edges  222 . Preferably, adjacent upper segments  218  are spaced from each other. 
     Each lower segment  220  preferably is pivotally attached to a distal end  224  of a respective upper segment  218  at a proximal joint  230 . As such, the lower segments  220  are pivotable relative to the upper segments  218  at the proximal joint  230 . Each lower segment  220  also is pivotally connected to a distal joint  232  at or adjacent a distal end of the sleeve  210 . The lower segment  220  pivots at the distal joint  232 . The proximal and distal joints  230 ,  232  can comprise any structure configured to allow the lower segment  220  to pivot relative to the major axis Y. With particular reference to  FIGS. 17 and 18 , preferably the lower segments  220  are configured so that each distal joint  232  generally maintains its radial distance from the major axis Y, and the distal joints  232  of successive segments  220  are immediately adjacent on another. Preferably, the distal joints  232  are linked so as not to separate from one another. 
     With continued reference to  FIGS. 16-18 , a dressing  70  preferably is disposed about the distal end of the applicator  200 . As the dressing  70  engages the wound, the sleeve  210  is pushed distally relative to the main body  202 . The generally rigid portion  212  of the sleeve  210  preferably is sufficiently rigid to communicate distal force without substantially buckling. However, as shown in  FIG. 18 , the upper segments  218  preferably are sufficiently flexible to bend outwardly as the lower segments  220  pivot about the joints  230 ,  232 . As such, when the dressing  70  is deployed, wound engagement pressure is communicated through the upper segments  218  to the lower segments  220  and dressing  70 . 
     In the embodiment illustrated in  FIGS. 16-18 , a vacuum, light adhesive, or the like may be employed to releasably hold the dressing  70  in place on the applicator  200 . Additionally, as with some embodiments disclosed herein, other embodiments may include a locking mechanism. Further, in another embodiment, the upper segments  218  are biased outwardly. Such a bias may be accomplished in any acceptable manner, such as by a ball and detent mechanism as shown and discussed above with reference to  FIG. 15 . In still further embodiments, a flexible cover may be disposed about the spreading portion to separate the dressing from the applicator and to reduce the likelihood that body tissue or a portion of the dressing may become pinched between segments when the segments are unfolded after deployment. 
     In practice, the embodiments illustrated in  FIGS. 1-18  are advantageously configured to deploy a dressing  70  to an internal wound location W by way of a minimally invasive incision in a patient. Accordingly, the applicator embodiments can be used to close a wound W without requiring the opening of a large incision in the patient&#39;s skin. Additionally, the embodiments provide a compact apparatus for applying and spreading a dressing  70  on a wound W. Preferably, the applicator embodiments are configured so that an effective circumference of the applicator expands when deployed to help apply the dressing to the wound and/or surgical field. As discussed above, the segments  78 ,  80  advantageously provide the applicator embodiments with a means for compressing and/or holding the dressing  70  against the field area F surrounding the wound W, especially when the dressing is considerably larger than the diameter of the applicator. 
     Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while a number of variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed invention. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.