Abstract:
A skin graft applicator with a handle member and a roller member is described for use in applying a skin graft to a patient. The skin graft applicator has a manipulator pad for positioning the skin graft, and a roller member for forcing air and fluid from underneath the skin graft ensuring the proper bond between graft and tissue.

Description:
BACKGROUND 
       [0001]    1. Field of the Invention 
         [0002]    The skin graft applicator is in the field of devices and methods for application and positioning of skin grafts during surgical grafting procedures. Skin grafts are typically difficult to reposition once applied to a wound site, as the wound tissue adheres to the skin graft and resists the movement of the graft. Similarly, air bubbles and fluid are often trapped under a skin graft, and are difficult to remove once the graft has been placed on the wound site. It may also be desirable to smooth the skin to prevent wrinkling as much as possible. The applicator described herein provides improved tools for the removal of air bubbles and fluid from underneath the graft and for the positioning and movement of the graft on the wound site. 
       SUMMARY OF THE INVENTION 
       [0003]    The skin graft applicator provides multiple tools for use in repositioning a skin graft in place on a wound site and for removing air bubbles and fluid trapped between the skin graft and the wound site and smoothing the skin graft. 
         [0004]    The skin graft applicator comprises a handle member with a manipulator pad; and a roller member rotatably attached to the handle member. In an embodiment of the skin graft applicator described herein, the manipulator pad is disposed adjacent to a first end of the handle member and the roller member is disposed adjacent to a second end of the handle member. 
         [0005]    In an embodiment of the skin graft applicator, the manipulator pad comprises a plurality of features extending outwardly from the surface of the handle member. The features in the manipulator pad may comprise hemispheres, or other shapes described with reference to the figures. 
         [0006]    In the embodiment of the skin graft applicator described herein, the roller member comprises a cylindrical foam tube. In some embodiments of the skin graft applicator, the foam tube has a foam density between 33 lb/ft 3  and 7.5 lb/ft 3 . In some embodiments of the skin graft applicator, the foam tube has a tensile strength between 14 lb/in 2  and 44 lb/in 2 . In some embodiments of the skin graft applicator, the foam tube is open cell foam, closed cell for or semi-open cell foam. 
         [0007]    A method of applying a skin graft is described herein comprising the steps of: providing a skin graft applicator having a roller member and a handle member with a manipulator pad; utilizing the manipulator pad to move, the skin graft laterally to the desired position; and rolling the roller member across the skin graft to force air bubbles and fluid to the edges of the skin graft. These steps may be repeated multiple times and in various orders until the desired disposition of the skin graft is achieved. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]      FIG. 1  is a perspective view of an embodiment of the skin graft applicator. 
           [0009]      FIG. 2  is a top view of an embodiment of the skin graft applicator. 
           [0010]      FIG. 3  is a bottom view of an embodiment of the skin graft applicator. 
           [0011]      FIG. 4  is a left side view of an embodiment of the skin graft applicator. 
           [0012]      FIG. 5  is a right side view of an embodiment of the skin graft applicator. 
           [0013]      FIG. 6  is a front view of an embodiment of the skin graft applicator. 
           [0014]      FIG. 7  is a back view of an embodiment of the skin graft applicator. 
       
    
    
     DETAILED DESCRIPTION 
       [0015]    The skin graft applicator provides an improved device for positioning and repositioning a skin graft on a wound site. Typically when a skin graft is placed on a wound site the exposed wound tissue readily adheres to the interior surface of the skin graft. While the graft may be peeled or similarly removed from the wound site for repositioning, the lateral movement of the skin graft on the wound is resisted by the adherence of the wound and skin graft tissues. Often attempts to reposition the skin graft result in stretching or other deformation of or damage to the skin graft, producing less than optimal results. Similarly, lifting the skin graft away from the wound site to allow repositioning is not desirable. 
         [0016]    The skin graft applicator also provides an improved device for removing the air bubbles and fluid trapped between the skin graft and the wound site and smoothing the skin graft out on the wound. When a skin graft is placed on a wound site, air bubbles and fluid are often trapped between the wound tissue and the interior surface of the skin graft. If the bubbles and fluid are allowed to remain between the graft and the wound, the skin graft may be compromised. The skin graft applicator provides an improved tool for removing the air bubbles and fluid. 
         [0017]    Referring now to  FIG. 1 , a perspective view of an embodiment of the skin graft applicator is depicted. The applicator comprises a handle member  100  and a roller member  102 . The handle member may be formed from plastics, metals, or any other material suitable for machining, casting or otherwise manufacturing into the desired shape. In an embodiment of the applicator the handle is formed from medical grade ISO 10993 biocompatible and sterilizable polymer. 
         [0018]    The roller member  102  is utilized to smooth the skin graft over the application site, and to force air bubbles and fluid to the edge of the skin graft and out from under the skin graft by the application of even pressure in a rolling manner across the skin graft. In one embodiment of the applicator, the roller member is formed from open cell foam, such as a medical grade ISO 10993 biocompatible and sterilizable hydrophilic, non-swelling polyurethane foam. In other embodiments of the applicator, the roller member is formed from other foam materials and can be hydrophobic. Additional characteristics of the roller that are preferred are (i) a non-abrasive surface to prevent scratching, tearing or grabbing of graft tissue, (ii) a density firm enough to allow a smooth and constant pressure to be exerted on the graft tissue but soft enough to follow and track the anatomical contours. In some embodiments, the roller may aid in tissue fluid management by absorbsion, for hydrophilic rollers, or transfer, for hydrophobic rollers, of fluid away from the interstitial space between the parent tissue and the graft tissue to ensure proper bonding of graft tissue. 
         [0019]    The handle member  100  is provided with a graft manipulator pad  104  located near a first end of the handle member  100 . The manipulator pad  104  is capable of manipulating the graft by Pushing or pulling the graft laterally across the wound side. The manipulator pad is provided with surface features described in more detail with reference to a later figure. 
         [0020]    The handle member  100  is also provided with a graft manipulator area  106  for exerting pressure on the graft to properly position it on the wound site. This area is used as an ergonomic aid to the user to apply force nearer to the normal, or perpendicular to the graft tissue surface. A force exerted normally will reduce lateral forces which tend to move the graft tissue away from the correct position. 
         [0021]    Referring now to  FIG. 2 , a top view of an embodiment of the skin graft applicator is depicted. The handle member  100  incorporates roller arm  200  for receiving and rotatably supporting roller member  102 . The roller arm may be cast or machined as a part of the handle member  100  or separately manufactured and attached to other components of the handle member. 
         [0022]    Similar to other roller arms known for various uses, the roller arm extends from the grip area  202  of handle member  100  to the side of roller member  102  and then through a cylindrical opening in roller member  102 . The end  204  of roller arm  200  is provided with a means of retaining roller member  102  on the roller arm  200  during use. 
         [0023]    In the embodiment shown in the figures, the end  204  of roller arm  200  is provided with a retaining flange  206  incorporated into the roller arm  200 . The arm  200  may also have a transverse slit  208  and retaining ring  210 , shown more clearly with reference to a later figure. The retaining flange  206  may be compressed along the length of slit  208 , thus allowing retaining ring  210  to be slid over the retaining flange  206 , at which time the flange  206  is released and engages the retaining ring  210 . 
         [0024]    Retaining ring  210  extends axially away from roller arm  200  a sufficient distance to overlap and retain roller member  102  on roller arm  200 . In some embodiments, retaining ring  210  may extend cylindrically along the roller arm  200  inside roller member  102  to provide support to the roller member  102  and to maintain it at the appropriate spacing from roller arm  200 . 
         [0025]    Referring now to  FIG. 3 , a bottom plan view of an embodiment of the skin graft applicator is depicted. Graft manipulator pad  104  is disposed on the end of handle member  100  opposite to the roller arm  200 . The pad  104  provides a user a means of gripping and pulling or pushing the skin graft in a lateral direction on the wound site. In the embodiment shown in the figures, the pad  104  comprises a pattern of features  300  extending outwardly from the surface of handle member  102  adjacent to the end thereof. The pattern of the features  300  may be uniform or random and is not limiting of the manipulator pad  104 . 
         [0026]    The features  300  may be a variety of shapes extending outwardly from the surface of handle member  100 . The shapes may be of various shapes, including, but not limited to hemispherical, semispherical, or polyhedron shapes, or asymmetric shapes such as ridges, hooks, or random shapes. The features  300  provide a means of exerting force on the skin graft by contact and lateral pulling or pushing of the handle member  100 . Any shape that grabs the graft tissue without damaging it may be utilized. 
         [0027]    In the embodiment depicted in the figures, features  300  are formed as a part of handle member  100 . In other embodiments of the skin graft applicator, the pad  104  or features  300  may be separately manufactured and then applied to handle member  100  by gluing, welding or other means of permanently attachment. 
         [0028]    During use, the manipulator pad  104  is placed against the skin graft with a substantial part of the surface of pad  104  and features  300  in contact with the skin graft. The handle member  100  is then pulled or pushed laterally to exert force on the skin graft and adjust its position as desired. 
         [0029]    Referring now to  FIG. 4 , a left side view of an embodiment of the skin graft applicator is depicted. The ergonomic handle naturally reduces fatigue and allows the even application of downward force on the face of the roller  102  that is in contact with the graft tissue. 
         [0030]    The embodiment of the applicator shown in  FIG. 4  comprises a handle member  100  that has an optional taper to a thin flat area near manipulator pad  104 . The thin area of handle member  100  provides some flexibility to handle  100  when pad  104  is pressed against a skin graft and allows the user to apply force more efficiently to the skin graft.  FIG. 4  also shows the slit  208  and retaining ring  210 . 
         [0031]    Referring now to  FIG. 5 , a right side view of an embodiment of the skin graft applicator is depicted. A second retaining ring  500  is depicted between roller member  102  and roller arm  200 . Like retaining ring  210 , ring  500  maintains roller member  102  at the appropriate position laterally on roller arm  200 . The ring  500  may optionally extend inside roller member  102  along roller arm  200  to maintain the appropriate distance axial distance between the two components, and to ease the rotation of roller member  102  around roller arm  200 . 
         [0032]    Referring now to  FIGS. 6 and 7 , a front and rear view of the skin graft applicator is depicted. 
         [0033]    The skin graft applicator is utilized to complete the application of a skin graft. Once the skin graft is disposed on the wound site the roller member and manipulator pad are utilized as necessary to dispose the skin graft in the final desired position and configuration. The manipulator pad may be utilized to move the skin graft laterally on the wound site and then the roller member may be utilized to force air and fluid from under the skin graft and smooth it out on the wound site. Bach step may be repeated separately a plurality of times, and in whatever order is necessary to achieve the desired result.