Abstract:
A wound closure system comprises a forceps including first and second legs adapted to close into a proximate position in response to a squeezing force applied to the forceps. The forceps also includes a ratchet strip connected to the second leg and passing through an opening in the first leg. The lower edge of the opening is formed as a ratchet pawl for engaging the ratchet strip, thereby providing a ratchet mechanism. Engaging the ratchet mechanism maintains the proximate position of the forceps; rotation of the ratchet strip about the hinge causes it to move upward, thereby disengaging the ratchet mechanism. The forceps may also include a safety latch connected to the first leg by a hinge. Rotation of the safety latch about the hinge inserts a portion of the safety latch into the opening to contact the ratchet strip and thereby prevent disengaging of the ratchet mechanism.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation-in-part of U.S. application Ser. No. 11/855,230, filed Sep. 14, 2007, the entire disclosure of which is incorporated herein by reference. 
     
    
     FIELD OF THE DISCLOSURE 
       [0002]    The present disclosure relates to an apparatus and method for closing a skin wound and more specifically to the art of using tissue glue in combination with tissue approximation forceps to glue wound edges together. 
       BACKGROUND OF THE DISCLOSURE 
       [0003]    In recent years, tissue adhesives such as the cyanoacrylates have become widely used for closing skin wounds, both those caused by trauma and those made as surgical incisions. In many cases, the use of tissue adhesives instead of skin sutures or staples allows wounds to be closed without the need for injecting local anesthetic into a wound, thereby expediting the procedure and sparing the patient the pain of an injection. 
         [0004]    When a wound is closed using sutures, the process of placing the sutures and tying the associated knots brings the wound edges into proper alignment at the same time that it closes the wound and secures that alignment. Thus it is not necessary to hold the wound edges together during suturing. 
         [0005]    When tissue adhesives are used appropriately, they yield cosmetic results typically better than the results achieved using sutures. The chief difficulty with using adhesives to close a wound is that the edges of the wound must be brought into alignment and held there as the liquid adhesive is applied. Unlike sutures, the wound edges must be held and kept in alignment while the adhesive cures. To assist in the process of keeping the wound edges aligned while the adhesive cures, there have been attempts to use prior art tissue forceps. However prior art forceps are not well suited to this task. 
         [0006]    Prior art tissue forceps come in a variety of types, each with various tissue mating surfaces adapted for the purpose of grasping the tissue adjacent the edges of a wound in a secure manner. These mating surfaces give only a limited degree of control over the wound edges. Prior art forceps indent the skin and evert the wound edges during closure. This is most desirable for suturing a wound because the edges eventually flatten and give a cosmetically acceptable result. However it is not desirable for wound closure when using a tissue adhesive material in place of sutures. 
         [0007]    Prior art forceps also require that one of the treating surgeon&#39;s hands be used to secure the forceps in position during the wound closure procedure due to the fact that the forceps will not remain on the skin if one hand does not remain on the forceps. Such limitations in the prior art therefore did not allow the use of two hands to stitch or apply the tissue glue. It is more desirable if the surgeon has his second hand available. The surgeon could then use that second hand to steady the patient rather than keeping it on the forceps in order to keep the wound edges together. 
         [0008]    Also in the prior art, if the patient moves then the forceps will move and the wound edges will not maintain registration. When the forceps slip out of position, the wound may open and allow tissue glue to enter the wound. If such forceps were capable of remaining attached to the skin in the closed position, then they would also be free to move with the patient&#39;s movement without a loss of wound edge closure. 
         [0009]    To solve the aforementioned problems associated with wound closure, the present disclosure is a unique system for simple and reliable closing of the edges of a wound allowing for optimal application of tissue glue. 
         [0010]    The new and improved tissue forceps, according to the present disclosure, have independent and detachable tissue mating surfaces which adhesively engage the skin adjacent to a wound in a manner which approximates the wound edges. The forceps may also include a locking mechanism which, in many cases, allows the operator to let go of the forceps once the wound edges have been positioned, thereby freeing up one hand. 
       SUMMARY OF THE DISCLOSURE 
       [0011]    The following summary of the disclosure is provided to facilitate an understanding of some of the innovative features unique to the present disclosure. A full appreciation of the various aspects of the disclosure can only be gained by taking the entire specification, claims, drawings, and abstract as a whole. 
         [0012]    The present disclosure is directed to improved wound closure using a forceps device, such as tissue approximation forceps, with detachable adhesive shoes that are adhesively affixed to the edges of the wound. The present disclosure can be used in combination preferably with applied tissue glue. 
         [0013]    According to a first aspect, in which specially adapted bandages are used as the adhesive shoes, the present disclosure provides a wound closure system comprising a first bandage with an open pocket portion, a second bandage with an open pocket portion, a forceps device, and a locking mechanism. The first bandage is adhesively adjacent to a first longitudinal edge of the wound, with its open pocket portion facing away from the wound. The second bandage is adhesively affixed adjacent to a second longitudinal edge of the wound, with its open pocket portion facing away from the wound. The forceps device includes a first leg adapted to fit within the open pocket portion of the first bandage and a second leg adapted to fit within the open pocket portion of the second bandage. The locking mechanism is adapted to hold the first and second legs in position when they are drawn together by closing the forceps device. 
         [0014]    In a further embodiment, tissue glue is applied directly to the edges of the wound when they are drawn together and locked into position. 
         [0015]    According to a second aspect, the present disclosure provides a wound closure system comprising a first adhesive shoe adhesively affixed adjacent to a first longitudinal edge of the wound, a second adhesive shoe adhesively affixed adjacent to a second longitudinal edge of the wound, a forceps device comprising a first leg adapted to couple with the first adhesive shoe and a second leg adapted to couple with the second adhesive shoe; and a locking mechanism adapted to hold the first and second legs in position when they are drawn together by closing the forceps device. 
         [0016]    According to a third aspect, the present disclosure provides a method for closing a wound using a forceps device and tissue glue including the steps of: affixing a first adhesive shoe adjacent to a first longitudinal edge of the wound, affixing a second adhesive shoe adjacent to a second longitudinal edge of the wound, coupling a first leg of said forceps device to said first adhesive shoe, coupling a second leg of said forceps device to said second adhesive shoe, closing the forceps device, thereby drawing the first and second longitudinal edges of said wound substantially together, locking the forceps device such that legs thereof remain fixed in position thereby holding the edges of said wound substantially together, applying tissue glue directly to the edges of said wound, waiting a predetermined period of time for said tissue glue to set, unlocking said forceps device, and decoupling the legs of said forceps device from said first and second adhesive shoes to complete the closing of said wound. 
         [0017]    According to a further aspect, a wound closure system comprises a forceps device, including a first leg and a second leg adapted to close toward each other into a proximate position in response to a squeezing force applied to the forceps. The first leg has an opening therein. The forceps also includes a ratchet strip connected to the second leg by a hinge and passing through the opening in the first leg. The lower edge of the opening is formed as a ratchet pawl for engaging the ratchet strip, thereby providing a ratchet mechanism. Engaging the ratchet mechanism maintains the proximate position of the forceps; rotation of the ratchet strip about the hinge causes movement of the ratchet strip upward in the opening, thereby disengaging the ratchet mechanism. In an embodiment, the forceps device further includes a safety latch connected to the first leg by a safety latch hinge. Rotation of the safety latch about the safety latch hinge inserts a portion of the safety latch into the opening to contact the ratchet strip and thereby prevent disengaging of the ratchet mechanism. 
         [0018]    The present disclosure seeks to overcome or at least ameliorate one or more of several problems with wound closure when using tissue adhesive, including but not limited to unsatisfactory results yielded by using prior art forceps. The present disclosure frees both of the surgeon&#39;s hands during a wound closure procedure so that he will be free to use two hands to apply tissue glue (or sutures, staples or other method, if desired) to join the wound edges together. 
         [0019]    When tissue adhesives are used to close a wound, the edges of the wound must be brought into alignment and held there as the adhesive is applied and for long enough for the adhesive to set. With commonly used adhesives such as cyanoacrylates, the wound edges must be held tightly enough together to keep the adhesive from flowing into the wound, as the presence of the adhesive in the wound is injurious to the tissue. Achieving correct alignment of wound edges is important, as misaligned wound edges can result in a poorly formed and unsightly scar. Often, bringing wound edges into alignment is made much more difficult when the patient, who may be a young child, is unable to cooperate with the procedure. 
         [0020]    The most common method for bringing wound edges into alignment for application of tissue adhesive is the use of fingers. The user places gloved fingers of one hand on either side of the wound and squeezes the edges together. This method is limited by the amount of friction obtainable between the medical operator&#39;s gloved hand and the patient&#39;s skin. The medical operator&#39;s fingers must also apply downward pressure to either side of the wound in order to obtain friction, and this pressure can be painful for the patient. It is easily possible for the adhesive to flow to the medical operator&#39;s glove, sticking the glove to the patient&#39;s skin. 
         [0021]    In another method, standard surgical forceps are placed with one leg of the forceps on either side of the wound, the forceps pressed down and squeezed together. However, there is typically not enough friction available to bring the wound edges together, and the downward pressure applied can be painful to the patient. Finally, as with the use of fingers, the forceps like the glove can inadvertently be glued to the patient&#39;s skin. 
         [0022]    In a third method, specially adapted forceps whose tips have flat surfaces with one or more pointed protrusions for increasing friction can be used to approximate the wound edges. With this method, the protrusions can cause pain as they are pressed into the skin, and the forceps can slip out of position during the application of the adhesive. All of the above methods can often be defeated by the movements of an uncooperative patient such as a young child. 
         [0023]    In each of the above present methods, it is important to recognize that while the tissue glue sets, the medical practitioner must maintain the wound edge alignment by holding the wound edges together. The present disclosure can eliminate this problem because the adhesive shoes allow the forceps to remain properly positioned on the skin surface even without the aid of the medical practitioner&#39;s hand holding them in place. The locking mechanism of the forceps holds the wound edges aligned. Thus the combination of the adhesive shoes and locking mechanism gives the medical practitioner the option to remove their hands from the forceps. 
         [0024]    Unless the context clearly requires otherwise, throughout the description and the claims, the words ‘comprise’, ‘comprising’, and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of “including, but not limited to”. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0025]      FIG. 1  shows a wound closure system that uses bandages with open pocket portions in accordance with a first illustrative embodiment of the disclosure. 
           [0026]      FIG. 2A  is a chart showing steps in an illustrative method of closing a wound in accordance with an embodiment of the disclosure. 
           [0027]      FIGS. 2B-202 ,  2 B- 204 ,  2 B- 207 ,  2 B- 208 , and  2 B- 210  respectively illustrate use of a wound closure system as in  FIG. 1  in steps  202 ,  204 ,  207 ,  208  and  210  of the method of  FIG. 2A . 
           [0028]      FIG. 2C  illustrates an optional concluding step of the method of  FIG. 2A . 
           [0029]      FIG. 3  depicts a wound closure system in which a forceps device includes a pivot where the first and second forceps legs connect, in accordance with an alternative embodiment. 
           [0030]      FIG. 4A  is a perspective view of a forceps including a ratchet and pawl mechanism, in accordance with a further embodiment of the disclosure;  FIG. 4B  is an edge view thereof. 
           [0031]      FIG. 5  shows details of the forceps of  FIG. 4A . 
           [0032]      FIGS. 6A-6E  respectively illustrate beginning, engaged, locked, unlocked and disengaged states of the forceps of  FIG. 4A . 
           [0033]      FIG. 7A  is a perspective view of a forceps including a ratchet and pawl mechanism, in accordance with an additional embodiment of the disclosure;  FIG. 7B  is an edge view thereof. 
           [0034]      FIG. 8  shows details of the forceps of  FIG. 7A . 
           [0035]      FIGS. 9A-9C  respectively illustrate beginning, engaged, and disengaged states of the forceps of  FIG. 7A . 
           [0036]      FIGS. 10A-10H  illustrate steps in a procedure for using the forceps of  FIG. 4A  to close a wound. 
       
    
    
       [0037]    The following is a list of the major elements in the drawings in numerical order.
     10  first adhesive shoe (e.g. specially adapted bandage)     11  open pocket (of bandage  10 )     20  second adhesive shoe (e.g. bandage)     21  open pocket (of bandage  20 )     50  wound     51  first longitudinal edge (of wound  50 )     52  second longitudinal edge (of wound  50 )     100  forceps device     101  first leg (of forceps device  100 )     102  second leg (of forceps device  100 )     105  wings     150  locking mechanism     151  push top (part of locking mechanism  150 )     160  pivot
         201  (step of) affixing a first adhesive shoe   
         202  (step of) affixing a second adhesive shoe     203  (step of) coupling a first forceps leg to the first adhesive shoe     204  (step of) coupling a second forceps leg to the second adhesive shoe     205  (step of) closing the forceps device     206  (step of) locking the forceps device     207  (step of) applying tissue glue     208  (step of) waiting for tissue glue to set     209  (step of) unlocking the forceps device     210  (step of) decoupling the legs of the forceps device     400  forceps device (additional embodiment)     401  first leg (of forceps device  400 )     402  second leg (of forceps device  400 )     403  ratchet strip   404 opening in leg  401       405  safety latch     406  ratchet pawl     407  hinge     408  hinge     409  wings     410  upper part of safety latch  405       411  first foot (end of leg  401 )     412  second foot (end of leg  402 )     413  lower part of safety latch  405       700  forceps device (additional embodiment)     701  first leg (of forceps device  700 )     702  second leg (of forceps device  700 )     703  ratchet strip
         704  opening in leg  701     
         706  ratchet pawl     708  hinge     709  wings     711  first foot (end of leg  701 )     712  second foot (end of leg  702 )   
 
       DETAILED DESCRIPTION 
       [0086]    The present disclosure is designed for use within a medical treatment environment for the purpose of closing skin wounds in place of more traditional stitches. 
         [0087]    Refer first to  FIG. 1 , which shows a first illustrative embodiment of the present disclosure. A patient has an open wound  50  that a surgeon is working to close with a forceps device  100 , such as tissue approximation forceps. A left adhesive shoe, such as a first bandage  10 , is applied to the patient&#39;s skin adjacent to a first longitudinal edge  51  of wound  50 . A right adhesive shoe, such as a second bandage  20 , is applied to the patient&#39;s skin adjacent to a second opposing longitudinal edge  52  of wound  50 . Next, the forceps legs  101  and  102  are slipped into the respective left and right shoes, such as open pocket portions  11  and  21  of the first and second bandages  10  and  20 . The forceps has sufficient stiffness to cause eversion of the wound edges when they are brought together by the closing of the forceps. 
         [0088]    Other embodiments of the present disclosure use different configurations in place of adhesive shoes for attaching the forceps to the skin surface, such as detachable portion of the forceps legs or even magnets that are affixed to edges of the wound. Another embodiment of the disclosure uses a weak adhesive applied directly to the legs of the forceps. In this embodiment, the ends of the forceps adhere directly to the skin surface, without the use of adhesive shoes. The adhesive is just strong enough to allow the forceps to control the wound edges but is weak enough to allow the legs of the forceps to be removed easily from the skin surface after the tissue glue has been applied and has cured. 
         [0089]    In yet another embodiment, the adhesive shoes are slipped onto the respective left and right forceps legs and then the forceps are pressed across the injury area to straddle the wound  50 . The adhesive shoes attach to the skin when the forceps are pressed down onto the skin. This embodiment does not require the surgeon to press down hard on the wound  50 , thus avoiding a source of pain and giving much greater control over the skin. 
         [0090]    The forceps legs  101  and  102  can then be drawn together by the surgeon to bring the edges  51  and  52  of the wound  50  together into proper registration. In new inventive forceps, the surgeon&#39;s fingers provide the force needed to close the jaws of the forceps. In an embodiment, the forceps device further includes a mechanical stop to prevent the forceps legs from being drawn too close together. The new improved forceps come in contact with only the skin surface such that there is no actual clamping of any tissue. The closing of the jaws of our forceps is done without the mechanism grasping the skin. Advantageously, a forceps according to the disclosure does not have any protrusions that poke into the skin of the patient, avoiding this source of pain. 
         [0091]    A locking mechanism  150 , such as a collar, serves to maintain a position of the closure of the forceps that has already been attained. The locking mechanism may have a push top portion  151 ; as shown in  FIG. 1 , the shape of the push top portion may be at least a portion of a circle configured to accommodate the surgeon&#39;s thumb or finger as the surgeon pushes downward or pulls upward on the locking mechanism. Advantageously, once the forceps are locked in place with the wound edges  51  and  52  in registration, the forceps are retained “hands free” on the patient. In certain embodiments, wings  105  are mounted on the legs of the forceps device to allow the surgeon&#39;s fingers to resist the force of the locking device and to allow the surgeon added degree of control in applying a lifting movement to one or both wound edges 
         [0092]    The surgeon is then free to use both hands during the remainder of the wound closure procedure. Advantageously, the use of adhesive shoes allows a greater ability to position the wound edges  51  and  52  into a desired registration of tissue movement because such adhesive shoes allow both lateral movement and a vertical lifting movement to be applied to one or both of the wound edges, which can facilitate better positioning of some wound edges. Certain embodiments of the present disclosure incorporate an additional degree of freedom in the forceps device to allow a small additional amount of longitudinal movement perpendicular to the direction of closing the wound. 
         [0093]    Finally, tissue glue is applied to hold the edges  51  and  52  of the wound  50  together. Note that the inventive forceps can be used not only with tissue glue but also with conventional wound closure methods, such as staples, sutures or stitches, since they help keep the wound edges in position and keep both of the treating surgeon&#39;s hands free. 
         [0094]    The disclosure provides much greater control in manipulating the wound edges. It also keeps the space over the wound open, not blocked, such as by a covering pad. Advantageously, this allows for better visualization of the wound, allows the wound to be blotted dry after the edges have been positioned, and allows the adhesive to be applied directly to the wound surface, without the use of a pad. 
         [0095]    Refer now to  FIG. 2A  which illustrates a method of closing a wound in accordance with an illustrative embodiment of the present disclosure. First, the surgeon affixes (step  201 ) a first adhesive shoe adjacent to a first longitudinal edge  51  of the wound  50 , as shown in  FIG. 1 . Next, the surgeon affixes (step  202 ) a second adhesive shoe adjacent to a first longitudinal edge  52  of the wound  50 , as shown in  FIG. 1 . 
         [0096]    The surgeon couples (step  203 ) a first leg of a forceps device, such as forceps, to the first adhesive shoe and then couples (step  204 ) a second leg of said forceps device to the second adhesive shoe. As noted above, in alternate embodiments, the adhesive shoe can be first coupled to the legs of the forceps and then pressed onto the patient&#39;s skin. Also, the present disclosure contemplates several coupling schemes, including, but not limited to pocket portions of bandages, detachable portions of forceps legs, rigid adhesive shoes and adhesive magnets. 
         [0097]    The surgeon closes (step  205 ) the forceps device, and thereby draws the first and second longitudinal edges of said wound substantially together. Next, the surgeon locks (step  206 ) the forceps device such that legs thereof remain fixed in position thereby holding the edges of said wound substantially together and applies (step  207 ) tissue glue directly to the edges of the wound 
         [0098]    Finally, after waiting (step  208 ) a predetermined period of time for the tissue glue to set, the surgeon unlocks (step  209 ) the forceps device; and decouples (step  210 ) the legs of the forceps device from the first and second adhesive shoes to complete the closing of the wound; the forceps may then be removed. 
         [0099]      FIGS. 2B-202 ,  2 B- 204 ,  2 B- 207 ,  2 B- 208 , and  2 B- 210  illustrate respectively steps  202 ,  204 ,  207 ,  208  and  210  of the method of  FIG. 2A . Optionally, after the forceps is removed, the adhesive shoes may also be removed (see  FIG. 2C ). 
         [0100]    It would be apparent to one skilled in the art to alter the sequence of steps in other similar fashions without altering the results achieved with the disclosure. 
         [0101]    In a forceps embodying the disclosure, the medical practitioner&#39;s fingers provide the force needed to close the jaws of the forceps. The collar only serves to maintain a position of the jaws that has already been attained. 
         [0102]    With the present disclosure there is no actual clamping of any tissue. The closing of the jaws of the forceps is done without the forceps grasping or pinching the skin. 
         [0103]    Alternate embodiments may be devised without departing from the spirit or the scope of the disclosure. By way of example, rather than affixing the adhesive shoes to the respective edges of the wound and then coupling one of each of the legs of the forceps to an adhesive shoe, the legs can first be coupled to the adhesive shoes prior the adhesive shoes being affixed to the edges of the wound. 
         [0104]    Yet another embodiment may incorporate an additional degree of freedom of the jaws to allow a small amount of lateral movement. By providing a pivot ( 160 ) where the first and second forceps legs connect, each individual leg may be rotated to align with opposing wound edges that are not parallel. The locking mechanism ( 150 ) is replaced with locking nut or thumbwheel attached to the pivot point which allows holding the forceps in the desired closed position. 
         [0105]    The pivot could be a swivel joint, a ball joint or other similar assembly well known in the art that provides the ability for each forceps leg to move in a rotational fashion in relationship to the opposite leg.  FIG. 3  shows the alternative forceps with the flexible pivot ( 160 ). 
         [0106]    In a further embodiment of the disclosure, a forceps has two legs which may be squeezed together, and a ratchet-and-pawl mechanism for holding the legs in a desired position.  FIG. 4A  is a perspective view of a forceps  400  having legs  401 ,  402  and a ratchet strip  403 . In contrast to forceps  100  shown in  FIG. 1 , forceps  400  may be locked without requiring a separate locking piece (such as locking collar  150 ). Ratchet strip  403  is connected to leg  402  by a hinge, and extends through an opening  404  in leg  401 . The lower edge of opening  404  is formed as a ratchet pawl for engaging teeth on the underside of ratchet strip  403 . In this embodiment, a safety latch  405  is provided on leg  401 , connected to leg  401  by a hinge; the safety latch may be rotated so that its lower portion presses the ratchet strip against the pawl, thereby locking the forceps.  FIG. 4B  is an edge view of forceps  400 , showing safety latch  405  in its unlocked position, permitting ratchet strip  403  to move through opening  404 . 
         [0107]      FIG. 5  shows additional details of forceps  400 . Ratchet pawl  406  engages with ratchet strip  403  at opening  404 . Safety latch  405  is connected to leg  401  by hinge  407 . In  FIG. 5 , the safety latch is shown rotated so that its upper portion  410  extends outward relative to leg  401 , and its lower portion  413  is inserted into opening  404  to press ratchet strip  403  against pawl  406 . This is the locked position of the forceps. 
         [0108]    Forceps  400  may advantageously be made of plastic as a single molded unit, where hinges  407 ,  408  are “living” hinges; that is, the hinges are part of the unit but are bendable joints. As in the previous embodiment, wings  409  may be provided on the legs of the forceps device to allow the surgeon&#39;s fingers to resist the force of the locking device and to provide the surgeon an added degree of control in applying a lifting movement to one or both wound edges. 
         [0109]      FIG. 6A  illustrates a beginning position of forceps  400 , before it is put into use (that is, legs  401  and  402  do not have any force applied to them). Safety latch  405  is in its unlocked position, with the lower portion  413  of the safety latch rotated away from opening  404 . Ratchet strip  403  rests at the lower end of opening  404 , engaging pawl  406 . When legs  401 ,  402  are squeezed together ( FIG. 6B ), ratchet strip  403  is moved through the opening and engages the pawl to maintain the proximate (squeezed-together) position of the legs. In this position, feet  411 ,  412  engage the adhesive shoes  10 ,  20  (not shown) in order to close the wound. Safety latch  405  may then be rotated about hinge  407  ( FIG. 6C ), so that the lower portion  413  of the safety latch presses against ratchet strip  403 , preventing the ratchet strip from dislodging. The forceps are removed by unlocking the safety latch ( FIG. 6D ) and lifting the ratchet strip upward to disengage the ratchet mechanism. Legs  401 ,  402  then spring apart ( FIG. 6E ) so that the feet  411 ,  412  disengage from shoes  10 ,  20 . Forceps  400  may thus be engaged, locked, unlocked and disengaged by the user with only one hand. 
         [0110]    In another embodiment, forceps  700  is similar to forceps  400  but does not include a safety latch. Forceps  700  has legs  701 ,  702  and a ratchet strip  703  passing through an opening  704  in leg  701  (see  FIG. 7A ). As in the previous embodiment, the lower edge of opening  704  is formed as a pawl  706  for engaging teeth on the underside of ratchet strip  703 .  FIG. 7B  is an edge view of forceps  700 , showing the end of ratchet strip  703  extending through opening  704 . 
         [0111]      FIG. 8  shows forceps  700  with the ratchet strip  703  engaged with pawl  706 . Forceps  700  may advantageously be made of plastic as a single molded unit, where hinge  708  is a “living” hinge. As in the previous embodiment, wings  709  may be provided on the legs of the forceps device to allow the surgeon&#39;s fingers to resist the force of the locking device and to provide the surgeon an added degree of control in applying a lifting movement to one or both wound edges. 
         [0112]      FIG. 9A  illustrates a beginning position of forceps  700 , before it is put into use (that is, legs  701  and  702  do not have any force applied to them). Ratchet strip  703  rests at the lower end of opening  704 , engaging pawl  706 . When legs  701 ,  702  are squeezed together ( FIG. 9B ), ratchet strip  703  is moved through the opening and engages the pawl to maintain the proximate (squeezed-together) position of the legs. In this position, feet  711 ,  712  engage the adhesive shoes  10 ,  20  (not shown) in order to close the wound. The forceps are removed by lifting the ratchet strip upward to disengage the ratchet mechanism ( FIG. 9C ). Legs  701 ,  702  then spring apart so that the feet  711 ,  712  disengage from shoes  10 ,  20 . Forceps  700  may thus be engaged and disengaged by the user with only one hand. 
         [0113]      FIGS. 10A-10H  illustrate a procedure for treating a wound using forceps  400 , in accordance with a further embodiment of the disclosure. As in previous embodiments, adhesive shoes  10 ,  20  are placed adjacent to the edges of wound  50  ( FIG. 10A ). The shoes have open pocket portions  11 ,  21  for receiving the feet of the forceps. The forceps are then coupled to the adhesive shoes ( FIG. 10B ); leg  401  is coupled to shoe  10  while leg  402  is coupled to shoe  20 . Legs  401 ,  402  are squeezed toward each other ( FIG. 10C ) to approximate the wound edges. As the legs are squeezed together, ratchet strip  403  passes through opening  404  and engages pawl  406  to maintain the proximate position of the legs. As shown in  FIG. 10C , safety latch  405  is moved to the locked position. With the forceps (and thus the shoes and wound edges) held in this position, the wound may have tissue adhesive applied ( FIG. 10D ). The forceps may be left in the proximate and locked position for as long as required for the tissue adhesive to set ( FIG. 10E ). Unlatching the safety latch permits the ratchet mechanism to be disengaged ( FIG. 10F ). The legs of the forceps then spring apart and decouple from the adhesive shoes, so that the forceps may be removed ( FIG. 10G ). Optionally the adhesive shoes may then be removed from the skin ( FIG. 10H ). 
         [0114]    While the disclosure has been described in terms of specific embodiments, it is evident in view of the foregoing description that numerous alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, the disclosure is intended to encompass all such alternatives, modifications and variations which fall within the scope and spirit of the disclosure and the following claims.