Abstract:
A medical closure screen device for a separation of first and second tissue portions is provided, which includes a mesh screen comprising tubular vertical risers, vertical strands with barbed filaments, and horizontal spacers connecting the risers and strands in a grid-like configuration. An optional perimeter member partly surrounds the screen and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. Various input/output devices can optionally be connected to the perimeter tube ends for irrigating and/or draining the separation according to methodologies of the present invention. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The use of mechanical forces associated with barbed strands for repositionably securing separated tissues together is disclosed. The use of same for eliminating or reducing the formation of subcutaneous voids or pockets, which can potentially form hematoma and seroma effects, is also disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a division of and claims priority in application Ser. No. 10/224,852, filed Aug. 21, 2002, now U.S. Pat. No. 7,381,211, dated Jun. 3, 2008. This application also claims priority in application Ser. No. 11/103,056, filed Apr. 11, 2005, now U.S. Pat. No. 7,410,495, application Ser. No. 11/103,052, filed Apr. 11, 2005, now U.S. Pat. No. 7,413,571, application Ser. No. 11/103,403, filed Apr. 11, 2005, now U.S. Pat. No. 7,351,250, and application Ser. No. 11/103,022, filed Apr. 11, 2005, now U.S. Pat. No. 7,413,570, which are continuations-in-part of the same parent application. All of the foregoing applications are incorporated herein by reference. This application is also related to application Ser. No. 12/130,516, filed May 30, 2008 and entitled Screen Devices and Methods for Closing Tissue Separations. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to medical closure and wound fluid management devices, and in particular to an absorbable screen closure member for closing tissue separations, such as incisions and wounds. 
     2. Description of the Prior Art 
     In the medical field, cutaneous incisions are commonly performed in surgery to provide access to underlying tissue, organs, joints, skeletal structure, etc. Incision and closure techniques are an important part of surgery in general. They tend to occupy surgical teams and other resources for significant portions of many surgical procedures. 
     Surgeons generally strive to minimize the traumatic and scarring effects of surgery on their patients by both minimizing the incisions, and by employing a variety of closure techniques which tend to reduce postoperative swelling, bleeding, seroma, infection and other undesirable postoperative side effects. For example, the fields of endoscopic-assisted surgery, microscopic surgery, and computer-enhanced instrumentation (e.g., the DaVinci System available from Intuitive Surgical, Inc. of Sunnyvale, Calif.) are generally concerned with minimally invasive surgery (“MIS”) procedures and techniques, which have proven to be increasingly popular. Such popularity is at least partly due not only to the minimally-sized scars left by such techniques, but also to the minimal trauma to the fascia and muscle layers and the correspondingly faster recoveries this allows. However, surgeons must balance such considerations with providing adequate access to perform various surgical procedures. 
     Some surgical procedures, by their nature, must include long incisions. Examples include cutaneous excisional procedures such as “lifts” and reduction procedures, flap procedures for closure of defects, and many bariatric procedures. 
     The “first intention” (primary intention healing) in surgery is to “close” the incision. For load-bearing tissues, such as bone, fascia, and muscle, this requires substantial material, be it suture material, staples, or plates and screws. For the wound to be “closed,” the epithelial layer must seal. To accomplish this, the “load bearing” areas of the cutaneous and subcutaneous layers (i.e., the deep dermal elastic layer and the superficial fascia or fibrous layers of the adipose tissue, respectively) must also at least be held in approximation. Important considerations include controlling infection and bleeding, reducing scarring, eliminating the potential of hematoma, seroma, and “dead-space” formation and managing pain. Dead space problems are more apt to occur in the subcutaneous closure. Relatively shallow incisions can normally be closed with surface-applied closure techniques, such as sutures, staples, glues, and adhesive tape strips. However, deeper incisions may well require not only skin surface closure, but also time-consuming placement of multiple layers of sutures in the load-bearing planes. Absorbable sutures are commonly used for this purpose and comprise an important class of surgical sutures. Depending on various factors, absorbable sutures typically dissolve over a period of a few days to a few months. Commercially available examples include Monocryl® monofilament absorbable synthetic sutures comprising a poliglecaprone and PDS® (polydrioxanone) and Vicryl® (polyglactin) sutures, all available from Ethicon, Inc., of Somerville, N.J. 
     Surgical mesh represents another important class of surgical closure devices. Applications include reconstruction, hernia repair, and organ repair. In such procedures, surgical mesh fabric prostheses are inserted into patients through either open surgery or endoscopic (MIS) procedures. Knitted surgical mesh for hernia repair is disclosed in the Agarwal et al. U.S. Pat. No. 6,287,316, which is assigned to Ethicon, Inc. Another Ethicon, Inc. patent, Duncan U.S. Pat. No. 4,548,202, discloses mesh tissue fasteners including various fastening members with spaced-apart legs for passing through tissue portions. Another closure procedure involves the placement of pins or rods through skin edge or bone followed by the placement of an external clamp or fixator device spanning the wound and frequently incorporating a worm-screw apparatus capable of progressive tightening over time to effect closure, stabilization or distraction. 
     Fluid management represents another important aspect of both open and minimally invasive surgery. Postoperative fluid drainage can be accomplished with various combinations of tubes, sponges, and porous materials adapted for gathering and draining bodily fluids. The prior art includes technologies and methodologies for assisting drainage. For example, the Zamierowski U.S. Pat. Nos. 4,969,880; 5,100,396; 5,261,893; 5,527,293; and 6,071,267 disclose the use of pressure gradients, i.e., vacuum and positive pressure, to assist with fluid drainage from wounds, including surgical incision sites. Such pressure gradients can be established by applying porous sponge material either internally or externally to a wound, covering same with a permeable, semi-permeable, or impervious membrane, and connecting a suction vacuum source thereto. Fluid drawn from the patient is collected for disposal. Such fluid control methodologies have been shown to achieve significant improvements in patient healing. Another aspect of fluid management, postoperative and otherwise, relates to the application of fluids to wound sites for purposes of irrigation, infection control, pain control, growth factor application, etc. Wound drainage devices are also used to achieve fixation and immobility of the tissues, thus aiding healing and closure. This can be accomplished by both internal closed wound drainage and external vacuum devices. Fixation of tissues in apposition can also be achieved by bolus tie-over dressings (Stent dressings), taping, strapping and (contact) casting. 
     Heretofore, there has not been available a medical closure screen with the advantages and features of the present invention, including the combination of same with vacuum-assisted closure. 
     SUMMARY OF THE INVENTION 
     In the practice of the present invention, a medical closure screen device is provided, which includes a mesh screen comprising tubular vertical risers, barbed filaments therebetween and horizontal spacers. An optional perimeter member partly surrounds the screen member and can comprise a perimeter tube fluidically coupled with the vertical risers to form a tubing assembly. The tubing assembly cooperates with the vertical risers to extract fluid from the tissue separation in a drain mode and to introduce fluid thereinto in an irrigate mode. In one embodiment of the invention the tubing assembly is fluidically coupled to a vacuum source to facilitate drainage. In another embodiment of the invention, the perimeter tube is passed through the surrounding tissue to secure the screen member in place. Fluid transfer elements, such as sponges, are optionally placed adjacent to and over an extension of the screen for fluid transfer, for example, in conjunction with a vacuum or pump source. Another embodiment of the invention includes a suture connected to the screen and adapted for securing same in a tissue separation. Alternative embodiment vertical risers are also disclosed, and can provide active fluid transfer utilizing the patient&#39;s body dynamics. Yet another alternative embodiment of the present invention utilizes the screen barbs for mechanical fixation in a separation for closure of same. Separation closure, irrigation and drainage methodologies are disclosed utilizing various combinations of closure screens, tubing, sutures, fluid transfer elements and gradient force sources. The closure screen of the present invention uses mechanical and other forces associated with screens and barbed strands for securing separated tissues together and for eliminating or reducing the formation of subcutaneous voids or pockets, which can potentially form hematoma and seroma effects. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side elevational view of a medical closure screen device embodying the present invention. 
         FIG. 2  is an enlarged, fragmentary, side elevational view thereof, taken generally within circle  2  in  FIG. 1 . 
         FIG. 3  is an enlarged, fragmentary, side elevational view thereof, taken generally along line  3 - 3  in  FIG. 2 , and particularly showing a barbed strand. 
         FIGS. 4   a - f  show alternative perimeter tube end closures comprising:  4   a ) subdermal termination;  4   b ) knotted end;  4   c ) Leur lock;  4   d ) transfer element (i.e., sponge);  4   e ) vacuum source; and  4   f ) clamped end. 
         FIGS. 5   a - e  show a tissue separation closure procedure embodying the method of the present invention. 
         FIG. 6   a  is an enlarged, fragmentary, cross-sectional view of the closure screen in a tissue separation, with skin hooks shown in hidden lines for positioning the separated tissue portions along the closure screen. 
         FIG. 6   b  is an enlarged, fragmentary, cross-sectional view of the closure screen in a substantially closed tissue separation. 
         FIGS. 7   a - f  show a tissue separation closure procedure embodying the method of the present invention and utilizing optional sponge or foam fluid transfer elements and a tubing placement tool. 
         FIG. 8  is a cross-sectional view of a tissue separation closure utilizing tubing for securing the closure screen with a fluid transfer subassembly connected to an upper edge of the closure screen. 
         FIG. 9  shows a needle mounting a length of drain tubing and adapted for passing same through tissue. 
         FIG. 10  is a side elevational view of a closure screen comprising an alternative embodiment of the present invention, with a perimeter suture. 
         FIG. 11   a  is an enlarged, fragmentary, side elevational view thereof, taken within circle  11   a  in  FIG. 10 . 
         FIG. 11   b  is an enlarged, fragmentary, side elevational view thereof, showing modified vertical risers. 
         FIG. 12  is a side elevational view of a screen-only closure screen comprising an alternative embodiment of the present invention. 
         FIG. 13   a  is an enlarged, fragmentary, side elevational view thereof, taken generally within circle  13   a  in  FIG. 12 . 
         FIG. 13   b  is an enlarged, fragmentary, side elevational view thereof, showing modified vertical risers. 
         FIGS. 14   a - g  show a tissue separation closure procedure utilizing the screen-only embodiment of the closure screen. 
         FIG. 15   a  is a side elevational view of a modified vertical riser with flexible, multi-tube risers forming a fluid passage. 
         FIG. 15   b  is a cross-sectional view thereof, taken generally along line  15   b - 15   b  in  FIG. 15   a.    
         FIG. 16   a  is a fragmentary, side elevational view thereof, shown in a compressed configuration. 
         FIG. 16   b  is a cross-sectional view thereof, taken generally along line  16   b - 16   b  in  FIG. 16   a.    
         FIG. 17  is a cross-sectional view of another modified vertical riser construction with risers bundled in a different configuration, with barbs. 
         FIG. 18  is a cross-sectional view of a modified vertical riser or perimeter element, comprising a fluted tube. 
         FIG. 19  is an enlarged, fragmentary, side elevational view of a modified barbed strand configuration. 
         FIG. 20  is an enlarged, fragmentary, side elevational view of another modified barbed strand configuration. 
         FIG. 21  is an enlarged, cross-sectional view of a closure screen comprising an alternative embodiment of the present invention, with barbs formed by cutting off the ends of looped filaments. 
         FIG. 22  is an enlarged, cross-sectional view of a closure screen comprising an alternative embodiment of the present invention, with barbs forming hooks and constructed by cutting looped filaments. 
         FIG. 23  is an enlarged, cross-sectional view of a closure screen comprising yet another alternative embodiment of the present invention, with barbs formed by cutting off the ends of looped filaments, which are laid over in a common direction or orientation. 
         FIG. 24  is an enlarged, cross-sectional view of a closure screen comprising a further alternative embodiment of the present invention, with barbs forming hooks and constructed by cutting looped filaments, which are laid over in a common direction or orientation. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     I. Introduction and Environment 
     As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure. 
     Certain terminology will be used in the following description for convenience in reference only and will not be limiting. For example, the words “upwardly”, “downwardly”, “rightwardly” and “leftwardly” will refer to directions in the drawings to which reference is made. The words “inwardly” and “outwardly” will refer to directions toward and away from, respectively, the geometric center of the embodiment being described and designated parts thereof. The words “horizontal” and “vertical” generally mean side-to-side and end-to-end, respectively. Said terminology will include the words specifically mentioned, derivatives thereof and words of a similar import. 
     Referring to the drawings in more detail, the reference numeral  2  generally designates a medical closure screen device or system embodying the present invention. Without limitation on the generality of useful applications of the closure screen system  2 , the primary application disclosed herein is for assistance with the closing, draining, irrigating and healing of a separation of first and second tissue portions, such as a wound or incision  4 . As shown in  FIG. 5   a , the wound  4  extends from and is open at the dermis  6 , through the deep dermal layer  7  and the subcutaneous layer  8 , and to approximately the fascia  10 . The wound  4  displays edges  12   a,b , which correspond to first and second tissue portions. The closure screen device  2  generally comprises a screen  14 , a screen perimeter member  16  and an input/output (I/O) subsystem  18 . 
     II. Screen  14   
     The screen  14  includes upper and lower margins  20   a,b ; first and second ends  22   a,b ; and first and second faces  24   a,b . The screen  14  generally forms a grid configuration with vertical, hollow, perforated tubular risers  26  cross-connected by horizontal spacer members  28 . Multiple barbed strands  30  are positioned between the risers  26 . The risers  26 , the spacers  28  and the strands  30  are preferably joined at their respective intersections. As shown in  FIG. 3 , each strand  30  includes a filament  32  with multiple, pointed barbs  34  extending upwardly and outwardly on both sides in staggered, spaced relation. The barbs  34  generally project outwardly from the screen faces  24   a,b , for purposes which will be described in more detail hereinafter. 
     The screen or mesh  14  material can be either dissolvable (absorbable) or non-dissolvable (non-absorbable) and can be chosen from a number of commercially-available, biocompatible products, which are commonly used in medical applications for sutures, implantable meshes, and similar medical devices. 
     Examples of absorbable materials include, but are not limited to: aliphatic polyesters, which include, but are not limited to: homo polymers and copolymers of lactide, .epsilon.-caprolactone, p-dioxanone, trimethylene carbonate, alkyl derivatives of trimethylene carbonate, .delta.-hydroxyvalerate, 1,4-dioxepan-2-one, 1,5-dioxepan-2-one, 6,6-dimethyl-1,4-dioxan-2-one and polymer blends thereof. Examples of nonabsorbable materials include, but are not limited to: cotton, linen, silk, polyamides, polyesters, fluoropolymers, polyolefins, polyethylene and combinations thereof. 
     III. Screen Perimeter Member  16   
     The optional screen perimeter member  16  can comprise, for example, a flexible, perforated, hollow tube  35  with multiple orifices  36 . As shown in  FIG. 1 , the tube  35  includes first and second legs  38 ,  40  extending generally along the screen first and second ends  22   a,b , and a base leg  41  extending generally along the screen lower margin  20   b . The tubing first and second legs  38 ,  40  terminate in respective first and second ends  38   a ,  40   a . The tube  35  can be secured to the screen  14  by multiple ties  42 , which can comprise extensions of the horizontal spacer members  28  and the strands  30 . By providing dissolvable ties  42 , the tube  35  can be designed for separation from the remainder of the closure screen  2  after a relatively short period of time. For example, the dissolvable material can dissolve into the patient&#39;s body after a few days, whereafter the tube  35  can be removed. 
     Optionally, portions of the tube  35  can be cut away from the screen  14 . For example, the screen  14  can be separated along each screen end  22   a,b , or it can be separated completely from the tube  35 . In this manner the screen  14  and the tube  35  can be configured to accommodate a variety of conditions and tissue separation configurations. 
     The vertical risers  26  are optionally fluidically coupled to the tube  35  at respective T intersections  44 . In this configuration the tube  35  and the vertical risers  26  cooperate to provide a manifold for fluid handling, i.e. either extraction or irrigation, as indicated by the fluid flow arrows  45 . 
     IV. Input/Output (I/O) Subsystem  18   
     The input/output subsystem  18  is designed for extraction and/or irrigation of the patient&#39;s bodily fluids and/or external fluids. As shown in  FIG. 1 , the input/output subsystem  18  includes first and second I/O devices  18   a,b  attached to the tubing first and second leg ends  38   a,b , which in this configuration are considered the “port” ends of the tube  35 . One or both of the I/O devices  18   a,b  can comprise a pressure differential source, such as a VAC® (Vacuum Assisted Closure) unit available from Kinetic Concepts, Inc. of San Antonio, Tex. The use of such units for wound treatment and fluid management is disclosed in the Zamierowski U.S. Pat. Nos. 4,969,880; 5,100,396; 5,261,893; 5,527,293; and 6,071,267, which are incorporated herein by reference. 
     Alternatively, the tubing port ends  38   a,b  can be connected to various other sources of pressure differential and various drainage and irrigation devices. For example, they can be cut short below the dermis  6  and left within the separation  4  for sealing by the adjacent tissue portions  12   a,b .  FIG. 4   a  shows a truncated tubing end  38   b . The tubing ends  38   a / 40   a  can be knotted (as shown at  48  in  FIG. 4   b ), clipped, tied (e.g., with a suture) or otherwise closed off either above or below the dermis  6 .  FIG. 4   c  shows a Leur lock coupling  46  mounted on a tubing end  38   a / 40   a . Still further, a transfer element comprising a piece of foam or sponge  50  can be coupled to the tube  35  at an end  38   a / 40   a  ( FIG. 4   d ). Examples of such foam and sponge materials and configurations are discussed in the Zamierowski U.S. patents identified above. A pressure differential source, such as a vacuum source  51 , can be connected to a tube end  38   a / 40   a  and to a fluid receptacle  66 , as shown in  FIG. 4   e . A clamp  62  is shown in  FIG. 4   f  and closes the tube end  38   a / 40   a . The clamp  62  can be chosen from among several suitable clamps, which are commonly used for medical applications. 
     Either tube end  38   a / 40   a  can function as either an inlet port or an outlet port with respect to the system  2 . For example, suction can be applied for pulling fluid from the patient through the system  2  through either tube end  38   a / 40   a . Still further, fluid can be pulled in both directions through the system  2  by alternately or jointly applying suction to the tube ends  38   a / 40   a . For example, suction can be simultaneously applied to both tube ends  38   a / 40   a.    
     V. Operation and Closure Method 
       FIGS. 5   a - e  show an installation methodology utilizing the system  2  of the present invention. In  FIG. 5   a , the closure screen  2  is placed in the separation  4  with the tubing base  41  located at the bottom of the separation (e.g., wound or incision)  4  and in proximity to the fascia layer  10 . As shown, the tissue portions or wound/incision edges  12   a,b  are spaced apart. The screen upper margin  20   a  can protrude outwardly from the dermis  6 .  FIG. 5   b  shows the tissue separation edges  12  being pushed together as indicated by the force arrows  52 .  FIG. 5   c  shows the separation edges  12  engaged at the dermis  6 , and spaced apart somewhat within the subcutaneous layer  8 . The edges  12  can be pushed together as indicated by the force arrows  52 . Moreover, the screen  2  can be held or positioned inwardly in order to advance the barbs  34  in the separation edges  12 , as indicated by the inward or downward force arrows  54   a .  FIG. 5   d  shows the separation edges  12   a,b  substantially closed on the screen  2 . Tugging on the screen  14  in the general direction of the outward force arrow  54   b  sets the mesh barbs  34 . 
       FIG. 5   e  shows the separation  4  closed on the closure screen  2 , with the tubing  35  removed from the screen  14 . The tubing  35  can be removed either pre-installation by cutting the ties  42 , or post-installation by allowing the ties  42  to dissolve, whereafter the unsecured tubing  35  can be extracted. 
       FIG. 6   a  shows the barbs  34  compressed by engagement with the separation edges  12   a,b . As shown, the separation edges  12  can be manually closed by pressing along the horizontal force arrows  52 . The barbs  34  thus deflect inwardly due to their flexibility, thereby allowing the separation edges  12   a,b  to slide upwardly or outwardly along the screen  14 . This process can be repeated until the separation  4  is closed, as shown in  FIG. 6   b . Any protruding length of the screen  14  can be cut close to the dermis  6 . In the final configuration ( FIGS. 5   e  and  6   b ), the barbs  34  are embedded in the tissue adjacent to the separation edges  12   a,b  and thus secure the separation  4  in a closed position. The fluid conducting properties of the screen  14  facilitate extracting fluid. An outward or upward force arrow  54   b  indicates a force direction whereby the screen barbs  34  are set in the adjoining tissue. It will be appreciated that the screen  14  can be securely set in place with the barbs  34 , yet the separation edges  12   a,b  will remain capable of sliding up on the screen  14  by disengaging the barbs  34  with lateral forces, as shown in  FIG. 6   a . Skin hooks  55  can be used for engaging the tissue portions  12   a,b  and tugging same outwardly as shown in  FIG. 6   a . The skin hooks  55  can facilitate positioning and repositioning the screen  14 . 
     VI. Alternative Embodiment Closure Screen Systems and Methodologies 
       FIGS. 7   a - f  show an alternative procedure for mounting the closure screen  2  in a wound drainage application utilizing pressure differential. As shown in  FIG. 7   a , the tubing  35  can pass through the tissue adjacent to the wound  4  and exit the dermis  6  for termination of the tubing end  38   a / 40   a  as described above. An optional layer of a suitable, biocompatible adhesive  64  is shown applied to the closure screen first face  24   a  for securing same to the first wound edge  12   a .  FIG. 7   b  shows the screen  14  extending upwardly from the dermis  6  with the wound edges  12   a,b  brought together in a manner similar to that described above. 
     The input/output subsystem  18  includes a pair of optional fluid transfer elements comprising foam or sponge members  56   a,b  placed on the dermis  6  on either side of a protruding portion  14   a  of the screen  14 . The screen  14  is then cut to a level generally flush with the upper surfaces of the sponges  56   a,b , as shown in  FIG. 7   c . An optional sponge bridge  58  is placed over the sponge members  56   a,b  ( FIG. 7   d ). Examples of suitable transfer element materials are discussed in the Zamierowski patents noted above and include open-cell, porous foam materials (e.g., polyurethane ester (PUE)) chosen for their hydrophobic properties and passage of liquids. Polyvinyl acetate (PVA) material can be used for its hydrophilic properties. The transfer element subassembly  59  formed by the sponge members  56   a,b  and  58  can be connected to a vacuum source, a fluid irrigation source, etc. Moreover, it can be connected to additional fluid transfer elements and covered with various flexible membranes and drapes, which can be semi-permeable or impervious, as indicated for the closure and treatment of particular separations and wounds. 
       FIG. 7   e  shows a tubing placement tool  120  with a handle  122 , a shaft  124  and a hook  126  terminating at a pointed or rounded, bullet-shaped tip  128 .  FIG. 7   f  shows the tool  120  passing tubing  35  through tissue in the subcutaneous layer  8  and into proximity with the dermis  6 . The tip  128  is received in a blind end  134  of the tubing  35  through a notch  136  formed therein. The thrust of the tool  120  causes tenting of the dermis  6 , as shown at  138 , whereat the dermis  6  can be opened with a scalpel  140  and the tubing  35  can exit the patient for suitable termination arrangements, such as those shown in  FIGS. 4   a - f  above. 
       FIG. 8  shows a modified embodiment closure system  202  with a pair of screens  14  positioned generally end-to-end in a separation  204 . A transfer element subassembly  59  is placed over the separation  204  and a membrane drape  205  is placed thereover. The tube  35  is passed through tissue on either side of the separation  204  (e.g., using the procedure and the tubing placement tool  120  described above) and exits the dermis  6  on either side of the transfer element subassembly  59 . The tube  35  lengths are knotted at  206 . The tube  35  lengths thus function as sutures or retainers for securing the closure system  202  in the separation  204 . The tube ends  38   a  or  40   a  can be utilized for this purpose, thus leaving the other tubing ends available for fluid communication with one or more of the input/output subsystems  18  described above. 
     The tube  35  can be secured by suitable fasteners, such as clips and the like, located above the dermis  6 . Moreover, the screens  14  can be overlapped, abutted, spaced slightly and otherwise configured and positioned as necessary for particular tissue separations. Still further, the screens  14  are adapted to be trimmed as necessary. 
       FIG. 9  shows a modified embodiment tubing/suture subassembly  220  with a needle  222  including a sharpened, distal end  224  and a proximate end  226  with multiple, annular ridges  226   a . A length of flexible tubing  228  combines the functions of screen perimeter member and suture. The flexible tubing  228  terminates at an end  228   a  adapted for releasably mounting on the needle proximate end  226 , whereat it is retained in place by the ridges  226   a . The tubing  228  is optionally connected to the screen  14  as described above and can include perforations  228   b  for fluid drainage and/or irrigation in conjunction with input/output subsystems  18 , also as described above. The tubing/suture subassembly  220  is adapted for securing the screen  14  in place and for closing the separation  4  by passing the tubing  228  through adjacent tissue. The tubing/suture subassembly  220  and the screen  14  can be prepackaged and presterilized for closing and treating separations, which can include wounds and incisions. 
       FIGS. 10 ,  11   a  and  11   b  show modified embodiment closure screen systems  302  with first and second suture subassemblies  304 ,  306  comprising the screen perimeter member. The suture subassemblies  304 ,  306  include respective curved needles  304   a ,  306   a  which are swaged or adhesively connected to opposite ends  304   b ,  306   b  of a common length of suture thread  307 . The suture thread  307  can be absorbable or nonabsorbable. As shown in  FIG. 10 , the screen closure system  302  can be preassembled with the suture thread length  307  releasably secured to the perimeter  308   a  of a screen  308 . Prior to installation of the screen  308 , the suture  307  can be disconnected or severed therefrom, either partly or completely. For example, the suture  307  can be separated along the screen ends  310   a ,  310   b  respectively, thereby leaving the suture thread lengths secured only along a screen lower margin  312 . 
     In operation, the suture subassemblies  304 ,  306  facilitate installation of the suture/screen closure system  302 , thereby providing a preassembled device which incorporates the necessary components for securing same in a separation  4 . For example, the screen  308  can be secured at the bottom alone by passing the suture subassemblies  304 ,  306  through tissue portions located at the bottom of the separation  4 . Alternatively, the suture subassemblies  304 ,  306  can be passed through the adjacent tissue and exit the surface of the dermis  6 , whereby the suture subassemblies  304 ,  306  can be used for closing the separation  4  at the dermis  6 . Barbed strands  320  can interact with the tissue portions  12   a,b  as described above, whereby the screen  308  provides a relatively secure mechanical connection between the separated tissue portions  12   a,b . The suture subassemblies  304 ,  306  can be utilized for various purposes in the separation  4 , including attachment and tacking of the dermis  6 , the deep dermal layer  7 , the subcutaneous layer  8  and the fascia  10 . Still further, all or part of the suture subassemblies  304 ,  306  can be removed, and additional suture subassemblies can be mounted on or sutured to the screen  308 . 
       FIG. 11   a  shows the screen  308  attached to the suture thread  307 .  FIG. 11   b  shows an alternative construction screen  318  with hollow tubular vertical risers  324  located between adjacent, respective vertical strands  320 , all connected by the spacers  322  and adapted for communicating fluid with the separation  4  through the open riser ends  324   a  and the perforations  324   b , as indicated by the fluid flow arrows  326 . All or part of the screen/suture system  302  can comprise absorbable material. 
       FIGS. 12 ,  13   a  and  13   b  show a modified embodiment screen-only closure screen system  402  and application methodology. A screen or mesh  404 , similar to the screen  14  with barbed strands  30  described above, is placed in a separation  4  against the first tissue portion  12   a . The second tissue portion  12   b  is then placed against the screen  404  whereby the separation  4  is closed and can be secured by the mechanical action of the screen  404 . The screen  404  can be supplemented with sutures, drainage tubing, I/O devices, and other auxiliary components for purposes of closing the wound edges  12 , draining the inside of the tissue separation  4 , fighting infection, pain management and all other functionalities associated with the present invention, as discussed elsewhere herein. For example, the screen  404  can be secured with sutures at the subcutaneous level  8 . Various fluid interconnecting devices can be utilized as necessary, and can be designed for removal after they serve their initial purpose. External drainage can also be achieved at the dermis level  6  utilizing transfer element subassemblies, such as the example designated  59  and described above ( FIG. 7   d ). Moreover, drainage and irrigation tubing can be installed within the wound  4  alongside or adjacent to the screen  404 . It will be appreciated that a screen-only version of the invention can comprise various suitable biocompatible absorbable and non-absorbable materials, including the materials disclosed above. 
       FIG. 13   a  is an enlarged view of the screen  404  and particularly shows barbed strands  406  and horizontal spacers  408 , which are connected together in a grid pattern forming the screen  404 .  FIG. 13   b  shows an alternative embodiment with a modified screen  410  including vertical risers  412  comprising hollow tubing, which are connected to and spaced by horizontal spacers  408 . Fluid flows into and out of the vertical risers  412  through open riser ends  412   a  and perforations  412   b , as indicated by the fluid flow arrows  420 . 
       FIGS. 14   a - g  show the screen  404  installed in a tissue separation  4  and closing same, utilizing the methodology of the present invention. The methodology shown in  FIGS. 14   a - g  is similar to the methodology shown in  FIGS. 5   a - e  and  6   a,b .  FIG. 14   c  shows a downward/inward force arrow  54   a  indicating a direction in which the screen  404  is pushed or guided into the separation. 
       FIGS. 15   a,b  and  16   a,b  show a modified vertical riser  502  comprising bundled tubes  504  secured together at spaced intervals by connectors  506 . The normal movement of the patient tends to alternately compress and expand the vertical risers  502 , thus providing a “pumping” action for transferring fluid from the wound  4 , as indicated by the fluid flow arrows  510 .  FIGS. 15   a,b  show a riser  502  in an extended configuration. Compressing the screen  14  longitudinally (i.e., end-to-end) compresses the bundled risers  504  to the configuration shown in  FIGS. 16   a,b , whereby fluid is drawn into the interstitial space  508  and pumped therefrom when the risers  502  extend. 
       FIG. 17  shows yet another configuration of a vertical riser  602  with bundled tubes  604 , which are closely bunched and define passages  606  for conveying fluid. Such fluid conveyance can be enhanced by a pumping action associated with normal patient movements. Barbs  608  project outwardly from the tubes  604 . It will be appreciated that various other bundled tube configurations, such as twisted, braided, etc., can be utilized. 
       FIG. 18  shows yet another vertical riser/perimeter member  702  alternative embodiment configuration. The member  702  has a configuration which is commonly referred to as a “fluted” drain and includes longitudinally-extending passages  704 . This configuration can substitute for the perimeter members described above and can function to communicate fluid to and from the wound  4  with the input/output subsystem  18 . 
     As additional alternative embodiment configurations for the vertical risers, they can comprise either barbed monofilament strands, similar to strand  30  shown in  FIG. 3 , or unbarbed monofilament strands. Such monofilament vertical risers can function as passive drains with fluid flowing alongside same. They can extend above the dermis  6  and abut or connect to transfer elements formed in various configurations with suitable absorbent materials. Examples include gauze dressings and transfer element subassemblies, such as  59  shown in  FIG. 7   d.    
       FIG. 19  shows an alternative embodiment strand  802  constructed by twisting and braiding multiple, individual filaments  804 . Barbs  805  are formed by respective individual filaments  804   a , which terminate at blunt ends  806 . The barbs  805  project generally outwardly from the strand  802  and form acute angles with respect to its longitudinal axis. They are adapted for penetrating tissue within a separation  4 , as described above. In use, the barbs  805  would normally be oriented in directions generally pointing outwardly from the patient and the tissue separation  4 . 
       FIG. 20  shows another alternative embodiment strand  902  comprising multiple twisted and braided filaments  904 . Barbs  905  are formed from individual filaments  904   a  and have notches  908  and pointed ends  910 . The notches  908  and the ends  910  are configured to allow the barbs  905  to easily extract from the separation edge tissues, whereby the screen is adapted for sliding along the separation edges in order to achieve the proper position. 
       FIG. 21  shows a further modified screen  1002  with barbs  1004  formed by looping individual filaments  1006  and cutting same at cut locations  1010  spaced inwardly from respective apexes  1008  of the filament loops. In operation, the barbs  1004  slightly penetrate the tissue and are imbedded therein. It will be appreciated that the filaments  1006  are relatively thin in diameter, similar to microfibers, whereby patient comfort is optimized. 
       FIG. 22  shows yet another modified screen  1102  with barbs  1104  formed by looping individual filaments  1106  and cutting same at locations  1110  spaced inwardly from respective apexes  1108  of the filament loops whereby respective hooks  1112  are formed. The hooks  1112  operate in a manner similar to hook-and-loop fasteners, with the adjacent tissue forming the loop parts of the connections. In operation, the hooks  1112  slightly penetrate the tissue and are imbedded therein. The configurations of the hooks  1112  tend to retain them in the tissue adjacent to the separation  4  whereby the separated first and second tissue portions  12   a,b  can be closed. 
       FIG. 23  shows a screen  1202  with a configuration similar to the screen  1002  discussed above, with additional fiber elements or filaments  1204 . The additional filaments  1204  tend to lay the filament barbs  1206  over whereby the screen  1202  can be directionally oriented within the wound separation  4  and operate in a manner similar to the screen  14  described above. The barbs  1206  are formed by cutting the apexes  1208  at cut locations  1210 . 
     Similarly,  FIG. 24  shows a screen  1302  with additional filaments  1304 , which engage the filament loops  1306  and orient same in a direction towards the right as shown in  FIG. 24 . The slanted orientations of the filament loops  1306  facilitate setting same in the tissue portions  12   a,b  adjacent to the separation  4  by tugging outwardly on the screen  1302 . Repositioning the screen  1302  is also possible, as described above. The filament loops  1306  can be cut at cut locations  1310 , which are spaced inwardly from filament loop apexes  1308  thereby hooks  1312  are formed. 
     It will be appreciated that  FIGS. 21-24  disclose screens with barbs and ending from one face thereof. The present invention also includes screens with hooks extending from both faces. 
     It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.