Abstract:
A medical sling device having a pair of tissue approximating devices each including a supportive backing member, a plurality of tissue engagement tines extending from the backing member, and an elongated extension member extending from the backing member. Each extension member is slidably engaged with the back member of the other tissue approximating device, such that pulling on the first and second extension members causes the first and second backing members to slide toward each other.

Description:
[0001]     This application claims the benefit of U.S. Provisional Application No. 60/553,782, filed Mar. 16, 2004. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention relates to surgical devices and procedures, and more particularly to a tissue approximation device and method for supporting the repair of tissue such as the platysma muscle in rejuvenation surgery of the face.  
       BACKGROUND OF THE INVENTION  
       [0003]     The platysma is a facial muscle in the neck region. It is a fanlike muscle that originates from the fascia of the cervical region and inserts in the mandible and the skin around the mouth. It is innervated by the cervical branch of the facial nerve, and acts to wrinkle the skin of the neck and to depress the jaw.  
         [0004]     Rejuvenation surgery of the neck includes a need for approximating the decussated edges and supporting the platysma muscle. However, using sutures alone for such approximation and support has a propensity to fail.  
       SUMMARY OF THE INVENTION  
       [0005]     The present invention provides a medical device and procedure for approximating the anterior edges and supporting tissue such as the platysma muscle using an adjustable multipoint tension distribution device.  
         [0006]     More specifically, the present invention is a medical sling device that includes a first tissue approximation device that includes a first supportive backing member, a first plurality of tissue engagement tines extending from the first backing member, and a first elongated extension member extending from the first backing member, and a second tissue approximation device that includes a second supportive backing member, a second plurality of tissue engagement tines extending from the second backing member, and a second elongated extension member extending from the second backing member, wherein the first extension member is slidably engaged with the second backing member, and the second extension member is slidably engaged with the first backing member, such that tension pulling on the first and second extension members causes the first and second backing members to slide toward each other.  
         [0007]     In another aspect of the present invention, a method of approximating first and second tissue portions uses a medical sling device, wherein the sling device comprises a first tissue approximation device that includes a first supportive backing member, a first plurality of tissue engagement tines extending from the first backing member, and a first elongated extension member extending from the first backing member; and a second tissue approximation device that includes a second supportive backing member, a second plurality of tissue engagement tines extending from the second backing member, and a second elongated extension member extending from the second backing member; wherein the first extension member is slidably engaged with the second backing member, and the second extension member is slidably engaged with the first backing member. The method comprises placing the sling device on the first and second tissue portions such that the first plurality of tines engage with a first tissue portion and the second plurality of tines engage with the second tissue portion, pulling on the first and second extension members such that the first and second backing members slide toward each other drawing the first and second tissue portions toward each other, and securing the first and second extension members in place.  
         [0008]     Other objects and features of the present invention will become apparent by a review of the specification, claims and appended figures. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0009]      FIG. 1A  is a top view of the tissue approximation sling of the present invention.  
         [0010]      FIG. 1B  is a side view of the tissue approximation sling of the present invention.  
         [0011]      FIG. 2A  is a perspective view of the tissue approximation devices of the present invention.  
         [0012]      FIG. 2B  is a perspective view of the supportive backing and tissue engagement tines of the tissue approximation devices of the present invention.  
         [0013]      FIG. 3  is a front view showing the implementation of the tissue approximation sling of the present invention on the platysma muscle area of the neck.  
         [0014]      FIG. 4  is a side view of an alternate embodiment of the tissue approximation sling of the present invention.  
         [0015]      FIGS. 5A and 5B  are perspective views of the alternate embodiment for the supportive backing and tissue engagement tines of the present invention.  
         [0016]      FIGS. 6A and 6B  are perspective views of the alternate embodiments for the tissue approximation sling of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0017]     The present invention is a tissue approximation sling device  1  as shown in  FIGS. 1A and 1B . Sling device  1  includes a pair of tissue approximation devices  10   a / 10   b  slidably interconnected to each other. The tissue approximation devices  10   a/b  are preferably identical, and are better shown in  FIGS. 2A and 2B . Each tissue approximation device  10   a/b  includes a supportive backing member  12 , a plurality of tissue engagement tines  14  extending from the backing member  12 , and an elongated extension member or leash  16  extending from the backing member  12 . The tines  14  are preferably angled or canted toward the extension member  16  portion of the approximation device. The extension member  16  preferably includes a plurality of through-holes  18  formed therein in a line along the length of the extension member  16 . The backing member  12  also includes a pair of apertures  20   a/b  for engaging with the extension member  16  of the other approximation device.  
         [0018]     The sling device  1  of the present invention is assembled by feeding the extension member  16  of approximation device  10   b  through the apertures  20   a/b  of approximation device  10   a  (so that the extension member extends behind much of the backing member  12  of approximation device  10   a ), and by feeding the extension member  16  of approximation device  10   a  through aperture  20   a  of approximation device  10   b , as shown in  FIGS. 1A and 1B . As the ends of extension members  16  are pulled away from each other, the approximation devices  10   a/b  slide relative to each other so that backing members  12  slide toward each other. Each of the extension members  16  have scalloped edges to reduce the visibility of the sling device after implementation (long straight lines are easier to see than a scalloped or uneven edges that geometrically break up visibility under the skin).  
         [0019]     The implementation of the sling device  1  in the repair of the platysma  30  is illustrated in  FIG. 3 . The sling device is inserted into the neck and over (or under with tines facing up) the platysma muscle  30  so that the tines  14  of the approximation devices  10  engage the desired portions of the platysma  30 . The ends of extension members  16  are then pulled up along the mastoid process (to which the sling device will be anchored). By pulling on the extension members  16 , the backing members  12  (along with the platysma portions engaged with the tines thereof) are drawn toward each other, until the platysma portions are approximated to their desired locations. At this time, the backing members engaged with the platysma can be secured in their new relative location prior to securing the extension members. The extension members  12  are then anchored to the mastoid process, preferably using screws  32  extending through selected through holes  18 . Additionally or alternately, sutures may be used to anchor the extension members to the mastoid fascia, also utilizing the through holes. Excess length of the extension members  16  can then be cut away. By engaging the platysma using a plurality of tines disposed over the areas of the backing members  12 , the tension of tissue engagement is broadly dispersed over a wide area. The sliding configuration of the tissue approximation devices  10   a/b  allows the surgeon to select the degree of tissue approximation after engaging the platysma simply by pulling on the extension members before anchoring. The sling can mobilize, move, or stabilize the selected regions of the platysma, where the approximation forces of the platysma are counteracted by the forces of tissue support to the mastoid fascia or process. The approximation forces of the platysma can also be counteracted through the use of a suture tied so as to fix the two extension members relative to each other. This same function can also be achieved through the use of a separate locking device or through a ratchet mechanism molded into the sling device.  
         [0020]      FIGS. 4 and 5 A/B illustrate an alternate embodiment of the tissue approximation devices  10   a/b , where apertures  20   a  are replaced by sleeve members  22  formed on the back side of backing members  12 . The extension members  16  extend through the sleeve members  22  instead of apertures  20   a.    
         [0021]     It is to be understood that the present invention is not limited to the embodiment(s) described above and illustrated herein, but encompasses any and all variations falling within the scope of the appended claims. For example, the sling components and/or the mounting screws can be made of biodegradable materials well known in the art or other bio-compatible materials. Additional tines can be formed on the extension members  16 , to engage with additional portions of the platysma, and/or to engage with the mastoid process or fascia instead of using screws. The sling of the present invention can be used on other types of tissue, and its application is not limited to the platysma. Lastly, it is within the scope of the present invention to provide a unitary sling device as shown in  FIGS. 6A  or  6 B, where the backing portions  12  are connected together in a non-sliding configuration ( FIG. 6A ), or tines are simply formed along the length of a single extension member ( FIG. 6B ).