Abstract:
A wound closure device including a flexible base strip having its bottom surface coated with an adhesive material suitable for adherence to skin and constructed with bridging links spaced along the inner edge of the base strip and extending outwardly therefrom. The inner edge of the base strip is intended to be aligned adjacent to a lip of the wound being treated. Each of the bridging links has an adhesive coated section displaced from the inner edge. In the packaged or stored position, prior to engagement, the bridging links are folded over the upper surface of the adhesive strip about a hinge that is at the joint of the bridging link to the base strip. The hinge includes a partially flexible material to enable stabilizing the bridging link in an angular position. In addition, a method is provided for use of the wound closure device.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims priority to a U.S. provisional application Ser. No. 61/664,463 entitled “Wound Closure Device”, filed on Jun. 26, 2012, which is incorporated in its entirety herein by reference. 
     
    
     FIELD 
       [0002]    The present teachings generally relate to wound closure devices, and more specifically to sutureless wound closure devices and methods. 
       BACKGROUND 
       [0003]    This application involves wound closures similar to the type described in U.S. Pat. No. 7,981,136, issued on Jul. 19, 2011, U.S. patent application Ser. No. 10/884,837, filed Jul. 2, 2004, Ser. No. 10/412,967, filed Apr. 14, 2003, and U.S. Provisional Patent Application Nos. 60/873,643, filed Dec. 8, 2006, and 60/934,248, filed Jun. 12, 2007, all owned in common with the instant application. The entire disclosures of all of the cited applications and patents are incorporated herein by reference. 
         [0004]    Among the most commonly used methods for closing wounds caused by lacerations or surgical incisions are suturing and stapling. Both of these procedures are skin invasive, which can traumatize and compromise the integrity of the wound. They increase the possibility of infection, expose the surgeon, as well as the patient, to blood-borne disease, leave behind scar tracks, and require a follow-up visit for suture or staple removal. 
         [0005]    As is well known, a cut that invades deeply into the tissue of the skin generally requires a mechanism for drawing the sides of a wound together to promote healing and to reduce the formation of scar tissue. Surgeons have become skilled in the various techniques of suturing to minimize the resulting blemish that occurs during the healing process. These methods have always generated issues of sterilization and the very nature of suturing requires a threshold of dexterity that escapes many care providers. This is particularly true in emergency situations, which call for immediate treatment to secure the wound for transport or until such time as proper surgery is available. Suturing, even by a skilled surgeon, punctures and stresses skin tissue causing scaring. In certain situations, such as in geriatric and pediatric applications, when patient&#39;s skin is either thin and fragile, using sutures can be impractical or impossible. 
         [0006]    It is well recognized that a sutureless wound closure would be a great benefit in many situations. Accordingly, the present disclosure provides improved sutureless wound closure devices and methods which overcomes the above problems and others. 
       SUMMARY 
       [0007]    In certain aspects the present teachings provide for a device for closing a wound. The device comprises all of or some of the following, an elongate, flexible base strip. The base strip has a bottom surface coated with an adhesive to adhere to one side of a wound, and a top surface opposite the bottom surface. The base also has an inner edge and an outer edge. The base strip also has a plurality of bridging links integrated with it in axially-spaced relation. The bridging links extending transversely from the inner edge of the base strip. Each bridging link can be moved about a hinge region between a first, storage position, in which the bridging links are folded over the top surface of the base strip, and a second, extended position, in which the bridging links extend outwardly from the inner edge of the base strip. Each bridging link has a first, engaging surface and a second surface opposite the engaging surface. The first engaging surface has an attachment region for attaching to another top surface of another base strip when that another base strip is placed on an opposite side of the wound and the bridging links are in the extended position. The hinge region of each bridging link comprises a partially flexible material capable of promoting stabilized orientation of the bridging link in an intermediate angular position between the first and the second positions. This device may comprise a holding tab integrated with the outer edge of the base strip and extending outwardly a predetermined distance from the outer edge. The holding tab is substantially free from adhesive and may be used for holding. The base strip of the device may be comprised of, for example, but not limited to, a loop tape of a hook-and-loop type fastener substrate. The loop tape is positioned to present loops at least on a portion of the top surface of the base strip. Complementary bridging links may comprise, for example, of a hook tape of the hook-and-loop type fastener substrate. The hook tape is oriented to present hooks in the attachment regions of the bridging links. The bridging links of the device may include a pulling tab at their outer ends. These pulling tabs are substantially free from adhesive and may be used for holding. The base strip and the bridging of the device may also be made of polyurethane or, for example, but not limited to, a breathable unidirectionally elastic substrate. The bridging links of the device may have adhesive in a locking area on the second surface. When the bridging links are in the stored position the locking area may be used to releasably secure the second surface to the top surface of the base strip. The device may have transverse indicia on the top of the bottom surfaces of the base strip. The transverse indicia may be used for guiding separating the base strip into shorter fragments. The device may also be comprised of a holding film attached to the bottom surface of the base strip at a predetermined distance from the inner edge of the base strip and extending beyond the outer edge of the base strip. 
         [0008]    In certain aspects the present teachings provide for another device for closing a wound. The device comprises some of or all of the following, a first closure strip removably attached to a lower support sheet, and a second closure strip removably attached to the lower support sheet. The first and second closure strips are in aligned, facing relation. Each of the first and second closure strips of the device includes an elongate, flexible base strip. The base strip has a bottom surface coated with an adhesive to adhere to a first side of a wound and a top surface opposite the bottom surface. The base strip has an inner edge and an outer edge. Each of the first and second closure strips include a plurality of bridging links connected to the base strip in axially-spaced relation. The bridging links extend transversely from the inner edge. Each of the bridging links are movable about a hinge region between a first, storage position in which the bridging links are folded over the top surface of the base strip, and a second, extended position in which the bridging links extend outwardly from the inner edge. Each bridging link has a first, engaging surface and a second surface opposite the engaging surface. The first engaging surface has an attachment region for attaching to another top surface of another base strip when that another base strip is placed on an opposite side of the wound and the bridging links are in their extended positions. The hinge region of each bridging link is comprised of a partially flexible material capable of stabilizing the orientation of the bridging links in an intermediate angular position between their first and second positions. Each bridging link of the device may further be comprised of a pulling tab at its outer end. The pulling tab is substantially free from adhesive and may be used for holding. The base strip and the bridging links of the device may comprise polyurethane or, for example, but not limited to, a breathable unidirectionally elastic substrate. Each bridging link may have adhesive in a locking area on the second surface. The locking area may be used to releasably secure the bridging link to the top surface of the base strip when the bridging link is in the storage position. The device may have a transverse indicia on the top surface or the bottom surface of the first or second closure strips. The transverse indicia may be used for guiding and/or separating the first or second closure strips into shorter fragments. The device may include a first holding film removably attached to the bottom surface of the first closure strip, between the first closure strip and the support sheet. The first holding film is attached at a predetermined distance from the inner edge of the first closure strip while extending beyond the outer edge of the first closure strip. The device may also include a second holding film removably attached to the bottom surface of the second closure strip, between the second closure strip and the support sheet. The second holding film is attached at a predetermined distance from the inner edge of the second closure strip while extending beyond the outer edge of the second closure strip. When the bridging links are in their storage position, the device may include a top film removably attached to the attachment regions of the bridging links. The support sheet of the device may have an indicia line between the first and second closure strips. 
         [0009]    In certain aspects the present teachings provide for a method of closing a wound. The method includes some of or all of the following, selecting a wound closing device. The wound closing device comprises a first closure strip removably attached to a lower support sheet, and a second closure strip removably attached to the lower support sheet. The first and second closure strips are in aligned, facing relation. Each of the first and second closure strips of the device includes an elongate, flexible base strip. The base strip has a bottom surface coated with an adhesive to adhere to a first side of a wound and a top surface opposite the bottom surface. The base strip has an inner edge and an outer edge. Each of the first and second closure strips include a plurality of bridging links connected to the base strip in axially-spaced relation. The bridging links extend transversely from the inner edge. Each of the bridging links are movable about a hinge region between a first, storage position in which the bridging links are folded over the top surface of the base strip, and a second, extended position in which the bridging links extend outwardly from the inner edge. Each bridging link has a first, engaging surface and a second surface opposite the engaging surface. The first engaging surface has an attachment region for attaching to another top surface of another base strip when that another base strip is placed on an opposite side of the wound and the bridging links are in their extended positions. The hinge region of each bridging link comprises a partially flexible material capable of stabilizing orientation of the bridging links in an intermediate angular position between their first and second positions. Each bridging link of the device further comprises a pulling tab at its outer end. The pulling tab is substantially free from adhesive and may be used for holding. The device includes a first holding film removably attached to the bottom surface of the first closure strip, between the first closure strip and the support sheet. The first holding film is attached at a predetermined distance from the inner edge of the first closure strip while extending beyond the outer edge of the first closure strip. The device also includes a second holding film removably attached to the bottom surface of the second closure strip, between the second closure strip and the support sheet. The second holding film is attached at a predetermined distance from the inner edge of the second closure strip while extending beyond the outer edge of the second closure strip. The method further includes identifying a mammalian wound. The method includes a step of removing the first closure strip from the support sheet while holding the first holding film. The method includes a step of adhering an unprotected with the first holding film portion of the bottom surface of the first closure strip to skin on one side of the wound at a predetermined distance from one wound lip. The method includes a step of removing the first holding film from the bottom surface of the first closure strip while adhering the bottom surface of the first closure strip to the skin on the one side of the wound. The method includes a step of removing the second closure strip from the support sheet while holding the second holding film. The method includes a step of adhering an unprotected with the second holding film portion of the bottom surface of the second closure strip to skin on an opposite side of the wound at a predetermined distance from an opposite wound lip. The method includes a step of removing the second holding film from the bottom surface of the second closure strip while adhering the bottom surface of the second closure strip to the skin on the opposite side of the wound. The method includes a step of attaching the attachment region of at least one bridging link of the first closure strip to the top surface of the base strip of the second closure strip while holding the pulling tab of that bridging link of the first closure strip. The method includes a step of attaching the attachment region of at least one bridging link of the second closure strip to the top surface of the base strip of the first closure strip while holding the pulling tab of that bridging link of the second closure strip. And the method includes a step of leaving one bridging link in the intermediate position while manipulating another bridging link. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]    The invention may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. 
           [0011]      FIG. 1  illustrates a principal unit of wound closure device of the present teachings. 
           [0012]      FIG. 2  illustrates an extended wound closure strip of the present teachings. 
           [0013]      FIG. 3  shows an illustration of an extended wound closure strip of the present teachings comprised of a plurality of principal wound closure units and lines marking approximate separations between units. 
           [0014]      FIG. 4  illustrates application of two wound closure strips of the present teachings to a wound. 
           [0015]      FIG. 5  illustrates an exploded view of a ready-for-use wound closure device of the present teachings. 
           [0016]      FIG. 6  illustrates an implementation of holding tabs on a wound closure strip of the present teachings. 
           [0017]      FIG. 7A  illustrates wound closure strip base holes allowing for strip expansion and shrinkage during wound healing. 
           [0018]      FIG. 7B  illustrates wound closure strip base slits allowing for strip expansion and shrinkage during wound healing. 
           [0019]      FIG. 8  illustrates wound closure strip base notches augmenting, for example, separating the strip into individual units. 
       
    
    
     DETAILED DESCRIPTION 
       [0020]    Although the present invention will be described with reference to the embodiments shown in the figures, it should be understood that the present invention may have many alternate forms. 
         [0021]    In the course of describing the wound closure embodiments herein, the bottom of the closing device will refer to the surface that is intended to engage the skin and the upper side or top will refer to the side of a component that is facing away from the skin after application. Directions will be indicated according to the position of the wound being treated, for example, transverse shall refer to directions across the wound. The inner edge of the closing device shall refer to the side that is intended to be adjacent to the wound lip (or edge), and the outer edge shall refer to the side of the device that is intended to be away from the wound. 
         [0022]    An implementation of a principal unit of the wound closure device of the present teachings is illustrated in  FIG. 1 . Principal unit  100  of the wound closure device comprises base  110 , which has a top surface (shown in  FIG. 1 ), a bottom surface opposite the top surface, inner edge  170 , outer edge  180 , and bridging link  120 , which is connected to base  110  at inner edge  170  by way of hinge region  130 . Bridging link  120  comprises tab  140  of appropriate size and shape as to allow for holding onto with at least two fingers. Hinge region  130  allows bridging link  120  to assume an extended (open) position, whereby bridging link  120  is substantially fully extended outwards and transversely with respect to inner edge  170 ; and a closed position, whereby bridging link  120  is folded backwards over the top surface of base  110 . It should be clearly understood that bridging link  120  may be integrated with base  110 , either by way of fusion with base  110 , or by way of any other connection to base  110 , i.e. chemical, thermal or mechanical bonding or incorporation. It should also be understood that the sizes and shapes of various elements shown in  FIG. 1 , as well as in other figures, are only illustrative and may vary, depending on specific implementations without departing from the general nature of the teachings. 
         [0023]    The top surfaces of base  110  and bridging link  120  (all seen in  FIG. 1 ), including hinge region  130  and tab  140 , are substantially free from adhesive. Whereas the bottom surface of base  110  (not shown) as well as the bottom surface of bridging link  120  (not shown), except for tab  140 , are substantially covered with adhesive which is strong enough as to ensure secure attachment of base  110  to human or animal skin while also allowing for removal of base  110  from skin if and when needed. In specific implementations it may also be desirable to leave hinge region  130  partially or completely free from adhesive, however not in the most general case contemplated herein. 
         [0024]    It should be emphasized that one of the purposes of tab  140  is to allow for confident holding by a user of the device as to permit for easy manipulation of bridging link  120 , as well as other device manipulations. Therefore, any size and shape of tab  140 , while having it adhesive free as to ensure attaining holding and unhindered release thereof, is compatible with contemplated purposes of tab  140 . 
         [0025]    For storage in the closed position, adhesive may optionally cover locking area  160  on the top surface of bridging link  120 , area  160  size is sufficient for securing bridging link in the folded back orientation, but may be expanded if greater tac is required. The adhesive used on locking area  160  may be the same adhesive applied elsewhere, e.g. to the bottom surface of base  110 , or it may be a different, for example a lighter tac adhesive. For storage, bridging link  120  is generally folded back onto the top surface of base  110 , and in case of utilizing locking area  160  the adhesive is allowed to attach to the top surface, thus securing bridging link  120  in the closed position. 
         [0026]    Base  110  of unit  100  can be manufactured utilizing a variety of flexible or partially flexible, or unidirectionally flexible, or drapable materials. Bridging link  120 , including hinge region  130  and tabs  140 , may be made of the same material as base  110 , in which case a single piece, including  110 ,  120 ,  130  and  140 , is cut to size from a single sheet of the material selected. Alternatively, each element of the latter four elements, or any combination thereof, can be made of an individual material, or have individual additional elements. For example, in certain implementations hinge region  130  may comprise partially flexible component  150  which could promote stabilizing bridging link  120  in an intermediate angular position (illustrated in  FIG. 1 ) between the extended (open) and the closed positions. However, the same stabilizing in the intermediate position effect can be achieved by choosing a partially flexible material for implementing any combination of the four elements that include hinge region  130 . Thus, in certain implementations, base  110  may be made of a flexible material, while bridging link  120 , including hinge region  130 , may be made of a partially flexible material, and bridging link  120  can be attached to base  110 , for example, by adhering it to the top surface of base  110 , or by other equivalent methods of attachment. 
         [0027]    The flexible material of choice for manufacturing principal unit  100  may be a non-woven, spunbond nylon material, such as ORION® or PBN-11 fabric available from Cerex Advanced Fabrics, Inc. of Cantonment, Fla. In such case utilizing partially flexible component  150  is preferred, which may comprise various partially flexible polymers, e.g. polyamides, polyesters, perforated ethylene vinyl acetate material, thin metal or nylon wires, etc. 
         [0028]    Principal unit  100  may also be manufactured utilizing various polyurethanes, or a breathable unidirectionally elastic substrate, as for base  110 , and bridging links  120 , including hinge region  130  and tab  140 . Utilizing a breathable unidirectionally elastic substrate allows for additional flexibility of unit  100 , which may be beneficial for certain applications. This flexibility, for example, can accommodate skin expansion or shrinkage in the process of wound healing. In such partially flexible component  150  may also be optionally implemented. 
         [0029]    For some applications principal unit  100  may be manufactured utilizing a hook-and-loop fastener substrate, such as a low-profile VELCRO® fabric available from Velcro USA, Inc. of Manchester, N.H. In this case, base  110  is manufactured of a loop tape material, having loops on the top surface of base  110  and adhesive of the loop-free bottom surface. Entire bridging link  120 , including hinge region  130  and tab  140 , is made of a hook tape material, having hooks on the bottom surface of bridging link  120  and thus no adhesive applied to the bridging link bottom surface. In this case utilizing partially flexible component  150  may not be necessary as hook tape itself is usually made of a partially flexible material, thus providing desirable properties in hinge region  130  of bridging link  120  as to stabilize bridging link  120  as an intermediate position. Bridging link  120  is attached to the top surface of base  110  by pressing its hooks against base  110  loops. For extra strength the attachment may be fortified by chemical bonding or thermal fusion. If necessary, smooth tab  140  on bridging link  120  can be implemented by melting down polymer hook tape hooks with local heating. 
         [0030]    Consistent with the foregoing teachings, principal unit  100  can be realized in extended wound closure strip  200 , examples of which are shown in  FIG. 2  and  FIG. 3 . Wound closure strip  200  may be comprised of a continuous plurality of units  100  extending longitudinally, substantially along inner edge  170 , thus forming extended base  210  and a plurality of bridging links  220 , as shown in  FIG. 2 . As shown in  FIG. 3 , in certain implementations it may be advantages to have perforation, colored, or shaded lines  180  on extended base  210 , for easy adjustments of base  210  length for particular application, or for enabling separation of wound closure strip  200  into individual units  100 . 
         [0031]      FIG. 4  shows an example of two wound closure strips  200  applied to wound  250 . In the figure, one wound closure strip  200  is applied to one side of wound  250 , such that the inner edge of wound closure strip  200  base is aligned with one edge of the wound substantially along that edge of the wound and at a predetermined distance from the edge of the wound. Another wound closure strip  200  is applied to the opposite side of wound  250 , such that the inner edge of another wound closure strip  200  base is aligned with the opposite edge of the wound substantially along that edge of the wound and at another predetermined distance from the opposite edge of the wound. Application of the two wound closure strips  200  is done in such a manner as to have bridging links of the one wound closure strip  200  offset or facing the spaces between bridging links of the other wound closure strip  200 , as illustrated in  FIG. 4 . Initially, the offset bridging links, facing each other, of wound closure strips  200  are in closed positions  210 . For closing wound  250  the bridging links are brought into extended positions  230 , when the bridging links of one wound closure strip  200  are attached to the top surface of the opposite wound closure strip  200  via the adhesive on the bottom surface of the bridging links. A complete closure of wound  250  may be achieved by bringing all bridging links into extended positions  230 . 
         [0032]    Wound closure can be readjusted, and if necessary improved, by detaching opposing bridging links from the opposite base and reattaching the bridging links while pulling the opposing bridging links into opposite direction, essentially in a “shoe string” manner. Tabs  140  on bridging links  120  (see  FIG. 1 ) are especially useful for such detaching and reattaching of the bridging links. Before attaching bridging links for closing the wound, the bridging links can be stabilized in the intermediate position  220  (as shown in  FIG. 4 ). This intermediate position is accomplished due to the presence of partially flexible materials in their hinge regions. Having the bridging links stabilized in intermediate positions  220  is beneficial because this allows for unhindered wound manipulation when the wound is completely or partially open for readjusting the wound closure, or for intermediate cleaning of the wound from exudates, applying medications to the wound, and/or other wound manipulations. Further, while in intermediate positions  220 , the bridging links are better presented for handling by the user, especially considering that practitioners, who are most likely to use the devices of the present teachings, are routinely wearing surgical gloves. Thus, enabling stable orientation of bridging links in intermediate positions  220  also enables easier wound manipulation by a practitioner. 
         [0033]    An exploded view of an example of an assembled ready-for-use wound closure device of the present teachings is illustrated in  FIG. 5 . Wound closure device  300  is comprised of two wound closure strips  200  assembled facing each other on support film  330 . A colored or shaded line  340  on support film  330  may be used to indicate to user the wound direction. Portions of base bottom surfaces of two wound closure strips  200  are covered by holding films  320 . Each holding film  320  has a folded lip  350 . Each folded lip  350  is folded along lip folding line  360  and has lip outer edge  370 . Two wound closure strips  200  are attached with portions of their base bottom surfaces, not covered by holding films  320 , to support film  330  so as to have their inner edges facing each other and line  340  and at a predetermined distance from line  340 , as illustratively shown in  FIG. 5 . In an assembled ready-for-use device, bridging links of each wound closure strip  200  are in closed positions, folded over backwards. Hinge regions of one wound closure strip  200  are facing into spaced between hinge regions of the opposite wound closure strip  200 , as they would be when the device is applied to a wound. A portion of each wound closure strip  200  base bottom surface is covered with folded lip  350  of holding film  320 , which may be clear or color coded, the remainder of holding film  320  extending beyond base outer edge as to cover at least a portion of bridging links&#39; tabs extending beyond base outer edge. In some, but not all, implementations of the wound closure device the tabs begin at the base outer edge when bridging links are in the closed (folded backwards) position. Holding films  320  are applied to the base bottom surface of wound closure strips  200  such as to leave uncovered a portion of the base bottom surface adjacent to each base inner edge. This is achieved by placing lip outer edges  370  at a predetermined distance from base inner edges, thus leaving portions of base bottom surfaces uncovered with lips  350 . The adhesive on these uncovered surfaces are used to attach wound closure strips  200  to support film  330 . The top of the assembled ready-for-use wound closure device  300  is protected with clear or color coded top films  310  covering each individual wound closure strip  200  of the device by attaching to the adhesive on the bottom surfaces of the folded backwards bridging links. 
         [0034]    Folded lips  350  may be made wide enough as to allow lip outer edges  370  to protrude a predetermined distance beyond base outer edges when holding strips  320  are attached to wound closure strips  200 . The surfaces (facing bases of wound closure strips  200 ) of the protruding portions of folded lips  320  may be covered with adhesive for adhering to portions of bridging links protruding beyond base outer edges of wound closure strips  200  when the bridging links are in closed positions (as shown in  FIG. 5 ). In this case having adhesive in locking area  160  of the bridging links (see  FIG. 1 ) may not be necessary as the bridging links will be held in closed positions by adhering to the protruding portions adjacent to outer edges  370  of folded lips  350  when holding strips  320  are attached to wound closure strips  200 . 
         [0035]    Wound closure device  300  can be used as follows. Initially, one wound closure strip  200  covered with holding film  320  and top film  310  is removed from support film  330 . This can be accomplished while holding onto the surfaces of films  320  and  310  to avoid adhesive covered areas of wound closure strip  200 . Continuing to hold the assembly of wound closure strip  200  with films  320  and  310  after removing wound closure strip  200  from support film  330 , wound closure strip  200  is applied to one side of the wound being closed with the exposed adhesive of the unprotected portion of the base adjacent to the base inner edge, leaving a predetermined distance between the edge of the wound and the base inner edge of wound closure strip  200  (as illustratively shown in  FIG. 4 ). Because only a limited adhesive covered portion of the base of wound closure strip  200  is exposed, the rest being covered by holding film  320 , it is easy to follow the edge of the wound with the base outer edge of wound closure strip  200  in case of a complex nature of the wound. If necessary, such as with an irregularly curved wound, the exposed base inner edge can be intermittently detached from skin and reattached back after a position adjustment. In certain applications, it may be desirable to remove top film  310  prior to applying the base inner edge of wound closure strip  200  to skin. In this case, only holding film  320 , with protruding onto it portions of bridging links adhesive free tabs, is used for holding wound closure strip  200  while applying it to skin. After its base outer edge has been completely applied, holding film  320  is removed from under wound closure strip  200  and the remaining exposed adhesive on its base is allowed to attach to skin. After one wound closure strip  200  has been applied to one side of the wound, the other wound closure strip  200  is removed from support film  330  and applied to the opposite side of the wound in a similar fashion. During application, the two opposing wound closure strips  200  are aligned essentially as shown in  FIG. 4 . After both wound closure strips  200  have been securely attached to skin on the opposite sides of the wound, their bridging linked are detached from their closed positions, while holding and pulling them by their tabs (in case of adhesive covered protruding areas of folded lips  350  bridging links are released when holding film  320  is removed). The wound is closed by attaching the bridging links to the base top surfaces of the opposing wound closure strips  200 , essentially in a “shoe string” manner. If it is necessary to adjust wound closure, any number of bridging links can be intermittently detached and held stably in intermediate position  220  without hindering access to the wound or neighboring bridging links, as illustrated in  FIG. 4 , until reattached later. 
         [0036]    In certain implementations it may be desirable to have adhesive free holding tabs extensions on the base outer side of wound closure strips, as illustrated with color code or noncoded holding tabs  240  in  FIG. 6 . Holding tabs  240  may be used without holding film  320 , in which case holding film  320  is not included into assembled ready-for-use wound closure device, or in combination with holding film  320 . For example, holding tabs  240  may be useful for holding while separating wound closure strip  260  into shorter units along perforation lines  270 , as illustrated in  FIG. 6 . 
         [0037]    Referring to  FIG. 7 , in certain applications it may be advantageous to implement openings of various shapes on wound closure strip base as to allow the base to stretch or shrink in the course of wound healing, thereby protecting sensitive/vulnerable skin from irritation, blistering or sheer. For example, such openings may be implemented as holes  410 , as illustrated in  FIG. 7A , or slits  420 , as illustrated in  FIG. 7B . Other opening shapes may be used as appropriate. 
         [0038]    Referring to  FIG. 8 , in certain applications it may be advantageous to implement notches  430  on wound closure strip base as to augment, for example, separating the strip into individual units or adjusting the length of the base. Notches may also be useful in aligning opposing strips with respect to each other when applying the strips to a wound. 
         [0039]      FIG. 8  shows a U-shaped implementation of the notches, which among other advantages may be advantageous to simplify strip manufacturing. However, other shapes of the notches may also be desirable for difference applications. 
         [0040]    In certain embodiments, the closure device  100  may be formed of a conformable non-woven textile-like fabric, e.g., formed of nylon or other synthetic material. The closure device  100  is preferably formed of ORION® spun bond nylon fabric. In particularly preferred embodiments, the closure device  100  is formed of having a weight in the range of from about 1 to about 2 ounces per square yard and is most preferably in the range of from about 1.8 to about 2.0 ounces per square yard. 
         [0041]    The spunbond fabric is breathable, translucent, and high-strength with longitudinal flexibility. The material is formed of nylon and is adaptable to a variety of environments. The flexibility and weight of the material allows it to curve around wounds in a one piece construction. Also, other fabrics that have longitudal, length flex and less width flex or cross directional flex provide a useful fabric for this invention. Other devices are inflexible and need to be cut into separately applied segments in order to contour to a curved or other nonlinear or irregular wound. 
         [0042]    The invention has been described with reference to the preferred embodiments. Modifications and alterations will occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be construed as encompassing all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.