Patent Publication Number: US-2022218954-A1

Title: Sutureless adhesion system

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This continuation application claims priority to and the benefit of U.S. non-provisional patent application Ser. No. 16/682,239 entitled: Sutureless Adhesion System, filed on Nov. 13, 2019, which claims priority to and the benefit of U.S. provisional Patent Application No. 62/760,720 entitled: Sutureless Adhesion System, filed on Nov. 13, 2018. 
    
    
     FIELD OF THE INVENTION 
     The present embodiments are directed to a chest tube anchoring system. 
     DESCRIPTION OF RELATED ART 
     The lungs are surrounded by a pleural sac made up of two membranes, the visceral and parietal pleurae. The parietal pleura lines the thoracic wall, and the visceral pleura surrounds the lung. The pleural space is a potential space between these two layers of pleurae. It contains a thin layer of serous pleural fluid that provides lubrication for the pleurae and allows the layers of pleurae to smoothly slide over each other during respiration. In abnormal circumstances the pleural space can fill with air and certain types of fluids not normally present requiring drainage. 
     In the industrialized world, trauma is the leading cause of death in males under the age of forty. In the United States, chest injuries are responsible for one-fourth of all trauma deaths. Many of these fatalities could be prevented by early recognition of the injury followed by prompt management. Some traumatic chest injuries require quick placement of chest tubes to drain out air and/or fluids (such as blood) from the chest cavity. 
     Several techniques are currently used to insert a chest tube, each of which involves a relatively lengthy manual procedure that requires knowledge and experience. The most common technique involves surgical preparation and draping at the site of the tube insertion (usually at the nipple level-fifth intercostal space, anterior to the mid-axillary line on the affected side), administering local anesthesia to the insertion site, and making a 2-4 cm vertical incision. A clamp is inserted through the incision and spread tearing muscle and tissue until a tract large enough to accept a finger is created. Next, the parietal pleura is punctured. One way is with the tip of a clamp, and the physician, on occasion, places a gloved finger into the incision to confirm the presence of a free pleural space locally. Next, the proximal end of the chest tube  145  is advanced through the incision into the pleural space. As the chest tube is inserted, it is sometimes directed posteriorly and superiorly towards the apex of the lung or elsewhere in the chest cavity. The goal is for the chest tube to drain the pleural space of both air and/or fluids such as blood. Accordingly, once the chest tube is appropriately in place to clear air and/or fluids (such as blood, infection, a transudate) from the pleural space, the tube is fixated to the skin  415  by with sutures around the tube anchoring the tube to the skin  415 , dressing is applied, and the tube covered with a sterile dressing. 
     Insertion of a chest tube using this standard technique can require more than 15 minutes to accomplish by a physician, requires extensive medical training to be performed properly and can be extremely painful as it is a difficult area to anesthetize due to the intercostal nerve that runs on the bottom of every rib. Further, while performing the procedure, the physician must attend to the patient receiving the chest tube and thus is precluded from attending to other patients. 
       FIG. 1A  depicts a prior art chest tube insertion gun  100  described in U.S. Pat. No. 7,811,293. This chest tube insertion gun  100  includes a housing  105 , a handle  110  with the trigger  125 , a probe tip  130  having a circular cutting tip  135  at the distal end thereof, a circular cross-sectioned cannula  140 , a circular cross sectioned chest tube  145 . The circular cutting tip  135  rotates outside of the distal end up to a 90° angle of rotation (rotation angle) from its neutral position before rotating back to its neutral position. The circular cutting tip  135  is also able to rotate a small negative angle from its neutral position in order to retract inside of the distal end of the probe tip  130 . The rotation angle works well for the circular cross-sectioned cannula  140 . 
       FIG. 1B  illustratively depicts a top view of another prior art actuator scalpel  200  next to a prior art cannula  140 . The cannula  140  is a linear tube that is arranged to slide over the probe tip  208  and cover the probe shaft  206  via a base opening and platform  102  and a distal end opening  104 . In practice, with the cannula  140  slid over the probe shaft  206 , which essentially covers the probe  206 , the actuator scalpel  200  is made to cut a pathway into the chest cavity of the patient whereby the cannula  140  is slid off of the probe tip  208  and thereby deployed into the chest of a patient. Accordingly, the probe  206  serves as a chest tube deployment shaft. The cannula  140  provides a pathway to feed a chest tube  145  into the chest cavity of the patient. The cannula  140  is typically removed by pulling over the chest tube  145  while the chest tube  145  is held in place by an operator. The chest tube is then sutured in place. 
       FIG. 2A  is a prior art drain guard system from Copenhagen MedLab, of Copenhagen Denmark comprising a foam support  262  that goes over a base substrate/carrier  260 . The foam support  262  is designed to position a drain line  266  at around 90° over an incision, as shown. A tube-line hole  264  also possesses a slit  265  that wraps around the drain line  266  at the incision point. An anchor bandage  268  holds everything in place. The problem with this system is that it is cumbersome with too many parts that need to be positioned just right. In an emergency situation, the system is considered to be problematic. 
       FIG. 2B  is a prior art bandage system that wraps around and incision produced by Centurion Medical Products of Williamston, Mich. This bandage system provides three layers that essentially surrounds an incision. This bandage system possesses a mechanical anchor  270  integrated with an adhesive pad  276  that holds the tube  272  in place with a clip  274 . A second bandage  278  forms an unobstructed opening around the incision with the adhesive pad  276 . The problem with this bandage system is that it is cumbersome with too many parts that not only needs to be positioned just right, the incision is not intended to be covered because it would obstruct the clip  274 . In an emergency situation, the system is considered to be problematic. 
     It is to innovations related to this subject matter that the claimed invention is generally directed. 
     SUMMARY OF THE INVENTION 
     The present embodiments are generally directed to a chest tube anchoring system with applications in a chest tube insertion device. 
     Certain embodiments of the present invention contemplate a Sutureless Adhesion System comprising: a flexible substrate defined by a bottom substrate surface, a top substrate surface and a substrate periphery, the substrate periphery comprising a substrate notch with a substrate butting edge sized to accommodate a chest tube diameter defined by a chest tube, the substrate notch defined by a notch length and notch width greater than the chest tube diameter, the notch configured to accommodate an incision in human skin  415  through which the chest tube is adapted to penetrate; an intermediate flexible membrane defined by a bottom membrane surface, a top membrane surface and a membrane periphery, the bottom membrane surface configured to cover a portion of the flexible substrate, the notch, and the chest tube when in the incision; a flexible cover sheet defined by a bottom sheet surface, a top sheet surface and a sheet periphery, the bottom sheet surface adapted to cover a portion of the top substrate surface within the substrate periphery and the bottom sheet surface adapted to cover at least a portion of the top membrane surface; adhesive covering at least a portion of only the bottom substrate surface, the bottom membrane surface, and the bottom sheet surface, the flexible substrate adapted to adhere to human skin  415 . 
     Yet other certain embodiments of the present invention contemplate a Sutureless Adhesion System comprising: a flexible substrate defined by a bottom substrate surface, a top substrate surface and a substrate periphery, the substrate periphery comprising a substrate notch with a substrate butting edge sized to accommodate a chest tube diameter defined by a chest tube, the substrate notch defined by a notch length and notch width greater than the chest tube diameter, the notch configured to accommodate an incision in human skin  415  through which the chest tube is adapted to penetrate; an intermediate flexible membrane defined by a bottom membrane surface, a top membrane surface and a membrane periphery, the bottom membrane surface configured to cover a portion of the flexible substrate, the notch, and the chest tube when in the incision; a flexible cover sheet defined by a bottom sheet surface, a top sheet surface and a sheet periphery, the bottom sheet surface adapted to cover a portion of the top substrate surface within the substrate periphery and the bottom sheet surface adapted to cover at least a portion of the top membrane surface; adhesive covering at least a portion of only the bottom substrate surface, the bottom membrane surface, and the bottom sheet surface, the flexible substrate adapted to adhere to human skin  415 . 
     While other certain embodiments of the present invention contemplate a method for stabilizing a chest tube, the method comprising: providing a flexible substrate defined by a bottom substrate surface, a top substrate surface and a substrate periphery, the flexible substrate possessing a substrate U-shaped notch, substrate adhesive disposed on the bottom substrate surface; adhering the flexible substrate via the substrate adhesive to human skin  415 , the substrate U-shaped notch providing unobstructed access to an incision into a human chest wall in the human skin  415 ; placing the chest tube on the top substrate surface when one end of the chest tube is disposed in the human chest via the incision; securing the chest tube to the top substrate surface with an intermediate flexible membrane by way of a bottom membrane surface comprising membrane adhesive, the membrane adhesive is not on a top membrane surface, the intermediate flexible membrane possessing a membrane U-shaped notch that does not cover any portion of the chest tube, the intermediate flexible membrane does not extend beyond the substrate periphery; covering a portion of a top membrane surface of the intermediate flexible membrane, the substrate U-shaped notch and a portion of the human skin  415  with a bottom side of a flexible cover sheet, the bottom side of the flexible cover sheet comprising cover sheet adhesive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  is a line drawing that illustratively depicts a prior art chest tube insertion gun; 
         FIG. 1B  is a line drawing that illustratively depicts a top view of the prior art actuator scalpel next to a prior art cannula; 
         FIG. 2A  illustratively depicts a perspective drawing of a prior art drain guard; 
         FIG. 2B  illustratively depicts a prior art bandage system that wraps around and incision; 
         FIG. 3A  is a line drawing that illustratively depicts a Sutureless Adhesion System consistent with embodiments of the present invention; 
         FIG. 3B  illustratively depicts an exploded view line drawing of a Sutureless Adhesion System revealing the top surface and the bottom surface consistent with embodiments of the present invention; 
         FIGS. 3C and 3D  illustratively depicts line drawings defining geometries of the flexible substrate and the intermediate flexible membrane consistent with embodiments of the present invention; 
         FIG. 4A  is a line drawing that illustratively depicts a typical location where an embodiment of the chest tube can be deployed; 
         FIG. 4B  is a line drawing that illustratively depicts one embodiment of a chest tube being inserted between ribs of a patient/subject consistent with embodiments of the present invention; 
         FIG. 5  is a line drawing that illustratively depicts drawings showing the general layout and position of the Sutureless Adhesion System with the chest tube in accordance with embodiments of the present invention; and 
         FIGS. 6A-6D  are line drawings that illustratively depict a method for stabilizing a chest tube consistent with embodiments of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     Initially, this disclosure is by way of example only, not by limitation. Thus, although the instrumentalities described herein are for the convenience of explanation, shown and described with respect to exemplary embodiments, it will be appreciated that the principles herein may be applied equally in other types of situations involving similar uses of a sutureless attachment for tubes that are deployed in a human body. In what follows, similar or identical structures may be identified using identical callouts. 
     Described herein are embodiments of a sutureless chest tube attachment assembly configured to quickly and easily anchor a chest tube. Certain examples of the assembly generally comprises a notched flexible substrate adapted to adhere to human skin  415 . A chest tube incision in a notched region of the substrate provides an entry point for the chest tube which is anchored to the substrate by way of an intermediate flexible membrane that covers and adheres to the chest tube and substrate. Some embodiments describe an intermediate flexible membrane has a matching notched region adapted to accommodate the chest tube. The chest tube and incision are adapted to be covered by a transparent cover sheet which covers and adheres to a portion of the substrate, the intermediate flexible membrane and to a portion of the human skin  415 . 
       FIG. 3A  illustratively depicts a line drawing of a Sutureless Adhesion System consistent with embodiments of the present invention. As shown, the present Sutureless Adhesion System  300  is generally comprised of a flexible substrate  302  that is adapted and arranged to adhere to a person&#39;s skin  415 , an intermediate flexible membrane  304  adapted and arranged to adhere to the top surface of the flexible substrate  302 , and a clear flexible coversheet  306  adapted to cover the notch regions  305  and  310 . In this embodiment, the membrane notch  310  is sized to essentially frame the substrate notch  305  and the flexible substrate  302  is sized to essentially frame the intermediate flexible membrane  304 . For example, membrane notch  310  partially surrounds the substrate notch  305  without overlapping the substrate notch periphery (see the dashed periphery  335  in the notch region  305 , shown in  FIG. 3C ). Likewise, in the present embodiment, the flexible substrate  302  frames the intermediate flexible membrane  304  because the membrane periphery  355  follows the shape of the substrate periphery  335  without overlapping the substrate periphery  335 . Accordingly, by framing, it is meant that one overlaying element may follow (either identically or sort of) the shape of the overlayed element without overlapping peripheries. 
       FIG. 3B  illustratively depicts an exploded view line drawing of a Sutureless Adhesion System  300  revealing the top surface  320  and the bottom surface  322  consistent with embodiments of the present invention. The flexible coversheet  306  (which is depicted as opaque in this view to help with the explanation) defines a top sheet surface  314  that in certain embodiments is devoid of any adhesive and a bottom sheet surface  312  that possesses adhesive. Certain embodiments envision the bottom sheet surface  312  being fully covered with adhesive while other embodiments envision the bottom sheet surface  312  being partly covered with adhesive. The intermediate flexible membrane  304  defines a top membrane surface  318  that in certain embodiments is devoid of any adhesive whatsoever and a bottom membrane surface  316  that possesses adhesive whereby certain embodiments envision adhesive entirely covering the bottom membrane surface  316 . The flexible substrate  302  defines a top substrate surface  320  that in certain embodiments is devoid of any adhesive whatsoever and the bottom substrate surface  322 , i.e., the skin adhering surface  322 , that possesses adhesive which in certain embodiments is envision to be completely covered in adhesive, while in other embodiments does not completely cover the skin adhering surface  322 . Certain embodiments envision that the adhesive on the bottom coversheet surface  312  is different than the adhesive on the bottom membrane surface  316  which is different than the bottom substrate surface  322  while other embodiments envision the adhesive all being the same. Certain other embodiments contemplate the adhesive on two of the three bottom surfaces being the same while one is different. 
       FIGS. 3C and 3D  illustratively depicts line drawings defining geometries of the flexible substrate  302  and the intermediate flexible membrane  304  consistent with embodiments of the present invention. With reference to the flexible substrate  302  of  FIG. 3C , the dashed line defines the substrate periphery  335 , which is essentially trapezoid-shaped in the present embodiment. Certain other embodiments envision a square, rectangle or some other shape within the scope and spirit of the present invention. The two parallel sides of the trapezoid define the front side  342  and the back side  340  which also define the length  336  of the flexible substrate  302 . The nonparallel sides  344  and  346  define the width  334  of the flexible substrate  302  in any given location along the nonparallel sides  344  and  346 . In the present embodiments, the corners  338  are rounded, however other embodiments envision no such limitation. The front side  342  possesses a U-shaped substrate notch  305  with a substrate butting-edge  331  that is sized to accommodate the diameter of a chest tube (generally between 6.7 and 13.3 mm for adults, designated as a 20. Fr to 40. Fr (Fr for French catheter scale) in contrast to 6-26. Fr for children). Certain embodiments envision the substrate notch  305  being channel shaped or something other than U-shaped without departing from the scope and spirit of the present invention. The U-shaped substrate notch  305  is defined by a notch length  332  and a notch width  330  which are both greater than the diameter of a selected chest tube. Certain embodiments envision that the notch length  332  and the notch width  330  have a standard size to accommodate a 40. Fr catheter tube or some other sized catheter tube. As will be discussed later, the U-shaped substrate notch  305  is adapted to accommodate an incision in human skin  415  through which the chest tube (not shown) is adapted to penetrate. 
     Likewise, with reference to the intermediate flexible membrane  304  of  FIG. 3D , the dashed line defines the membrane periphery  355 , which is essentially trapezoid-shaped in the present embodiment. As with the substrate, other embodiments envision a square, rectangle or some other shape within the scope and spirit of the present invention. The two parallel sides of the trapezoid are defined as the front side  362  in the back side  360  which further define the length  356  of the intermediate membrane  304 . The nonparallel sides  364  and  366  define the width  364  of the intermediate membrane  304  in any given location along the nonparallel sides  364  and  366 . In the present embodiments, the corners  358  are rounded however other embodiments envision no such limitation. The front side  362  possesses a U-shaped membrane notch  310  that is larger in length  352  and width  350  than the U-shaped substrate notch  305 . As with the substrate notch  305 , certain embodiments envision the membrane notch  310  being channel shaped or something other than U-shaped without departing from the scope and spirit of the present invention. Certain other embodiments envision the membrane notch  310  being essentially the same size (notch length and width) as the substrate notch  305 . Certain embodiments envision the intermediate membrane periphery  355  fitting inside of the flexible substrate periphery  335 , while other embodiments envision the intermediate membrane periphery  355  in the flexible substrate periphery  335  essentially being the same size or some other different size. 
       FIG. 4A  illustratively depicts a typical location where an embodiment of the chest tube  400  can be deployed. As shown, the patient/subject  410  is marked with a dashed-X to better see the incision  401  pointing to a typical location at the fifth rib (under the armpit) where a chest tube  400  (or cannula) can be deployed. It is well known in the art that an entry point to the chest cavity  403  can be elsewhere depending on the issue at hand. The dashed-X and incision  401  in the cross point resides soundly in an optimal location to access the internal locations of the chest cavity  403  wherein fluid/air buildup can occur due to trauma, for example.  FIG. 4B  illustratively depicts one embodiment of a chest tube being inserted between ribs of a patient/subject consistent with embodiments of the present invention. Here, an incision  401  is made via a scalpel (such as a hand held scalpel or actuator scalpel  200  (not shown in this figure) in the intercostal muscles  405  between an upper rib  406  and a lower rib  408 . Certain embodiments envision the chest tube  400  being oval in cross-section in order to fit more effectively between the ribs  406  and  408  while providing greater volume of liquid/air to drain out from buildup in the chest cavity  403 . The intercostal artery  412  and the intercostal vein  411  are shown for reference. In practice either at the chest tube  400  is inserted directly into the incision  401  along the dashed arrow  402 . Optionally, with reference to  FIGS. 1A and 1B , a cannula  140  can be disposed over the probe shaft  206  so that the probe tip  208  is unobstructed for the scalpel blade to make the incision  401 . The scalpel blade is not shown. Once the incision  401  is made, the probe tip  208  and probe shaft  206  are pressed into the chest cavity  403  up to the platform  102 . The actuator scalpel  200  is then pulled out by one of the operator&#39;s/surgeon&#39;s hand while the other operator&#39;s/surgeon&#39;s hand holds the cannula  200  in place via the platform  102 . Once deployed, the platform  102  can cover the incision  401  in order to seal the incision  401 . In the present embodiment, the platform  102  can be covered and held in place with the Sutureless Adhesion System  300 , or other embodiment of the Sutureless Adhesion System, whereby the cannula  140  can serve as a makeshift chest tube. Optionally, and conventionally, the chest tube  145  is fed through the cannula  140  into the chest cavity  403 . 
       FIG. 5  illustratively depicts drawings showing the general layout and position of the Sutureless Adhesion System  300  with the chest tube  400  in accordance with embodiments of the present invention. In certain commercial embodiments of the present invention, the flexible substrate  302  can be a closed-cell foam, such as a 1773 white closed-cell foam with an adhesive backing manufactured by 3M Corporation of St. Paul, Minn., rated for long-term contact with human skin  415 . The flexible substrate  302  provides a cushioning layer to improve comfort when the chest tube  400  is pressed against the flexible substrate  302 . As shown in this embodiment, there is nothing between the chest tube  400  and the flexible substrate  302 . The diameter  441  of the chest tube  400  is shown here for reference. The intermediate flexible membrane  304  can be a 3M 4076 white nonwoven adhesive backed flexible layer. The intermediate flexible membrane  304  is specifically adapted to hold/retain the chest tube  400  essentially fixedly in place. Based on a 36 Fr catheter tube, the area of the intermediate flexible membrane  304  needs to be between 30 in 2  and 60 in 2  in order to provide retention of the chest tube comparable to being sutured in place. Based on a 14. Fr catheter tube, the area of the intermediate flexible membrane  304  needs to be approximately 20 in 2 . Based on a 40 Fr catheter tube, the area of the intermediate flexible membrane  304  needs to be approximately 60 cm 2 . As should be appreciated by those skilled in the art, a more thorough or different analysis may yield different numbers. The present use of adhesive bonding the intermediate flexible membrane  304  to the flexible substrate  302  improves times, reduces pain to a patient, increases consistency in tube  400  retention, just to name several advantages. Lastly, the clear flexible coversheet  306  can be a clear 3M Tegaderm adhesive backed membrane that protects the incision site while allowing medical personnel to effortlessly inspect incision  401 . Moreover, the clear flexible coversheet  306  protects the incision external element, while somewhat sealing the incision site  401  from leaking bodily fluids therefrom. The flexible coversheet  306 , which in certain embodiments is not clear, can cover both a portion of the flexible substrate  302  and a portion of the intermediate flexible membrane  304  as well as the skin  415  and the incision  401  as shown in  FIG. 6D . As shown, the flexible coversheet periphery  319  is partially on the flexible substrate  302  and the intermediate flexible membrane  304 . 
       FIGS. 6A-6D  illustratively depict a method for stabilizing a chest tube consistent with embodiments of the present invention. As shown in  FIG. 6A , the flexible substrate  302  is adhered to a human chest wall  403  whereby an incision  401  sized for a chest tube  400  is exposed via the substrate U-shaped notch  305 . In other words, the U-shaped notch  305  frames the incision  401 , whereby the incision  401  is at least partially surrounded by the U-shaped notch  305  without, or essentially without, covering any part of the incision  401 , as shown. In certain embodiments the flexible substrate  302  is attached to the chest wall  403  prior to cutting the incision  401  in the space provided by the U-shaped notch  305 . Other embodiments contemplate the incision  401  first being made and then the flexible substrate  302  being placed over the incision, however adhering the flexible substrate  302  to the chest wall  403  may be compromised due to the blood from the incision  401 . 
       FIG. 6B  illustratively depicts the chest tube  400  inserted in the chest wall  403  via the incision  401  and bent down to be in contact with the top surface  320  of the flexible substrate  302 . As shown, the substrate U-shaped notch  305  provides unobstructed access to the incision  401 . Also as shown, the U-shaped notch  305  is a butting edge  331  that in some embodiments butts up against the chest tube  400  while in other embodiments the U-shaped notch  305  is simply in close proximity but not in contact with the chest tube  400 . In this embodiment, the flexible substrate  302  accommodates at least the diameter of the chest tube  400  but does not close around the chest tube  400  whatsoever. In other words, the notch width  330  remains greater than the chest tube diameter as the U-shaped notch  305  approaches the front side/edge  342 . This provides an added vantage of simplicity over prior art elements that close around a tube. 
       FIG. 6C  illustratively depicts adhering the intermediate flexible membrane  304  to the top surface  320  of the flexible substrate  302  thereby retaining or otherwise locking in place the chest tube  400  in position. The chest tube  400  is depicted with dashed lines in the portion that is covered up by the intermediate flexible membrane  304 . Certain embodiments contemplate that the intermediate flexible membrane  304  is sized to provide chest tube retention strength similar to that obtained by a scenario of suturing the chest tube to the incision. As also depicted in the present embodiment, the intermediate membrane periphery  355  is smaller than and remains inside of the substrate periphery  335 . Certain embodiments envision that the intermediate flexible membrane  304  is within 1 cm the same shape as the flexible substrate  302 . Other embodiments envision the intermediate flexible membrane  304  having a range between 50% the size of the flexible substrate  302  up to 100% of the size of the flexible substrate  302 . This facilitates removal of the Sutureless Adhesion System  300  by simply pulling up on the flexible substrate  302 . Certain embodiments envision that this could be made easier by a nonadhesive tab extending from the substrate periphery  335 . Other embodiments envision that the substrate periphery  335  is the same size as the intermediate membrane periphery  355 . Some embodiments envision the intermediate flexible membrane  304  exceeding the periphery size of the flexible substrate  302  so long as the membrane notch  310  does not eclipse or otherwise cover the substrate notch  305 . While other embodiments envision the intermediate flexible membrane  300  and  4 B integrated with the clear coversheet  306 . 
       FIG. 6D  illustratively depicts the configuration of  FIG. 6C  but with the clear flexible coversheet  306  covering at least a portion of the top substrate surface  320  and a portion of the top membrane surface  318 . As shown, the clear flexible coversheet  306  covers the incision  401  and the chest tube  400  going into the incision  401 . The clear flexible coversheet  306  also covers a portion of the human skin  415 . 
     With continued reference to the intermediate flexible membrane  304  being sized to provide chest tube retention strength similar to that obtained by a scenario of suturing the chest tube to the incision. Certain embodiments envision determining retention strength by establishing the tensile strength of the suture material (note: there are multiple types of suture material including silk and nylon, suture sizes, and suture brands) and not the tearing strength of the skin  415  for at least the reason that the act of putting in a suture is variable between operators. 
     In one example, size 0 and 2-0 polyamide (nylon) sutures from Ethicon Inc., headquartered in Somerville, N.J. were used to establish a baseline tensile strength. Based on five samples tested, the average of the size 0 sutures (larger diameter) had an average breaking strength of 6.99 pound-force (lbf) and the size 2-0 had an average breaking strength of 5.43 lbf. The average combined breaking strength was 6.05 lbf with a standard deviation of approximately 0.99 lbf. From an engineering point of view, three standard deviations should account for 99.73% of the data. Thus, force of 9.02 lbf, of simply 9 lbf, is assumed to account for the majority of suture breaking forces measured for these suture elements. Accordingly, 9 lbf serves as the example input breaking strength for the Sutureless Adhesion System  300 . 
     Figuring out the area of the flexible substrate  302  and the intermediate flexible member  304  is a classic calculus problem including changing force vectors with both sheer force of the adhesive sheet and tension force of the adhesive sheet. Based on whatever model or iteration is used for bonding failure due to the tube being pulled upwards and orthogonal to the Sutureless Adhesion System  300  when using the 9 lbf from above, a person skilled in the art can calculate the appropriate area of both the flexible substrate  302  and the intermediate flexible membrane  304 . Current calculations indicate, depending on the adhesive used, that the area of the flexible substrate  302  should be between 10 in 2  and 60 in 2 . Hence, at least a membrane area (of the intermediate flexible membrane  304 ) is determined by the membrane separation force of the intermediate flexible membrane  304 , which is the force that causes the adhesion between the intermediate flexible membrane  304  to separate from the flexible substrate  302 . This assumes that the intermediate flexible membrane  304  is smaller than the flexible substrate  302  and the adhesive strength of the intermediate flexible membrane  304  is approximately the same as the adhesive strength of the flexible substrate  302 . The membrane separation force should be equal to or greater than the traditional strength of the sutured system. The traditional strength of the sutured system is the force of which sutured tube is pulled out or otherwise broken from the incision. 
     With the present description in mind, some additional embodiments of the present invention are provided below within the scope and spirit of the present invention. 
     For example, certain embodiments envision a sutureless adhesion system  300  comprising: a flexible skin adhering substrate  302  defined by a skin adhering substrate surface  322 , a top substrate surface  320  and a substrate periphery  335 , the substrate periphery  335  comprising a substrate incision framing notch  305  at a substrate butting edge  342 , the substrate incision framing notch  305  sized to accommodate a chest tube diameter  441  defined by a chest tube  400 , the substrate incision framing notch  305  defined by a substrate notch length  332  and a substrate notch width  331  greater than the chest tube diameter  441 , the substrate incision framing notch  305  configured to frame an incision in human skin  415  through which the chest tube  400  is adapted to penetrate; an intermediate flexible non-skin contacting membrane  304  defined by a bottom membrane surface  316 , a top membrane surface  318  and a membrane periphery  355 , the bottom membrane surface  316  configured to only cover a portion of the flexible substrate  302  and the chest tube  400  when in the incision  401 ; a flexible cover sheet  306  defined by a bottom sheet surface  312 , a top sheet surface  314  and a sheet periphery  319 , the bottom sheet surface  312  is adapted to cover a portion of the top substrate surface  320  and the bottom sheet surface  312  adapted to cover at least a portion of the top membrane surface  318 ; adhesive covering at least a portion of the bottom substrate surface  322 , the bottom membrane surface  316 , and the bottom sheet surface  312 , the flexible substrate  322  adapted to adhere to human skin. 
     The sutureless adhesion system is further envisioned wherein the intermediate flexible membrane  304  further comprising a membrane notch  310  that is wider than the substrate notch width  330 . Certain embodiments further envision the membrane notch  310  comprises a membrane notch length  352  that is equal to or less than the substrate notch length  332 , the membrane notch  310  frames the substrate notch  305  when the intermediate flexible non-skin contacting membrane  304  is attached to the flexible skin adhering substrate  302 . While other embodiments further envision the substrate incision framing notch  305  is located at a substrate butting edge  331 , no portion of the intermediate flexible non-skin contacting membrane  304  covers the substrate butting edge  331 . 
     The sutureless adhesion system is further envisioned wherein the intermediate flexible non-skin contacting membrane  304  is within 1 cm of having an identical shape as the flexible skin adhering substrate  302 . 
     The sutureless adhesion system is further envisioned wherein the flexible cover sheet  306  is adapted to constrain the chest tube  400  in place when covering the top membrane surface  318  when the chest tube  400  is in the incision  401 . 
     The sutureless adhesion system is further envisioned wherein the Sutureless Adhesion System  300  consists of the flexible substrate  302 , the intermediate flexible membrane  304  and the flexible cover sheet  306 . 
     The sutureless adhesion system is further envisioned wherein the substrate periphery  335  is essentially a trapezoidal shape is defined by two parallel sides, a longer of the two parallel sides defines a butting edge. 
     The sutureless adhesion system is further envisioned wherein the flexible substrate is at least 2.5 inches in length and 2.5 inches in width. 
     The sutureless adhesion system is further envisioned wherein the flexible skin adhering substrate  302  possesses adhesive-1, the intermediate flexible non-skin contacting membrane  304  possesses adhesive-2 and the flexible cover sheet  306  possesses adhesive-3, the adhesive-1, the adhesive-2 and the adhesive-3 are not identical adhesive. 
     Certain other embodiments envision a method for stabilizing a chest tube  400 , the method comprising: providing a flexible substrate  302  defined by a bottom substrate surface  322 , a top substrate surface  320  and a substrate periphery  335 , the flexible substrate  302  possessing a substrate U-shaped notch  305 , substrate adhesive disposed on the bottom substrate surface  322 ; adhering the flexible substrate  302  via the substrate adhesive to human skin  415 , the substrate U-shaped notch  305  providing unobstructed access to an incision  401  into a human chest wall  403  in the human skin  415  by framing the incision  401 ; placing the chest tube  400  on the top substrate surface  320  when one end of the chest tube  400  is disposed in the human chest  403  via the incision  401 ; securing the chest tube  400  to the top substrate surface  320  with an intermediate flexible membrane  304  by way of an adhesive covered bottom membrane surface  316 , the membrane adhesive is not on a top membrane surface  318 , the intermediate flexible membrane  304  possessing a membrane U-shaped notch  310  that frames the substrate U-shaped notch  305 , the intermediate flexible membrane  304  does not extend beyond the substrate periphery  335 ; covering a portion of a top membrane surface  318  of the intermediate flexible membrane  304 , the substrate U-shaped notch  310  and a portion of the human skin  315  with a bottom sheet side  312  of a flexible cover sheet  360 , the bottom sheet side  312  comprising cover sheet adhesive. 
     The method for stabilizing a chest tube  400  is further envisioned with no elements other than the flexible substrate  302 , the chest tube  400 , the intermediate flexible membrane  304  and the cover sheet  306  are used in the method. 
     The method for stabilizing a chest tube  400  is further envisioned wherein there is nothing between the chest tube  400  and the flexible substrate  302 . 
     The method for stabilizing a chest tube  400  is further envisioned wherein the membrane U-shaped notch  310  is wider than the substrate U-shaped notch  305 . 
     The method for stabilizing a chest tube  400  is further envisioned wherein the intermediate flexible membrane  304  is between 50% and 100% the size of the flexible substrate  302 . 
     The method for stabilizing a chest tube  400  is further envisioned wherein a membrane area of the intermediate flexible membrane  304  is proportional to a membrane separation force of the intermediate membrane  304 , the membrane separation force is equivalent to a suture strength force required to pull the chest tube  400  from the human skin  415  when sutured thereto. 
     Yet other certain other embodiments envision a method for fixing a chest tube by providing a flexible substrate pad  302  possessing a substrate U-shaped notch  305  located at a substrate pad edge  342 ; positioning the substrate U-shaped notch  305  over an incision  401  in a human chest  403 ; adhering the flexible substrate pad  302  to human skin  415 , the substrate U-shaped notch  305  unobstructedly (without obstructing) framing the incision  401 ; inserting the chest tube  400  in the incision  401 ; securing the chest tube  400  to the substrate pad  302  with an adhesive covered intermediate flexible membrane  304 , nothing is between the chest tube  400  and the flexible substrate pad  302  when secured (nothing other than empty space/air), the flexible membrane  304  does not extend onto the human skin  415  or over any portion of the substrate pad edge  335 ; and covering a portion of the intermediate flexible membrane  304  over the substrate U-shaped notch  305  and a portion of the human skin  415  with an adhesive coated flexible cover sheet  306 . 
     The method of method for fixing a chest tube is further envisioned wherein the intermediate flexible membrane  304  possesses a membrane U-shaped notch  310  that frames the substrate U-shaped notch  305 . 
     The method of method for fixing a chest tube is further envisioned wherein there are no other elements other than the chest tube  400  between the flexible substrate pad  302  and the flexible cover sheet  304 . 
     While still other certain embodiments envision a sutureless adhesion apparatus  300  comprising: a flexible skin adhering substrate  302  defined by a skin adhering substrate surface  322 , a top substrate surface  320  and a substrate periphery  335 , the substrate periphery  335  comprising a substrate incision framing notch  305  at a substrate butting edge  342 , the substrate incision framing notch  305  unobstructely frames an incision  401  that is capable of being made in human skin  415 , a chest tube  400  extending from the incision  401 ; an intermediate flexible non-skin contacting membrane  304  defined by a bottom membrane surface  316  with adhesive, a top membrane surface  318  and a membrane periphery  355 , the bottom membrane surface  316  adhered to and covering nothing other than a portion of the flexible substrate  302  and a portion of the chest tube  400 ; a flexible cover sheet  306  defined by a bottom sheet surface  312 , a top sheet surface  314  and a sheet periphery  319 , the flexible cover sheet  306  adhered at least a portion of the top substrate surface  320  and at least a portion of the top membrane surface  318 , the skin adhering substrate surface  322  and a portion of the bottom sheet surface  312  configured to adhere to human skin  415 . 
     The sutureless adhesion apparatus is further envisioned wherein the apparatus between the flexible skin adhering substrate  302  and the flexible cover sheet  406  consists of the chest tube  400  and the intermediate flexible non-skin contacting membrane  304 . 
     The sutureless adhesion apparatus is further envisioned wherein the membrane U-shaped notch  310  is wider than the substrate U-shaped notch  305 . 
     The sutureless adhesion apparatus is further envisioned wherein the intermediate flexible membrane  304  is between 50% and 100% the size of the flexible substrate  302 . 
     The sutureless adhesion apparatus is further envisioned wherein a membrane area of the intermediate flexible membrane  304  is proportional to a membrane separation force, which is equivalent to a suture strength force required to pull the chest tube  400  from the human skin  415  when sutured thereto. 
     The above embodiments are not intended to be limiting to the scope of the invention whatsoever because as a skilled artisan will recognize, there are many more embodiments easily conceived within the teachings and scope of the instant specification. 
     It is to be understood that even though numerous characteristics and advantages of various embodiments of the present invention have been set forth in the foregoing description, together with the details of the structure and function of various embodiments of the invention, this disclosure is illustrative only, and changes may be made in detail, especially in matters of structure and arrangement of parts within the principles of the present invention to the full extent indicated by the broad general meaning of the terms in which the appended claims are expressed. For example, though a chest tube  400  is depicted is the only element held in place by the Sutureless Adhesion System  300 , other elements such as the cannula  140  of  FIG. 1A  can be similarly used without departing from the scope and spirit of the present invention. Another example can include providing various other shaped flexible substrates, intermediate flexible membranes and flexible cover sheet without departing from the scope and spirit of the present invention. Though embodiments of the present invention are directed to a person and person&#39;s skin  415 , it is envisioned that the embodiments could be used with animals in similar situations while staying within the scope and spirit of the present invention. Yet another example includes adhesive being applied to only a portion of the bottom surfaces and not on the entire surfaces as exemplified in the above description. Further, the terms “one” is synonymous with “a”, which may be a first of a plurality. 
     It will be clear that the present invention is well adapted to attain the ends and advantages mentioned as well as those inherent therein. While presently preferred embodiments have been described for purposes of this disclosure, numerous changes may be made which readily suggest themselves to those skilled in the art and which are encompassed in the spirit of the invention disclosed and as defined in the appended claims.