Patent application title: METHODS AND APPARATUS FOR INHIBITING SCAR FORMATION
Amir Belson (Los Altos, CA, US)
ZipLine Medical, Inc.
IPC8 Class: AA61F1302FI
Class name: Bandage structure skin laceration or wound cover wound contact layer containing treatment material
Publication date: 2013-12-12
Patent application number: 20130331757
Scar formation is inhibited by simultaneously applying a vertical force
and a lateral compression to the wound site during the healing process.
Apparatus for applying such simultaneous forces comprise a backing and a
tissue displacement device. The backing holds the tissue displacement
device over the wound. The tissue displacement device may be expanded to
both apply the vertical force against the wound and to draw the backing
radially or laterally inward to apply the desired compression forces to
1. A method for inhibiting scar formation in a healing wound on a skin
surface, said method comprising applying a downward force on the healing
wound while simultaneously applying a lateral compression force to tissue
across the wound.
2. A method as in claim 2, wherein the forces are applied at a time beginning from 1 day to 30 days after the wound began to heal.
3. A method as in claim 2, wherein the forces are applied for a period of time in the range from 1 day to 21 days.
4. A method as in claim 3, wherein the force is increased at least once during said period of time.
5. A method as in claim 3, wherein the force is deceased at least once during said period of time.
6. A method as in claim 1, wherein applying the vertically downward force comprises attaching a tissue displacement device on the skin surface and then actuating the tissue displacement device to apply said vertically downward force.
7. A method as in claim 6, wherein attaching comprises securing a backing to tissue on either side of the healing wound and raising a center of the backing with the tissue displacement device to draw the sides of the backing laterally inwardly after the backing has been secured.
8. A method as in claim 6, wherein attaching comprises wrapping a backing around a limb, torso, or abdomen which comprises the skin surface and healing wound and raising a portion of the backing over the wound with the displacement device to draw the sides of the backing inwardly.
9. A method as in claim 7, wherein the tissue displacement device comprises a balloon having a relatively non-distensible bottom surface which is applied against the wound and a relatively distensible top surface which inflates upwardly to raise the backing.
10. A method as in claim 8, wherein the tissue displacement device comprises a balloon having a relatively non-distensible bottom surface which is applied against the wound and a relatively distensible top surface which inflates upwardly to raise the backing.
11. A method as in claim 7, wherein the tissue displacement device comprises a spring element that can be depressed to provide a convex surface which engages and applies force to the wound.
12. A method as in claim 8, wherein the tissue displacement device comprises a spring element that can be depressed to provide a convex surface which engages and applies force to the wound.
13. Apparatus for inhibiting scar formation in a healing wound on a skin surface, said apparatus comprising: an expandable structure with a relatively non-distensible bottom surface for engaging the wound and a relatively distensible top surface which moves upwardly away from the bottom surface when actuated; and a backing having two lateral regions adapted to adhere to skin on opposites of the wound and a central section adapted to cover the expandable structure when placed over the wound; wherein expansion of the expandable structure causes the lower surface to apply downward pressure against the wound and adjacent tissue and simultaneously causes the top surface to rise and draw the lateral regions of the backing inwardly to laterally compress the tissue adjacent the wound.
14. Apparatus as in claim 13, wherein the expandable structure is inflatable.
15. Apparatus as in claim 14, wherein the inflatable structure has a flexible lower surface and an elastomeric upper surface so that the upper surface deforms and moves away from the lower surface while the lower surface remains dimensionally stable as the structure is inflated.
16. Apparatus as in claim 15, wherein the inflatable structure has a D-shaped profile when inflated.
17. Apparatus as in claim 13, wherein at least the lateral regions of the backing are non-distensible.
18. Apparatus as in claim 13, wherein the entire backing is non-distensible.
19. Apparatus as in claim 13, wherein the lateral regions each have an adhesive surface which adheres to the skin.
20. Apparatus as in claim 13, wherein the expanded structure comprises a plurality of segments joined along a line, where the segments are displaceable relative to each other to allow the structure to conform to a long wound.
21. Apparatus as in claim 20, wherein each segment is held onto the skin by a separate backing.
22. Apparatus as in claim 13, wherein the expandible structure comprises a spring element that can be depressed to provide a convex surface which engages and applies force to the wound.
23. Apparatus as in claim 13, wherein a bottom surface of the expandible structure is coated with a drug.
CROSS-REFERENCE TO RELATED APPLICATIONS
 The present application is a continuation of PCT Application No. PCT/US2011/040213 (Attorney Docket No. 35383-705.601), filed Jun. 13, 2011, which claims priority from provisional application No. 61/397,604 (Attorney Docket No. 35383-705.101), filed on Jun. 14, 2010, the full disclosures of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
 1. Field of the Invention
 Scarring is a natural response to the healing of wounds in a patient's skin. The wound healing process can be divided into three successive stages. A first inflammatory stage begins immediately after the injury which caused the wound. The inflammatory stage lasts up to a week during which time cellular processes remove damaged tissue and foreign matter from the wound. The inflammatory stage is followed by a proliferative stage which is characterized by fibroblast proliferation and the production of collagen and proteoglycans. The proliferative stage can last from days to weeks and is typically the stage during which hypertrophic scar formation begins, typically as a result of excess production of the extra cellular matrix which is synthesized to heal the wound. Such scars are referred to "hypertrophic scars." After the proliferative stage, a remodeling phase begins where the matrix which was produced in the proliferative is remodeled into an organized, cross-linked structure which increases the mechanical strength of the healed tissue.
 Scars which are formed during the healing response are often treated after the healing is complete by cosmetics or surgical treatment. Cosmetic treatments are at best temporary solutions, and the need to have subsequent surgery is both inconvenient and a risk to the patient. It would therefore be desirable to provide methods and apparatus which could diminish scar formation during the healing process itself so that such subsequent procedures would be unnecessary or at least reduced in scope.
 2. Description of the Background Art
 WO/2011/019859 describes a device for inhibiting scarring in skin wounds, where the device is fixed to the skin and applies an outward force to spaced-apart skin locations. US2008/0069855 describes materials that will prevent scars and tissue adhesions. U.S. Pat. Nos. 7,511,185, 4,702,251, 4,539,990 and 4,535,772 describe wound healing devices that apply laterally inwardly opposed forces to the tissue on either side of the wound.
SUMMARY OF THE INVENTION
 The present invention provides methods and apparatus for inhibiting scar formation during the healing of a wound on a skin surface. The term "scar" is intended includes not only common hypertrophic scars which occurs from cuts, abrasions, and the like, but also to include keloids which are hyperplastic masses that occur in the dermis and adjacent subcutaneous tissue in certain individuals, typically following trauma.
 The methods and apparatus of the present invention treat healing wounds by applying a downward force on the wound while simultaneously applying a compression force in order to relieve tension in the tissue across or surrounding the wound, usually during the proliferative and/or remodeling stages of the wound healing process. Treatment during the late portions of the inflammatory stage might also be useful, and in some instances treatment after remodeling might also be performed. For example, simultaneous downward compression and lateral compression may applied to the wound at or near the end of the inflammatory stage, typically at a time in the range form 1 day to 30 days after the wound occurred and first began to heal. After commencing treatment, the forces may continue to be applied for a period of time in the range from one day to 21 days, or longer, and the forces may be increased, decreased, or held constant during the treatment period.
 Apparatus according to the present invention are specially adapted to provide such simultaneous downward and lateral compressive forces to the region of the wound in the skin, typically comprising a tissue displacement device which can placed on the skin surface to cover the wound itself as well as some distance lateral to the wound, typically from several millimeters to one or two centimeters or more on each side of the wound. The tissue displacement device may be actuated to apply the desired vertically downward force in a variety of ways as described below.
 The apparatus of the present invention will also typically include a backing which can be secured to the skin on either side of the healing wound, where the backing is typically adapted to draw the skin surface and underlying tissue layers laterally inwardly to provide the desired lateral compression and in turn relieve tension in the tissue. In the described embodiments, the inward lateral movement of the skin and underlying tissue will be effected by raising a center of the backing (after the backing has been applied to the skin surface), usually as a result of actuating the tissue displacement device, to draw the sides of the backing laterally inwardly.
 The backing may comprise a strip or layer of material which can be attached to the skin over the tissue displacement device, with lateral regions of the backing adhering to the skin surface on opposite sides of displacement device. Usually at least the lateral portions of the backing will be non-distensible (resistant to stretching or inelastic), and more usually the entire backing will have limited stretchability or elasticity, often being entirely non-distensible. By non-distensible, it is meant that the backing material will have an elongation at break of less of less than 20%, typically less than 15%, and often less than 10%. Alternatively, the backing may comprise a strap or other longer structure which can be wrapped around a patient's limb in order to constrain the tissue displacement device on the skin surface above below.
 In the exemplary embodiments, the tissue displacement device comprises a balloon or other expandable device having a relatively non-distensible bottom surface which is disposed against the wound and a relatively distensible top surface which inflates upwardly to raise a central region of the backing which in turn causes the lateral portions of the backing to draw laterally inwardly to provide the desired inward tissue compression.
 In order to treat long wounds covering five centimeters, ten centimeters, twenty centimeters, or longer, the apparatus of the present invention can be formed in segments, each usually comprising a separate backing and a separate tissue compression device as described previously. The segments will be linked together by flexible joints, links or other components which allow the resulting assembly to conform to a skin surface and follow irregular topology of the wound and skin. The resulting "flexibility" is also useful in allowing the assembly to conform to the skin surface when the patient moves or is moved by others. In some embodiments, the joints will be formed as short tubes or other structures capable of delivering an inflation medium to each successive segment from either end of the assembly.
 Still other apparatus could be constructed in accordance with the principles of the present invention. For example, for localized wounds, a circular, stretchable elastic backing having an adhesive surface for adhering to the skin could be provided. By initially stretching the elastic backing radially outwardly, for example using a constraining frame or other component, the elastic backing could be placed over the wound and released from its constraint to apply the literally inward force to the wound. A variety of tissue compression devices can be placed under or over the backing in order to provide the vertical compression desired.
 Still alternative, apparatus could be provided including a more rigid disk having an adhesive on an outer annular surface and a center portion free from the adhesive that can be everted or otherwise deformed to press inwardly against tissue and draw the annular circumference of the disk inwardly to provide simultaneous radial compression and vertical force. For example, the center portion could "snap" from an everted configuration to an inverted configuration much like a bottle top with an indication that the top has been previously opened.
 In still other embodiments, a lower of other surface of the tissue displacement device may be coated with a drug to deliver that drug to the skin during the treatment.
BRIEF DESCRIPTION OF THE DRAWINGS
 FIG. 1 is a schematic illustration of a wound showing vertical and lateral force compression applied in accordance with the principles of the present invention.
 FIGS. 2, 2A and 2B illustrate a first apparatus and its use for applying such vertical and lateral force compression.
 FIG. 3 illustrates a segmented assembly constructed in accordance with the principles of the present invention which can be used for treating elongated or irregular wounds.
 FIG. 4 illustrates an alternative apparatus for treating wounds in accordance with the principles of the present invention.
 FIGS. 5A and 5B illustrate use of the apparatus of FIG. 4 in treating a localized wound.
DETAILED DESCRIPTION OF THE INVENTION
 FIG. 1 is a schematic diagram illustrating a subcutaneous wound W in a skin surface S where the wound extends some distance beneath the surface. To reduce scarring as the wound heals in accordance with the principles of the present invention, a downward or vertical force will be applied over a region spanning the wound and extending from several millimeters to several centimeters or longer onto the skin surface from each side of the wound as generally indicated by the vertical arrows. Pressure is preferably applied along most or all of the length of elongated. The cuts, incisions, and other elongated wounds that are treated by the present invention will typically extend into the dermis by several millimeters or more. In addition to the vertical force, present of the invention will provide a compressive force or pressure indicated by arrows 12 preferably extending from the surface down to a depth close to or equal to the depth of the wound.
 Methods of the present invention for applying the forces illustrated in FIG. 1 can be performed using a variety of apparatus. One exemplary apparatus is illustrated in FIG. 2 and includes both a backing 14 and a tissue displacement device 16 which can be assembled and used in combination for applying the desired forces. The backing 16 will usually be non-distensible over most or all of its length from end 18 to end 20. The length will usually be in the range from 5 centimeters to 10 centimeters, 20 centimeters, or longer. The width will typically be in the range from 1 centimeter to 5 centimeters. Backing will be divided into regions, including a first lateral region 22 and a second lateral region 24. At least a portion of each of these lateral regions will be substantially non-distensible and they will have adhesive surfaces 26 and 28 which can be applied to the skin to hold the backing in place. A central region 14 of the backing between the lateral regions 22 and 24 may have some ability to stretch (distensibility), but the central region will also typically be non-distensible over all or a portion of its length. The bottom surface of this central region of the backing, however, will be usually free from all adhesives so that the central region may be placed over the tissue displacement device 16 with the central region able to move over the top of the displacement device as the displacement device is expanded as shown in broken line in FIG. 2. The displacement device 16 will typically be formed from an elastic material over its upper portions to allow the desired vertical expansion while a bottom or base 30 of the device 16 resists expansion. Thus, the upper surface 32 which is elastic can expand to the extent shown in broken line when the device is actuated. Usually, the tissue displacement device 16 will be an inflatable structure, such as a balloon, where the thickness of and/or reinforcement within the bottom of the structure resists stretching and the upper portion is elastic to allow expansion upon inflation of the structure. In other cases, a balloon or other inflatable of expandable structure with a round or elliptical profile could be used.
 In use, the assembly of FIG. 2 is placed over a wound so that the lateral regions 22 and 24 of the backing 14 adhere to the skin's surface on opposite sides of the wound W. The tissue displacement device 16 is held directly over the wound W by the central section of the backing as shown in FIG. 2A, and the tissue displacement device 16 then inflated to raise the central section and as shown in FIG. 2B. By raising the central section 25, the lateral portions 22 and 24 are drawn laterally inward to compress the upper surface of the tissue which in turn compresses the tissue on either side of the wound at the lower depths as shown by the arrows in FIG. 2B. Simultaneously, the bottom of the tissue displacement device applies a downward pressure over the wound as indicated by the vertical arrows in FIG. 2B. The asymmetric structure of the tissue displacement device allows this selective application of forces to achieve the objectives of the present invention. Each of the lateral portions 22 and 24 will be attached on the skin surface up to a point P. the backing will be unattached to the skin between point P and area covered by the tissue displacement device 16. It is this short unattached region of the backing which allows the lateral portions 22 and 24 to be drawn inwardly without significantly pulling the skin upwardly, as shown in FIG. 2B.
 In order to treat lengthy wounds, the apparatus as generally shown in FIG. 2, can be formed in multiple segments 40, as illustrated in FIG. 3. Each segment 40 will generally have the structure illustrated in FIG. 2, and adjacent segments will be joined by short tubular connectors of links 42 which both hold the segments together and which permit simultaneous inflation of each of the tissue displacement devices 16. The segmented structure of FIG. 3 is advantageous since it permits the assembly to follow non-linear wounds and also allows the assembly to conform to the tissue surface as the patient moves or is moved during the scar treatment.
 An alternative treatment device 50 is illustrated in FIG. 4. The device comprises a backing 52 having an outer annular portion 54 which has an adhesive surface for attachment to the patient's skin. The device 50 further includes a central section 54 which can be everted or depressed in order to both apply vertical force to a wound and simultaneously apply radially inward forces, as illustrated in FIGS. 5A and 5B. Such an evertable central section could also be used with the elongated or strip-like devices described previously.
 As shown in those FIGS. 5A and 5B, a localized (non-elongated) wound W may be covered by the central portion 54 of the device 50 while the annular portion 52 adheres to the skin surrounding the wound. By then deforming and depressing the center section 54 and shown in FIG. 5B, a vertical force is applied over the wound while simultaneously the annular portion 52, which will typically be elastic, is drawn inwardly to radially compress the tissue about the wound.
Patent applications by Amir Belson, Los Altos, CA US
Patent applications by ZipLine Medical, Inc.
Patent applications in class Wound contact layer containing treatment material
Patent applications in all subclasses Wound contact layer containing treatment material