DE10300787A1 - Nailing device for attaching a net to animal or human tissue, has magazine manually pressed to release and drive tissue nails towards marked points on surface of tissue, and needle or meter used to determine depth of driven tissue nails - Google Patents

Abstract

The nailing device (1) has a magazine containing tissue nails used in attaching a net in predetermined position on the surface of a tissue. The magazine is manually pressed to release and drive the tissue nails towards marked points on the surface of the tissue. A needle or a meter is used to determine the penetration depth of the tissue nails driven onto the tissue. An independent claim is also included for attaching a net to animal or human tissue using the nailing device.

Description

The invention relates to a method and a device for attaching a net to human or animal tissue according to the preambles of claims 1 and 4th

Fracture surgery is increasingly becoming a fracture gate closure a non-absorbable plastic network, for example polypropylene, used, which has the advantage that the one vulnerability fracture gaps in the abdominal wall are closed without tension can. For this purpose, when a scar breaks, the hernia gap closed by a gathering of the abdominal wall before the net put on and sewn onto the muscle fiber. Since there are numerous Stitches necessary is the sewing effort considerably. Similar conditions also result in an inguinal hernia operation in which the fracture gap only is covered with a mesh, which is in the side area at the bottom of the inguinal ligament and in the middle area on the vagina of the rectum muscle sewn becomes.

In the case of laparoscopic inguinal hernia surgery the groin region that has been freed from the peritoneum is covered with a large area a mesh covered on the inside of the abdominal muscles is fastened with titanium clips. However, these titanium clips are radiopaque. Moreover there is a risk that over the titanium clip blood vessels and / or Nerves are captured.

With the subject of US 5,203,864 A nail has become known which has a barb-like tip, which can be driven into the tissue through the mesh to be fastened using an appropriate applicator. However, the disadvantage of this tissue nail is that the barb-like tip leads to considerable tissue damage when penetrating through the tissue, because the tip of the nail itself is intended to penetrate through the tissue. In the case of very tough tissue, penetration of the tissue with such a tissue nail is therefore difficult and there is a risk of extensive injury to the tissue or damage to the nail due to bending.

In this publication is also as further embodiment a nail with a front swiveling in two positions spreader shown. The actual hole (passage gate) in the tissue is by a tubular knife created in the applicator, in which hole the nail with its longitudinal aligned swivel tip is driven through. Once the Nail has passed through the tissue hole, the swivel tip swung out vertically and puts on like a spreading part the back the fabric layer firmly. The disadvantage of this arrangement is that extensive injuries with the punch on the applicator in the tissue have to, to then insert the nail into the tissue hole created in this way and swing out the expansion part behind the fabric hole. The Handling effort with this type of tissue nail has proven to be unreasonable.

WO 98/37825 has disclosed clip-like (U-shaped) tissue clips, in which barbed tips are arranged on both sides of a U-leg. Here, too, there is the disadvantage that the tips have to penetrate the tissue layer even with great effort in order to be fixed there. The same criticism applies to those in the US 4,635,637 . US 4,994,073 and US 5,089,009 disclosed tissue clips.

The end is therefore the task based on a method for operating a device and a device for attaching a net to human or animal tissue to further develop according to the preambles of claims 1 and 4, that the for this used tissue nails no or only minor damage Arrange on the tissue to be penetrated and still secure anchoring find in the tissue.

An applicator should be a subtask (Device) are created, the such tissue nails in particular can apply simple and reliable type.

As state of the art, the invention is based on a method such as that described in US Pat US 5,089,009 is disclosed. In this known method, the tissue nail to be fastened is arranged in a magazine of an applicator in a first method step.

In a second step a corresponding pressure is exerted on the magazine and that arranged in the magazine pressure piece acts against the tissue nail to be penetrated.

In a third step the nail with its tips directed against the tissue the tissue is driven in and lies there with barb-like attachments firmly.

Drawing on this state of the art the method according to the invention is characterized in that before Penetration of the respective tip of the tissue nail in the feed direction a needle runs in front of this tip, which sticks out a hole in the tissue through which the tip follows penetrates the tissue nail, after which in a fifth process step the needle withdrawn and the nail in the piercing hole in the tissue with its barb-like Resolutions.

Significant difference according to the procedure The invention of the prior art is that initially by means of a small hole in the tissue is pricked with a needle. A pricking means that by means of a relatively thin needle and a smooth one Tip a simple, thin Hole (hole) is pierced in the tissue, by penetration the thin Needle tip in the tissue this is pushed back elastically and by this displacement of the Fabric that follows immediately after this preamble needle Tip of the tissue nail into the tissue that is thus expanded and elastically displaced penetrates. After withdrawing the pilot needle closes the pre-punched hole becomes independent due to the elasticity of the tissue, whereby the fabric due to the elasticity acting in the closing direction nail inserted into the piercing hole with its barb-like projections stretched elastically and thereby an excellent fit of the nail is secured in the tissue.

The method according to the invention distinguishes It differs from the prior art in that in the feed direction a pre-engineering needle runs in front of the tissue nail to be inserted, which a relatively small hole protrudes through which the nail then is inserted and then the needle is withdrawn, causing the Tissue the shaft of the tissue nail with its barb-like Protrusion surrounds elastically.

This is an essential advantage compared to the State of the art in large-area bores and punchings were made in the tissue, reducing the properties the elastic recovery of the fabric (for closure a piercing hole) could not be used. This will be after the invention now achieved for the first time.

The term “pricking needle” as used below is largely used. It is important that a relatively small hole is punched or cut so that the afterwards the next tip of the nail is definitely larger than the diameter of the needle advancing in the feed direction. This will cause the tissue to penetrate the nail shaft pre-punched hole elastically widened and lies down after retracting the Needle while maintaining the elastic restoring force of the tissue the shaft of the nail positively and non-positively.

So it is preferred in a first Embodiment claims a "piercing needle", the The diameter of the shaft of the piercing needle is smaller than that Diameter of the nail shaft following in the direction of advance.

In another embodiment of the According to the invention, a cutting tool is claimed instead of the pre-engineering needle, which works like a punch, only that Punch does not punch a tissue plug out of the tissue, but only two or three at an angle to each other Provides incisions in the tissue so that there is always at least one with two or three fastening edges on the tissue hanging rag remains on the tissue. So no tissue is punched out, only one cut edge delimited by two or three sides in the tissue, so that through this cutting edge caused by a cutting tip in Direction of feed behind the following fabric nail with a larger diameter into this cut opening can penetrate and also with elastic deformation of the tissue this pushes back which then also non-positively and positively on the shaft of the tissue nail creates when the cutting tip is withdrawn.

Instead of the “pre-piercing” described above, “pre-cutting” is also proposed according to the invention. Both embodiments are presented below as essential to the invention.

Incidentally, it becomes independent device protection for the Tissue nails used in the present invention claimed.

In a first embodiment of a Tissue nail it consists essentially of a circular disc, a shaft attaches to its underside, to its outer circumference a series of barb-like projections are arranged. The shaft turns into a top. It is important that the tissue nails are arranged in a row, that is, the top of the rear tissue nail engages in an associated opening of the tissue nail in front so that the tissue nails are tight packed one behind the other in a magazine. and intermittently through actuation with a pressure piece pushed out of a magazine can be.

In another embodiment proposed a tissue nail made up of an asymmetrical part exists, which has a front, approximately harpoon-like tip, such nails can also be lined up here one behind the other are arranged in a magazine. The individual magazine compartments are separated from each other by appropriate spring tabs, so that when pressed on the fabric nail in the back of the magazine Pressure over the contact surfaces of all tissue nails forwarded to each other and on the applicator tissue nail sitting at the forefront is driven out.

The arrangement of the two described embodiments of the tissue nails in associated, spring-loaded magazines of the applicator has the advantage that very reliable operation is guaranteed. The tissue nail located at the front tip of the applicator can only ever be expelled when pressure is applied to the applicator. This is independent of the stroke that is on the pressure rod of the applicator is applied by a handle. A further tissue nail can only be driven out if the pressure rod is pulled back again due to the spring-loaded handle, so that when the pressure rod is advanced again, a further tissue nail can be moved forward from the magazine to the tip of the applicator.

It becomes a long, slim, reusable, straight or angled steel instrument proposed for the application of absorbable "nails", which can be equipped with different loading units.

The loading units are sterile packed delivered and are intended for single use.

The network is attached through different sizes and differently designed "nails" made of PGA material. These "nails" anchor themselves in the abdominal wall, so hold the net in the desired position and are through Hydrolysis from the body completely dismantled within 6 to 18 months.

• – Resorbierbar;
• – Kein Raffen des Gewebes, kein Schmerz postoperativ durch traumatisierte Nerven;
• – Verwendbar für die verschiedensten OP-Methoden in der Hernienchirurgie.

Novelty:

• - absorbable;
• - No gathering of the tissue, no pain after surgery due to traumatized nerves;
• - Can be used for a wide variety of surgical methods in hernia surgery.

• a) Sicherstellung eines Haltes in verschiedenen Gewebelagen der Bauchdecke;
• b) Möglichkeit, die Gewebenägel auch im „Periost" einzubringen;
• c) Die Kopfform ist so gestaltet, um eine möglichst sichere Befestigung der verschiedenen Maschenformen und Maschengrößen der Netze abzudecken.

The tissue nails described below have the following advantages:

• a) ensuring a hold in different tissue layers of the abdominal wall;
• b) possibility of introducing the tissue nails into the "periosteum";
• c) The shape of the head is designed to cover the various types of meshes and mesh sizes of the nets as securely as possible.

The applicator according to the invention stands out in that it is easy to disassemble, easy to clean and is easy to use.

The nails described below fit in a slim shaft of the instrument with a diameter of 5 to 10 mm.

• – Biologisches Implantat, welches durch Hydrolyse in CO₂ und H₂O zerlegt wird;
• – Geringes Risiko der Irritation von Nerven und/oder Blutgefäßen, weniger postoperativer Schmerz;
• – Weniger OP-Belastung.

Wirtschaftliche Vorteile für den Chirurgen:

• – Schnelle und sicher Befestigung des Netzes;
• – Kürzere OP-Zeit;
• – Für offene und laparoskopische Verfahren geeignet;
• – Geringe Gefahr der Traumatisierung von Nerven und/oder Blutgefäßen;

Wirtschaftliche Vorteile für das Krankenhaus:

• – Kürzere OP-Zeit;
• – Weniger Abfall, geringere Entsorgung.

Overall, the method according to the invention and the applicator operating according to the method have the following advantages:
Economic benefits for the patient

• - Biological implant, which is broken down into CO ₂ and H ₂ O by hydrolysis;
• - Low risk of nerve and / or blood vessel irritation, less post-operative pain;
• - Less surgical burden.

Economic benefits for the surgeon:

• - Fast and secure attachment of the net;
• - Shorter surgery time;
• - Suitable for open and laparoscopic procedures;
• - Low risk of traumatizing nerves and / or blood vessels;

Economic advantages for the hospital:

• - Shorter surgery time;
• - Less waste, less disposal.

It predominate with this product certainly the medical benefits. The use of this product does not increase the cost of an operation of this type to lead.

The subject of the present invention arises not only from the subject of the individual claims, but also from the combination of the individual claims.

All in the documentation, including the Summary disclosed information and features, especially the spatial training shown in the drawings claimed as essential to the invention, insofar as they are used individually or in Combination versus the state of the art are new.

The invention is described below of several execution routes illustrative drawings explained. Here go from the drawings and their description essential features and advantages of the invention.

Show it:

1 : Side view and partial section through an applicator in a first embodiment;

2 : Longitudinal section through the applicator 1 ;

3 : enlarged section through the front part of the applicator;

4 : an exploded view of the front part of the applicator;

5 : the front part of the applicator in section;

6 : the 90 ° cut through the front part;

7 : a full cut through the front part;

8th : the 90 ° cut through the front part:

9 : a first functional position of the front part in section;

10 : the representation after 9 in another sectional view;

11 : the second functional position on average;

12 : the cut offset by 90 ° 11 ;

13 : a nail according to the invention in side view;

14 : Longitudinal section through the nail 13 ;

15 : Top view of the nail;

16 : bottom perspective view of the nail;

17 : perspective side view of the nail;

18 : a second embodiment of an applicator in a disassembled state;

19 : the enlarged sectional view of the front part of the applicator after 18 ;

20 : a perspective exploded view of the holder for the tissue nails and the separately drawn tissue nails to be received in the holder;

21 : the representation after 20 , wherein the tissue nails and a pressure piece are now ready for use in the holder;

22 : one opposite 21 changed perspective view;

23 : the top view of the arrangement according to 21 and 22 ;

24 : the holder when empty;

25 : the top view of the holder after 24 ;

26 : the side view of the holder;

27 : the front view of the holder;

28 : the perspective view of the pressure piece;

29 : another perspective view of the pressure piece;

30 : the top view of the pressure piece;

31 : the side view of the pressure piece;

32 : the bottom view of the pressure piece;

33 : the front view of the pressure piece;

34 : the perspective view of the second embodiment of the tissue nail;

35 : a rotated perspective view of the tissue nail after 34 ;

36 : the end view of the tissue nail;

37 : the side view of the tissue nail.

In the two exemplary embodiments of applicators to be described below 1 . 31 functionally identical parts have been given the same reference numerals.

During the first applicator 1 by means of a needle 11 pierces a hole in the tissue, after which a nail 13 the second applicator works 31 with a cutting needle 41 which is a cutting tip 42 with which a V-shaped or U-shaped cutting opening is introduced from, for example, three mutually perpendicular cut edges in the tissue. The resulting tissue flap is then still connected to the surrounding tissue via a connecting edge. Another embodiment of a nail is placed in this resulting cutting opening 43 driven.

It goes without saying that the nails described in the various exemplary embodiments 13 . 43 are interchangeable. As already explained in the general description section, the material of the nails 13 . 43 be absorbable. However, the invention is not restricted to this. The invention also provides non-absorbable materials.

After the introductory preliminary remarks, the first embodiment of the applicator is now 1 described in more detail.

According to 1 is a handle on a housing 3 molded, the housing is a tube 4 surrounds a pressure rod in its central inner bore 2 is spring-loaded displaceable. The displacement of the pressure rod 2 takes place in a manner not shown by pivoting a handle 5 in the direction of the arrow 6 with which the pressure rod 2 through the pipe 4 is driven forward.

The front part 10 on the pipe 4 is easy to connect to the pipe 4 educated. According to the 1 and 3 the coupling takes place in that at the front free end of the pressure rod 2 an external thread is arranged, which in an associated threaded bore 14 at the top of a holder 9 is screwed in. At the same time, the pipe points 4 an external thread, with which it is in an associated, threaded bore 18 is screwed in.

In addition to the screw fastening of pipe described here 4 and pressure rod 2 with the front part 10 a locking connection is also shown in the second embodiment.

According to 4 there is the front part 10 from a sleeve-shaped magazine 7 , in a row of locking openings 19 are incorporated. In the magazine 7 a holder can be moved 9 attached, in the manner described above with the pressure rod 2 is coupled. The outer circumference of the holder 9 has opposing locking ribs 16 on that with a sleeve-like spring element 12 interact.

At the front of the holder 9 is the needle 11 attached, which serves as a piercing instrument and which the spring element 12 interspersed and everyone on the needle 11 strung nails 13 that lie one behind the other on the needle 11 are threaded. The nails 13 are in this case taken up on the needle in such a way that an unintentional axial slipping by gravity cannot occur, but an intentional axial pushing out by actuating the handle 5 , Pressure rod 2 and holder 9 with needle attached to it 11 is possible. This is preferred by an at least partially slightly conical through hole through the nail 13 reached so part of the nail 13 when moving axially somewhat radial to the cylindrical needle 11 evades and thus by friction holds. The nail thus held frictionally 13 can then only via increased pressure using the handle 3 axially from the needle 11 be stripped.

The front of the applicator 1 is by a removable protective cap 8th covered, which is removed in use.

According to 4 there is the spring element 12 from two opposing, longer feather lobes 15 which with their inwardly curved ends on the associated locking ribs 16 sit up like it in 5 is shown. The shorter feather lobes 17 of the spring element 12 on the other hand act with the locking openings 19 in the magazine 7 together like this also in 5 and 6 is shown.

These relationships can also be seen in the 7 and 8th in which the in the 5 and 6 parts shown are shown in full section.

In the basic position, the two spring tabs lying opposite each other thus grip 17 into the assigned top latching opening 19 in the magazine 7 a while the feather lobes accordingly 15 of the spring element 12 at the top locking rib 16 of the holder 9 invest.

The one after the other on the needle 11 strung nails 13 fill the front area of the magazine 7 out. For use, the in the 7 and 8th protective cap shown 8th removed and the pressure rod 2 will be in the direction of the arrow 36 pushed forward so the holder 9 (when comparing 7 and 9 ) is pushed forward by one step. The feather lobes snap here 17 from the top stop opening 19 on the magazine 7 and come into locking engagement with the further locking opening behind 19 ,

At the same time it becomes the foremost nail 13 from the mouth 30 of the magazine 7 expelled.

It is now important that the length of the needle 11 is selected so that its tip 29 when driving out the nail 13 its tip 26 surmounted. That is, the top 29 the needle 11 runs the nail 13 ahead and pierce the hole in the tissue. The fabric edge 40 is here in 9 indicated by a hatched line. Appropriate pressure on the applicator thus removes the nail 13 driven into the tissue, the tip 29 the needle 11 the nail 13 goes ahead. Through the thin tip 29 the needle opens the tissue slightly and elastically displaces it so that the shaft 24 of the nail 13 penetrates the tissue with elastic displacement and attaches itself there.

It then becomes the magazine 7 over the one with the pressure rod 2 detained holder 9 in the direction of the arrow 49 withdrawn, creating the needle first 11 with her needle tip 29 out of engagement with the nail now anchored in the tissue 13 comes. The functional position then results 11 and 12 where it can be seen that the feather lobe 15 to a second locking rib located under the first locking rib 16a are engaged and the shorter spring tabs also grip 17 in a further locking opening arranged behind the top locking opening 19a on.

So there was an intermittent feed by one stroke at the transition from 7 on 11 carried out. Here, the end face of the spring element 12 that immediately the holder 9 surrounds as a feed for the in the magazine 7 nail behind 13a used so that the nail in the foremost position in the magazine 13 is driven into the tissue.

In the 13 to 17 is a preferred embodiment of a resorbable nail 13 shown.

The nail 13 consists essentially of an approximately round disc 20 , on the underside of which a shaft is made of one piece of material 24 is molded into a tip 26 transforms.

Circumference of the shaft 24 are a series of barbs 25 formed.

So the nails 13 one behind the other in the most densely packed form on the needle 11 in the magazine 7 can be threaded in every disc 20 a recess 21 arranged, in which the top 26 of the following nail 13 can engage loosely and without jamming, reducing the number of times in the magazine 7 taped nails 13 can be increased. On the inner circumference of this recess 21 are two opposite ribs 22 arranged which has a smaller diameter of the recess 21 and thus axial end faces 70 for the subsequent nail 13 define.

This front axial stop surfaces 70 the profiled recess 21 are corresponding axial end faces on the face 71 at the bottom of one in the top 26 located transverse slot 27 assigned. Thus there are larger pressure areas between the neighboring nails 13 present so the top 26 of the nail 13 cannot be harmed.

Every tip 26 of the nail 13 can into the recess 21 of the nail in front of it 13 be used, the slot 27 with the associated ribs 22 corresponds. This is also a side effect of the respective nail 13 with the other nail 13 Connected against rotation and only separable from it in the axial direction, but this is not necessary for a solution.

The recess 21 incidentally sits towards the top 26 through a hole 28 and the front gutter 50 continued, which is graduated. This gradation is used for demoulding in the tool. The gutter 50 is in the area of the slot 27 the top 26 provided and is slightly tapered towards the free end of the tip 26 of the nail 13 , This causes the nail 13 on the cylindrical needle 11 axially displaceable due to the conical groove 50 light radially tilted and thus jammed. This prevents the nails from slipping out 13 from the needle 11 avoided and only a predefined pressure via the spring 12 , the holder 9 , the pressure rod 2 and the handle 5 can be the foremost nail 13 from the needle 11 seperate.

In the 18 to 37 becomes another applicator 31 described below. With this applicator, the pressure rod 32 thanks to a spring-loaded handle 5 postponed. The front end of the push rod 32 has a locking tip 33 enlarged diameter, which in an associated locking opening 45 on a holder 39 can be snapped in, for example in the 20 and the following is shown in more detail.

At the same time, the pipe also points 4 of the applicator 31 two opposite locking openings 35 on the outer circumference, with assigned, over the outer circumference of a magazine 37 protruding locking tab 34 interact.

This way the magazine 37 over the mentioned locking connection 34 . 35 easy to connect to the pipe 4 of the applicator 31 connected.

Because the pressure rod too 32 in the assigned locking opening 45 on the holder 39 can be snapped in, there is a quick-connectable connection between the front part of the applicator and the applicator 31 self.

For a better graphic clarification, in 20 the holder 39 is shown in the empty state and the parts engaged in the holder, namely the pressure piece 38 and the nails which are in positive engagement one behind the other 43 are drawn separately.

The 19 on the other hand shows the parts mentioned in their functional condition in the magazine 37 used.

The keeper 39 is preferably a metal or plastic part, which individual by spring tabs 47 . 48 separate receiving openings 46 for the nails to be used there 43 forms. At the rear of the holder 39 is the previously mentioned rest opening 45 for the locking engagement of the locking tip 33 of the pressure rod 32 arranged. This is formed by two U-shaped metal parts opposite each other, each of which is made of spring plates that are oriented at an angle to each other 44 are punched out so that the locking tip 33 enlarged diameter in the locking opening 45 occurs, the two feather lobes 44 spreads apart and finally in the recess 51 comes to rest, after which lies behind the locking tip 33 the feather lobes 44 close again.

The keeper 39 is an elongated plastic or metal part, which is open on one side and a channel-shaped sliding track 52 defined on which the individual, one below the other and with the receiving openings 46 nails in positive engagement 43 are arranged latching and displaceable in the longitudinal direction.

In every opening 46 is therefore always a nail 43 can be used and - as will be explained later - the nails are inserted into one another in mutual engagement, which, however, is not necessary for a solution and essentially should only prevent the subsequent nail from being pushed under, but also any other movement of the nails that does not take place axially.

As a feed drive for the nails 43 serves a pressure piece 38 which in the 28 to 33 is shown in more detail. The pressure piece 38 is slightly jammed in the sleeve-shaped magazine 37 guided axially displaceable. Will the holder 39 over the locking tip 33 of the pressure rod 32 moved in the direction of the tissue, then there is an axial relative movement between the sleeve-shaped magazine 37 and the holder 39 , making the leading nail 43 at the front free end of the magazine 37 is issued individually and anchored in the tissue. This relative movement between the sleeve-shaped magazine 37 and the holder 39 takes place while overcoming the frictional force between the inner wall of the magazine 37 and the outer casing of the pressure piece 38 , because the pressure piece 38 in the magazine 37 slightly jammed. The pressure piece also stands 38 then on the spring lobes that are closed behind each other in an arrow shape 47 . 48 while pushing forward so that the thrust piece 38 not backwards into an empty receiving opening 46 can drive in. Now the holder 37 in the starting position via the handle 5 pulled back, then the clamping force between the pressure piece now acts 38 and the sleeve-shaped magazine 37 so that the pressure piece 38 together with the remaining nails 43 forward by one position of the receiving openings 46 can move. For this, the frictional clamping force between the pressure piece 38 and magazine sleeve 37 be greater than the clamping force of the spring tabs 47 . 48 , Every nail 43 and also the pressure piece 38 is about a position in the receiving openings 46 forward towards the free end of the magazine 37 landed and another nail 43 can be separated in the same way.

The 21 to 23 show the operational state of the holder 39 where it can be seen that the latching tip 33 behind the pressure piece 38 is arranged and this with its front face on the back lying in the direction of the nail 43 acts.

It is based on the 34 to 37 explained later that the nails 43 are designed so that they run in the longitudinal direction, mirror-symmetrically arranged slots 53 . 54 have on the longitudinal sheets 55 . 56 of the holder 39 sit on and are slidable on it. This is in 22 shown.

It is important that the front end of the holder 39 as a cutting needle 41 is formed, which two mutually mirror-symmetrical cutting bit Zen 42 formed.

By cutting action of the two cutting tips arranged parallel to each other 42 a tissue flap that is still holding only at one tissue edge is thus punched into the tissue. So no piece of tissue is punched out, only a tissue hole is cut, so that - as in the first exemplary embodiment described above - when the applicator is placed on the edge of the tissue (reference symbol 40 in 9 and 10 but not shown here in the drawing) first the holder 39 in the feed direction through the pressure rod 32 is pushed forward so that the cutting needle 41 with their cutting tips 42 penetrates into the tissue and executes the aforementioned three-sided U-shaped or V-shaped cut in the tissue. The cutting needle 41 and the nails 43 by pressing on the pressure rod 32 and thus on the holder 39 and that in a receiving opening 46 on the faces of the feather lobes 47 . 48 adjacent pressure piece 38 pushed forward and the next to the cutting needle 41 lying nail 43 is only partially through the leading cutting needle 41 (Knife) punched out fabric hole inserted and out of the magazine 37 sporadically. By withdrawing the holder 39 by pulling on the pressure rod 32 becomes the thrust piece 38 on the holder 39 moved forward by one click because the pressure piece 38 in the sleeve-shaped magazine 37 slightly stuck and thus the spring force of the spring tabs 47 . 48 is overcome. Here, all nails 43 through the pressure piece 38 over that from the keeper 39 defined trajectory 52 moved towards the free end.

When moving all nails 43 on the transfer track 52 All of the feather lobes thus open in succession 47 . 48 , which the front end of the respective latching receiving opening 46 form and leave a nail 43 pass therethrough.

That on the face of the rearmost nail 43 adjacent pressure piece 38 is in the 28 to 32 shown in more detail.

It essentially consists of an approximately circular body which has a longitudinal rib running in the longitudinal direction 57 with which this pressure piece 38 on the trajectory 52 of the holder 39 seated.

Left and right of the longitudinal rib 57 are symmetrical longitudinal slots with respect to the longitudinal central axis 58 in the material of the pressure piece 38 incorporated, which are open at the bottom. In this way, the longitudinal slots sit 58 on the longitudinal sheets 55 . 56 of the holder 39 on.

The respective rear nail 43 assigned face 60 of the pressure piece 38 has a central recess 59 on, into which a rear approach 61 of the nail 43 intervenes. This ensures that the face 60 of the pressure piece 38 on the assigned rear face 62 of the last nail 43 is applied.

On the opposite end 63 of the pressure piece 38 is the locking tip 33 of the pressure rod 32 and drives the pressure piece 38 forward on the sliding track 52 ,

The 34 to 37 show a preferred embodiment of a nail 43 ,

This preferably consists of a resorbable material and has one, a barb 64 showing lace 65 on, in the front area an approximately rectangular profiled recess 66 is arranged.

In this profiled recess 66 engages with nails lined up in a row 43 the respective approach 61 of the front nail 43 on. The coupling of the nails 43 over the into the recess 66 engaging approach 61 mainly serves to make the top 65 when moving axially forward, not under the front nail 43 and therefore does not push the axial force forward onto the first nail to be separated 43 can be passed on and there is a risk that nails in the magazine 37 tilt and the applicator becomes unusable. The coupling can preferably only be designed as a loose fit without an axial force fit, but in another embodiment as a slight press fit with an axial force fit. This coupling can also be completely dispensed with if the tip is suitably shaped so that the nails are pushed under 43 is excluded.

The summit 65 is about a shaft 67 reduced diameter in the longitudinal direction with a body 68 connected, on the front face of several tips 69 are arranged.

In the body 68 are two slots that are parallel to each other and mirror-symmetrical to the longitudinal center axis and open at the bottom 53 . 54 incorporated. The previously mentioned longitudinal sheets engage in these slots 55 . 56 of the holder so that the nail 43 thus slidable on the sliding track 52 of the holder 39 is stored. The shaft 67 reduced diameter lies in the interior of the respective receiving opening 46 and the top 65 is able to feed the respective nail 43 in the direction of the longitudinal axis of the holder 39 the spring lugs biased against each other 47 . 48 to open to the next opening 46 on the holder 39 to get.

This in turn ensures that every nail 43 an associated receiving opening 46 on the transfer track 52 of the holder 39 is assigned and that the nails 43 due to the locking action of the spring tabs which are resiliently placed against one another 47 . 48 from the one opening 46 into the following opening 46 can be pushed.

It is important that the foremost nail 43 the cutting needle 41 runs so that when the applicator tip is placed on the tissue and when the pressure rod is advanced 32 first the cutting needle 41 penetrates the tissue and with the help of cutting tips 42 executes a three-sided cut in the tissue, for example offset by 90 °, so that the tip is inserted into the punching opening thus formed 65 of the nail 43 then drive in with his body 68 and the tips at the front 69 , as well as the barb 64 anchored in the fabric on the one hand and the net with the tips on the other 69 is held.

This means that the net is secured against displacement using the nail 43 guaranteed on the fabric.

That the cutting needle 41 the forefront 65 the foremost nail 43 is preceded, for example, in 22 shown.

1

applicator

2

pressure bar

3

Handle

4

pipe

5

Handle

6

arrow

7

magazine

8th

protective cap

9

holder

10

front

11

needle

12

spring element

13

nail

14

threaded hole

15

spring tabs

16

locking rib

17

spring tabs

18

location hole

19

latching opening

20

disc

21

recess

22

rib

24

shaft

25

barb

26

Tip (nail 13 )

27

slot

28

drilling

29

Tip (needle 11 )

30

muzzle

31

applicator

32

pressure bar

33

locking tip

34

locking tabs

35

latching opening

36

arrow

37

magazine

38

Pressure piece

39

holder

40

-

41

cutting needle

42

cutting tip

43

nail

44

spring plate

45

latching opening

46

receiving opening

47

spring tabs

48

spring tabs

49

arrow

50

gutter

51

recess

52

sliding track

53

slot

54

slot

55

longitudinal plates

56

longitudinal plates

57

longitudinal rib

58

longitudinal slot

59

recess

60

front

61

approach

62

front

63

front

64

barb

65

top

66

recess

67

shaft

68

body

69

top

70

front axial stop surfaces of 22

71

front axial stop surfaces of 27

Claims (25)

Method for attaching a net to human or animal tissue by means of a device, including an applicator ( 1 ; 31 ) with a magazine ( 7 ; 37 ) to hold a number of tissue nails ( 13 ; 43 ), the following steps being carried out: a) arranging the tissue nails to be fastened ( 13 ; 43 ) in the magazine ( 7 ; 37 ) of the applicator ( 1 ; 31 ); b) placing the applicator ( 1 ; 31 ) on the net, which is on the surface of the fabric, in a suitable place; c) Applying manual pressure to the applicator magazine ( 1 ; 31 ), which press pressure is in the magazine ( 7 ; 37 ) located pressure element ( 9 . 12 ; 38 ) on the number of nails ( 13 ; 43 ) which causes the foremost nail ( 13 ; 43 ) with its tip directed against the tissue ( 26 . 65 ) is driven into the tissue and has barb-like attachments ( 25 ; 64 . 69 ) there, characterized in that before the respective tip ( 26 . 65 ) of the tissue nail ( 13 . 43 ) in the feed direction in front of this tip ( 26 . 65 ) a needle ( 11 ) or a knife ( 41 ) that pierces or pre-cuts a hole or incision in the tissue through which the tip ( 26 . 65 ) of the tissue nail ( 13 . 43 ) penetrates, and that in a last step the needle ( 11 ) or the knife ( 41 ) is withdrawn and the nail ( 13 . 43 ) in the hole or the one cut in the tissue with its barb-like attachments ( 25 ; 64 . 69 ) sets. A method according to claim 1, characterized in that through the piercing needle ( 11 ) caused puncture hole in the tissue or by the incision needle ( 41 ) incision in the tissue in the passage cross-section for the nail is at least partially smaller than the cross-section of the associated shaft ( 24 . 27 ) of the nail subsequently inserted into the piercing hole or the incision of the tissue ( 13 . 43 ) so that the shaft ( 24 . 27 ) of the nail ( 13 . 43 ) while maintaining the elastic restoring force of the tissue in the piercing hole or in the incision. A method according to claim 1 or 2, characterized in that only a single tissue nail is pushed through the applicator ( 1 ; 31 ) is delivered. Device for attaching a net to human or animal tissue, including an applicator ( 1 ; 31 ) with a magazine ( 7 ; 37 ) for receiving and dispensing a number of tissue nails ( 13 ; 43 ), characterized in that in the interior of the magazine ( 7 . 37 ) a holder ( 9 ; 39 ) for picking up and dispensing individual tissue nails ( 13 ; 43 ) and the entire holder ( 9 ; 39 ) or at least part of it together with the nails ( 13 ; 43 ) relative to the magazine ( 7 . 37 ) is slidable in the longitudinal direction, with the holder ( 9 ; 39 ) in the feed direction in front of the leading nail to be separated ( 13 ; 43 ), a needle ( 11 ) or a knife ( 41 ) is arranged, which / which pierces or pre-cuts a hole or an incision in the tissue, through which / which subsequently the leading nail to be separated ( 13 ; 43 ) partially penetrates and is caught in the tissue with its barbs ( 25 ; 64 . 69 ) sets. Apparatus according to claim 4, characterized in that the displacement of the holder by a push rod ( 2 . 32 ) takes place on the one hand with the holder ( 9 . 39 ) and on the other hand with the handle ( 5 ) of the applicator ( 1 . 31 ) connected is. Apparatus according to claim 4 or 5, characterized in that the tissue nails ( 13 ; 43 ) in the magazine ( 7 ; 37 ) can be lined up in series. Device according to one of claims 4-6, characterized in that at the front free end of the applicator a front part ( 10 ) is arranged, including the magazine ( 7 ), and the holder, which is guided in a longitudinally displaceable manner ( 9 ), and one between magazine ( 7 ) and holder ( 9 ) acting tap changer ( 12 . 16 . 19 ), where on the holder ( 9 ) aligned in the feed direction at the front a needle ( 11 ) is arranged on which the nails ( 13 ) can be lined up serially one behind the other, and by means of the tap changer ( 12 . 16 . 19 ) the holder ( 9 ) with needle ( 11 ) and nails ( 13 ) relative to the magazine ( 7 ) can be shifted by one step in the feed direction and after the leading nail has been separated ( 13 ) can be brought back to its original position to separate the subsequent nail ( 13 ). Apparatus according to claim 7, characterized in that the tap changer ( 12 . 16 . 19 ) a feather ( 12 ) containing the first spring lobe ( 17 ) in a serial number of locking openings ( 19 ) in the magazine ( 7 ) engages resiliently releasably, and which are connected with second spring tabs ( 15 ) on locking ribs ( 16 ) of the holder ( 9 ) creates a relative displacement between the spring ( 12 ) and the holder ( 9 ) is prevented in the feed direction, but is made possible against the feed direction. Device according to claim 8, characterized in that the spring ( 12 ) is designed as a circumferentially closed or slotted pot with an open lid and at least partially closed bottom and the bottom of the pot through which the needle ( 11 ) can be moved longitudinally, on the last nail to be separated ( 13 ) and the spring tabs ( 15 . 17 ) form at least part of the lateral surface and face towards the holder ( 9 ) and locking openings ( 19 ) of the magazine. Device according to one of claims 4-6, characterized in that at the front free end of the applicator a front part ( 10 ) is arranged, including the magazine ( 37 ), and the holder, which is guided in a longitudinally displaceable manner ( 39 ), and one between magazine ( 37 ) and holder ( 39 ) acting tap changer ( 38 . 46 - 48 ), where on the holder ( 39 ) a cutting needle aligned in the feed direction at the front ( 41 ) is arranged, the nails ( 43 ) one after the other longitudinally displaceable on the holder ( 39 ) can be lined up, and by means of the tap changer ( 38 . 46 - 48 ) the holder ( 39 ) with cutting needle ( 41 ) and nails ( 43 ) relative to the magazine ( 7 ) can be shifted by one step in the feed direction and after the leading nail has been separated ( 43 ) can be brought back to its original position to separate the subsequent nail ( 43 ). Apparatus according to claim 10, characterized in that in the holder ( 39 ) serial ports ( 46 ) are provided, which lead to the adjacent receiving opening ( 46 ) over feather rags ( 47 . 48 ) are separated, which are only an axial movement of a pressure piece located therein ( 38 ) towards the free end of the holder ( 39 ) and the pressure piece ( 38 ) the farthest Nail ( 43 ) and the pressure piece ( 38 ) and all nails ( 43 ) together with the holder ( 39 ) relative to the magazine ( 37 ) axially forward towards the free end of the holder ( 39 ) can be moved by locking the pressure piece ( 38 ) at the receiving opening ( 46 ) and the pressure piece ( 38 ) all nails ( 43 ) around a receiving opening ( 46 ) towards the free end of the holder ( 39 ) if the holder ( 39 ) via the push rod ( 32 ) is withdrawn by frictional interaction of the pressure piece ( 38 ) with the magazine ( 37 ). Device according to one of claims 4-11, characterized in that the respective tissue nail ( 13 . 43 ) is essentially rotationally symmetrical or mirror-symmetrical to the longitudinal axis. Device according to one of claims 4-12, characterized in that the respective tissue nail ( 13 ) essentially in the direction of the nail ( 13 ) seen from a circular base disc ( 20 ) on which a shaft ( 24 ) with a smaller cross-section, on the outer circumference of which a row in the direction of the base disc ( 20 rejecting barbs ( 25 ) are arranged and the shaft ( 24 ) in a tip ( 26 ) and both on the back of the base disc ( 20 ) as well as at the top ( 26 ) a respective front contact surface ( 22 . 27 ) is located on the front side with another nail in front of and / or behind it in the direction of thrust ( 13 ) and the nails ( 13 ) an approximately central passage recess in the longitudinal extension ( 21 . 28 . 50 ) through which the needle ( 11 ) of the holder ( 9 ) is guided so gently that the nails ( 13 ) only deliberately with defined force exerted on the pressure piece ( 9 . 12 ) axially from the needle ( 11 ) can be brought down, but not unintentionally by the pure gravitational force of the earth. Device according to claim 13, characterized in that the axial passage recess ( 21 . 28 . 50 ) of the nail ( 13 ) at least in one part ( 50 ) tapered towards the free end of the needle 11 runs. Device according to claim 13 or 14, characterized in that the tip ( 26 ) of the posterior tissue nail ( 13 ) in an assigned opening ( 21 ) of the tissue nail in front ( 13 ) intervenes loosely and without jamming. Device according to one of claims 4-12, characterized in that the respective tissue nail ( 43 ) essentially in the direction of the nail ( 43 ) seen from a disc-shaped base body ( 68 ), on which there is an axial shaft ( 67 ) with a smaller cross-section, with a tip at its free end ( 65 ) is located with at least one in the direction of the base body ( 68 rejecting barb ( 64 ), where on the base body ( 68 ) towards the barb ( 64 ) at least one claw ( 69 ) is located. Apparatus according to claim 16, characterized in that both on the back of the base body ( 68 ), as well as at the top ( 65 ) of the nail ( 43 ) a respective coupling element ( 61 . 66 ) is for coupling with another nail in front of and / or behind it in the direction of thrust ( 43 ), to prevent movement of the nails ( 43 ) in an undesirable, non-axial direction with respect to the longitudinal axis. Device according to claim 16 or 17, characterized in that the coupling of the adjacent nails ( 43 ) by the tip ( 61 ) of the front tissue nail ( 43 ) in an assigned opening ( 66 ) of the tissue nail behind it ( 43 ) engages axially. Device according to one of claims 16-18, characterized in that the coupling of the adjacent nails ( 13 . 43 ) is frictionally jammed. Device according to one of claims 15-19, characterized in that interlocking adjacent nails ( 13 . 43 ) have a positive anti-rotation lock. Device according to one of claims 16-20, characterized in that in the body ( 68 ) two slots that are parallel to each other and mirror-symmetrical to the longitudinal center axis and open at the bottom ( 53 . 54 ) are incorporated into the longitudinal sheets ( 55 . 56 ) of the holder so that the nail ( 43 ) thus slidable on the sliding track ( 52 ) of the holder ( 39 ) is stored. Device according to one of claims 16-21, characterized in that the individual compartments ( 46 ) of the magazine ( 37 ) by means of appropriate spring tabs ( 47 . 48 ) are separated from each other so that when pressed on the in the magazine ( 37 ) back tissue nail ( 43 ) this pressure over all tissue nails ( 43 ) is forwarded and that on the applicator ( 31 ) fabric nail at the forefront ( 43 ) from the front mouth ( 30 ) is driven out. Device according to one of claims 1-22, characterized in that the tissue nails ( 13 . 43 ) intermittently indexed and isolated by operating a handle ( 5 ) of the applicator ( 1 . 31 ) via an associated pressure rod ( 2 ) and the one with the pressure rod ( 2 ) connected holder ( 9 . 39 ) of the magazine ( 7 ; 37 ) from the magazine ( 7 ; 37 ) can be pushed forward over the mouth. Device according to one of claims 1-23, characterized in that the applicator ( 1 . 31 ) a long, slim, reusable, bendable steel instrument for application of the nails ( 13 . 43 ) whose shaft ( 4 ) has a cross section of about 5 mm to 10 mm. Device according to one of claims 4-24, characterized in that the nails ( 13 ; 43 ) consist of PGA material that can be completely absorbed by the body in about 6 to 18 months by hydrolysis and broken down into CO ₂ and H ₂ O.