Tape applicator device and method for tape-assisted wound closure

Abstract

The tape applicator device 10 has a case 12 with a chamber 24 housing a spool 14 with a roll of tape 16, and tape outlet 26, for dispensing single sided tape 18, and a cutter 20. A tape feed mechanism

Description

TECHNICAL FIELD This invention relates to a tape applicator device for tape-assisted wound closure for use in the medical field of plastic and reconstructive surgery for external tissue expansion of skin for wound closure management and for other forms of soft tissue reconstructions. The invention relates also to a method of using the tape applicator 5 device in a procedure for closing a wound in a patient. SUMMARY OF INVENTION 10 According to a first aspect of the invention there is provided a tape applicator device for tape-assisted wound closure, the applicator device including: a casing sized to fit within the palm of a hand of a user, the casing defining an internal chamber and a tape dispensing outlet through which tape having an adhesive applied to 15 one side thereof, can be dispensed from the casing; a supply spool for receiving a roll of the tape, rotatably mounted within the internal chamber; a tape cutting mechanism mounted to the casing near the tape dispensing outlet for cutting the tape to a desired length as the tape is dispensed from the casing; a tape feed mechanism including: a) at least one driven roller rotatably mounted within the internal chamber for receiving tape from the supply spool; b) at least one follower guide roller rotatably mounted within the internal chamber for receiving tape from the driven roller; and c) a displaceable conveyor element mounted to and extending between the driven and guide rollers, the conveyor element being displaceable via rotation of the driven roller and having a friction engaging surface for frictionally engaging the tape for displacing the tape towards the tape dispensing outlet, brake means for applying a braking force to the driven roller preventing rotation of the roller, permitting the application of a tensile force to the tape when the tape is adhered to skin; and a hand-operated, displaceable actuator device which is displaceably mounted to the casing, the actuator device including a drive member for engaging the driven roller for driving rotation of the driven roller as the actuator device is displaced relative to the casing. In use, the application of the tensile force to the tape by the brake means when the tape is adhered to the skin permits a relatively high mechanical traction force to be exerted on the skin of a patient for drawing the skin towards the wound. In addition, the application of the tensile force to the tape facilitates cutting of a section of the tape under tension, by the tape cutting mechanism. The brake means may comprise at least one brake pad associated with the actuator device for applying a braking force to the driven roller when the actuator device is displaced towards the casing in an arrangement causing the brake pad to engage the driven roller. The tape applicator device may include at least one pressure abutment formation for abutting and applying a force to a side of the tape at a location opposite a side of the tape which is in contact with the guide roller. More specifically, the pressure abutment formation may comprise a freely rotatable abutment roller mounted to the casing within the internal chamber. The conveyor element may comprise an elongate band which spans the driven roller and the follower guide roller and which frictionally engages the side of the tape having adhesive applied thereto. More specifically, the applicator device may include a pair of the spaced conveyor elements in the form of elongate bands which span the driven roller and the follower guide roller in a spaced-apart arrangement. The tape cutting mechanism may comprise: a) a cutting blade; b) a hand-operated applicator formation mounted to the cutting blade for exerting a force on the cutting blade for displacing the cutting blade between a cutting position wherein the cutting blade severs the tape and an inoperative position wherein the cutting blade is spaced from the tape; and c) a biasing element for biasing the cutting blade towards the inoperative position, the casing defining a guide formation within which the cutting blade is slidingly received. The driven roller may have a first ratchet wheel mounted thereto and the drive member of the actuator device may include a complementary first pawl for engaging the first ratchet wheel and driving rotation of the driven roller when the actuator device is displaced relative to the casing. The actuator device may be pivotally mounted to the casing in an arrangement wherein the actuator device is displaceable towards the casing for driving rotation of the driven roller for dispensing tape from the casing and away from the casing for returning the first pawl to an inoperative home position. The actuator device may include urging means for displacing the actuator device to the inoperative home position. The actuator device may comprise a displaceable wall portion which is received within an aperture in the casing and which partly defines the internal chamber of the casing. The casing and the actuator device may be configured so as to fit within the palm of the user’s hand in an arrangement wherein a squeezing action applied between the actuator device and the casing, drives rotation of the driven roller. Each driven roller may include resistance means for resisting but not preventing rotation of the driven roller. The resistance means may comprise a second ratchet and a second pawl fixedly mounted to a central axle rotatably mounted to the casing, the second pawl being engaged with the second ratchet in an arrangement resisting but not preventing rotation of the driven roller. The resistance provided by the second ratchet and the second pawl, to dispensing of tape from the applicator device, may be sufficient in certain applications to permit a mechanical traction force to be applied to a portion of the tape that is adhered to skin tissue providing for expansion of the skin. In use, tension in the tape resulting from a user of the tape applicator device exerting a tensile force on the tape when the tape is adhered to skin, facilitates cutting of the tape by the tape cutting mechanism. According to a second aspect of the invention, there is provided a method of using the tape applicator device as defined and described hereinabove, in a procedure for closing a wound in a patient, the method including: a user holding the tape applicator device in one hand; and a) in order to initiate a taping procedure for closing the wound, the user ejecting a predetermined length of the tape from the tape applicator device, by displacing the actuator device in order to drive rotation of the driven roller; b) the user holding a leading end region of the tape in the user’s free other hand and pulling the tape to dispense a required additional length of tape from the tape applicator device; c) the user applying tape to one side of the wound using the user’s free hand and pressing the tape onto the patient’s skin to adhere the tape to the patient’s skin; d) while pressing the tape onto the patient’s skin, applying the brake means to the driven roller of the tape applicator device, exerting a braking force on the driven roller; and applying a tensile force to the tape thereby imparting mechanical traction to the skin for drawing the skin closer to the wound; e) the user holding the wound in a pinched condition between the index finger and thumb of the user’s free hand as laxity of the skin will allow; f) the user extending the tape across the wound by dispensing additional tape by a controlled pull on the tape using the user’s free hand or by dispensing additional tape in increments using the actuator device; g) the user pressing the tape onto the patient’s skin at the opposite side of the patient’s wound, adhering the tape to the patient’s skin, while holding the wound in the pinched condition and continuing to apply a tensile force to the tape; h) while the tape is in a state of tension and the braking means is applied, the user cutting the tape using the tape cutting mechanism of the tape applicator device; and repeating steps a) - h) as many times as may be required to achieve wound closure. BRIEF DESCRIPTION OF THE DRAWINGS Further features of the invention are described hereinafter by way of a non-limiting example of the invention, with reference to and as illustrated in the accompany diagrammatic drawings. In the drawings: Figure 1 shows a three-dimensional view from the front of a tape applicator device in accordance with the invention; Figure 2 shows a three-dimensional view of the tape applicator device of Figure 1, as seen from the rear; Figure 3 shows a side view of the tape applicator device of Figure 1 with the top body portion closed; Figure 4 shows a side view of the applicator device of Figure 1, with the top body portion open; Figure 5 shows a top plan view of the tape applicator device of Figure 1; Figure 6 shows an exploded three-dimensional view of the tape applicator device of Figure 1, as seen from above; Figure 7 shows an exploded three-dimensional view of the tape applicator device of Figure 1, as seen from below; Figure 8 shows an exploded side view of the tape applicator device of Figure 1; Figure 9 shows a sectional side view of the tape applicator device of Figure 1, sectioned along section line IX-IX of Figure 5; Figure 10 shows a sectional side view of the tape applicator device of Figure 9, with the displaceable wall portion raised, illustrating the manner in which the tape is fed from the supply spool through the dispensing outlet of the casing; Figure 11 shows a fragmentary sectional side view of one of the driven rollers of the tape applicator device of Figure 1 as viewed from an inner side of the roller; Figure 12 shows fragmentary sectional side view of the driven roller of Figure 11 as viewed from an outer side of the roller; and Figure 13 illustrates the tape applicator device in accordance with the invention held by a user during a wound-closure procedure; and Figures 14-19 illustrating, in sequence, the manner in which the tape applicator device 10 of Figure 1 is used in a wound closure procedure for closing a head wound in a patient. DETAILED DESCRIPTION OF THE INVENTION With reference to the drawings, a tape applicator device for tape-assisted wound closure, in accordance with the invention, is designated by the reference numeral 10. The tape applicator device 10 is sized and ergonomically configured so as to be received within the palm of the hand of a user thereby allowing seamless single-handed operation of the applicator device in which the user’s other hand is freed to perform other tasks simultaneously. The tape applicator device is specifically adapted for applying adhesive tape to skin wherein a mechanical force is applied to the skin when the tape is adhered thereto in order to achieve stretch the skin over time to produce tissue expansion of the skin and in doing so achieve future simple wound closure. The tape applicator device uses adhesive tape to assist in applying mechanical forces to the 5 wound and surrounding skin to produce time-honoured closure of wounds for which immediate simple closure is not achievable. With each session of tape application, the skin is stretched and held in place over the wound to produce skin tissue expansion and a reduction wound size over time. Once sufficient skin is generated, wound closure is achieved by surgery or by natural wound healing using ongoing taping of the wound. 10 The stretching of the skin is produced by traction on the skin from the tape as it is applied. Holding the skin’s position under tension (over time the tension in the skin matrix dissipates and the skin relaxes) facilitates more skin recruitment with each new serial application of the tape to produce tissue expansion. C\J15 The tape applicator device 10 comprises, broadly, a casing 12 sized and configured to fit within the palm of a hand of a user; a supply spool 14 for receiving a roll 16 of tape 't_— 18; a tape cutting mechanism 20; a tape feed mechanism 22. The tape 18 is in the form of paper surgical tape having an adhesive applied to one side thereof. The Applicant has identified 3M (RTM) Micropore (RTM) surgical paper tape as suitable for use. 20 The casing 12 defines an internal chamber 24 within which the supply spool is rotatably located and a tape dispensing outlet 26 through which the tape is dispensed from the casing. 25 The tape feed mechanism 22 includes a pair of driven rollers 28 rotatably mounted within the internal chamber for receiving tape from the supply spool and two parallel spaced follower guide rollers 30 freely rotatably mounted in a side-by-side arrangement within the internal chamber for receiving tape from the driven rollers. 30 The tape feed mechanism 22 further includes a number of displaceable conveyor elements in the form of nitrile rubber bands 32 mounted to and extending between the driven and guide rollers. The bands are displaced via rotation of the driven roller and frictionally engage the tape for displacing the tape 18 towards the tape dispensing outlet 26. As such, the tape has an adhesive applied to a side thereof which contacts the bands 32, assisting in frictionally engagement of the tape by the bands. The tape cutting mechanism 20 is mounted to the casing near the tape dispensing outlet for cutting the tape to a desired length as the tape is dispensed from the casing. The tape applicator device includes a hand-operated displaceable actuator device in the form of a displaceable wall portion 36 which is pivotally mounted at an end thereof to the casing 12 via pivot pin 41. The displaceable wall portion 36 is received in an aperture defined in the casing therefor. The casing comprises a first body portion 38 and a second body portion 40 which are hingedly mounted to one another and which together define the internal chamber 24 within which the driven roller and the guide rollers are housed. The first body portion 38 is latched to the second body portion in a closed condition of the casing. Upon final assembly of the tape applicator device 10, the first and second body portions are sealed closed so as to provide a sterile environment within which the roll of surgical tape 18 is housed. The driven rollers and the guide rollers are rotatably mounted to the second body portion 40. The first body portion 38 forms a cover which has a rounded outer profile which conforms anatomically to the palm of a cupped hand of a user holding the tape applicator device. The first body portion 38 has a pair of pressure abutment rollers 42 freely rotatably mounted to an inner side thereof at a location opposite the driven rollers 28 for pushing the tape onto the driven rollers when the first body portion is in the latched closed position of the casing 12. Each driven roller 28 has a toothed ratchet wheel 44 mounted to an outer side thereof and the drive member of the actuator device includes a pair of complementary toothed pawls 46 for engaging the ratchet wheels and driving rotation of the driven roller 28 when the displaceable wall portion 36 is displaced relative to the main body portion 34 of the casing. The pawls 46 have a curved configuration in the region thereof which engages the ratchet wheels. The pawls are of fixed lengths resulting in a fixed amount of rotation of the ratchet wheels. Once the pawls reach the limits of their displacement, rotation of the ratchet wheels ceases. The tape cutting device 20 includes a cutting blade 50 and a hand-operated applicator formation 52 mounted to the cutting blade for exerting a force on the cutting blade for displacing the cutting blade between a cutting position wherein the cutting blade severs the tape and an inoperative position wherein the cutting blade is spaced from the tape. The tape cutting device further includes a biasing element in the form of a coil spring 54 for biasing the cutting blade towards the inoperative position. The casing defines a guide formation 56 within which the cutting blade is slidingly received. As is more clearly seen in Figures 11 and 12, the driven rollers 28 each have a toothed annular internal second ratchet 60 defining a number of ratchet teeth 62 at an inner side thereof which is engaged by a second pawl 64. The pawl 64 is fixedly mounted to a central axle 66 which is rotatably mounted at opposite ends thereof to the second body portion 40 in apertures 68. The internal second ratchet and pawls offer inherent resistance to rotation of the driven rollers 28 and thereby resistance to dispensing of tape from the tape applicator device. The taping procedure is initiated by ejecting a predetermined length of tape from the tape applicator device by displacing the displaceable wall portion 36 to drive rotation of the driven rollers 28. Thereafter, predetermined amounts of tape can be dispensed by further displacing the displaceable wall portion 36 in order to feed tape from the supply spool. The positive engagement of the ratchet wheels by the pawls of the displaceable wall portions, provides for resistance to feeding of the tape from the spool and thereby allows for tensioning of the tape. The resistance to dispensing of tape 18 from the tape applicator device 10, provided by the internal ratchets 60 and pawl levers 64 of the driven rollers 28 may be sufficient, for certain applications of the tape applicator device, to provide for an adequate mechanical traction force to be applied to skin when the tape is adhered to the skin, while also allowing tape to be manually pulled, under resistance, from the spool through the tape dispensing outlet 26. The resistance provided by the internal ratchets 60 and the lever pawls 64 is such that a desired length of tape can be manually pulled from the spool of the applicator device by a user of the device. For other applications, such as wound-closure procedures, wherein a greater degree of traction is required to be imparted to skin, a larger mechanical tensile force needs to be applied to the tape. For this purpose, the applicator device 10 includes brake means in the form of a brake pad 70 which is fixedly mounted to an end region 72 of the displaceable wall portion 36 for applying a braking force to the driven rollers 28 preventing rotation of the roller and thereby permitting the application of a relatively high mechanical traction force to tape that is adhered to the skin. In use, the brake pad is brought into contact with the driven rollers 28 when the displaceable wall portion 36 is fully depressed thereby applying a braking force to the driven rollers. The Applicant has found that the tension that is applied to the tape when the brake pad is applied to the driven rollers is essential to maintain the tape in a taught condition in order to facilitate clean and accurate cutting of the tape by the tape cutting device 20. The main body portion 34 and the displaceable wall portion 36 are configured so as to fit snugly within the palm of the user’s hand in an arrangement wherein a squeezing action applied between the displaceable wall portion and the main body portion of the casing, wherein depression of the displaceable wall portion drives rotation of the driven roller. The displaceable wall portion includes gripping formations conforming to a user’s fingers, which can be held by the user. With reference to Figure 13, the tape applicator device 10 is held in the hand of a user between the palm of the hand and the gripping fingers of the middle, ring and little finger. These three fingers are responsible for controlling the displaceable wall portion 36 by pressing and releasing to the desired positions to affect the functions of first delivery of the tape and fine incremental forward propulsion of the tape. A full press of the displaceable wall portion 36 engages the brake pad 70 for tensioning of the tape for use in a medical procedure and for cutting of the tape. With reference to Figures 14-18, the manner in which the tape applicator device 10 is used in a wound closure procedure for closing a head wound in a patient, is illustrated in sequence. The tape applicator device 10 fits as facing forward protruding between the thumb and the index finger of a user’s right hand as shown in Figure 13. This grip stabilises the device for applying the tape and, as required, the index finger can be moved away from its hold on the applicator device to participate directly in handling the dispensed tape to apply the tape under tension to the skin surrounding a wound to be closed. In this example, the tape applicator device is held in the user’s right hand, while the user’s left hand is free to apply the tape to the wound area. In order to initiate the taping procedure, a predetermined length of the tape is ejected from the tape applicator device by displacing the displaceable wall portion 36 to drive rotation of the driven rollers 28. With the brake pad 70 disengaged, the surgeon’s left hand is used to manually pull additional tape from the spool of the tape applicator device, under resistance, through the tape dispensing outlet 26 (see Figure 14). The tape is gripped between the index finger and thumb of the user’s free left hand when pulling tape from the applicator device. Alternatively, additional lengths of the tape can be ejected from the tape applicator device using the actuator device. The tape is applied to one side of the wound using the user’s free hand wherein the index finger presses the tape onto the patient’s skin to adhere the tape to the patient’s skin (see Figure 15). The brake pad is then engaged by displacing the displaceable wall portion 36, so as to brake the driven rollers and while pressing the tape onto the patient’s skin, a tensile force is applied to the tape thereby imparting mechanical traction to the skin for drawing the skin closer to the wound. Pressure is exerted on opposite sides of the wound to stretch the skin in a direction for closing the wound by pinching the skin on either side of the wound between the thumb and index finger of the free hand. The tape is extended across the wound and pressed down onto the opposite side of the wound using the bent index finger of the user’s right hand while holding the applicator device (see Figure 16). In order to hold the wound closed, the pinching thumb moves over and presses down on the tape, the brake pad is held in the engaged position and the tape is in a state of tension (see Figure 17). The user’s thumb is then moved from the side gripping position on the applicator device to lie on the top of the applicator formation 52 of the cutting device 20 to depress the applicator formation, causing the cutting blade 50 to cut the tape while the tape is under tension (see Figure 18). The process is then repeated for dispensing and applying tape to the skin as many times as may be required in a particular medical procedure using the tape applicator device. As is evident from the example shown in Figure 19, four sections of the tape were used to close the wound. Tape applied to one side of a wound can thus be held by the free hand of the user while the applicator device is held by and manipulated in the other hand of the user while using the applicator device to apply a tensile force to the tape drawing the skin on either side of the wound closer to each other using the created tension as the tape adherence imparts direct traction on the skin. This is particularly important because the tape applicator device facilitates traction-assisted skin expansion generated by a hand-controlled mechanical force applied to the skin. The configuration of the tape applicator device renders the applicator device particularly suitable for use by a medical practitioner or wound specialist for applying surgical tape to the skin and wound, as the user’s other hand is free to perform other tasks such as attaching an already dispensed part of the tape to the skin at a side of the wound and by pulling on the device, draw the skin attached to the tape towards the skin on the other side of the wound, and, in doing so, reducing the size of the wound. Several lengths of tape are applied as required across the wound, partially overlapping each other as it is performed along the entire length of the wound. This exercise is repeated a day to several days later by dispensing and applying further tape from the applicator device and adhering the tape to the skin to further stretch the skin. Taping is performed as many times as may be required over a period of days or even weeks in order to achieve the required tissue expansion for surgical wound closure or until the skin on either side of the wound can be approximated to each other over the wound and holding this position with the tape. The tape may be changed as required but the closure of the wound is not to be disrupted. Skin to skin contact will promote skin to skin bonding resulting from spontaneous wound healing. The Applicant envisages that the use of the tape applicator device may extend to other clinical contexts. One of them is the reconstruction of a scar. In a typical application using the applicator device 10, the area of the scar to be resurfaced with surrounding normal skin is delineated. The surrounding normal skin is stretched to its maximum in the direction which is appropriate for obtaining the final closure by the flap advancement. Tape 18 is then applied to hold this position of stretch of the normal skin by applying the tape to the skin under tension using the applicator device to apply a mechanical traction force to the skin in order to achieve stretching of the skin. Further tape is applied using the tape applicator device for the rest or the scar and the surrounding skin in the same manner. The tape is typically retained for a period of a few days to one week after which it is removed. A new and subsequent application(s), if required, of tape is performed using the tape applicator device once the skin is stretched further recruiting the developed laxity following the last application. In wound closure applications and in applications involving scar resurfacing in which surgical incisions are made to entirely or partially cover the wound or the excised scar area, normal skin on either side of the affected area is stretched using tape applied by the tape applicator device 10 under tension, towards the area of final closure can be achieved by applying the tape under tension across the wound and holding the tape in place. This process is repeated after removal of the tape a period of time when it is deemed that tension in the skin has relaxed so that additional skin extension can be achieved by repeating the process of taping using the tape applicator device. The tape applicator device in accordance with the invention provides for generation of physical forces to produce tissue expansion of skin, scar improvement and wound healing. Primarily a mechanical tensile force is be applied to normal skin surrounding a target zone in a direction towards the target zone. Beneficial secondary effects of taping applied by the tape applicator device and produced by normal intrinsic elasticity of the skin, are compression of the target zone and shear forces at the tape-skin interface which promote any of the clinical endpoints. 24 10 24

Claims

1. A tape applicator device for tape-assisted wound closure tape, the tape applicator device including:a casing sized to fit within the palm of a hand of a user, the casing defining an internal chamber and a tape dispensing outlet through which tape having an adhesive applied to one side thereof, can be dispensed from the casing;a supply spool for receiving a roll of the tape, rotatably mounted within the internal chamber;a tape cutting mechanism mounted to the casing near the tape dispensing outlet for cutting the tape to a desired length as the tape is dispensed from the casing;a tape feed mechanism including:a) at least one driven roller rotatably mounted within the internal chamber for receiving tape from the supply spool;b) at least one follower guide roller rotatably mounted within the internal chamber for receiving tape from the driven roller; andc) a displaceable conveyor element mounted to and extending between the driven and guide rollers, the conveyor element being displaceable via rotation of the driven roller and having a friction engaging surface for frictionally engaging the tape for displacing the tape towards the tape dispensing outlet,brake means for applying a braking force to the driven roller preventing rotation of the roller, permitting the application of a mechanical traction force to tape that is adhered to skin; anda hand-operated displaceable actuator device which is displaceably mounted to the casing, the actuator device including a drive member for engaging the driven24 10 24roller for driving rotation of the driven roller as the actuator device is displaced relative to the casing.

2. The tape applicator device according to claim 1, wherein the brake means comprises at least one brake pad associated with the actuator device for applying a braking force to the driven roller when the actuator device is displaced towards the casing in an arrangement causing the brake pad to engage the driven roller.

3. The tape applicator device according to claim 1 or claim 2, wherein the casing defines the internal chamber within which the driven roller and the guide rollers are rotatably mounted.

4. The tape applicator device according to claim 3, which includes at least one pressure abutment formation for abutting and applying a force to a side of the tape at a location opposite a side of the tape which is in contact with the guide roller.

5. The tape applicator device according to claim 4, wherein the pressure abutment formation comprises a freely rotatable abutment roller mounted to the casing within the internal chamber.

6. The tape applicator device according to any one of the preceding claims, wherein the conveyor element comprises an elongate band which spans the driven roller and the follower guide roller and which fractionally engages a side of the tape having adhesive applied thereto.

7. The tape applicator device according to claim 6, wherein the conveyor element includes a pair of the elongate bands which span the driven roller and the follower guide rollers in a spaced-apart arrangement.

8. The tape applicator device according to any one of the preceding claims, wherein the tape cutting device comprises:24 10 24a) a cutting blade;b) a hand-operated applicator formation mounted to the cutting blade for exerting a force on the cutting blade for displacing the cutting blade between a cutting position wherein the cutting blade severs the tape and an inoperative position wherein the cutting blade is spaced from the tape; andc) a biasing element for biasing the cutting blade towards the inoperative position,the casing defining a guide formation within which the cutting blade is slidingly received.

9. The tape applicator device according to any of the preceding claims, wherein the driven roller has a first ratchet wheel mounted thereto and the drive member of the actuator device includes a complementary first pawl for engaging the first ratchet wheel and driving rotation of the driven roller when the actuator device is displaced relative to the casing.

10. The tape applicator device according to any one of the preceding claims, wherein the actuator device is pivotally mounted to the casing in an arrangement wherein the actuator device is displaceable towards the casing for driving rotation of the driven roller for dispensing tape from the casing and away from the main body portion for returning the pawl to an inoperative home position.

11. The tape applicator device according to claim 10, wherein the actuator device includes urging means for displacing the actuator device to the inoperative home position.

12. The tape applicator device according to claim 10 or claim 11, wherein the actuator device comprises a displaceable wall portion which is received within an aperture in the casing and which partly defines the internal chamber of the casing.

13. The tape applicator device according to any one of claims 1 to 12, wherein the casing and the actuator device are configured so as to fit within the palm of the user’s hand in an arrangement wherein a squeezing action applied between the actuator device and the casing, drives rotation of the driven roller.

14. The tape applicator device as claimed in any one of claims 1 to 13, wherein the driven roller includes resistance means for resisting but not preventing rotation of the driven roller.

15. The tape applicator device as claimed in claim 14, wherein the resistance means comprises a second ratchet and a second pawl fixedly mounted to a central axle rotatably mounted to the casing, the second pawl being engaged with the second ratchet in an arrangement resisting but not preventing rotation of the driven roller.

16. The tape applicator device as claimed in claim 15, wherein the resistance provided by the second ratchet and the second pawl, to dispensing of tape from the tape applicator device, is of a magnitude sufficient in certain applications to permit a mechanical traction force to be applied to a portion of the tape that is adhered to skin providing for expansion of the skin.

17. A method of closing an open wound in a patient, which includes:a user holding the tape applicator device as claimed in any one of claims 1-16 in one hand;a) in order to initiate a taping procedure for closing the wound, the user ejecting a predetermined length of the tape from the tape applicator device, by displacing the actuator device in order to drive rotation of the driven roller;24 10 24b) the user holding a leading end region of the tape in the user’s free other hand and pulling the tape to dispense a required additional length of tape from the tape applicator device;c) the user applying tape to one side of the wound using the user’s free hand and pressing the tape onto the patient’s skin to adhere the tape to the patient’s skin;d) while pressing the tape onto the patient’s skin, applying the brake means to the driven roller of the tape applicator device, exerting a braking force on the driven roller; and applying a tensile force to the tape thereby imparting mechanical traction to the skin for drawing the skin closer to the wound;e) the user holding the wound in a pinched condition between the index finger and thumb of the user’s free hand as laxity of the skin will allow;f) the user extending the tape across the wound by dispensing additional tape by a controlled pull on the tape using the user’s free hand or by dispensing additional tape in increments using the actuator device;g) the user pressing the tape onto the patient’s skin at the opposite side of the patient’s wound, adhering the tape to the patient’s skin, while holding the wound in the pinched condition and continuing to apply a tensile force to the tape;h) while the tape is in a state of tension and the braking means is applied, the user cutting the tape using the tape cutting mechanism of the tape applicator device; andrepeating steps a) - h) as many times as may be required in order to achieve wound closure.

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