Abstract:
Suture clip appliers, suture clips and methods of their use for securing sutures during an endoscopic or laparoscopic procedure are provided, wherein the method includes the steps of providing a suture clip applier having a working tip configured to retain and fire a suture clip; providing a suture clip having a biased closed configuration; loading the suture clip into the working tip of the clip applier; translating the suture clip distally relative to the working tip to a first position wherein the suture clip is splayed open; inserting a suture into the opened suture clip; and translating the suture clip distally relative to the working tip such that the suture clip is ejected from the working tip and biased to the closed configuration to close on and to retain the suture.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/250,894, filed on Oct. 13, 2009, the entire content of which is incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to a device for use in a surgical procedure. More particularly, the present disclosure relates to a surgical suture clip applier adapted for securing sutures during an endoscopic or laparoscopic procedure. 
     2. Background of Related Art 
     In surgical operations it is well known that surgical sutures are applied to repair the body tissue. Such sutures generally are of the non-absorbable or the absorbable type and are generally applied with the use of surgical needles. If the sutures are non-absorbable, they may or may not be removed after an estimated predetermined healing period has passed. Absorbable sutures are absorbed gradually over time by coming in contact with moisture in the human body. 
     In many surgical procedures, application of sutures generally involves knotting or tying the suture after it is applied to the body tissue in order to retain its position with respect to the tissue and to maintain the tissue in the repaired position. In cases where the surgeon has full access to the operative site by virtue of a large incision, knotting the suture or applying knotting or equivalent devices is relatively simple due to the access provided by the incision. 
     In endoscopic and laparoscopic procedures, on the other hand, large incisions are avoided. In laparoscopic procedures surgery is performed in the interior of the abdomen through a small incision; in endoscopic procedures surgery is performed in any hollow viscus of the body through narrow endoscopic tubes inserted through small entrance wounds in the skin. Laparoscopic and endoscopic procedures generally require that any instrumentation inserted into the body be sealed, i.e., provisions must be made to ensure that gases do not enter or exit the body through the laparoscopic or endoscopic incision as, for example, in surgical procedures in which the surgical region is insufflated. Moreover, laparoscopic and endoscopic procedures often require the surgeon to act on organs, tissues, and vessels far removed from the incision, thereby requiring that instruments to be used in such procedures generally be both long and narrow. 
     In laparoscopic and endoscopic procedures surgical sutures are generally applied by directing and manipulating needled sutures through an aperture in the body or through elongated narrow tubes known as cannulae with the assistance of specially designed needle graspers, needle drivers, and the like. However, tying the sutures in such procedures can be relatively difficult due to the limited access afforded to the surgeon through the narrow tubes. In particular, since biocompatible, preferably bioabsorbable, sutures are generally used in such procedures it would be desirable to have available a cinching device and system that facilitates tying the sutures through the tubes in a manner to retain their position in the body tissue at least until the healing process is in full progress. The use of the term “endoscopic” herein contemplates endoscopic as well as laparoscopic procedures. 
     SUMMARY 
     The present disclosure relates to surgical suture clip appliers, suture clips and methods of their use for securing sutures during an endoscopic or laparoscopic procedure. 
     According to an aspect of the present disclosure, a suture clip applier is provided and includes a housing; an elongated plunger slidably supported in the housing, the plunger having a distal end portion disposed within the housing and a proximal end portion extending from a proximal end of the housing; a hollow tube extending distally from the housing and defining a lumen therethrough; an actuation member having a distal end extending into the hollow tube and a proximal end operatively engaged with the plunger; and a working tip coupled to a distal end of the hollow tube. The working tip has a substantially U-shaped transverse cross-sectional profile defining a channel having a base wall and a pair of spaced apart side walls. The working tip defines a lower contact surface along an internal face of the base wall, and an upper contact surface defined along an upper end surface of each side wall. The upper contact surface of each side wall includes a distal recess formed near a distal end of thereof and a proximal recess formed proximal of the distal recess; and an internal retaining surface on both side walls parallel to the base wall. In use, the distal end of the actuation member is configured to engage a suture clip loaded into the working tip. 
     The plunger may define a race formed in a surface thereof. The race may include a plurality of portions each defining a cam surface of varying depth. The clip applier may include a rocker arm having a distal end portion and proximal end portion. The rocker arm may have a follower pin extending therefrom near the distal end portion thereof and a retaining pin near the proximal end portion thereof. The rocker arm may be pivotally attached to the housing by the retaining pin and the follower pin may be slidably disposed within the race of the plunger to modulate the motion of the plunger and actuation member. 
     The race may define four interconnected cam portions, with each cam portion having a start position and an end position, and each cam is deepest at its respective start position and shallowest at its respective end position. 
     The rocker arm may be elastically deformable laterally from the plunger thereby providing a biasing force upon the follower pin and plunger relative to the body. 
     The clip applier may further include finger loops extending from the housing. 
     The actuation member may be configured to transmit axial translative forces to the suture clip. 
     The clip applier may further include a biasing member disposed within the housing and providing a proximal bias upon the plunger relative to the housing. The biasing member may be a coil spring. 
     The distal recess and the proximal recess, formed in each vertical side wall, may be interconnected by a camming surface. 
     According to another aspect of the present disclosure, a suture clip for selective attachment to a suture is provided and includes an elongated flexible beam having a distal end portion, a proximal end portion, a top surface and a bottom surface, the flexible beam further including a pair of arms extending laterally therefrom; and an elongated rigid channel, wherein the elongated rigid channel has a substantially U-shaped transverse cross-sectional profile with a horizontal base wall and vertical side walls having a distal end portion and proximal end portion, wherein each vertical side wall defines a holding step formed in an upper edge thereof. The flexible beam and the channel are coupled to one another at their proximal end portions; and the pair of arms of the flexible beam are in registration with a corresponding holding step framed in the upper edge of the vertical side walls. 
     A proximal end portion of the pair of vertical side walls of the channel of the suture clip may include inwardly projecting lips for retaining the proximal end portion of the beam within the channel. The proximal end portions of the beam and channel may be adhesively coupled to one another. 
     The pair of arms of the flexible beam may project beyond the pair of vertical side walls of the channel. 
     According to a further aspect of the present disclosure, a suture clip applier system is provided and includes a suture clip applier for filing a suture clip onto a suture. The clip applier includes a housing; an elongated plunger slidably supported in the housing, the plunger having a distal end portion disposed within the housing and a proximal end portion extending from a proximal end of the housing; a hollow tube extending distally from the housing and defining a lumen therethrough; an actuation member having a distal end extending into the hollow tube and a proximal end operatively engaged with the plunger; and a working tip coupled to a distal end of the hollow tube. The working tip has a substantially U-shaped transverse cross-sectional profile defining a channel having a base wall and a pair of spaced apart side walls. The working tip defines a lower contact surface along an internal face of the base wall, and an upper contact surface defined along an upper end surface of each side wall. The upper contact surface of each side wall includes a distal recess formed near a distal end thereof and a proximal recess formed proximal of the distal recess; and an internal retaining surface on both side walls parallel to the base wall. The distal end of the actuation member is configured to engage a suture clip loaded into the working tip 
     The suture clip applier system further includes a suture clip loadable into and deployable from the working tip. The suture clip includes an elongated flexible beam having a distal end portion, a proximal end portion, a top surface and a bottom surface, the flexible beam further including a pair of arms extending laterally therefrom; and an elongated rigid channel, wherein the elongated rigid channel has a substantially U-shaped transverse cross-sectional profile with a horizontal base wall and vertical side walls having a distal end portion and proximal end portion, wherein each vertical side wall defines a holding step formed in an upper edge thereof. The flexible beam and the channel are coupled to one another at their proximal end portions. The pair of arms of the flexible beam are in registration with a corresponding holding step formed in the upper edge of the vertical side walls; and, in use, as the suture clip is urged in a distal direction relative to the working tip, the flexible beam is splayed apart from the channel to open the suture clip for receipt of a suture therein. 
     The plunger of the clip applier defines a race formed in a surface thereof, the race includes a plurality of portions each defining a cam surface of varying depth; and the clip applier includes a rocker arm having a distal end portion and proximal end portion, the rocker arm has a follower pin extending therefrom near the distal end portion thereof and a retaining pin near the proximal end portion thereof. The rocker arm is pivotally attached to the housing by the retaining pin and the follower pin is slidably disposed with in the race of the plunger to modulate the motion of the plunger and actuation member. 
     The race may define four interconnected cam portion, with each cam portion having a start position and an end position and each cam is deepest at its respective start position and shallowest at its respective end position. 
     The rocker arm of the clip applier may be elastically deformable laterally from the plunger thereby providing a biasing force upon the follower pin and plunger relative to the body. 
     The clip applier may further include a biasing member disposed within the housing and providing a proximal bias upon the plunger relative to the housing. The distal recess and the proximal recess formed in each vertical side wall may be interconnected by a camming surface. 
     A proximal end portion of the pair of vertical sides walls of the channel of the suture clip may include inwardly projecting lips for retaining the proximal end portion of the beam within the channel. The pair of arms of the suture clip may project beyond the pair of vertical side walls of the channel thereof. 
     According to yet another aspect of the present disclosure, a method of securing a suture through an incision is provided. The method includes the steps of providing a suture clip applier having a working tip configured to retain and fire a suture clip; providing a suture clip having a biased closed configuration; loading the suture clip into the working tip of the clip applier; translating the suture clip distally relative to the working tip to a first position wherein the suture clip is splayed open; inserting a suture into the opened suture clip; and translating the suture clip distally relative to the working tip such that the suture clip is ejected from the working tip and biased to the closed configuration to close on and to retain the suture. 
     According to still another embodiment of the present disclosure, a method of securing a suture through an incision is provided and includes the steps of providing a suture clip applier having a working tip, and providing a suture clip. The working tip of the suture clip has a substantially U-shaped transverse cross-sectional profile defining a channel having a base wall and a pair of spaced apart side walls. The working tip defines a lower contact surface along an internal face of the base wall; and an upper contact surface defined along an upper end surface of each side wall. The upper contact surface of each side wall includes a distal recess formed near a distal end of thereof and a proximal recess formed proximal of the distal recess; and an internal retaining surface projecting inwardly from both side walls of the channel. The suture clip includes an elongated flexible beam having a distal end portion, a proximal end portion, a top surface and a bottom surface, the flexible beam further including a pair of aims extending laterally therefrom; and an elongated rigid channel. The elongated rigid channel of the suture clip has a substantially U-shaped transverse cross-sectional profile with a horizontal base wall and a pair of spaced apart vertical side walls having a distal end portion and a proximal end portion. Each vertical side wall of the suture clip defines a holding step formed in an upper edge thereof. The flexible beam and the channel of the clip are coupled to one another at their proximal end portions; and the pair of arms of the flexible beam are in registration with a corresponding holding step formed in the upper edge of the vertical side walls of the channel of the clip. 
     The method further includes the steps of loading a suture clip into the working tip such that the vertical side walls of the clip channel abut the retaining surface of the working tip, and the laterally extending arms of the flexible beam rest in the proximal recess of the working tip; and translating the suture clip distally relative to the working tip such that the laterally extending arms of the suture clip are translated from the proximal recess of the working tip channel to the distal recess of the working tip while the clip channel is retained by the internal retaining surfaces of the working tip such that the distal ends of the flexible beam and the channel of the suture clip are separated to define an opening, and so that the distal end of the suture clip protrudes from the working tip. 
     The method further includes the steps of inserting a suture into the opening of the suture clip; and translating the suture clip distally relative to the working tip such that the suture clip is ejected from the working tip and the flexible beam and the channel of the clip are biased toward one another to close on and retain the suture. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present disclosure will be more fully appreciated as the same becomes better understood from the following detailed description when considered in connection with the following drawings, in which: 
         FIG. 1  is a perspective view of a clip applier according to an embodiment of the present disclosure; 
         FIG. 2  is a perspective view, with the parts separated, of the clip applier of  FIG. 1 ; 
         FIG. 2A  is an enlarged perspective view illustrating the connection of a crimp of an actuating member in a set screw; 
         FIG. 3  is an enlarged perspective view of the indicated area of detail of  FIG. 1 , illustrating a clip loaded in a distal end of the clip applier; 
         FIG. 4  is a perspective cut-away view of the clip applier of  FIG. 1 , illustrated with a body half-section removed therefrom; 
         FIG. 5  is an enlarged view of the proximal end portion of the suture clip applier of  FIG. 3 ; 
         FIG. 6  is an enlarged perspective view of a suture clip according to an embodiment of the present disclosure, for use in the clip applier of  FIGS. 1-5 ; 
         FIG. 7A  is an enlarged cross-sectional view of the working tip and clip according to section A of  FIG. 2 ; 
         FIG. 7B  is a side view of the working tip and clip of  FIG. 2 ; 
         FIGS. 8A-D  are schematic illustrations showing a sequence of operation of the clip applier of  FIGS. 1-5 ; 
         FIG. 9  is a perspective view of a clip applier according to another embodiment of the present disclosure including a hook-shaped working tip for use with a flat suture clip; 
         FIG. 10  is a perspective view of the hook-shaped working tip illustrating an attachment of the suture clip to a suture; 
         FIG. 11  is a perspective view of the suture clip shown secured upon a suture; 
         FIG. 12  is a perspective view of another embodiment of a spring clip according to the present disclosure and shown in its neutral position; 
         FIG. 13  is a perspective view of the suture clip of  FIG. 12  shown on a suture; and 
         FIG. 14  is a perspective view of a suture clip according to yet another embodiment of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     While embodiments of the present disclosure are susceptible to various modifications and alternative constructions, certain illustrated embodiments thereof have been shown in the drawings and will be described below in detail. It should be understood, however, that there is no intention to limit the embodiments of the present disclosure to the specific form disclosed, but, on the contrary, the embodiments are intended to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the present disclosure as defined in the claims. 
     While various embodiments of the invention are described herein, it is to be distinctly understood that this invention is not limited thereto but may be variously embodied to practice within the scope of the following claims. The present invention may be understood more readily by reference to the following detailed description of the invention taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this invention is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed invention. 
     The present disclosure relates to devices and methods for applying suture clips in an endoscopic, endoluminal, laparoscopic, or other surgical setting. Throughout the following description, the term “proximal,” will refer to the end of a device or system that is closest to the operator, while the term “distal” will refer to the end of the device or system that is farthest from the operator. 
     With reference to  FIGS. 1-7B , a clip applier, in accordance with the present disclosure, is generally designated as  100 . Clip applier  100  includes a body or housing  110 , a plunger  120  disposed substantially within body  110 , a hollow outer tube  160  extending from and operatively supported by body  110 , a working tip  140  supported on at a distal end of outer tube  160  and configured for operation on or with a suture clip  150 , and an actuation member  130  extending through body  110  and hollow outer tube  160  and coupled at a proximal end thereof to plunger  120 . 
     With reference to  FIGS. 1 ,  2  and  4 , body  110  is a hollow, elongated, annular member with a distal end portion  102  and proximal end portion  104  defining a longitudinal axis. The distal end portion  102  of body  110  has a frustoconical profile which narrows to define a distal opening  112   a  which is coincident with the exterior circumference of and supports a proximal end  160   b  of outer tube  160 . As seen in  FIG. 2 , body  110  may be formed in a pair of half-sections  110   a ,  110   b  that are joined to one another using know techniques in the art, such as, for example, gluing, welding, fastening and the like. 
     As shown in  FIGS. 1 and 2 , it is contemplated that a substantially frustoconical, hollow strain relief  116 , substantially composed of a complaint material, is disposed or supported at a distal end portion  102  of body  110 . Strain relief  116  is configured to permit outer tube  160  to pass therethrough in order to provide a bias to outer tube  160  in order to help maintain outer tube in substantially parallel relation with the longitudinal axis. 
     With further reference to  FIGS. 1 ,  2  and  4 , a proximal end portion  104  of body  110  further includes opposing co-planar annular projections defining finger engaging loops  114   a ,  114   b.    
     With reference to  FIG. 4 , plunger  120  is an elongated substantially cylindrical member defining a distal body portion  122  disposed within body  110  and a proximal end portion  123  projecting from the proximal end portion  104  of body  110 . Distal body portion  122  of plunger  120  has a pair of opposed, protruding, longitudinally extending rails  122   a  (see  FIG. 5 ) configured to be slidably retained within a complementary recess  110   c  (only one recess shown in  FIG. 2 ) formed in an internal face of body half  110   b  of body  110  so as to facilitate linear translation along the longitudinal axis of body  110 . 
     Proximal end portion  123  of plunger  120  protrudes from body  110 . Proximal end portion  123  of plunger  120 , which protrudes from body  110 , defines an actuation portion  123   a  which may be configured to be actuated by an operator&#39;s thumb, linear actuator, or other linear motion device known in the art. 
     Clip applier  100  includes a biasing member  118  disposed within body  110  and retained between the distal end of plunger  120  and an internal distal surface of body  110 . Biasing member  118  may be an elastically deformable helical coil which provides a biasing force upon plunger  120  relative to body  110 . 
     With reference to  FIGS. 4 and 5 , one or more sides of distal body portion  122  of plunger  120  are flattened to define a surface  122   b . Further, distal body portion  122  includes an audible/tactile feedback member defined by a race  124   e  formed in surface  122   b  of distal body portion  122 . Race  124   e  includes a series of cam channels  124   a - 124   d , each defining stepped or sloping cam surfaces  125   a - 125   d . The depth of cam channels  124   a - 124   d  is such that they are deepest at the furthest counter-clockwise point along their respective paths. Race  124   e  accommodates a follower pin  126  that is coupled to and projects traversely from an end of a rocker arm  128  which is itself pivotally connected to body  110  by a proximal pin  129 . Rocker arm  128  may be in the form of a biasing member, such as a leaf spring, to thereby exert a force upon follower pin  126  relative to body  110  so as to bias follower pin  126  against sloping cam surfaces  125   a - 125   d  of race  124   e  which provides control of the plunger stop positions as further detailed below. 
     The motion of plunger  120 , actuating member  130  and clip  150  are modulated by the travel of follower pin  126  through race  124   e . Plunger  120 , actuating member  130 , and clip  150  cannot be displaced until the proximal end portion  123  of plunger  120  is translated distally relative to body  110  by the operator, with sufficient force to overcome the biasing forces of biasing member  118  and rocker arm  128  and displace follower pin  126  along cam surfaces  125   a - 125   d  of race  124   e . When plunger  120  is so actuated, follower pin  126  is caused to travel clockwise through the aforementioned cams. As follower pin  126  translates along a particular cam channel  124   a - 124   d , respective cam surface  125   a - 125   d  urges follower pin  126  out of race  124   e  and exerts a biasing force on rocker arm  128 . As follower pin  126  passes from one cam channel  124   a - 124   d  to an adjacent cam channel  124   a - 124   d , across the step defined between adjacent cam surfaces  125   a - 125   d , the bias force of the rockers arm  128  drive follower pin  126  against a cam surface  125   a - 125   d , thereby creating an audible/tactile indication to the user. An audible/tactile indication may be provided for each stage of the firing sequence. 
     With reference to  FIGS. 1 and 2 , outer tube  160  of clip applier  100  is a hollow elongated tubular member including a distal end portion  160   a , a proximal end portion  160   b , and a lumen extending therethrough. Actuation member  130  is slidably disposed at least partially within the lumen of outer tube  160 . It is contemplated that outer tube  160  may be rigid or flexible. It is further contemplated that outer tube  160  is a hollow tube with a substantially elliptical or rectilinear traverse cross-sectional profile. 
     With continued reference to  FIGS. 1 and 2 , actuation member  130  of clip applier  100  is a solid shaft like member including a distal end portion  130   a  and a proximal end portion  130   b . As mentioned above, distal end portion  130   a  of actuation member  130  extends through the lumen of outer tube  160 , and proximal end portion  130   b  of actuation member  130  is connected or secured to distal body portion  122  of plunger  120 . 
     As seen in  FIGS. 2 ,  2 A,  4  and  5 , clip applier includes a set screw  170  disposed in plunger  120  and secured to actuation member  130 . In particular, set screw  170  defines a shaped cavity  170   a  configured to receive a stop or crimp  130   c  affixed to proximal end  130   b  of actuation member  130 , whereby set screw  170  is axially and rotatably fixed with respect to actuation member  130 . Additionally, a proximal end  160   c  of outer tube  160  is received and secured within a distal end of set screw  170 . It is contemplated that proximal end  160   c  of outer tube  160  is threadably connected to set screw  170 . In this manner, as set screw  170  is rotated with respected to outer tube  160 , outer tube  160  is axially displaced relative to actuation member  130 . In this manner, set screw  170  functions to enable fine tuning of the position of a distal tip or distal end portion  130   a  of actuation member  130  relative to distal end  160   a  of outer tube  160 . 
     With reference to  FIGS. 3 and 7A , working tip  140  of clip applier  100  is operatively supported at its proximal end portion  140   a  to a distal end  160   a  of outer hollow tube  160 . Working tip  140  has a substantially centrally disposed lumen  144  having a transverse cross-sectional profile, at the distal end of working tip  140 , that is configured to retain clip  150 . The shape of working tip  140  is described in greater detail hereinbelow. 
     With reference to  FIGS. 3 ,  7 A and  7 B, lumen  144  of working tip  140  is enclosed near a proximal end portion  140   b  thereof. Meanwhile, a distal end portion  140   a  of working tip  140  has been cut away to reveal or expose lumen  144 , thereby defining a channel  146  having a pair of contact or cam surfaces  141  along which a cross beam  155  of suture clip  150  can travel, as will be described in greater detail below. 
     With reference to  FIG. 7A , channel  146  of working tip  140  includes a base wall  146   a  and a pair of upstanding side walls  146   b ,  146   c . Each side wall  146   b ,  146   c  defines a respective ledge  146   d ,  146   e , extending into lumen  146  and extending substantially along the length of working tip  140 . 
     With reference to  FIG. 7B , upstanding side walls  146   b ,  146   c  have material removed therefrom defining a cam surface  141  along which traverse cross beams  155  of clip  150  can travel. Cam surface  141  includes, beginning with the proximal-most portion of the cam surface  141 , a proximal shoulder  141   a , a proximal retaining groove  141   b , a medial incline  141   c , a distal retaining groove  141   d , and a distal ejection shoulder  141   e.    
     As shown in  FIG. 6 , a suture clip  150 , according to the present disclosure, includes a clip beam  151  connected to a clip channel  152 . A distal end  152   a  of clip channel  152  has a substantially U-shaped traverse cross-sectional profile with a base wall  152   b  and a pair of spaced apart upstanding side walls  152   c ,  152   d . The upstanding side walls  152   c ,  152   d  of clip channel  152  each have a rounded forward edge  153 , a distal retaining step or shoulder  156 , and a clip beam recess  157  cut into the upper surface thereof. Clip channel  152  is dimensioned for slidable reception in lumen  144  of working tip  140  such that upstanding side walls  152   c ,  152   d  of clip channel  152  are disposed beneath ledges  146   d ,  146   e  of side walls  146   b ,  146   c  of channel  146  of working tip  140 . 
     Clip beam  151  has a pair of transverse cross beams  155  extending therefrom at a location disposed proximally from distal tip  154  of clip beam  153 . When the components of clip  150  are assembled, clip beam  151  is disposed between upstanding side walls  152   c ,  152   d  of clip channel  152 . Further, clip beam  151  and clip channel  152  are secured or coupled at their proximal ends and separable at their distal ends. The proximal ends of clip beam  151  and clip channel  152  are coupled to one another by retaining bends  158  extending from side walls  152   c ,  152   d . It is contemplated that the proximal ends of clip beam  151  and clip channel  152  may be coupled by a pin, chemical adhesive, weld, or other coupling or laminating method known in the art. 
     It is contemplated that clip beam  151  is constructed of a flexible, resilient, spring-like-material urging or biasing the assembled clip into a “closed” configuration wherein the distance between the distal ends of the clip beam  151  and clip channel  152  is minimized. It is further contemplated that clip beam  151  may be substantially composed of a permanent material such as a metal (stainless steel or titanium) or a polymer, or a non-permanent material such as bio-absorbable natural or manmade polymer. 
     Referring now to  FIGS. 8A-8D , a method of using clip applier  100  and suture clip  150  is shown and will be discussed. Initially, as shown in  FIG. 8A , a clip  150  is placed or loaded into the lumen  144  of the working tip  140  either by manually inserting clip  150  or by an automatic dispensing mechanism such that the proximal end of clip  150  abuts the distal end of the actuation member  130  and the lateral cross beams  155  of clip  150  rest within cam surfaces  141  of working tip  140 . In particular, lateral cross-beams  155  of clip  150  rest in the nadir  141   b  of cam surfaces  141 , between a proximal shoulder  141   a  and medial incline  141   c  of cam surface  141 . In this initial configuration, plunger  122  is disposed at a proximal most position relative to body  110  such that follower pin  126  is disposed in a first cam channel portion  124   a  of race  124   e  (see  FIG. 5 ). 
     Next, as shown in  FIGS. 5 and 8B , as plunger  120  is depressed (i.e., translated distally relative to body  110 ), follower pin  126  is translated through race  124   e  from first cam channel portion  124   a  to second cam channel portion  124   b . As follower pin  126  is translated from first cam channel portion  124   a  to second cam channel portion  124   b , an audible/tactile indication is created, in the manner described above. 
     By depressing plunger  120  to translate plunger  120  distally, actuation member  130  is also translated distally which translates clip  150  distally such that cross-beam  155  is disposed upon distal retaining groove  141   d  of cam surfaces  141  of working tip  140 . The translation of cross beam  155  to distal retaining groove  141   d  urges clip beam  151  away from beam channel  152  which is retained by ledges  146   d ,  146   e . This separates distal beam tip  154  from clip channel  152  to define opening  127  exposing suture retaining step  156 . 
     Next, as shown in  FIG. 8C , clip applier  100  is maneuvered to capture a suture  131  in opening  127  or a suture  131  is moved into opening  127 . With suture  131  disposed within opening  127 , plunger  120  is further depressed (i.e., translated distally relative to body  110 ), thereby translating follower pin  126  through race  124   e  from second cam channel portion  124   b  to third cam channel portion  124   c . As follower pin  126  is translated from second cam channel portion  124   b  to third cam channel portion  124   c , an audible/tactile indication is created, in the manner described above. As plunger  120  is further depressed, actuating member  130  is further translated in a distal direction thereby translating clip  150  distally until cross beams  155  are moved onto respecting distal ejection shoulders  141   e  of working tip  140 , thus partially closing clip  150  (i.e., approximating clip beam  151  and clip channel  152 ) onto suture  131 . 
     Next, as plunger  120  is fully depressed, follower pin  126  is translated from third cam channel portion  124   c  to fourth channel portion  124   d . As follower pin  126  is translated from third cam channel portion  124   c  to fourth cam channel portion  124   d , an audible/tactile indication is created, in the manner described above. As plunger  120  is fully depressed, actuating member  130  is fully translated in a distal direction to a distal-most portion of its stroke and ejecting clip  150  from the working tip  140 . As clip  150  is fully ejected, suture  131  is captured between clip beam  151  and clip channel  152  of clip  150 . 
     Finally, as shown in  FIG. 8D , after clip  150  has been ejected from working tip  140  of clip applier  100 , clip  150  securely holds a suture  131  between clip channel  151  and clip beam  152 . 
     Turning now to  FIGS. 9-11 , an embodiment of a suture clip  250  and a working tip  240  for a clip applier, according to another embodiment of the present disclosure, is shown and described. Working tip  240  has a substantially hook-like profile. In particular, with reference to  FIG. 9 , the hook-like profile of working tip  240  includes a transverse recess or notch  242  defined by a pair of coincident curved surfaces  242   a ,  242   b , wherein recess  242  is angled or oriented so as to define a proximally extending hook  244 . As shown in  FIG. 9 , working tip  240  further defines a longitudinally axially extending slot  246  configured and dimensioned to receive suture clip  250  therein. 
     As shown in  FIG. 11 , suture clip  250  has a substantially rectangular, flattened profile having a distal end portion and proximal end portion. Suture clip  250  includes a pair of spaced apart legs  252 ,  254  joined to one another by a crown or backspan  256 . Legs  252 ,  254  are separated from one another to define a slot  258  therebetween. Each leg  252 ,  254  includes a respective angled surface  252   a ,  254   a  thereby defining a widened mouth or entry  258   a  of slot  258  for better receiving a suture  131  therein. A proximal end of slot  258  is dimensioned so as to cinch and retain suture  131  therein. Backspan  256  of suture clip  250  may have a generally V-shaped profile. 
     In use, as shown in  FIGS. 9 and 10 , with suture clip  250  loaded into slot  246  of working tip  240 , such that mouth  258   a  of suture clip  250  is disposed proximal of notch  242  of working tip  240 , a suture  131  is placed into notch  242  of working tip  240 . Preferably, suture  131  is disposed at a base of notch  242 . With suture  131  so positioned, an actuating member of the clip applier is manipulated to engage suture clip  250  and urge suture clip  250  in a distal direction. Suture clip  250  is translated distally such that suture is first received in mouth  258   a  and then advanced into the proximal end of slot  258  of suture clip  250 . With suture clip  250  secured to suture  131 , the actuation member of the clip applier may be retracted and working tip  240  may be disengaged from suture clip  250 . 
     Turning now to  FIGS. 12 and 13 , another embodiment of a suture clip, according to the present disclosure, is generally designated as suture clip  350 . Suture clip  350  includes a leaf spring  351 , a beam  352 , and a lever  353 . The leaf spring  351  is fixably attached to a proximal end  352   b  of beam  352  by, for example, a weld. Meanwhile, leaf spring  351  is fixably attached to a distal end  353   a  of lever  353  by, for example, a weld. Beam  352  defines a traverse groove  352   c  formed near distal end  353   a  and being configured to receive a suture therein. It is further contemplated that the attachment of beam  352  to lever  353  and leaf spring  351  may be achieved using a pin, staple, chemical adhesive or other attachment method known in the art. 
     As shown in  FIG. 12 , in its neutral configuration or at rest, leaf spring  351  maintains the distal ends  352   a ,  353   a  of beam  352  and lever  353  in contact with one another and maintains the proximal ends  352   b ,  353   b  of beam  352  and lever  353  separate from one another. With reference to  FIG. 13 , when a compressive force is applied to proximal ends  352   b ,  353   b  of beam  352  and lever  353 , the distal ends  352   c  of beam  352  and lever  353  are separated from one another to open suture clip  350  and define a suture entry area  355 . With suture clip  350  in an open condition, a suture  131  may be inserted through suture entry area  355  and captured into the suture retaining groove  352   d  of beam  352 . Once the compressive force is removed, leaf spring acts on beam  352  and lever  353  to close the suture retaining area  355  and secure the suture therebetween. 
     Turning now to  FIG. 14 , yet another embodiment of a suture clip, according to the present disclosure, is generally designated as suture clip  450 . Suture clip  450  includes a backspan or crown  452  and a pair of spaced apart legs  454 ,  456  extending therefrom, with each leg  454 ,  456  being divided into a pair of spaced apart first and second legs  454   a ,  454   b , and first and second legs  456   a ,  456   b , respectively. 
     As seen in  FIG. 14 , first and second legs  454   a ,  454   b  of leg  454  are separated from one another by a relatively smooth longitudinally extending slot  454   c . First and second legs  456   a ,  456   b  of leg  456  are separated from one another by a relatively smooth longitudinally extending slot  456   c.    
     Further as seen in  FIG. 14 , first leg  454   a  of leg  454  and first leg  456   a  of leg  456  are separated from one another by a longitudinally extending slot  458  having an undulating or sinusoidal profile. Also, second leg  454   b  of leg  454  and second leg  456   b  of leg  456  are separated from one another by a longitudinally extending slot  460  having an undulating or sinusoidal profile. 
     Suture clip  450  further includes a pair of longitudinally extending channels  462 ,  464  formed in opposed outer surfaces thereof and extending along an entire length thereof. Each channel  462 ,  464  is defined by a pair of opposed ledges or shoulders  462   a ,  462   b  and  464   a ,  464   b , respectively. Each ledge or shoulder  462   a ,  462   b  and  464   a ,  464   b  of respective channel  462 ,  464  includes a respective cam surface  463   a ,  463   b  (the cam surfaces of ledge or shoulder  464   a ,  464   b  not being visible in  FIG. 14 ) projecting towards one another. 
     As shown in  FIG. 14  and as can be appreciated by one skilled in the art, suture clip  450  may be used with a clip applier that is configured to bias leg  454  and leg  456  apart from one another to receive a suture  131  therebetween. It is contemplated that as suture clip  450  is advanced in a distal direction relative to the clip applier that legs  454 ,  456  may be biased apart from one another as the cam surfaces  463   a ,  463   b  of legs  454   b ,  456   b  and the cam surfaces of legs  454   a ,  456   a  ride against a corresponding cam surface of the clip applier. 
     Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure. 
     Those skilled in the art, having the benefit of the teachings of the present invention as herein and above set forth, may effect modifications thereto. Such modifications are to be construed as lying within the scope of the present invention, as defined by the appended claims. 
     Although specific features of the suture clip applier are shown in some of the drawings and not in others, this is for convenience only as each feature may be combined with any or all of the other features in accordance with the aspects of the present disclosure. Other embodiments will occur to those skilled in the art and are within the following claims. 
     It is to be understood that the illustrated embodiments are for the purpose of example, and that numerous other configurations of wound dressing systems having a plurality of beads exist. Accordingly, the illustrated and described embodiments are not intended to limit the scope of the inventive subject matter only to those embodiments.