Patent Publication Number: US-2015073440-A1

Title: Suture collector

Description:
BACKGROUND 
     1. Field 
     The present disclosure relates surgical procedures and devices, for example, surgical devices for managing sutures. 
     2. Description of the Related Art 
     Sutures are widely used in many types of surgical procedures to pull severed tissues, such as muscles, nerves, and skins and tendons, away from the surgery site. Typically, multiple sutures are used in such procedures. In some instances, it can be difficult to keep the individual sutures separated and valuable time can be lost in untangling the sutures. Also, it can be difficult for surgeons to locate the proper suture pairs which are to be tied and knotted if the sutures are not properly organized. To aid the surgeons, a number of suture organizers have been developed. The most common of which is known as the Gabbay-Frater organizer. Examples of this type of device include suture organizers that are specific for heart surgery as described in U.S. Pat. Nos. 4,185,636 and 4,492,229. There is a need to provide a new and improved device for organizing and/or collecting sutures, in particular multiple sutures. 
     SUMMARY 
     Some embodiments disclosed herein include a surgical device for managing sutures surrounding a surgical site, the device comprising a suture collecting member configured to receive and releasably hold at least two surgical sutures, and wherein the device is movable relative to the surgical site. 
     In some embodiments the suture collecting member comprises at least one suture holder configured to receive and releasably hold at least one surgical suture. 
     In some embodiments the suture holder comprises at least one extension spring. In some embodiments the suture holder comprises at least one slit or clasp. 
     In some embodiments the suture collecting member comprises at least two clamp arms, with at least two of the clamp arms that are movable relative to one another. 
     In some embodiments at least one of the clamp arms is rigid. In some embodiments at least one of the clamp arms is flexible. 
     In some embodiments at least two of the clamp arms are substantially parallel to each other. In some embodiments at least two of the clamp arms are pivotally connected. 
     In some embodiments, the suture collecting member has a shape selected from the group consisting of rectangle, triangle, C-shape, U-shape, and O-shape. In some embodiments the clamp arms are shaped so as to surround an opening configured to accommodate the surgical site. 
     In some embodiments the diameter of the opening is not greater than 30 cm. In other embodiments, the diameter of the opening is about 1 cm to about 10 cm. In still other embodiments, the diameter of the opening is about 50 mm to about 1 μm. 
     In some embodiments the surgical site is a site for intestinal anastomosis, debridement, or anastomosis of blood vessels. 
     In some embodiments the clamp arms are pivotally connected to one another in the hinge region. 
     In some embodiments the surgical device comprises two handle arms pivotally connected to one another in the hinge region, wherein each of the handle arms comprising an articulating region along an end portion thereof. 
     In some embodiments the angle between the handle portion and the suture collecting member is about 90° to about 180°. 
     In some embodiments the articulating region comprises a loop sized to accommodate a thumb or a finger. 
     In some embodiments the clamp arms have opposing end regions and are movable between opened and closed configurations, where the opposing end regions contact one another when the clamp arms are in the closed configuration, and where at least one clamp arm comprises at least one suture holder. 
     In some embodiments the surgical device comprises a locking device for securing the clamp arms in one or more locked positions between the opened and closed configurations. In some embodiments the locking device is incorporated into the handle portion. 
     In some embodiments the clamp arms comprise an engaging surface configured to engage a living tissue. 
     In some embodiments the device is made of a sterilizable material. In some embodiments the sterilizable material is selected from the group consisting of stainless steel, titanium, plastic, silicon rubber, aluminum, hydronalium, polymers, carbon fiber, composite materials composed of those above-mentioned materials. 
     In some embodiments the surgical device comprises a handle portion with two handle arms pivotally connected to one another in a hinge region, and each handle arm comprises an articulating region along an end portion thereof. In some embodiments the clamp portion comprises two clamp arms pivotally connected to one another in the hinge region and having opposing end regions, the clamp arms are movable between opened and closed configurations, the opposing end regions contact one another when the clamp arms are in the closed configuration, and the clamp arms are shaped so as to surround an opening formed therebetween when the clamp arms are in the closed configuration. In some embodiments the opening is configured to accommodate a site on a patient, where each of the clamp arms comprises a suture collecting member, and where the suture collecting member is configured to receive and releasably hold two or more sutures. In some embodiments the surgical device comprises a locking device for securing the clamp arms in one or more locked positions between the opened and closed configurations. 
     Some embodiments disclosed herein include a surgical device kit, where the kit comprises: at least one surgical device for managing sutures surrounding a surgical site, the device comprises a suture collecting member configured to receive and releasably hold at least two surgical sutures, and wherein the device is movable relative to the surgical site, at least one suture, at least one suture needle, at least one suture holder, and instructions for using the surgical device, wherein the surgical device kit is contained in a package which maintains a sterile environment for the at least one surgical device, at least one suture, at least one suture needle, and at least one suture holder. 
     In some embodiments, the suture collecting member comprises at least one suture holder configured to receive and releasably hold at least one surgical suture. 
     In some embodiments, the suture holder comprises at least one extension spring. In some embodiments, the suture holder comprises at least one slit or clasp. 
     In some embodiments, the suture collecting member comprises at least two clamp arms, wherein at least two of the clamp arms are moveable relative to one another. 
     Some embodiments disclosed herein include a method for suturing a site on a patient, where the method comprises: providing a surgical device comprising a suture collecting member, where the suture collecting member is configured to receive and releasably hold two or more surgical sutures, and where the device is movable relative to the site; positioning the device along a perimeter of the site; deploying a first suture at a first position at the site and threading a free end of the first suture into a first receiving region of the suture collecting member; deploying a second suture at a second position at the site and threading a free end of the second suture into a second receiving region of the suture collecting member; and cutting the first and second sutures at the site, such that the free ends of the first and second sutures remain releasably held by the suture collecting member. 
     In some embodiments, the method for suturing a site comprises providing the suture collecting member which comprises one or more suture holders, where each suture holder is configured to receive and releasably hold one or more surgical sutures. 
     In some embodiments, the method for suturing a site comprises providing a surgical device further comprising a surgical clamp, where the surgical clamp comprises pivotally connected clamp arms having opposing end regions, where the clamp arms are movable between opened and closed configurations, and where the opposing end regions contact one another when the clamp arms are in the closed configuration, and wherein at least one clamp arm comprises one or more suture holders. 
     In some embodiments the method for suturing a site further comprises moving the device along with the suture releasably held by the suture collecting member away from the patient to tighten the suture. 
     In some embodiments the method for suturing a site further comprises moving the surgical clamp between opened and closed configurations to tighten or loosen the suture. 
     In some embodiments the method for suturing a site is used at a debridement site. 
     In some embodiments the method for suturing a site further comprises moving the device along with the suture releasably held by the suture collecting member so that the tissue around the debridement site is pulled up to accommodate an insertion of gauze into the debridement site. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  depicts a perspective view of an embodiment of the suture collector in a closed configuration. 
         FIG. 1B  depicts a side view of an embodiment of a suture holder. 
         FIG. 2  depicts a perspective view of an embodiment of the suture collector in an opened configuration. 
         FIG. 3  depicts a perspective view of an embodiment of the suture collector with a triangle shaped suture collecting member. 
         FIG. 4A  depicts a perspective view of an embodiment of the clamp region and suture collecting member in a closed configuration 
         FIG. 4B  depicts a perspective view of an embodiment of the clamp region and a slideable suture collecting member in an open position. 
         FIG. 5A  depicts a top view of an embodiment of the suture collecting member retaining sutures at a surgical site. 
         FIG. 5B  depicts a side view of an embodiment of a suture holder. 
         FIG. 6  depicts a perspective view of an embodiment of the suture collecting member having slit-type suture holders. 
         FIG. 7A  depicts a perspective view of an embodiment of the suture collecting member having clasp-type suture holders. 
         FIG. 7B  depicts a cross-sectional view of an embodiment of the suture collecting member having clasp-type suture holders. 
     
    
    
     DETAILED DESCRIPTION 
     In the following detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. Other embodiments may be utilized, and other changes may be made, without departing from the spirit or scope of the subject matter presented herein. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are explicitly contemplated herein. 
     Disclosed in the present application are surgical devices that can be used for managing and/or collecting sutures during a surgical procedure. In some embodiments, the surgical devices are used to manage and/or collect multiple sutures surrounding a surgical site. The present disclosure also relates to methods of suturing a site on a patient by using any of the surgical devices disclosed herein. 
     As described herein, the surgical device can include a suture collecting member configured to receive and hold at least two surgical sutures. In some embodiments, the suture collecting member can releasably hold at least two surgical sutures. In some embodiments, the device is movable relative to the surgical site. In some embodiments, the suture holder comprises at least one helical spring, for example an extension spring. In some embodiments, the suture holder comprises at least one slit or clasp to hold the suture. In some embodiments, the suture collecting member can include at least two clamp arms, where at least two of the clamp arms are movable relative to one another. In some embodiments, the surgical device may be made of a reusable sterilizable material, or of sterile disposable material, such as plastic, as in the case of a single-use surgical device. In some embodiments the surgical device may be sterile or it may be sterilized by a user prior to use. 
     Although certain embodiments of the present invention are shown and described in detail, it should be understood that various changes and modifications may be made without departing from the scope of the appended claims. The scope of the present application is in no way be limited to the number of constituting components, the materials thereof, the quantities thereof, the relative arrangement thereof, etc. 
     In some embodiments, a suture collector provides a user with the ability to hold multiple sutures (for example, two or more sutures) in place while performing medical procedures, such as, but not limited to, intestinal, vascular, or portacaval anastomosis procedures, wound debridement, resection of small intestines or a coarctation of the aorta, repair of indirect inguinal hernia, connecting artificial valves to the natural annulus of the heart valve, surgical implantations, or any other procedures in which holding multiple sutures in place may be advantageous. By way of a non-limiting example, a user of an embodiment of a suture collector may be a surgeon, surgical assistant, doctor, nurse, emergency medical technician, dentist, plastic surgeon, physician&#39;s assistant, or similar person. Additionally, suture collector may be positioned near a surgical site and be supported in place by resting directly on a surgical site or other object or by clamp, harness, restraint, apparatus, capable of supporting a suture collector at a surgical site. 
       FIG. 1A  illustrates a perspective view of an embodiment of a suture collector  100  in a closed configuration. Referring to  FIG. 1A , a suture collector  100  comprises a handle region  110 , a hinge region  115 , and a clamp region  120 . The handle region comprises two handles  141  and  142 , which can be manipulated by a user. Handles  141  and  142  may be formed such that they form loop structures  151  which provide a user the ability to comfortably manipulate handles  141  and  142 . Loop structures  151  may be shaped or sized to accommodate the fingers or thumb of a user. Skilled artisans will appreciate that any other configurations that facilitate user manipulation, besides or in addition to a loop, may be employed. In a non-limiting illustrated embodiment, handle region  110  further comprises a locking arm  160  which may be integrally formed with handle  141 , or may be attached to handle  141  at an attachment point  165 . The locking arm  160  may be attached at attachment point  165  by a rivet, a screw, or other similar attachment device, or may be welded, brazed, or otherwise similarly attached. Alternatively, locking arm  160  may be disposed in the clamp region  120  and may be attached thereon as described above. Locking arm  160  has a locking surface  161  which makes contact with handle  142  such that handles  141  and  142  are releasably held in place relative to each other due to the surface interactions of handle  142  and locking surface  161 . Locking surface  161  may comprise one or more ratcheting teeth positioned such that the teeth releasably lock against handle  142 , or locking surface  161  may comprise an engraved, marked, grooved, embossed, or similar surface so that the frictional forces created between locking surface  161  and handle  142  are sufficient to releasably lock handle  141  and  142  relative to each other. 
     Hinge region  115  comprises a pivot point  130  which attaches the two handles together and acts as a fulcrum when the handles are manipulated. Pivot point  130  may be a hinge, rivet, pin, bearing, or other similar structure that allows for movement of the handles relative to each other, around a fulcrum. Locking arm  160  provides the user the ability to lock handles  141  and  142  such that clamp arms  125  and  126  can be held in direct contact or close proximity at one extreme of the pivoting range, and apart from each other at the other extreme of the pivoting range. 
     Clamp region  120  comprises at least two clamp arms and a suture collecting member. Clamp arms  125  and  126  are individually attached to either handle  141  or  142  at pivot point  130 . Clamp arms  125  and  126  may be formed of rigid material, or may be of a flexible material with sufficient resilience to provide a stable structure for supporting sutures at a surgical site. Clamp arms  125  and  126  may be integrally formed pieces with handles  141  and  142 , or may be attached to handles  141  and  142  using a screw, rivet, weld, or other similar attaching method. Clamp arms  125  and  126  are individually attached to handles  141  and  142  respectively at pivot point  130  such that manipulation of handles  141  and  142  causes movement of clamp arms  125  and  126 . For example, manipulation of the handles away from one another in the same plane causes clamp arms  125  and  126  to move toward one another in the same plane. Manipulation of the handles toward one another in the same plane causes clamp arms  125  and  126  to move away from one another in the same plane. It will be appreciated by skilled artisans that handles  141  and  142  may be attached at pivot point  130  to clamp arms  125  and  126  respectively in a variety of ways, not limited to that described above. Clamp arms  125  and  126  are shaped to create a void region  135  bounded by the inner engaging surface  127  of clamp arms  125  and  126  into which the target of the suture (not shown) can be placed. By way of non-limiting example, the target of the suture may be tissue at a wound site, skin, an internal body structure such as an intestine, artery, or blood vessel or other organ structure or part. Clamp arms  125  and  126  may be formed to create a void region  135  which can be ovoid, elliptical, circular, rectangular, square, teardrop, C-shaped, U-shaped, or other shape suitable for enclosing the target of the sutures. Clamp arms  125  and  126  may be sized such that the diameter of void region  135  varies according to the ideal size for a particular surgical application. For example, some embodiments of suture collector  100  may have a void region with a diameter of about 30 centimeters or less. In some embodiments the diameter of the opening is about 220 cm. In other embodiments the diameter of the opening is about 100 cm to about 200 cm. In other embodiments, the diameter of the opening is about 30 cm to 100 cm. In other embodiments, the diameter of the opening is about 10 cm to 30 cm. In other embodiments, the diameter of the opening is about 1 cm to about 10 cm. In still other embodiments, the diameter of the opening is about 50 mm to about 1 μm. These sizes are exemplary only and are not intended to limit the size of suture collector  100 . Some embodiments may have a void region with a diameter of about 1 to about 10 centimeters. Some embodiments may have void regions with a diameter of about 1 micrometer to about 50 millimeters. For void region shapes which are substantially non-circular, the diameter of a void region may be measured across the longest dimension of the void region. 
     Suture collecting members  111  and  112  are attached to clamp arm surfaces  121  and  122  such that suture collecting members  111  and  112  may move with their respective clamp arms as handles  141  and  142  are manipulated around pivot point  130 . In some embodiments, the suture collecting members can be fixedly attached to clamp arm surfaces in, e.g., disposable or reusable and sterilizable embodiments of the device. In some embodiments, the suture collecting members can be releasably attached to clamp arm surfaces, such that the suture collecting members can be replaced, e.g., where different sized interstices may be desired to accommodate different sized sutures, or where a suture collecting member may fail to provide a secure suture grip. Suture collecting members  111  and  112  may be positioned on clamp arm surfaces  121  and  122 , follow the general contour of clamp arms  125  and  126 , and provide an array of sites to releasably hold one or more surgical sutures. Because suture collecting members  111  and  112  generally follow the contour of clamp arms  125  and  126 , the shape of suture collecting members may vary as the shape of the clamp arms varies. Suture collecting members  111  and  112  may comprise an extension spring  113  as depicted in  FIG. 1B , which is formed with loops or coils wound with interstices sized to allow the extension spring  113  to act as a suture holder, releasably holding one or more surgical sutures placed into the interstices between spring windings or coils. Or, extending the extension spring  113  may allow for one or more sutures to be threaded therethrough in a tortuous path between the windings or coils of extension spring  113 . Relaxing the extension spring  113 , may provide a clamping action upon the sutures. Extension spring  113  can be formed of any nontoxic, noncorrosive material, such as molded plastic or stainless steel. Other configurations besides extension springs may be used as the suture holders. Suture collecting members  111  and  112  are not limited to a single suture holder  113 ; a plurality of suture holders can be included in the suture collecting members. 
     In one embodiment, the suture collector  100  may be used, for example in performing an intestinal anastomosis. The user manipulates handles  141  and  142  causing clamp arms  125  and  126  to move relative to the handles through pivot point  130 . The user manipulates handles  141  and  142  toward one another in a common plane, thereby moving clamp arm tips  123  and  124  away from each other. The surgical site along the intestine for the anastomosis procedure is positioned within the void region  135  bounded by inner surface  127 . Once the surgical site is within the void region  135 , handles  141  and  142  are manipulated away from one another in a common plane, thereby causing clamp arm ends  123  and  124  to move toward each other into direct contact or close proximity with one another. As handles  141  and  142  are manipulated, locking surface  161  may ratchet or slide along handle  142 , and once handles  141  and  142  are in the position desired by the user, locking surface  161  will provide sufficient force to hold handles  141  and  142  in the position desired. As sutures are deployed, a needle end of the suture is sown through the tissue layers to be joined and tied off, and the free end of the suture is placed or threaded into a receiving region of the suture collecting member  111  or  112  where it is releasably held by extension spring  113 , thereby providing tension on the suture and support for the target of the suture while other sutures are performed. If a user desires more or less tension on the suture, handles  141  or  142  may be manipulated to widen or narrow the distance between clamp arm ends  123  and  124  thereby changing the tension on the sutures. Handles  141  and  142  are then re-locked into position via the force of the locking surface  161  on handle  142 . Using suture collector  100 , sutures can be placed around substantially the entirety of the target of the suture, utilizing the array of holding sites in spring coils  113  on suture collecting members  111  and  112 . 
     In some embodiments, the clamp arms are movable between opened and closed configurations. For example,  FIG. 2  depicts a perspective view of a suture collector  200  in an opened configuration. Suture collector  200  provides a user with the ability to hold multiple sutures in place while performing medical procedures, such as, but not limited to, intestinal or vascular anastomosis procedures, wound debridement, or any other procedures in which holding multiple sutures in place may be advantageous. Referring to  FIG. 2 , a suture collector  200  comprises a handle region  210 , a hinge region  215 , and a clamp region  220 . The handle region comprises two handles  241  and  242 , which can be manipulated by a user. Handles  241  and  242  may be formed such that they create loop structures  251  similar to those described elsewhere herein. In the illustrated embodiment, handle region  210  further comprises a locking arm  260  which may be formed with or attached to handle  241  as described elsewhere herein. Locking arm  260  has a locking notch  262  which is sized to accept handle  242  as handles  241  and  242  are manipulated toward one another. Locking notch  262  has an interior surface which may be engraved, marked, grooved, embossed, or similarly surfaced such that handles  241  and  242  are held in place relative to each other due to the surface interactions of handle  242  and the interior surface of locking notch  262 . Pivot point  230  attaches the two handles together and acts as a fulcrum when the handles are manipulated. The pivot point, as depicted, is a pin, but pivot point  230  may also be a hinge, rivet, bearing, or other similar structure that allows for movement of the handles relative to each other around a fulcrum 
     Clamp region  220  comprises at least two clamp arms and at least one suture collecting member. Clamp arms  225  and  226  are individually attached to either handle  241  or  242  at pivot point  230 . Clamp arms  225  and  226 , by way of example, are depicted as integrally formed pieces with handles  241  and  242 . Clamp arms  225  and  226  may also be attached to handles  241  and  242  as described elsewhere herein. Clamp arm  225  is attached to handle  242  and clamp arm  226  is attached to handle  241  at pivot point  230  such that manipulation of handles  241  and  242  causes movement of clamp arms  225  and  226 . For example, manipulation of the handles toward one another in the same plane causes clamp arms  225  and  226  to move toward one another in the same plane. Manipulation of the handles away from one another in the same plane causes clamp arms  225  and  226  to move away from one another in the same plane. It will be appreciated by a skilled artisan that handles  241  and  242  may be attached at pivot point  230  to clamp arms  225  and  226  respectively in a variety of ways, not limited to that described above. Clamp arms  225  and  226  and suture collecting members  211  and  212  may be constructed and operate as described elsewhere herein. 
     In some embodiments, the clamp arms may be of varying shapes and the handles may be disposed in a plane other than that in which the clamp arms and suture collecting members are disposed. To illustrate,  FIG. 3  depicts a perspective view of a suture collector with a triangle-shaped suture collecting member. Suture collector  300  provides a user with the ability to hold multiple sutures in place while performing medical procedures, such as, but not limited to, intestinal or vascular anastomosis procedures, wound debridement, or any other procedures in which holding multiple sutures in place may be advantageous. Referring to  FIG. 3 , a suture collector  300  comprises a handle region  310 , a hinge region  315 , and a clamp region  320 . The handle region comprises two handles  341  and  342 , which can be manipulated by a user. Handles  341  and  342  may be formed and function as described elsewhere herein. In the illustrated embodiment, handle region  310  attaches to clamp region  320  via pivot point  330 . Pivot point  330  may be constructed or operate as described elsewhere herein. 
     Clamp region  320  comprises two clamp arms and a suture collecting member. Clamp arms  325  and  326  are individually attached to either handle  341  or  342  at pivot point  330 . Clamp arms  325  and  326  may be integrally formed pieces with handles  341  and  342 , or may be attached to handles  341  and  342  as described elsewhere herein. Clamp arms  325  and  326  are individually attached to handles  341  and  342  respectively at pivot point  330  such that handles  341  and  342  extend in a plane other than that containing clamp arms  325  and  326  and suture collecting members  311  and  312 . For example, as illustrated, handles  341  and  342  extend upward at an angle out of the plane in which clamp arms  325  and  326  are disposed. It will be appreciated that handle angles other than those depicted are possible, selected based on comfort of a user or ease of positioning suture collector  300  as desired at a surgical site. For example, handles  341  and  342  may extend out of the plane of clamp arms  325  and  326  at nearly any angle, for example, about 0°, about 5°, about 10°, about 15°, about 20°, about 25°, about 30°, about 35°, about 40°, about 45°, about 50°, about 60°, about 70°, about 80°, about 90°, about 100°, about 110°, about 120°, about 130°, about 140°, about 150°, about 160°, about 170°, or about 180°, or a range between any two of these values. Furthermore, although not depicted, handles  341  may extend at an angle upward from the plane wherein clamp arms  325  and  326  are disposed, and the portion of handles  341  and  342  which form loops  351  may be disposed at an angle away from the plane of handles  341  and  342 , such as in a plane parallel to the plane wherein clamp arms  325  and  326  are disposed. Clamp arms  325  and  326  are shaped to create a void region  335  bounded by the inner engaging surface  327  of clamp arms  325  and  326  into which the target of the suture (not shown) can be placed. As illustrated, clamp arms  325  and  326  may be formed to create a triangular void region  335 . However, it will be appreciated that the void region  335  could be ovoid, circular, rectangular, square, teardrop, or other shape suitable for enclosing the target of the sutures. 
       FIGS. 4A and 4B  depict a perspective view of a slideable suture collecting member in a closed and open position, respectively. Referring to  FIGS. 4A and 4B , the clamp arms  425  and  426  are shaped such that inner surface  427  defines a square-shaped void region  435 . Clamp arms  425  and  426  may be attached to handles as described elsewhere herein. The suture collecting members  411  and  412  are positioned along clamp arms  425  and  426  as described elsewhere herein. When clamp arms  425  and  426  are manipulated, clamp arms  425  and  426  move away from each other in the same plane, along a common axis as indicated in  FIG. 4B . Clamp arms  425  and  426  may be substantially hollow such that slide rail  440  is disposed within clamp arm ends  423  and  424 . Slide rail  440  may have a stopping member which prevents slide rail  440  from being completely removed from clamp arm ends  423  and  424 , thereby providing a maximum axial range of motion of clamp arm ends  425  and  426 . The stopping member may be a tab, groove, or dimensional difference which retains stopping member within clamp arm ends  423  and  424 . 
     In some embodiments, the suture collecting member may be an extension spring which is able to releasably retain at least one suture or, alternatively, a plurality of sutures, as described elsewhere herein.  FIG. 5  depicts a top view of a suture collecting member retaining sutures at a surgical site. Referring to  FIG. 5 , clamp region  520  is positioned at a surgical site. The target  550  of the suture  555  is enclosed within void region  535 . Sutures  555  are deployed around the target  550 . As sutures are deployed, the needle end  556  of suture  555  is sown through target  550  and tied. The free end  557  of suture  555  is placed into suture collecting member  511  or  512  where it is releasably held by extension spring  513 . Extension spring  513 , as depicted in  FIG. 513 , releasably holds and provides tension on the free end  557  of suture  555 , allowing suture  555  to provide support for the target of the suture  550  while other sutures are performed. Suture collecting members  511  and  512  substantially surround target of the suture  550 , enabling multiple sutures to be performed without using a multiplicity of instruments, and allowing for organized and efficient support of sutures  555  while the necessary sutures are deployed. While sutures  555  are retained within suture collecting member  511  and  512 , the suture collecting members may be moved in relation to the surgical site such that sutures  555  relax or are placed under greater tension. Lifting suture collecting members  511  and  512  away from the surgical site placing the sutures under greater tension may tend to separate and organize sutures  555 , preventing them from becoming tangled with each other or falling into the surgical site. Organizing sutures  555  may simplify a suturing procedure by keeping sutures  555  from tangling with each other, and allowing for easy identification of individual sutures. In some surgical application, a user desires to tie together separate sutures disposed at particular locations on the target of the suture. For example, a surgical application may require sutures which are disposed opposite or 180° from each other to be tied together. Sutures  555  which are releasably retained in suture collecting members  511  and  512  may be located and identified if cross-tying sutures are desired. 
     Furthermore, as suture collecting members  511  and  512  are moved away from the surgical site, tension will be created on sutures  555  disposed therein. Sutures  555  may then be sheared such that free end  557  remains releasably retained in suture collecting member  511  and  512  and needle end  556  remains in target of the suture  550 . 
     In some embodiments, the suture collecting member may comprise at least one slit which releasably retains at least one suture. For example,  FIG. 6  depicts a perspective view of a suture collecting member having slit-type suture holders. Clamp region  620  may be connected via a pivot point to handles as described elsewhere herein. Suture collecting members  611  and  612  may comprise slits  670 . Slits  670  are sized as to be able to releasably hold at least one surgical suture due to the frictional force of the suture and the interior of slit  670 . Slits  670  may be formed as small notches in suture collecting members  611  or  612  which are in turn fixedly or releasably attached to surfaces  621  and  622  as described elsewhere herein. Alternatively, slits  670  may be formed directly into clamp arms  625  and  626  wherein there is no separate suture collecting member. 
     In some embodiments, the suture collecting member may comprise at least one clasp which releasably retains at least one suture. For example,  FIGS. 7A and 713  depict, respectively, a perspective and cross-section view of a suture collecting member having clasp-type suture holders. Referring to  FIGS. 7A and 7B , suture collecting members  711  and  712  comprise clasps  770 . Referring to  FIG. 7B , clasps  770  comprise a clasp bracket  773  having an attachment end  771  and a flare end  772 . Attachment end  771  is attached to suture collecting member  711  or  712  such that clasp bracket  773  is disposed in close proximity to or in direct contact with surface  721  or  722  of suture collecting member  711  or  712 . As suture  755  is inserted underneath clasp bracket  773 , clasp bracket  773  and attachment end  771  may flex slightly, allowing entry of suture underneath the clasp bracket  773 , and exerting a force on suture  755  such that suture  755  is releasably held in place due to friction between suture  755  and surface  721  or  722 . Flare end  772  of clasp  770  extends upward, away from surface  721  and  722 , easing the entry of surgical suture underneath clasp bracket  773 . Suture collecting member  711  or  712  may be fixedly or removably attached to clamp arms  725  and  726  as described elsewhere herein. Alternatively, attachment end  771  of clasp  770  may be attached directly to the clamp arm surface with no separate suture collecting member. 
     In some embodiments, a suture holder may be formed by modifying a surgical clamp such as a mosquito clamp, periarticular clamp, forceps, bone repositioning forceps, bulldog clamp, or hemostatic clamp by fixedly or removably attaching a suture collecting member to the arms of the surgical clamp, attaching the suture collecting member to the clamp arms such that sutures can be supported at a surgical site where the suture holder is used. 
     In some embodiments, a suture holder may be formed by modifying a surgical clamp by shaping the clamp arms into a desired shape, such as those depicted elsewhere herein, e.g. ovoid, elliptical, circular, triangular, rectangular, tear-drop, U-Shaped, C-shaped, or other desired shapes, and fixedly or removably attaching a similarly shaped suture collecting member to the shaped clamp arm. 
     In some embodiments, the suture holder may be part of a suture holder kit. In some embodiments, the kit can comprise any suture holder as described herein, at least one suture, at least one suture needle, at least one needle holder, scissors, and forceps. The suture holder kit can also comprise a package which maintains the contents of the kit, e.g., a suture holder, at least one suture, and other components in a sterile environment and which can be opened prior to use at a surgical site. The package may comprise a variety of materials. By way of non-limiting example the package material may comprise medical-grade paper, latex-reinforced paper, polypropylene-polyethylene, spun high-density polyethylene, foil-lined paper, or any combination of these. The suture holder kit may be a disposable, single-use kit, or may be a sterilizable and resealable package. The suture holder kit may comprise a single package containing the kit components, or the kit may comprise separately and sterilely packaged items combined into a larger package which contains the kit components. The suture holder kit may also comprise instructions for using a suture holder. The instructions may be written or depicted a package insert or directly on the package, or both. In some embodiments, the instructions are in the form of a computer readable medium, such as a CD-ROM or a DVD-ROM. 
     EXAMPLES 
     Additional embodiments are disclosed in further detail in the following examples, which are not in any way intended to limit the scope of the claims. 
     Example 1 
     Suture Holder Device Used During Debridement of a Necrotic Wound 
     This example illustrates that a suture collector as described herein can be used for wound debridement procedures. 
     A patient presents with a slow-healing, necrotic wound requiring debridement, and a physician chooses to employ a surgical or sharp debridement approach. The physician selects a suture holder as described herein. The physician positions the suture holder at the debridement site such that the clamp arms surround the edges of the wound. To prepare the wound for proper debridement of the necrotic tissues, the physician ties one end of a suture into the tissue surrounding the perimeter of the wound and places the free end of the suture into the suture collecting member on the suture holder. The physician ties multiple sutures around the exterior of the wound, placing the free ends of multiple sutures into the suture collecting members in an orderly fashion, where they are releasably held such that no sutures overlap and the ends of the sutures are neatly organized around the wound. 
     The physician then manipulates the entire suture holder away from the wound or in any desired direction in order to open the wound and facilitate debridement. The physician moves the clamp arms away from each other by manipulating the handles, thereby spreading the tissue surrounding the wound site. As the clamp arms move away from each other, the edges of the wound are pulled along with the sutures, opening the wound. This wound opening provides greater access to the necrotic tissue, bone, or internal bodily material, or any foreign objects, facilitating more complete, effective, and efficient debridement. 
     The physician excises the necrotic tissue or removes the foreign material, and cleans the wound. Following the excision or removal of tissue or other material from the wound, the physician then closes the wound by moving the clamp arms toward one another by manipulating the handles, and removing the free end of a suture from the suture collecting member. The physician ties the free end to a suture located at another position on the suture collecting member, such as to a suture directly across the suture collecting member. As the sutures are all tied and the wound is closed, the suture collecting member maintains organization of the individual sutures, making wound closure easier by preventing tangling of the sutures and maintaining tension on the sutures as they are tied. 
     Example 2 
     Suture Holder Used in Intestinal Anastomosis 
     This example illustrates that a suture collector as described herein can be used in intestinal anastomosis procedures. 
     A patient is identified who needs intestinal anastomosis after undergoing bisection or removal of a length of small intestine. A physician selects a suture holder which is appropriately shaped for the surgical site, such as a suture holder with elliptical or C-shaped clamp arms. The physician positions the appropriate suture holder at or near the site of the anastomosis. One end of the intestine which is to be reattached is inserted into the space between the clamp arms of the suture holder. The physician then ties one end of a suture into the perimeter of the intestine and attaches the free end of the suture of the suture collecting member, where it is releasably held. The physician proceeds around the perimeter of the intestine, repeating the sutures. This suturing pattern provides support for the open end of the intestine in preparation for anastomosis by allowing for easy manipulation and by positioning the intestine in a convenient and desirable orientation. 
     The physician manipulates the clamp arms using the handles so that the sutures releasably held in the suture collecting member pull the opening of the intestine end into a roughly uniform shape as the clamp arms move away from each other. The surgeon pulls the intestine into a substantially round or elliptical shape in order to facilitate anastomosis. The surgeon also manipulates the shape and size of the open end of the intestine by varying the length of the free end of the sutures as they are placed into the suture collecting member. 
     With the sutures organized substantially uniformly around the perimeter of the intestine and one end of the intestine supported in a suture holder, the other end of the intestine is positioned near the suture holder and the physician then sutures together the two ends of the intestine. Additionally, a physician may choose to support both ends of the bisected intestine in suture holders prior to anastomosis. 
     The above examples are given by way of illustration only, and are not intended to limit the potential uses of a suture holder. One skilled in the art will appreciate the other ways in which a suture holder could be employed during a surgical procedure. 
     While various aspects and embodiments have been disclosed herein, other aspects and embodiments will be apparent to those skilled in the art. The various aspects and embodiments disclosed herein are for purposes of illustration and are not intended to be limiting, with the true scope and spirit being indicated by the following claims. 
     One skilled in the art will appreciate that, for this and other processes and methods disclosed herein, the functions performed in the processes and methods can be implemented in various orders. Furthermore, the outlined steps and operations are only provided as examples, and some of the steps and operations can be optional, combined into fewer steps and operations, or expanded into additional steps and operations without detracting from the essence of the disclosed embodiments. 
     It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that virtually any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase “A or B” will be understood to include the possibilities of “A” or “B” or “A and B.” 
     In addition, where features or aspects of the disclosure are described in terms of Markush groups, those skilled in the art will recognize that the disclosure is also thereby described in terms of any individual member or subgroup of members of the Markush group. 
     As will be understood by one skilled in the art, for any and all purposes, such as in terms of providing a written description, all ranges disclosed herein also encompass any and all possible subranges and combinations of subranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, etc. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, etc. As will also be understood by one skilled in the art all language such as “up to,” “at least,” and the like include the number recited and refer to ranges which can be subsequently broken down into subranges as discussed above. 
     From the foregoing, it will be appreciated that various embodiments of the present disclosure have been described herein for purposes of illustration, and that various modifications may be made without departing from the scope and spirit of the present disclosure. Accordingly, the various embodiments disclosed herein are not intended to be limiting, with the true scope and spirit being indicated by the following claims.