The Role of Packing and Planned Reoperation in Severe Hepatic Trauma

Effective Control of Hepatic Bleeding With a Novel Collagen-Based Composite Combined With Autologous Plasma

“…9 Manual compression and packing of the raw liver surfaces to tamponade bleeding sites are commonly performed with the use of gauze, sponges, and other agents. 6,[10][11][12] Topical hemostatic agents also have been used with varying degrees of success in this setting. These agents include oxidized regenerated cellulose, 13 …”

“…2,4,5 In the case of trauma, underlying coagulopathy may further complicate the effective control of diffuse bleeding, and this sometimes requires that measures such as perihepatic packing be undertaken. [5][6][7] Effective hemostasis during hepatic resection also can be difficult to attain and is especially troublesome in the cirrhotic patient. In these patients, marked h e m o r r h a g i c d i a t h e s e s a r e o f t e n observed, which may make intraopera-…”

Perihepatic Packing of Major Liver Injuries

“…6 Proponents of perihepatic packing have demonstrated that better antibiotics, improved surgical techniques, and "planned" reoperations have resulted in better survival rates and fewer infectious complications with perihepatic packing than with hepatic resection in the acute postinjury setting. [7][8][9][10][11][12] We performed this study to reinforce the concept that perihepatic packing is a valid option in the treatment of patients with uncontrolled hemorrhage due to a major liver injury. We also wanted to determine if the timing of pack removal affected the rate of rebleeding and the incidence of postoperative liver-related complications such as biloma, bile leak, and intra-abdominal abscess.…”

Packing to Tamponade Severe Intracranial Hemorrhage in Pediatric Patients

“…Stylianos [17 ]reported the effectiveness of abdominal packing for severe hemorrhage in refractory abdominal and retroperitoneal sites and in hepatic hemorrhage in pediatric patients. Other situations in which packing has been used to effectively tamponade severe hemorrhage in adults include thoracic hemorrhage [18,19], facial trauma [20], pelvic fractures [21,22,23], abdominal trauma [24], liver trauma [25], maxillofacial trauma [26], and postpartum hemorrhage [27]. …”