Intrahepatic absorbable fine mesh packing of hepatic injuries: preliminary clinical report

Mesh wrapping for severe hepatic injury: a beneficial option in the trauma surgeon's armamentarium

BACKGROUND

The purpose of this study was to assess the efficacy of absorbable mesh wrapping (MW) versus perihepatic packing (HP) for severe hepatic injury.

METHODS

From January 2001 to December 2012, data were collected for MW patients with hepatic injury. Patients who underwent HP were matched with MW patients by injury mechanism, liver injury grade, Injury Severity Score, and age.

RESULTS

Twenty-six MW and twenty-six HP patients were matched. Eighteen blunt and 8 penetrating injuries were present in each group. There were 9 (35%) mortalities in the MW group and 16 (62%) in the HP groups (P = .03). Average transfusions were 12.0 and 24.5 (P = .03) packed red blood cells in the MW and HP groups, respectively. Average laparotomies per survivors were 1.3 for the MW and 3.1 for the HP groups (P = .01). Average length of stay for survivors was 19 and 47 (P = .04) days in the MW and HP groups, respectively.

CONCLUSION

MW for hepatic injuries can significantly decrease mortality, transfusions, laparotomies, and length of stay.

Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries: an extension of resuscitation in the nonoperative management of traumatic hepatic injuries

BACKGROUND

Recognizing the significant mortality and complications inherent in the operative management of blunt hepatic injuries, hepatic arterial embolization was evaluated as a bridge between operative and nonoperative interventions in patients defined as hemodynamically stable only with continuous resuscitation.

METHODS

Seven of 11 patients with grade IV or V hepatic injuries identified by computed tomography underwent hepatic arterial embolization. A prospective evaluation of hepatic embolization based on subsequent hemodynamic parameters was assessed by matched-pair analysis. A summary of this study population's demographic data and outcomes is presented, including age, Glasgow Coma Scale score, Injury Severity Score, Revised Trauma Score, computed tomography grade, intensive care unit and hospital length of stay, transfusion requirements, complications, and mortality.

RESULTS

No statistical difference was demonstrated between pre-embolization and postembolization hemodynamics and volume requirements. After embolization, however, continuous resuscitation was successfully reduced to maintenance fluids. Hepatic embolization was the definitive therapy for all seven patients who underwent embolization.

CONCLUSION

Results of this preliminary investigation suggest that hepatic arterial embolization is a viable alternative bridging the therapeutic options of operative and nonoperative intervention for a subpopulation of patients with hepatic injury.

Rehabilitation results of patients with multiple injuries and multiple organ failure and long-term intensive care

BACKGROUND

Multiple organ failure is regarded to be the major complication of trauma victims treated in the intensive care unit. Long-term rehabilitation results of this special group of patients have not been analyzed so far.

METHODS

Fifty patients with multiple injuries and multiple organ failure (Injury Severity Score > or = 36.8) were followed-up 4.9 +/- 0.3 years after the trauma. To show any organotopic sequelae, laboratory tests for the function of lungs, liver, kidney, and the hematologic system were performed. Additionally their functional (locomotion and neurologic system) and occupational rehabilitation results were investigated.

RESULTS

The laboratory tests showed entirely normal results. The only pathologic values could be found in the lung function tests. Nineteen percent of the patients showed nonphysiologic results in either spirometry, body plethysmography, or diffusion capacity of carbon monoxide. In more than 25% of the patients, permanently decreased range of motion (limitation of more than 30% of the entire range of motion) of the elbow, hip, knee, or ankle joint were found. In 40% of the patients, permanent motoric nerve lesions were identified; in 50% of the patients, permanent sensoric nerve lesions could be verified. The return to work rate was 60%.

CONCLUSIONS

Patients with multiple injuries, who survived multiple organ failure during their long-term intensive care treatment, show an excellent functional and occupational rehabilitation result. They show no major sequelae in their organ function even years after the trauma. Although often these patients suffer from permanent central or peripheral paralysis and decreased range of motion, this finding does not correlate with the patients' ability to return to work.