The applicability of the swine model for human liver injury has been well described in the literature. This model, however, is not without its limitations. The compression of the portal inflow during creation of the liver laceration minimized initial blood losses. In the clinical setting, uncompensated hypovolemic shock may result in the ‘bloody vicious cycle’
of hypothermia, acidosis, and coagulopathy. Obtaining check details hemostasis from bleeding viscera in the face of these physiologic derangements can be quite challenging. In this regard, the model used for this experiment was artificial given that the pig was well compensated hemodynamically, with functioning coagulation cascades. However, given the mechanism of action of the VAC device, the authors contend that L-VAC placement may be the ideal therapy for control of hemorrhage
in such cases. Consideration is being given to repeating this experiment in animals that are hypothermic and coagulopathic. Future areas of investigation should be directed toward comparing this innovative method to Linsitinib research buy well-established therapies such as packing, mesh wrapping, and application of hemostatic agents. In summary, these data demonstrate the feasibility and utility of a perihepatic negative pressure device for the treatment of hemorrhage from severe liver injury in the porcine model. This method is potentially applicable in the clinical setting and may afford advantages over traditional damage control procedures such as perihepatic packing. Financial disclosure This study was funded in part by funds
from the Kansas University Medical Center, and the Wesley Medical Center Trauma Research Fund. Institutional animal use and care committee approval This study was approved for implementatin by the IACUC of the Kansas University Medical center. References 1. Pachter HL, Liang HG, Hofstetter SR: Liver and biliary tract trauma. In Trauma. 3rd edition. Edited by: Feliciano DV, Moore EE, Mattox KL. Stamford, CT: Appleton & Lange; 1996:487. 2. Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, Wilson MA, Polk HC Jr, Flint LM: Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000, 232:324–330.CrossRef 3. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, Pritchard FE: Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000, 231:804–813.PubMedCrossRef Farnesyltransferase 4. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA, Ramenofsky ML, Trafton PG: Organ injury scaling: spleen, liver, and kidney. J Trauma 1989, 29:1664–1666.PubMedCrossRef 5. Aaron S, Fulton RL, Mays ET: Selective ligation of the hepatic artery for trauma of the liver. Surg Gynecol Obstet 1975, 141:187–189.PubMed 6. Stone HH, Lamb JM: Use of pedicled omentum as an autogenous pack for control of hemorrhage in major injuries of the liver. Surg Gynecol Obstet 1975, 141:92–94.PubMed 7.