HEMORRHAGE has always been a limiting factor in resective or traumatic surgery of the liver.* Despite the development of absorbable hemostatic agents such as oxidized cellulose (Oxycel), fibrin foam, or absorbable gelatin sponges, extensive surgery of the liver is usually performed in large institutions by a relatively few surgeons.† Even then, it may be limited to total left lobectomy or readily available nodules on the surface of the right lobe.14 This limitation is due primarily to inadequate methods of hepatic hemostasis. Even with all of the artificial aids and the almost routine use of strangulating mattress sutures, exsanguination can occur from biopsies or relatively small resections.
In cases of severe trauma, either from a shearing force or penetrating missiles, the problem of hemorrhage is even more acute.‡ A small penetrating wound in which bleeding is easily controlled by packing is unusual. Often, there is a ragged irregular tear in
MASTERS F, GEORGIADE N, HORTON C, PICKRELL K. CONTROL OF LIVER HEMORRHAGE BY SPLIT-THICKNESS SKIN GRAFTINGExperimental Study. AMA Arch Surg. 1954;69(5):718-725. doi:10.1001/archsurg.1954.01270050122021