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April 1989

Hepatic Packing in Major Hepatic Trauma-Reply

Author Affiliations

Los Angeles, Calif

Arch Surg. 1989;124(4):509. doi:10.1001/archsurg.1989.01410040118031

In Reply.—Dr Ferguson's well-documented case demonstrates the value of packing a major hepatic and juxtahepatic venous injury in two clinical situations. The first indication was as a temporary expedient to permit transfer of the patient to a site more suitable for definitive treatment. We cited Blumgart and colleagues' report1 in this regard; this clearly is a useful expedient. The second was to permit correction of hypothermia that develops intraoperatively with concurrent coagulopathy. Both Feliciano and associates2 and Cogbill and associates3 have reported favorable results with packing of the hepatic wound after repair of major venous injury with ensuing coagulopathy. The survival rates of their patients were 34% and 59%, respectively. We have recently had a favorable experience in a similar circumstance.

Both Feliciano et al2 and Cogbill et al3 and their respective associates also reported that packing was ineffective when undertaken as a desperation measure