TOTAL MESH WRAPPING OF PARENCHYMATOUS LIVER INJURY: AN EXPERIMENTAL STUDY

Uncontrollable bleeding remains a life-threatening problem in severe liver injury. The majority of liver injuries can be 
managed by simple techniques, however a substantial proportion of hepatic injuries require more complex procedures. 
To investigate the value of an absorbable mesh wrap under standardized conditions, an experimental study was 
performed in fifteen dogs. A standard liver laceration imitating liver injury grade IV (liver injury scale of the American 
association for the surgery of trauma) was made in all animals, and they were classified into 3 groups (five animals in each group). The first group animals served as controls, the second group animals were treated by laparotomy packs, and the third group animals were treated with total mesh wrap. Four of five animals in the first group died, all animals in the second group died, and all animals in the third group survived. Intrahepatic pressure in the third group varied from 3 to 55 mm Hg. Liver function tests were temporary elevated. Necropsy at 2 weeks revealed adhesions to the wrapped lobe, but no hematomas or abscess formation. Histologic examination revealed foreign-body reaction to the mesh. 
It can be stated that the application of this type of mesh wrap is a relatively simple and easy procedure. It can 
effectively control bleeding from severely injured liver and improve survival significantly in animal model. 
Abbreviations:Hepatic injury, Liver packing, Mesh wrap.