Hepatic Packing in Major Hepatic Trauma-Reply

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