Figure 1.
Dissection demonstrating the anatomy of the porcine intrahepatic portal venous system.
Ex vivo porcine liver, inferior aspect (scale in cm). The soft tissues overlying the portal venous system have been dissected and retracted with silk stay sutures. RL = right lateral lobe; RM = right medial lobe; LM = left medial lobe; LL = left lateral lobe; Q = quadrate lobe; Gb = gallbladder; 1 = cut orifice of main portal vein; 2 = intrahepatic portal vein; 3 = RM lobe portal vein branch; 4 = 1st LL lobe portal vein branch; 5 = cut orifice of 2nd LL lobe portal vein branch (proximal end); 6 = distal end of structure 5; 7 = pedicle containing the common bile duct and hepatic artery (reflected laterally by stitch). In this dissection the 2nd LL lobe portal vein branch was transected (the two ends are labeled as 5 and 6). The hepatic veins were not exposed in this dissection. The dashed blue polygon indicates the portion of the portal vein that was resected for the PVR injury mechanism. The dashed yellow line indicates where the cut was made across base of LL lobe for the LLLH injury mechanism. Scale = cm. [201 words].
Figure 2.
Operative set-up for the porcine noncompressible hemorrhage model.
View of the open abdomen in a living anesthetized pig, looking toward the head. The left medial (LM) and left lateral (LL) lobes of the liver have been exteriorized through a ventral midline incision. The dashed yellow line indicates the location of the imminent cut across base of LL lobe. The tips of the scissors are touching the 2nd LL lobe portal vein branch (refer to Figure 1).
Figure 3.
Kaplan Meier survival plot for the three models of noncompressible hemorrhage.
Time zero = moment of injury; CLI = central liver injury (N = 6); PVR = portal vein resection (N = 6); LLLH = hepatic left lower lobe hemitransection (N = 10).
Figure 4.
Vital sign data for three porcine models of noncompressible truncal hemorrhage.
(A) Temperature. (B) Heart rate. (C) Mean arterial pressure (MAP). Time zero = moment of injury; CLI = central liver injury (N = 6); PVR = portal vein resection (N = 6); LLLH = hepatic left lower lobe hemitransection (N = 10). Values shown are mean ± sd; *p<0.05, Kruskal–Wallis one-way analysis of variance on all three time points for a given injury; **p<0.05, Kruskal–Wallis one-way analysis of variance on all three injuries at the indicated time point. Also refer to Table S2 in file S2.
Figure 5.
Hematologic testing for three porcine models of noncompressible truncal hemorrhage.
(A) Serum hemoglobin. (B) Protime. (C) Serum fibrinogen. Time zero = moment of injury; CLI = central liver injury (N = 6); PVR = portal vein resection (N = 6); LLLH = hepatic left lower lobe hemitransection (N = 10). Values shown are mean ± sd; *p<0.05, Kruskal–Wallis one-way analysis of variance on all three time points for a given injury; **p<0.05, Kruskal–Wallis one-way analysis of variance on all three injuries at the indicated time point. Also refer to Table S2 in file S2.
Table 1.
Select endpoints (at time of death or 1 hr post-injury) for the three injury mechanisms of noncompressible hemorrhage.
Figure 6.
Postmortem liver ex vivo, demonstrating the standard injury.
(A) Inferior aspect; anterior toward top of image. (B) Left inferior oblique aspect; anterior toward right of image. Scale in cm. RL = right lateral lobe; RM = right medial lobe; LM = left medial lobe; LL = left lateral lobe; Q = quadrate lobe; C = caudate lobe (black arrow indicates location of infrahepatic IVC); Gb = gallbladder. The scissors in panel A has been inserted through the cut orifice of the main portal vein, and the scissors tip are emerging through the transected 2nd portal vein branch to the LL lobe (1); the distal end of this portal vein branch also is indicated (2). The gap in the liver parenchyma created by the injury is indicated with a dashed yellow line. The 1st portal vein branch to the LL lobe (3), visible at the bottom of the wound, was not injured in this subject. The soft tissues (including the common bile duct and hepatic artery) overlying the portal venous system have been dissected and flipped anteriorly (4). White arrow indicates orifice of transected hepatic vein to the LL lobe; the latter has a dusky appearance relative to the other lobes.
Table 2.
Pre-injury parameters not equivalent among the three injury groups.