Scott-Conner & Dawson: Essential Operative Techniques and Anatomy by Carol E.H. Scott-Conner

Author:Carol E.H. Scott-Conner [Scott-Conner, Carol E. H.]
Language: eng
Format: epub
ISBN: 978-1-4698-3062-9
Publisher: Lippincott Williams & Wilkins
Published: 2014-02-15T00:00:00+00:00

Figure 70.8 Splenorrhaphy. A: Simple splenic laceration amenable to suture. B: Closure with mattress sutures. C: Use of pledgeted sutures. D: Omentum used to buttress repair. E: Shattered spleen with intact hilar vessels suitable for wrap. F: Completed mesh wrap of shattered spleen.

If there is considerable damage to the spleen but the hilar vessels are intact, it may be possible to salvage the spleen by wrapping it in absorbable mesh (Fig. 70.8E, F). Debride the injured parenchyma and cut a piece of mesh large enough to enclose the spleen completely. Place a purse-string suture around the edge to create a bag. Tighten the purse-string around the hilum. Take care not to compromise venous return from the spleen. Make the wrap a little loose initially, then place a running suture on the outer aspect to tighten it. As the wrap works by compression, it must be snug and work to pull lacerated edges together in order to be effective. Check the completed wrap for hemostasis.

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