- Splenic salvage techniques
- Indications: haemodynamically stable patients with low- to moderate-grade splenic injuries (AAST I–III), especially in children and young adults
- Splenorrhaphy:
- Direct suture repair of capsular or parenchymal lacerations using absorbable sutures
- Often combined with topical haemostatic agents
- Topical haemostatics:
- Application of fibrin glue, collagen, oxidised cellulose, or gelatin sponges over bleeding areas
- May be used alone or in combination with suture or mesh
- Mesh wrapping:
- Encasing the spleen in absorbable or non-absorbable mesh to tamponade bleeding and support parenchyma
- Useful for shattered but perfused spleens
- Partial splenectomy:
- Resection of damaged portion with preservation of viable splenic tissue and vascular supply
- Aims to retain some immunological function
- Angioembolisation:
- Non-operative approach for bleeding control in stable patients with contrast blush or pseudoaneurysm on CT
- Selective embolisation of bleeding vessels by interventional radiology
- Kidney salvage techniques
- Indications: stable patients with blunt or penetrating renal trauma, especially Grade I–III injuries, or solitary functioning kidney
- Direct haemostasis:
- Localised lacerations controlled with suture repair using fine absorbable material
- Avoid deep bites that may occlude segmental vessels or calyces
- Topical haemostatic agents:
- Similar agents to splenic salvage, applied directly to bleeding surfaces
- Renorrhaphy:
- Closure of renal parenchyma using absorbable suture over absorbable bolster (e.g. Surgicel or Gelfoam)
- Often used with partial nephrectomy
- Partial nephrectomy:
- Excision of damaged pole or segment, preserving viable renal tissue and collecting system
- Ureteric stenting or nephrostomy:
- Used for urinary extravasation or collecting system injury to divert urine and allow healing
- Angioembolisation:
- For active arterial bleeding or AV fistula formation identified on imaging
- Avoids need for nephrectomy in many cases