Initial and final output from the negative pressure device was measured. Figure 1 Illustration demonstrating the procedure for internal application of Liver Vacuum Assisted Closure (L-VAC)

device. (A) The injured right lobe is rapidly mobilized. (B) A perforated bowel bag is placed over the right lobe. (C) A large black sponge is placed over the perforated bag. (D) The sponge is covered with a standard bowel bag. (E) The Trac pad is applied and connected to suction. Figure 2 Photograph of the device used to create the liver injury. The stellate shape is as described by GS-1101 datasheet Holcomb [37]. Figure 3 Intraoperative photographs of liver vacuum assisted closure (L-VAC) device PI3K inhibitor deployment. (A) The liver injury device was applied to the medial lobe of the right liver, moved laterally by 50% and reapplied creating a Grade V injury. (B) A perforated bowel bag is placed over the injured lobe from lateral to medial. (C) Suction is applied to the device. (D) The abdomen was temporarily closed with an abdominal wound VAC device. The abdomen was temporarily closed

with a second negative pressure device. The intraabdominal contents were covered with a large 10cm ×10cm plastic drape. A large black abdominal sponge was placed over the drape, followed by the suction pad. This negative pressure device was connected to 70cm of water suction (51 mmHg, Figure 3D). click here After 60 minutes the abdomen was opened and the device was removed and the animal was then euthanized. Results Injury Visual inspection of the liver

parenchyma confirmed Grade V liver injury according to the solid organ injury scale with visible disrupted portal and hepatic veins (Figure 3A). Brisk, active bleeding consistent with this grade of injury was encountered with brief release of the Pringle maneuver. Blood loss Initial blood loss prior to L-VAC placement was 280 ml (8.75 ml/kg). At initial device placement there was 75ml of immediate blood return. Continued losses after applying the device to suction were negligible over the next 60 minutes. Immediate blood loss after removal of the device was 270 ml (8.4 ml/kg) for a total blood loss of 625ml (19.5 ml/kg) for the entire procedure. Hemoglobin counts were 12.2 g/dl, 11.5g/dl, and 9.6g/dl at 0, 30, and 60 minutes, respectively. No blood products were administered. IMP dehydrogenase Hemodynamics Figure 4 illustrates hemodynamic values during the procedure. The animal remained tachycardic and normotensive throughout the experiment. No cardiovascular compromise was encountered. Figure 4 Graph of pulse rate and systolic blood pressure (SBP) as a function of time. Presence of acidosis Initial and serial arterial lactate levels were 1.1, 5.8, and 6.8mol/l at 0, 30, and 60 minutes, respectively. Intraabdominal pressures The bladder pressure was 12, 17, and 12 cm H2O at 0, 30, and 60 minutes, respectively. Urine output was 73 ml (2.2ml/kg) at 60 minutes.