The medical records of all children in whom packing was used to control severe intracranial hemorrhage were reviewed. Eight children, with ages ranging from newborn to 4 years, met the inclusion criteria and all survived. Five were victims of severe closed head trauma, 2 had received penetrating cranial injuries, and 1 developed severe bleeding while undergoing surgery for a malignant tumor in the posterior fossa. Blood loss at the time of removal of the packing was minimal in 7 patients and was surgically controllable in the other. Packing is a simple, efficient, and safe maneuver which can very often halt intracranial bleeding that is considered to be otherwise uncontrollable, and can thereby limit the consequences of prolonged or repeated periods of hypotension and possible exsanguination.

1.
Krause F, Haubold HA: Care of wounds of the brain: tamponade for bleeding; in: Surgery of the Brain and Spinal Cord, Based on Personal Experiences. New York, Medical Art Agency, 1909, pp 1-282.
2.
Winston KR, McBride LA, Dudekula A: Bandages, dressings and cranial neurosurgery. J Neurosurg 2007;106(suppl):450-454.
3.
Ringdal KG, Skaga NO, Steen PA, Hestnes M, Leake P, Jones JM, Lossius HM: Classification of comorbidity in trauma: agreement and reliability of the pre-injury ASA physical status classification. Injury 2013;44:29-35.
4.
Skaga NO, Eken T, Sovik S, Jones JM, Steen PA: Pre-injury ASA physical status classification is an independent predictor of mortality after trauma. J Trauma 2007;63:5-972.
5.
Brohi K, Cohen MJ, Davenport RA: Acute coagulopathy of trauma; mechanism, identification, and effect. Curr Opin Crit Care 2007;13:680-685.
6.
Cap AP, Spinella PC: Severity of head injury is associated with increased risk of coagulopathy in combat casualties. J Trauma 2011;71(1 suppl):81.
7.
Talving P, Lustenberger T, Lam L, Inaba K, Mohseni S, Plurad D, Green DJ, Demetriades D: Coagulopathy after isolated severe traumatic brain injury in children. J Trauma 2011;71:1205-1210.
8.
Van der Sande JJ, Veeltkamp JJ, Goekhout-Mussert RJ, Bouwhuis-Hoogerwerf ML: Head injury and coagulation disorders. J Neurosurg 1978;49:357-365.
9.
McGauley JL, Miller C, Penner JA: Diagnosis and treatment of diffuse intravascular coagulation following cerebral trauma. Case report. J Neurosurg 1975;43:374-376.
10.
Clark JA, Finelli RE, Netsky MG: Disseminated intravascular coagulation following cranial trauma. Case report. J Neurosurg 1980;52:266-269.
11.
Binns JH: Case of extradural haemorrhage successfully treated by packing. Br Med J 1964;2:31-32.
12.
Carlucci GA: Injury to the longitudinal sinus accompanying a depressed fracture of the skull. Am J Surg 1939;XLV:120-124.
13.
King JEJ: Hematomas: extradural, subdural and subcortical. Am J Surg 1943;59:248-271.
14.
McKenzie KG: Extradural haemorrhage. Br J Surg 1938;26:346-365.
15.
Reichert FL, Morrissey EJ: Extradural venous hemorrhage. Ann Surg 1940;113:204-208.
16.
Wharton HR: Wounds of the venous sinuses of the brain: an analysis of seventy cases. Ann Surg 1901;34:82-109.
17.
Stylianos S: Abdominal packing for severe hemorrhage. J Pediatr Surg 1998;33:339-342.
18.
Moriwaki Y, Toyoda H, Harunari N, Iwashita M, Kosuge T, Arata S, Suzuki N: Gauze packing as damage control for uncontrollable haemorrhage in severe thoracic trauma. Ann R Coll Surg Engl 2013;95:20-25.
19.
Wall MJ Jr, Soltero E: Damage control for thoracic injuries. Surg Clin North Am 1997;77:863-878.
20.
Orthopoulos G, Sideris A, Velmahos E, Troulis M: Gunshot wounds to the face: emergency interventions and outcomes. World J Surg 2013;37:2348-2352.
21.
Richardson JD, Harty J, Amin M, Flint LM: Open pelvic fractures. J Trauma 1982;22:533-538.
22.
Abrassart S, Stem R, Peeter R: Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res 2013;99:175-182.
23.
Cheng M, Cheung MT, Lee KB, Chan SC, Wu AC, Chow YF, Chang AM, Ho HF, Yau KK: Improvement in institutional protocols leads to decreased mortality in patients with haemodynamically unstable pelvic fractures. Emerg Med J 2013;32:214-220.
24.
Sharpe RP, Nance ML, Stafford PW: Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: case report and review of the literature. J Pediatr Surg 2000;28:1747-1753.
25.
Carmona RH, Peck DZ, Lim RD Jr: The role of packing and planned reoperation in severe hepatic trauma. J Trauma 1984;24:779-784.
26.
Laversanne S, Pierrou C, Haen P, Thiery G: Damage control applied to severe maxillofacial trauma (in French). Rev Stomatol Chir Maxillofac Chir Orale 2014;115:37-41.
27.
Hester JD: Postpartum hemorrhage and revaluation of uterine packing. Obstet Gynecol 1975;45:501-504.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.