Phase III: Second operation repair of all injuries general and orthopedics

Abstract

The primary objectives of Damage Control Phase III (DC III) are definitive organ repair and fascial closure. Timing for this stage is critical to successful outcomes. The decision to proceed is predicated upon all physiological and biochemical deficits being corrected. The patient should be normothermic, have normal coagulation studies, have a normal pH, and have normal lactate. This state usually takes 24-36 h to achieve following aggressive ICU management. During this time, a complete tertiary survey of potential missed injuries, particularly extremity soft tissue and orthopedic injuries, is performed. An incidence of missed injuries of 10-20% has been reported in similar patient populations [1]. Additional necessary radiographic and ancillary studies must be completed. Planning by surgical specialty consultants for definitive management of associated injuries is initiated during this time. Occasionally, the timing of definitive repair is influenced by other clinical circumstances. One pressing concern that often leads to early planned reoperation is salvage of an ischemic limb due to shunt occlusion or suboptimal vascular repair following restoration of a normal coagulation profile. Other situations in which early planned reoperation is advisable include: (1) bowel that has been interrupted at several sites, resulting in a closed loop obstruction mechanism that threatens bowel viability and (2) suboptimal control of spillage at the initial laparotomy from packed or drained duodenal, pancreas, kidney, or bladder disruption. © 2010 Springer-Verlag New York.