Damage control surgery

Abstract

Damage control surgery (DCS) are the temporary measures, applied as a part of a staged approach to complex problems, mainly related to severe trauma. This approach is designed to disrupt the lethal cascade of events, leading to the death by exsanguination. DCS is unfolded in three phases and its success is based on (a) judicious patient selection (hemodynamic instability, complexity of the injuries, injury pattern, pH < 7.30, temperature <35 °C, coagulopathy), (b) timing, based on the development of the abnormal physiology. The first phase of DCS consists of immediate exploratory laparotomy for control of hemorrhage and contamination using the simplest techniques, the application of intra-abdominal packing to all injured organs and the rapid temporary closure of the abdomen. The second phase consists of a secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, core rewarming, correction of coagulopathy, complete ventilatory support and continuing injury identification. The third phase will take place when normal physiology has been restored and consists of reoperation for removal of intra-abdominal packing, definitive repair of abdominal injuries and if possible primary tension-free closure of the abdomen. At this time, extra-abdominal injuries may as well be treated, while the patient remains physiologically normal. DCS has been shown to increase overal survival and should be applied in cases of severe trauma.