Damage Control Surgery

DAMAGE CONTROL – INTRODUCTION During the last two decades, numerous factors have resulted in the arrival of more severely injured patients. First, advances in prehospital care and the adoption of the “scoop and run” philosophy has resulted in the expedient arrival of sicker trauma patients who typically might have died in the field or en route to the hospital. Second, there has been a definite shift toward the use of more powerful rapid firing guns with the capacity for greater tissue destruction. Moreover, patients wounded with automatic weapons are arriving with multiple penetrations, often in multiple body cavities, literally exsanguinate d and physiologically depleted. The “traditional approach” to these patients is not effective. While the physical or mechanical completion of the operation is often technically possible, the pathophysiology is so extreme that death occurs despite anatomic repair. A combination of profound acidosis, hypothermia, and coagulopathy, also known as the “lethal triad” is commonly seen in these patients. It often precludes the completion of the operation. In this context, the concept of “damage control” has emerged. Borrowed from the United States Navy it represents “the capacity of a ship to absorb damage and maintain mission integrity” (1). In surgery, “damage control” refers to those maneuvers designed to ensure patient survival. It is a staged strategy for the treatment of severe exsanguinating injury occurring from either blunt or penetrating mechanisms. The concept of abdominal packing for uncontrolled hemorrhage, one of the initial damage control maneuvers, is not a new one. It has been described most often in patients with massive liver