Thoracic Damage-Control Operation: Principles, Techniques, and Definitive Repair

m t w p p o p t t a t A t e h t s n appreciation for the consequences of the shock state as led to a revision of trauma surgery principles over the ast 2 decades. Operations with good technical results ut bad patient outcomes secondary to irreversible metbolic distress prompted surgeons to begin truncating nitial procedures on severely injured patients after chieving hemostasis and controlling spill from the alientary tract. These temporized patients would unergo aggressive correction of their acidosis, coagulopahy, and hypothermia in the intensive care unit, with lans for a return trip to the operating room for definiive management of their injuries if they survived their esuscitation. This technique of quickly and solely conrolling hemorrhage and contamination to expedite restablishing a survivable physiology has come to be nown as “damage-control” operation, and its use has esulted in improved mortality rates. Although its aplication in abdominal trauma is now routine, the conept has also begun to be used in thoracic trauma, albeit ith some modifications. The principle of expediting he operative management of unstable patients still olds in thoracic damage control. In addition to abdomnal damage-control’s emphasis on temporizing injuries, horacic damage control also entails performing definiive techniques that are rapid and relatively simple. Use f damage-control thoracotomy has led to better-thanxpected survival rates for these badly injured patients. ts successful application requires not only specific taiored maneuvers, but a change in the mindset of the perating surgeon as well. This collective review will iscuss both as they apply to various injuries in the chest, ith an emphasis on surgical technique.