Damage control surgery

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Damage control surgery (DCS) is a form of surgery utilized in severe unstable injuries typically by trauma surgeons. This form of surgery puts more emphasis on preventing the trauma triad of death, rather than correcting the anatomy.[1][2]

Indications[edit]

This procedure is generally indicated when a person sustains a severe injury that impairs their ability to maintain homeostasis due to severe hemorrhage leading to metabolic acidosis, hypothermia, and increased coagulopathy.[3] This phenomenon is referred to as the trauma triad of death.[4] A common clinical presentation of this would include metabolic acidosis, hypotension, and hypothermia.[2][4][5] The reason why a regular fix would not work is because the person would succumb to the physiologic effects of the injury, despite the anatomical correction.

Technique[edit]

A major component of the surgery is early recognition of a person who could benefit from it, which often means bypassing the emergency department except for attempts of immediate stabilization techniques, such as gaining airway access.[4][6] Typically the operating room is heated higher than normal to help deal with the associated hypothermia.[5]

The procedure comprises three different steps that are needed for full effect. In the first procedure a laparotomy is performed to control hemorrhage.[7] Generally this procedure will last no longer than one hour.[5] After immediate life threats have been surgically managed, the area is then covered temporarily and the person sent to an intensive care unit for the second phase.[7][8]

In the second phase the patient is given a combination of various medications and treatments to help restore a physiologic balance, especially with regards to their temperature, oxygenation, and pH level.[3] An important element of treatment at this stage is passive rewarming, as generally it will reverse most of the ill effects of the trauma triad.[2] This phase generally lasts no longer than two days but is dependent on the persons condition.[7] If the person's condition has not improved within the first 24 hours, it could mean there was missed hemorrhage which could require immediate surgery, regardless of the reversal of the trauma triad.[9]

In the third phase, the person is operated on again and more definitive procedures are performed.[3][7]

History[edit]

The first recorded instance of damage control surgery was in 1983 by Stone.[10] In 1993, Rotondo was the first to show definitive proof that damage control surgery yielded better outcomes than alternatives, and coined the term.[11]

References[edit]

  1. ^ Jaunoo SS, Harji DP (April 2009). "Damage control surgery". International Journal of Surgery (London, England) 7 (2): 110–3. doi:10.1016/j.ijsu.2009.01.008. PMID 19303379. 
  2. ^ a b c Fries, C. A.; Midwinter, M. J. (2010). "Trauma resuscitation and damage control surgery". Surgery (Oxford) 28 (11): 563. doi:10.1016/j.mpsur.2010.08.002.  edit
  3. ^ a b c Garth Meckler; Cline, David; Cydulka, Rita K.; Thomas, Stephen R.; Dan Handel (2012). Tintinalli's Emergency Medicine Manual 7/E. McGraw-Hill Professional. ISBN 0-07-178184-6. 
  4. ^ a b c Midwinter MJ (December 2009). "Damage control surgery in the era of damage control resuscitation". Journal of the Royal Army Medical Corps 155 (4): 323–6. PMID 20397611. 
  5. ^ a b c Sugrue M, D'Amours SK, Joshipura M (July 2004). "Damage control surgery and the abdomen". Injury 35 (7): 642–8. doi:10.1016/j.injury.2004.03.011. PMID 15203303. Retrieved 2012-08-05. 
  6. ^ Moore 2013, p. 725
  7. ^ a b c d Chaudhry, R.; Tiwari, G. L.; Singh, Y. (2006). "Damage control surgery for abdominal trauma". Medical Journal Armed Forces India 62 (3): 259. doi:10.1016/S0377-1237(06)80015-8.  edit
  8. ^ Blackbourne LH (2008). "Defining combat damage control surgery". U.S. Army Medical Department Journal: 67–72. PMID 20091976. Retrieved 2012-08-05. 
  9. ^ Moore 2013, p. 737
  10. ^ Stone HH, Strom PR, Mullins RJ (May 1983). "Management of the major coagulopathy with onset during laparotomy". Annals of Surgery 197 (5): 532–5. PMC 1353025. PMID 6847272. Retrieved 2012-08-05. 
  11. ^ Rotondo MF, Schwab CW, McGonigal MD, et al. (September 1993). "'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury". The Journal of Trauma 35 (3): 375–82; discussion 382–3. PMID 8371295. 

Bibliography[edit]

  • Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J (2012). Trauma, Seventh Edition (Trauma (Moore)). McGraw-Hill Professional. ISBN 0-07-166351-7. 

External links[edit]