Damage control surgery

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

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

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 person's 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

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

Bibliography

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

External links

• Trauma.org - Damage Control Surgery overview