Damage control surgery: old concepts and new indications

Abstract

Purpose of review While the principles of damage control surgery - rapid hemorrhage and contamination control with correction of physiologic derangements followed by delayed definitive reconstruction - have remained consistent, forms of damage control intervention have evolved and proliferated dramatically. This review aims to provide a historic perspective of the early trends of damage control surgery as well as an updated understanding of its current state and future trends. Recent findings Physiologically depleted patients in shock due to both traumatic and nontraumatic causes are often treated with damage control laparotomy and surgical principles. Damage control surgery has also been shown to be safe and effective in thoracic and orthopedic injuries. Damage control resuscitation is used in conjunction with surgical source control to restore patient physiology and prevent further collapse. The overuse of damage control laparotomy, however, is associated with increased morbidity and complications. With advancing technology, catheter- and stent-based endovascular modalities are playing a larger role in the resuscitation and definitive care of patients. Summary Optimal outcome in the care of the most severely injured patients requires judicious use of damage control surgery supplemented by advancements in resuscitation and surgical adjuncts.

Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper

“…Some studies have investigated the possibility to deploy autologous reinfusion drains for post-operative cell salvage [ 107 , 108 ]. Damage control surgery Damage control surgery (DCS) as part of damage control strategy is generally performed together with damage control resuscitation in severely bleeding patients [ 109 – 112 ]. DCS should be implemented as soon as its necessity is recognized [ 113 – 116 ].…”

“…The patients are then transferred to intensive care unit to allow them to recover from the physiological derangements and to be able to face further reconstructive surgical phases. It is demonstrated that DCS helps in increasing overall survival of patients, reduces the risk of developing trauma coagulopathy and can potentially reduce the total amount of blood product usage [ 109 , 110 ]. DCS strategies may be also applied to non-traumatic emergency surgical patients.…”

Editorial: Acute trauma management in a changing environment

“…Much research energy has been invested over the past two decades to develop, implement and optimize strategies and measures to early control severe bleeds and restore hemostasis in the context of severe trauma. While the principles of damage control surgery have essentially remained consistent, forms and frequency of interventions have evolved dramatically [9]. Surgical damage control is now used in conjunction with damage control resuscitation to restore physiology and prevent further collapse.…”

“…Surgical damage control is now used in conjunction with damage control resuscitation to restore physiology and prevent further collapse. Chung and Scalea critically review this concept and highlight potential risks when being overused, in particular along with damage control laparotomy [9]; subsequently, Cioffi et al provide current evidence and guidance for the nonoperative management of blunt abdominal trauma in hemodynamically stable patients [10]. In mangled extremities where integrity and viability are in danger, the decision of primary amputation versus limb salvage becomes critical.…”

“…Amputation may no longer present a defeat, rather it has become a valid part of the therapeutic spectrum. In any case, careful patient selection is key to minimize treatment failure which also expands to catheter- and stent-based endovascular modalities [9]. Marsden et al share interesting signals from the first randomized controlled trial on the add-on use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to standard major trauma care in uncontrolled torso trauma hemorrhage [12].…”