Damage control surgery: Trauma

Abstract

The damage control approach to severe injury has been adopted by most trauma practitioners. The concept is borrowed from naval warfare and is one that promotes rapid or temporising measures in the battlefield (i.e. damage control operation) to keep a ship (the patient) afloat such that the vessel can "limp" to safety or back to port (ICU), and thereafter definitive repairs can be planned and undertaken (relook operations). It was first described in Stone et al. in 1983, and replaced the technically correct but physiologically flawed approach of exposure, resection and reconstruction/repair of exsanguinating injuries, with the modern approach focused on temporary haemostasis, peritoneal pack tamponade, and rapid abdominal closure.^1,2 This new approach allowed for correction of the "deadly triad" of hypothermia, coagulopathy, and acidosis (since updated to include hypocalcaemia), such that the patient was in a physiologically better condition to withstand further operations for repair of all injuries.