Damage Control Surgery - Concepts and Practice

• Published in: BMJ military health 2000-10, Vol.146 (3), p.176-182
• Main Authors: Bowley, DMG, Barker, P, Boffard, KD
• Format: Article
• Language: English
• Subjects: Abdomen; Acidosis - etiology; Biological and medical sciences; Blood Coagulation Disorders - etiology; Cause of Death; Humans; Hypothermia - etiology; Injuries of the abdomen. Foreign bodies of the digestive system; Laparotomy; Medical sciences; Military Medicine - methods; Monitoring, Physiologic - methods; Multiple Trauma - complications; Multiple Trauma - mortality; Multiple Trauma - physiopathology; Multiple Trauma - surgery; Philosophy, Medical; Resuscitation - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Warfare; Wounds, Gunshot - complications; Wounds, Gunshot - mortality; Wounds, Gunshot - physiopathology; Wounds, Gunshot - surgery
• ISSN: 0035-8665; 2633-3767; 2052-0468; 2633-3775
• DOI: 10.1136/jramc-146-03-05

The results of prolonged and extensive procedures in the critically injured are poor, even in experienced hands. The operating theatre is a hostile and physiologically unfavourable environment for the severely injured patient. Laparotomy for major trauma involves dissipation of heat and massive blood loss requiring replacement. The result is a vicious cycle of hypothermia, acidosis and coagulopathy leading to death from an irreversible physiological insult (62). The damage control concept places surgery as an integral part of the resuscitative process, rather than an end in itself, and recognises that outcomes after major trauma are determined by the physiological limits of the patient, rather than by efforts of anatomical restoration by the surgeon. All those involved in the care of wounded patients should be familiar with this concept and its surgical and logistical implications.