Planned reoperation for severe trauma.
OBJECTIVE
The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma.


BACKGROUND
Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries.


METHODS
The authors review the literature.


RESULTS
Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization.


CONCLUSIONS
Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients.
Hirshberg
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Cora and Web Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Mattox
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D000007:Abdominal Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011182:Postoperative Care; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000379:methods