Combat damage control surgery.
BACKGROUND
Although the use of damage control surgery for blunt and penetrating injury has been widely reported and defined, the use of damage control surgery on the battlefield (combat damage control surgery) has not been well detailed.


CONCLUSIONS
Damage control surgery is now well established as the standard of care for severely injured civilian patients requiring emergent laparotomy in the United States. The civilian damage control paradigm is based on a "damage control trilogy." This trilogy comprises an abbreviated operation, intensive care unit resuscitation, and a return to the operating room for the definitive operation. The goal of damage control surgery and the triology is avoidance of irreversible physiological insult termed the lethal triad. The lethal triad comprises the vicious cycle of hypothermia, acidosis, and coagulopathy. Although the damage control model involves the damage control trilogy, abbreviated operation, intensive care unit resuscitation, and definitive operation, all in the same surgical facility, the combat damage control paradigm must incorporate global evacuation through several military surgical facilities and involves up to ten stages to allow for battlefield evacuation, surgical operations, multiple resuscitations, and transcontinental transport.


CONCLUSIONS
Combat damage control surgery represents many unique challenges for those who care for the severely injured patients in a combat zone.
Blackbourne
Lorne H
LH
Trauma Service, Brooke Army Medical Center, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA. lorne.blackbourne@amedd.army.mil
D000138:Acidosis / Q000209:etiology; D001778:Blood Coagulation Disorders / Q000209:etiology; D003422:Critical Care / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000458:organization & administration*; D017146:Models, Organizational; D009937:Organizational Objectives; D019990:Perioperative Care / Q000458:organization & administration; D012086:Reoperation; D012151:Resuscitation / Q000379:methods; D014187:Transportation of Patients / Q000458:organization & administration; D014194:Traumatology / Q000458:organization & administration*; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*