Damage control surgery--new concept or reenacting of a classical idea?
Damage-control surgery is an example of a paradigm shift. The term is borrowed from naval teminology and means gaining the initial control of a damaged ship. Because of the lethal triad the polytrauma patient is at a grave risk. The classical concept of surgically solving all the patient's injuries in the first moment was even theoretically incorrect as a multiple injured patient is a critical patient with depleted reserves. As such, complex procedures were doomed from this point of view. The concept of damage-control surgery emerged in 1992. The core idea was that as minimal as possible had to be done in these critical patients in the first phase, meaning temporary control of a hemorrhage and simple measures for stopping contamination. After 24-48 hours in the ICU, in which time the physiological disturbances were corrected, a further intervention is perfomed for definitively treating the injuries. Further refinements consider five stages and not three in damage-control surgery. The bright side of the concept is an up to 70% survivability rate but with a higher risk of complications, mostly due to the policy of temporary closing the abdomen and sepsis.
Beuran
Mircea
M
Department of Surgery, Emergency Clinical Hospital, Bucharest, Romania.
Iordache
Florin-Mihail
FM
D000007:Abdominal Injuries / Q000601:surgery; D001424:Bacterial Infections / Q000517:prevention & control; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D009104:Multiple Trauma / Q000601:surgery; D010348:Patient Care Team; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000601:surgery; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*