The Concept of Damage Control

The term "damage control" is accredited to Rotondo and Schwab (Rotondo et al. 1993) who in 1993 described a prioritized three-phase approach to patients with major vascular and visceral injuries. The first phase consists of expeditious control of hemorrhage and contamination using simple and quick measures and temporary abdominal closure. This is followed by intensive care resuscitation with the goal of restoring temperature, coagulation, perfusion, and oxygenation of tissues. Only then, as a third step in a stabilized patient, is definitive surgery and abdominal wall closure considered. This concept has emerged as a life-saving strategy in multitrauma injuries. Trauma surgeons have adopted this relatively novel concept based on the observation that multitrauma patients eventually die from hypothermia, coagulopathy, and acidosis-in-duced irreversible physiologic insults (Feliciano et al. 2000; Hirshberg and Mattox 1993; Hirshberg and Wal-den 1997; Rignault 1992). In accordance, extensive and time-consuming organ-ablating and reconstructive procedures in an unstable patient might often bring the patient beyond the point of reversible physiological changes. However, identifying those critically injured patients who are candidates for damage control maneuvers, aimed to achieve hemostasis and prevent uncontrolled spillage of bowel contents and urine, is a challenge. Decisions are therefore often taken by the most senior trauma surgeon in cooperation with other specialist surgeons who should all be fully familiar with damage control principles. Increased awareness among all surgical specialists will eventually improve the communication between the members of this group, which should ultimately function as a well-orchestrated mul-tidisciplinary team. Nowadays, damage control principles have also been successfully adopted in the context of civilian mass casualty events, military field surgery, and treatment in rural areas with long-range transfers (Holcomb et al. 2001; Rignault 1992).

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