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Damage Control Surgery
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
All actions have consequences and damage control surgery is not without its problems. A review by Rotondo et al.45 identified an overall 50% mortality and 40% morbidity in 961 damage control patients. The early reports of damage control surgery demonstrated a significant improvement in mortality when comparing patients undergoing abbreviated procedures to those patients undergoing conventional surgery. It is important to note that these comparisons apply to damage control laparotomy; mortality outcomes have not yet been demonstrated in other damage control procedures.
Trauma Laparotomy and Damage Control Laparotomy
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
The surgeon communicates with the anaesthetic team to assess the haemodynamic and haematological parameters. Once gross haemorrhage control has been achieved, this pause period also allows the anaesthetic team to ‘catch up’ with resuscitation using blood and blood products and limiting crystalloid. The patient’s parameters are continually reassessed by both the surgeon and the anaesthetic team. If possible, serial blood gases should be sent to assess the acid–base status and the temperature should be under continuous monitoring. The team, led by the surgeon, may then decide if abbreviated damage control surgery is indicated. They must remain vigilant to the changing parameters and patient condition and be dynamic and prepared to adjust the planned surgical track to respond to the changing situation.
Damage Control
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Damage control concepts are not restricted to the abdomen and extend to every cavity in the body as well as vascular damage control. The need for damage control in children is much less common; however, they are much more prone to hypothermia given larger surface area relative to their smaller blood volume. Although the physiological parameters are very different, the principles are the same. At the other end of the spectrum, the application of damage control to the elderly who have decreased physiological reserve and a high morbidity and mortality has also been successful, with survival of greater than 50% when damage control is applied to this group.2 Damage control surgery may be performed in smaller hospitals before transfer to a larger centre. Damage control surgery procedures, on properly selected patients, can be life-saving, and may have to be performed in any hospital admitting trauma cases.
A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment
Published in Journal of Investigative Surgery, 2020
Weihang Wu, Zhicong Cai, Nan Lin, Weijin Yang, Jie Hong, Li Lin, Zhixiong Lin, Junchuan Song, Yongchao Fang, Chen Lin, Hongwen Zhang, Dongsheng Chen, Yu Wang
The principle of damage control surgery was staged treatment, so as to minimize damage and save more intestines. Thus, the intestinal segments suspected for necrosis were temporarily preserved in the early stage of trauma. However, the suspicious necrotic intestine is equivalent to a time bomb. They may recover in the later stage of treatment, or may be necrosis in a short time. Once an intestinal segment becomes necrotic, it can also involve adjacent intestinal segments. The experimental results of the present study showed that intestinal ligation can accelerate the necrotization process in intestines suspicious for necrosis. As an alternative method, we used BST to restore the continuity of intestinal segments with the potential for necrosis, which provided favorable conditions and time for intestinal function recovery and for maximum retention of the surviving intestinal segments.
Challenges to improving patient outcome following massive transfusion in severe trauma
Published in Expert Review of Hematology, 2020
According to the data from trauma patients captured into the German TraumaRegistry database (TR-DGU), the percentage of patients in need for immediate transfusion of blood products upon Emergency Room (ER) arrival has declined consistently over the last two decades, from 42% prior to the year 2000, to 19% in 2009 and to 7% in 2017 [6]; in the same registry, the percentage of patients in need for a massive transfusion decreased from 12,4% in 2002 to 1,4% in 2017 (Figure 1). The proportion of major trauma patients receiving a massive transfusion reported from single-center cohort in Australia (n = 5,915 patients) decreased from 8,2% to 4,4% (p < 0,001) between 2006 and 2011 [7]. This decline can be mainly attributed to improvements in both pre-hospital and early in-hospital trauma management through the implementation of standardized protocols and algorithms for acute care surgery and resuscitation (e.g. Pre-hospital/Advanced Trauma Life Support (PHTLS and ATLS), Damage Control Resuscitation (DCR) and Damage Control Surgery (DCS) principles), as well as overall improved and more selective fluid resuscitation strategies, thereby avoiding the detrimental ‘lethal triad of death’.
Outcomes and clinical characteristics of transmural intestinal necrosis in acute mesenteric ischemia
Published in Scandinavian Journal of Gastroenterology, 2019
Xinyu Wang, Chengnan Chu, Shilong Sun, Tian Xie, Zehua Duan, Kai Wang, Baochen Liu, Xinxin Fan, Xingjiang Wu, Weiwei Ding
Patients with AMI were administrated by multidisciplinary stepwise management strategy that focused on early mesenteric recanalization and retention of bowel viability as previous reports [6,13]. First, mesenteric recanalization was performed in a hybrid operating room. For patients with superior mesenteric artery (SMA) and endovascular therapy (aspiration embolectomy or thrombectomy, stenting and thrombolysis) were used. When endovascular approach failed, laparotomy and exposure of the SMA were performed, especially for retrograde SMA recanalization, involving local thrombectomy and angioplasty, followed by retrograde stent. Endovascular procedures for mesenteric vein thrombosis include mechanical thrombectomy and local thrombolysis via catheter. Then damage control surgery would be applied for patients with emergency laparotomy. The intestinal ostomy was performed in patients with necrotic bowel resection. Temporary abdominal closure with an abdominal sandwich dressing with negative pressure and irritation system was applied to patients with high risk of intra-abdominal hypertension and second laparotomy. And for patients with intestinal stricture, primary anastomosis was executed. After mesenteric recanalization procedures, all patients were transferred into surgical ICU receiving resuscitation, antibiotic therapy, multiple-organ function support and nutrition therapy.