True regarding 'Damage control surgery is:
Ref: Charles M. Court-Brown et al. Trauma. Lippincott, 2006, Page 16. Washington Manual of Surgery 2012. 6th edition, Page 514Explanation:DAMAGE CONTROL SURGERY (DCS)It is a form of surgery utilized in severe unstable injuries typically by trauma surgeons.This form of surgery puts more emphasis on preventing the trauma triad (Hypothermia, Coagulopathy and Acidosis) of death, rather than correcting the anatomy.DCS is about minimal intervention done to stabilize the patient and the definitive surgery later.DCS includes abbreviated laparotomy, temporary packing and closure of the abdomen in an effort to blunt the physiologic response to prolonged shock and massive hemorrhage.DC'S centers on coordinating staged operative interventions with periods of aggressive resuscitation to salvage trauma patients sustaining major injuries.These patients are often at limits of their physiological reserve when they present to operating room and persistent operative efforts results in exacerbation of their underlying hypothermia, coagulopathy and acidosis, initiating a vicious cycle that culminates in death.PHASES OF DAMAGE CONTROL SURGERYPhase 1 - Initial ExplorationTo attain rapid control of active hemorrhage and contamination.The abdomen is entered via a midline incision and if exsanguinating hemorrhage is encountered four quadrant packing should be performed.Any violations of GI tract should be treated w ith suture closure or segmental stapled resection.External drains are placed to control any major pancreatic or biliary injuries.Phase 2 - Secondary ResuscitationFollowing completion of the initial exploration, the critically ill patient is transferred to the ICU.Invasive monitoring and complete ventilator support needed.This phase focuses on secondary resuscitation to correct hypothermia, coagulopathy and acidosis.Phase 3 - Definitive OperationIt consists of planned re-exploration and definitive repair of injuries.Occurs 48 - 72 hours following initial and after successful secondary resuscitation.The abdomen should be closed primarily if possible.Risky GI anastomoses or complex reconstruction should be avoided.INDICATIONS FOR DAMAGE CONTROL SURGERYPolytrauma and thoracic trauma.Polytrauma with severe abdominal/pelvic trauma and hemodynamic shock (BP < 90 mm Hg).Bilateral lung contusions.Initial mean pulmonary artery pressure > 24 mmHg.Pulmonary artery pressure increase > 6 mm Hg during long bone intramedullary nailing.
Done during damage control surgery
Done during triage
Minimal intervention to stabilize patient so that definitive surgery can be done later on
Maximum possible surgical intervention considering the event
Initial Assessment