Damage control surgery is:
Ans. a. Minimal intervention done to stabilize the patient and do the definitive surgery later (Ref: Sabiston 19/e p438; Schwartz 9/e p166-167)Damage control surgery is minimal intervention done to stabilize the patient and do the definitive surgery later.Damage control includes an abbreviated laparotomy, temporary packing, and closure of the abdomen in an effort to blunt the physiologic response to prolonged shock and massive hemorrhage.Damage Control Surgery (DCS)DCS centers on coordinating staged operative interventions with periods of aggressive resuscitation to salvage trauma patients sustaining major injuriesQ.Damage control includes an abbreviated laparotomy, temporary packing, and closure of the abdomen in an effort to blunt the physiologic response to prolonged shock and massive hemorrhageQ.These patients are often at limits of their physiological reserve when they present to operating room and persistent operative efforts result in exacerbation of their underlying hypothermia, coagulopathy and acidosis, initiating a vicious cycle that culminates in deathQ.In these situations, abrupt termination of the procedure after control of surgical hemorrhage and contamination, followed by ICU resuscitation and staged reconstruction, can be life savingQ.Phases of Damage Control SurgeryPhase I (Initial Exploration)Phase II (Secondary Resuscitation)Phase III (Definitive Operation)* This phase consists of an initial operative exploration to attain rapid control of active hemorrhage and contamination* The abdomen is entered via a midline incision and if exsanguinating hemorrhage is encountered four quadrant packingQ should be performed* Any violations of Gl tract should be treated with suture closure or segmental stapled resectionQ* External drains are placed to control any major pancreatic or biliary injuries* Following completion of the initial exploration, the critically ill patient is transferred to the ICUQ.* Invasive monitoring and complete ventilator supportQ are often needed.* This phase focuses on secondary resuscitation to correct hypothermia, coagulopathy and acidosisQ* It consists of planned reexploration and definitive repairQ of injuries* This phase typically occurs 48 to 72 hours following initial and after successful secondary resuscitation* The abdomen should be dosed primarily if possible* Risky Gl anastomoses or complex reconstruction should be avoidedQ
Minimal intervention done to stabilize the patient and do the definitive surgery later
Maximum possible surgical intervention is done immediately
Done during triage procedure
Done to control damage during surgery
Initial Assessment