Damage Control Surgery: An Update

Abstract

The historical evolution of damage control surgery (DCS) represents a pivotal journey within trauma management, transitioning from foundational principles to contemporary advanced practices. Established through the identification of the lethal triad—hypothermia, aci dosis, and coagulopathy—DCS addresses the complex needs of severely injured patients in both civilian and military contexts. This review emphasizes key con- tributions in the field, including traditional DCS with open abdomen, to adjunct innovative techniques used together with DCS today. Many surgical clinical fig ures have shaped the practice of DCS. Among them are Pringle’s temporary occlusion techniques for diagnosing and controlling hepatic hemorrhage, A. O. Whipple’s staged laparotomy, and Ogilvie’s stomas in colorectal trauma. Others questioned DCS such as Madding and Kennedy, whose observations during World War II raised concerns regarding liver packing practices due to the risks of severe complications like sepsis. Yet, Lucas and Ledgerwood demonstrated the necessity of rapid hemostatic control for better patient outcomes, challenging these concerns significantly. The effectiveness of temporary laparotomy pad tam ponade was highlighted in studies by Stones, Feliciano, Ivatury and many others showing high survival rates for patients with liver injuries. Stone’s landmark study contrasted survival rates of patients treated with abdominal packing to historical controls, leading to rapid acceptance of staged laparotomy strategies. Finally, Rotondo and Bill Schwab were instrumental in formalizing DCS concepts for exsanguinating penetrating abdominal injuries, advocating for a staged approach that significantly improved survival rates. Through these contributions, this paper illustrates the progression and refinement of trauma surgery aimed at enhancing survival outcomes during critical injuries.