Damage Control Surgery

DCS is a staged approach, tailored to the patient’s condition and injuries:

1. Before Surgery Evaluation:
   
   • Assessment:
     
     • Rapid trauma assessment (ATLS protocol) identifies life-threatening injuries.
     • Focused Assessment with Sonography for Trauma (FAST) detects intra-abdominal bleeding.
     • CT scan (if stable) maps injuries; often skipped in unstable patients.
     • Blood tests assess hemoglobin, lactate, and coagulopathy (e.g., INR, fibrinogen).
   • Resuscitation begins immediately: IV fluids, blood transfusions, and correction of hypothermia/coagulopathy.
   • Patients are triaged to the operating room if unstable (e.g., systolic BP <90 mmHg, pH <7.2, temperature <35°C).
2. Surgical Techniques (Stage 1: Damage Control):
   
   • Principles:
     
     • Control hemorrhage: Ligate bleeding vessels, pack the abdomen (e.g., liver, pelvis), or use temporary vascular shunts.
     • Prevent contamination: Control bowel perforations with stapling or resection without anastomosis.
     • Minimize operative time: Avoid complex repairs; focus on stabilization (typically <1–2 hours).
   • Procedure:
     
     • Performed under general anesthesia in a trauma operating room.
     • A midline laparotomy (abdominal incision) provides rapid access.
     • Hemorrhage Control:
       
       • Packing: Gauze packs compress bleeding sites (e.g., liver, spleen).
       • Ligation: Major vessels (e.g., splenic artery) are tied off.
       • Temporary shunts: For major vascular injuries (e.g., iliac artery), a shunt maintains blood flow.
     • Contamination Control:
       
       • Bowel perforations are stapled closed or resected without anastomosis; a temporary stoma may be created.
       • Irrigation removes contamination (e.g., feces, bile).
     • Temporary Closure:
       
       • The abdomen is left open to prevent abdominal compartment syndrome; a temporary closure device (e.g., vacuum-assisted closure, Bogota bag) is used.
   • Extremity Injuries:
     
     • Temporary shunts for vascular injuries, external fixation for fractures, and fasciotomy for compartment syndrome.
3. After Surgery (Stage 2: Resuscitation):
   
   • The patient is transferred to the ICU for 24–48 hours.
   • Goals: Correct hypothermia (warming blankets), acidosis (bicarbonate if needed), and coagulopathy (blood products: packed RBCs, fresh frozen plasma, platelets).
   • Monitoring: Vital signs, lactate levels, urine output, and ventilator support if needed.
4. Definitive Surgery (Stage 3):
   
   • Once stable (typically 24–72 hours), the patient returns to the operating room.
   • Definitive repairs: Bowel anastomosis, vascular reconstruction, organ repair/removal (e.g., splenectomy), and abdominal closure.
   • Hospital stay: 10–30 days, depending on injuries and complications.