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  • Print publication year: 2008
  • Online publication date: January 2010

28 - Damage Control in Severe Trauma



Understand concept of damage control surgery (DCS).

Understand that reversal of lethal triad requires aggressive intervention for improved outcome.

Understand staged physiological restoration (four stages).


The management of the multiply injured patient has been revolutionized during the past century. Advances in prehospital care, resuscitation, interventional radiology, and intensive care medicine have all contributed to better trauma outcomes. The damage control process of abbreviated laparotomy with rapid control of hemorrhage and contamination has proved to be effective to combat the physiologic failure associated with severe blunt and penetrating injury.

This chapter reviews some of the key issues of damage control surgery, highlighting the importance of a multidisciplinary team approach to optimize trauma patient management.


Damage control surgery (DCS) is abbreviated surgery performed on selected critically injured patients. Definitive operative management is accomplished in a stepwise fashion based on the patient's physiologic tolerance; the objective is to gain time to stabilize the severely traumatized patient and to optimize their physiologic state before definitive repair. Rather than restoring anatomic integrity, the rationale for DCS is to minimize the metabolic insults of coagulopathy, hypothermia, and acidosis. Each of these three factors tends to exacerbate the others and interact to produce a downward metabolic spiral: the bloody vicious cycle [36]. The concept of DCS originally emerged from collective experience with major abdominal injuries. Over the past decade, however, other surgical subspecialties have adopted the DCS concept success-fully.

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