Damage control surgery--concepts and practice

The results of prolonged and extensive procedures in the critically injured are poor, even in experienced hands. The operating theatre is a hostile and physiologically unfavourable environment for the severely injured patient. Laparotomy for major trauma involves dissipation of heat and massive blood loss requiring replacement. The result is a vicious cycle of hypothermia, acidosis and coagulopathy leading to death from an irreversible physiological insult (62). The damage control concept places surgery as an integral part of the resuscitative process, rather than an end in itself, and recognises that outcomes after major trauma are determined by the physiological limits of the patient, rather than by efforts of anatomical restoration by the surgeon. All those involved in the care of wounded patients should be familiar with this concept and its surgical and logistical implications.