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A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma

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Damage control in trauma and abdominal sepsis.

Brett H Waibel¹, Michael F Rotondo

¹Department of Surgery, Division of Trauma and Surgical Critical Care, The Brody School of Medicine, East Carolina University, Greenville, NC, USA. brett.waibel@pcmh.com

Critical Care Medicine

|August 21, 2010

Summary

Damage control surgery has improved outcomes for trauma patients by controlling bleeding and contamination. However, it has led to new challenges like open abdomens, prompting innovative treatments.

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Area of Science:

Surgical Innovation
Trauma Surgery
Critical Care Medicine

Background:

Damage control surgery emerged less than 20 years ago to address high mortality in exsanguinating abdominal trauma.
It involves abbreviated laparotomy for hemorrhage and contamination control, followed by resuscitation before definitive repair.
This approach has transformed emergent surgery for abdominal sepsis and battlefield injuries.

Purpose of the Study:

To review the evolution and impact of damage control surgery.
To discuss the expanded understanding of abdominal compartment syndrome in relation to damage control surgery.
To explore emerging complications and innovative solutions in damage control surgery.

Main Methods:

Review of historical development and clinical application of damage control surgery.
Analysis of the impact of damage control surgery on surgical outcomes and complications.
Examination of current and developing strategies for managing open abdomens and abdominal wall reconstruction.

Main Results:

Damage control surgery has significantly improved outcomes for critically ill trauma and general surgery patients.
Understanding and avoidance of abdominal compartment syndrome is a key factor in improved surgical outcomes.
New challenges include increased rates of enterocutaneous fistulas and open abdomens.

Conclusions:

Innovative strategies, including negative pressure therapies and acellular allograft meshes, are being developed for open abdomen management.
Advancements in resuscitative strategies may reduce the future need for damage control surgery while maintaining its benefits.
Damage control surgery remains a critical intervention for severely ill patients, despite ongoing challenges and evolving techniques.