Damage control surgery

2021 ◽  
Vol 21 (S1) ◽  
pp. 147-154
Author(s):  
C. Güsgen ◽  
A. Willms ◽  
R. Schwab
Keyword(s):  
Damage Control ◽  
Damage Control Surgery

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Clinical Scenario ◽  
Cross Sectional ◽  
Iliac Vessel ◽  
Civilian Trauma ◽  
Definitive Surgery

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

3 Damage control surgery in a regional trauma centre – defining the population: a pilot study

2021 ◽  
Vol 167 (4) ◽  
pp. 223.1-223
Author(s):  
Matthew J Burton
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Trauma Centre ◽  
University Hospital ◽  
Trauma Network ◽  
List Type ◽  
Prospective Data ◽  
Penetrating Abdominal Injury ◽  
Fatal Trauma

IntroductionTrauma has a major disease burden, by causing physiological disruption.1 Damage Control Surgery (DCS) minimises physiological disruption.2 3 The demographics of patients who undergo DCS surgery within our institution are unknown. This study aims to characterise our DCS cohort and potential for prospective study.MethodsOur hospital has a DCS protocol.4 This ensures the appropriate patients are safely and promptly transferred to a prepared operating theatre. All ORSOS data were captured from Nov 2017 – Sep 2019. Data was reviewed, and demographics analysed.ResultsThe DCS protocol was put on stand-by 42 times and activated in 21. Patient data was held for 38 cases, 30 male and 8 female, median age 37 years.Median Injury Severity Score was 29, with patients sustaining injuries from a range of mechanisms, figure 1. Median inpatient stay was 12 days, with a 29% 30-day mortality.Abstract 3 Figure 1Together this shows that despite prompt surgical intervention, a young patient cohort carries a significant mortality.ConclusionsWe have established the demographics of those who trigger DCS protocol use in a regional trauma centre. The resultant database enables prospective data collection for future DCS patients. Such data will afford our region a greater understanding of the DCS population.ReferencesPolinder S, Haagsma JA, Toet H, van Beeck EF. Epidemiological burden of minor, major and fatal trauma in a national injury pyramid. British journal of surgery 2012 Jan;99(S1):114–20.Schreiber MA. Damage control surgery. Critical Care Clinics 2004 Jan 1;20(1):101–18.Rotondo MF, Schwab CW, McGonigal MD, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. The Journal of Trauma 1993 Sep;35(3):375–82.Moor P, Droog S, Adams S. Damage Control Surgery (Online). Peninsula Trauma Network. University Hospital Plymouth. 2016 Feb [2019 December]. Available from: https://www.plymouthhospitals.nhs.uk/download.cfm?doc=docm93jijm4n3410.pdf&ver=4326

Peacekeepers suffered combat-related injuries in Mali: a retrospective, descriptive study

2018 ◽  
Vol 166 (3) ◽  
pp. 161-166
Author(s):  
Zhao Yongqiang ◽  
H Dousheng ◽  
L Yanning ◽  
M Xin ◽  
W Kunping
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Descriptive Study ◽  
Body Parts ◽  
Medical Treatment Facility ◽  
Chinese Military ◽  
Overseas Operations ◽  
Minor Injuries ◽  
Improvised Explosive ◽  
Explosive Devices

PurposeTo describe the combat-related injuries cured by Chinese Level 2 medical treatment facility (CHN L2) in Mali from 1 March 2016 to 1 March 2018, including type of weapon, mortality, nature of injuries, degree and location of injuries and surgical procedures.Methods A retrospective, descriptive study of 176 injured cases that met the terrorist attacks was conducted. The medical data were collected by an electronic database system. All collected data were entered into an Excel spreadsheet for calculation.ResultsWe found that improvised explosive devices (114/176, 65%) were the most commonly used weapons of attack in Mali. 68.75% of the injuries (121/176) were classified as 'minor injuries according to Abbreviated Injury Scale score. As one patient may suffer multiple injuries, each location and nature of injuries was counted separately. Surface injuries were the top (116/197, 58.88%), followed by orthopaedic injuries (52/197, 26.39%) and internal injuries (29/197, 14.72%). The extremities were the most frequently injured body parts (144/197, 73.09%). We operated 175 surgeries to deal with the 176 combat-related injuries, which accounted for 40.05% of all 437 surgeries. The surgical debridement to remove fragments of explosive was the most frequently performed surgery. We also admitted 20 cases (18/176, 34%) into intensive care unit and transferred 40 cases to Level 3 medical facility.Conclusion Peacekeepers taking protective measures for head and trunk frequently got surface injuries. And their unprotected extremities often got injured. The fragment removal was the top surgery and the damage control surgery was the highly technical nature surgery we performed. Chinese military should offer advanced surgical training course to military surgeons who carry out overseas operations.

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