Timing of Fracture Fixation in Multitrauma Patients: The Role of Early Total Care and Damage Control Surgery

Relevance. Currently, damage control surgery (DCS) is actively used in polytrauma. However, data on the effectiveness of this tactic for combined radiation-mechanical injuries (CRMI) in the available literature was not found.Objective. To develop a model of CRMI on small laboratory animals (rabbits), which allows studying the effectiveness of the use of DCS in comparison with the early total care surgery tactics.Methods. A model of a severe CRMI was proposed. The animals were subjected to a generally uniform short-term gammairradiation, and then they suffered a liver injury on the background of blood loss of 40% of the blood volume and hypothermia. After modeling the lesion, a comparison was made of the effectiveness of the tactics of the DCS and the early total care surgery tactics. During the study, the following indicators were evaluated: the average life expectancy and mortality of animals, changes in the cellular composition of peripheral blood, features of behavioral reactions to irradiation, the amount of blood loss during the implementation of the surgical intervention.Results and their analysis. The experiment showed that the tactics of the DCS have an advantage over the traditional tactics of a one-time exhaustive operation in the case of the CRMI. When performing DCS, there was no death of rabbits on the 1st day after the operation, when implementing early total care surgery - 3 rabbits died, besides, the mortality was absolute, while with DCS one rabbit survived (12.5%). The final operation at the DCS occurs prior to the beginning of the acute period of CRMI, which corresponds to the requirements of the instructions for the treatment of CRMI. In the course of the study, it was found that the proposed model of CRMI contributes to the formation of the phenomenon of mutual burdening and, as a result, complicates both the radiation and mechanical components of the lesion occurs.Conclusion The proposed experimental model for the application of severe CRMI helps to explore DCS tactics in the treatment of this pathology. DCS is a promising method of surgical treatment of CRMI, however, for more accurate extrapolation of data from animal to human, additional research on large laboratory animals is required.

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The choice of tactics for treatment of the injured persons with vertebra-abdominal trauma due to traffic-transport accident

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2019.06.30 ◽

2019 ◽

Vol 86 (6) ◽

pp. 30-33

Author(s):

S. О. Guryev ◽

P. V. Таnasiyenko ◽

S. Ya. Balyasevych

Keyword(s):

Abdominal Trauma ◽

Traffic Accident ◽

Damage Control ◽

Damage Control Surgery ◽

Mortality Reduction ◽

Early Total Care ◽

Group I ◽

Treatment Measures ◽

Total Care ◽

Group Ii

Objective. To estimate the results of application of treatment-diagnostic tactics in the injured persons, suffering vertebro-abdominal trauma as a consequence of the traffic accident. Маterials and methods. For achievement of the investigation aim 122 injured persons with vertebro-abdominal trauma due to traffic accident were analyzed. The injured persons were divided into two Groups: Group I - 53 patients, in whom the «early total care» was applied, and Group II (a control one) - 69 patients, to whom the treatment measures were conducted in accordance to the «damage control surgery» tactics. Results. In the investigation there was established, that in the injured persons, suffering vertebro-abdominal trauma two tactics are affordable: «early total care», which is indicated in moderate internal hemorrhage, injuries of large omentum and intestinal mesentery, and «damage control surgery», which is indicated in presence of severe internal hemorrhage, hepatic, splenic and the retroperitoneal organs damages. Conclusion. Application of the «damage control surgery» tactics in the injured persons, suffering vertebro-abdominal trauma has advantages, what is proved by the mortality reduction by 6.3% and the rate of the infection complications occurrence - by 3.5%.

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Damage control orthopaedics vs early total care in hip fractures: Is 36 hours too soon?

Injury Extra ◽

10.1016/j.injury.2012.07.278 ◽

2012 ◽

Vol 43 (10) ◽

pp. 99

Author(s):

L. Murphy ◽

S. McKenna ◽

D. Shirley

Keyword(s):

Hip Fractures ◽

Damage Control ◽

Damage Control Orthopaedics ◽

Early Total Care ◽

Total Care

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Training in the practical application of damage control and early total care operative philosophy – perceptions of UK orthopaedic specialist trainees

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12518836440045 ◽

2010 ◽

Vol 92 (2) ◽

pp. 154-158 ◽

Cited By ~ 6

Author(s):

WGP Eardley ◽

DM Taylor ◽

PJ Parker

Keyword(s):

External Fixation ◽

Damage Control ◽

Practical Application ◽

Web Based ◽

High Exposure ◽

Orthopaedic Surgeons ◽

Early Total Care ◽

Total Care ◽

High Level ◽

Optimum Management

INTRODUCTION Despite improvements in the outcome of individuals sustaining significant injury, the optimum management of fractures in traumatised patients remains an area of debate and publication. There is, however, a paucity of studies regarding the specifics of acquired experience and training of junior orthopaedic surgeons in the practical application of these skills. Our null hypothesis is that, despite alteration in surgical training, the perceived confidence and adequacy of training of UK orthopaedic specialist trainees in the application of damage control orthopaedics (DCO) and early total care (ETC) philosophy is unaffected. PATIENTS AND METHODS A web-based survey was sent to a sample of orthopaedic trainees. From 888 trainees, 222 responses were required to achieve a 5% error rate with 90% confidence. RESULTS A total of 232 responses were received. Trainees reported a high level of perceived confidence with both external fixation and intramedullary devices. Exposure to cases was sporadic although perceived training adequacy was high. A similar pattern was seen in perceived operative role with the majority of trainees expecting to be performing such operations, albeit under varying levels of supervision. In a more complicated case of spanning external fixation for a ‘floating knee, trainees reported a decreased level of perceived confidence and limited exposure. One-third of trainees reported never having been involved in such a case. In contrast to nationally collated logbook data, exposure to and perceived confidence in managing cases involving ETC and DCO were similar. CONCLUSIONS Despite changes in the training of junior orthopaedic surgeons, trainee-reported confidence and adequacy of training in the practical application of DCO and ETC was high. Exposure to cases overall was, however, seen to be limited and there was a suggestion of disparity between current operative experiences of trainees and that recorded in the national trainee logbook.

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Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606542 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S08-S13 ◽

Cited By ~ 9

Author(s):

Luigi Valdatta ◽

Pierluigi Tos ◽

Salvatore D'Arpa ◽

Luigi Troisi ◽

Pellegatta Igor ◽

...

Keyword(s):

Soft Tissue ◽

Negative Pressure ◽

Chronic Wounds ◽

Damage Control ◽

Physiological State ◽

Damage Control Surgery ◽

Soft Tissue Reconstruction ◽

Pressure Therapy ◽

Temporary Closure

AbstractThe concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed. A negative-pressure dressing can be easily and rapidly applied to obtain a temporary closure between surgical stages. While negative pressure wound therapy (NPWT) has clear indications in the management of chronic wounds, its applications in the acute setting in victims of polytrauma are uneven. We conducted a review of the current clinical literature to evaluate the role of NPWT in this field, which points out that the negative pressure, applied immediately after the first debridement, seems to be an optimal bridge to the final reconstruction up to 7 days.

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