J.Jpn. Surg. Soc.. 103(7): 503-506, 2002

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Feature topic

PARADIGM SHIFT FROM STANDARD SURGERY TO DAMAGE CONTROL SURGERY IN MAJOR TRAUMA

“Damage control surgery (DCS)" is currently the most commonly used term to describe the surgical strategy for major trauma. Standard surgical approaches to trauma consist of a priority-driven sequence of steps, including exposure, homeostasis, repair, resection, and reconstruction. Patients with massive exsanguination, however, will not survive complex procedures. It is well known that those patients are more likely to die from intraoperative physiological deterioration resulting from a failure to complete surgical repair. The surgical team must undergo a paradigm shift focusing on saving life or resuscitation DCS has three separate components. The first is abbreviated resuscitative surgery for rapid control of hemorrhage and contamination. This is achieved as quickly as possible in the operating room, but traditional repairs are deferred in favor of rapid measures that control hemorrhage, restoreflow where needed, and control or contain contamination. The second step in DCS is systemic management in the ICU, where the care consists of ongoing core rewarming, correction of coagulopathy, fluid resuscitation, and optimization of hemodynamic status, as well as reexamination to diagnose all injuries. When normal physiology has been restored, reoperation is undertaken for definitive repairs of injuries and abdominal closure. In addition to the above three components, an earlier phase before the initial operation, referred to as “DC ground zero" has recently been added.

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