Damage Control in Surgery-An Expanding Concept

Patients with multiple injuries suffer severe Physiological insult by single overwhelming hit or secondary hits leading to development of fatal triad namely Coagulopathy, Hypothermia and Acidosis. Without prompt corrective measures the patient will be pushed towards Systemic Inflammatory Response Syndrome, Organ failure and finally Death.

The concept of damage control surgery developed in order to prevent secondary hits due to magnitude of surgery and involves doing the minimal in the shortest possible time followed by stabilization in ITU before definitive surgery. Since then the concept has expanded.

The expansion of the concept of DCIS can be considered in four stages. First Stage involved Establishment of the Damage control Surgery (DCS) in severe abdominal trauma. Stage Two saw establishment of Damage control Resuscitation with DCS as a component. DCR, a systematic approach to exsanguinating trauma, incorporating several strategies to reduce morbidity and mortality is achieved by wide range of efforts to minimize fatal triad. Stage Three the concept encompassed other regions such as thorax, limbs and brain. Stage four extended it beyond Trauma in to critical surgical illnesses across a vast range which includes cholecystitis, bleeding peptic ulcers, intestinal obstructions and pyonephrosis.

DCIS has become a key component in trauma care saving many severely injured. Since origins in Abbreviated laparotomy, DCIS has evolved in to concepts of DCR and branched off to cover other areas and systems and also engulfed care of non-trauma surgical emergencies. More conceptual, technical and technological developments are expected in the future care of injured and ill.