DAMAGE CONTROL SURGERY

A SAFE APPROACH FOR EXSANGUINATING TRAUMA PATIENTS.

Abstract

Objective: To analyze the role of damage control in surgery in severely injured and polytrauma patients. D e s i g n:
Descriptive study. S e t t i n g : Surgical unit of District Headquarter (teaching) Hospital, Rawalpindi. P e r i o d : January 2000 to December 2007.
Patients a n d m e t h o d s : This study included 28 severely injured patients who presented in the accident and emergency department of
District Headquarters (teaching) Hospital, Rawalpindi. These patients were unstable because of life threatening hemorrhage following some
blunt or penetrating trauma. After immediate shifting to operation theater, resuscitation and operative intervention was done simultaneously.
Different procedures of damage control surgery like abdominal packing for hepatic and pelvic trauma, major vascular ligation for vascular
injuries of neck and extremities were adopted in phase I. In phase II patients were managed in ITC for coagulopathy and hypothermia.
Definitive treatment was done in Phase III after 24-72 hours once patients got stable. R e s u l t s : Total 28 patients included in the study. In
18 patients abdominal packing for hepatic injury (n=11) and pelvic fractures (n=7) was done. Major vascular ligations in n=11 and temporary
intestinal clamping in n=1 patient. Planned re-exploration after 24-72 hours in n=16 and unplanned re-exploration within 24 hours in n=5
patients was done. Complications included ongoing hemorrhage (n=5), coagulopathy (n=2), controlled biliary fistula (n=1), abdominal
compartment syndrome (n=1), cerebral ischemia (n=1) and gangrene of abdominal wall (n=1). Two patients died.