Operative Exposure of Abdominal Injuries and Closure of the Abdomen

2019 ◽  
Author(s):  
Matthew D Nealeigh ◽  
Mark W Bowyer
Keyword(s):  
Open Abdomen ◽  
Nonoperative Management ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation ◽  
Abdominal Injuries ◽  
Penetrating Injuries ◽  
Optimal Outcomes ◽  
Medial Rotation ◽  
Selective Nonoperative Management

Operative exposure and management of significant blunt or penetrating injuries to the abdomen is a critical skill required of all surgeons caring for victims of trauma. Application of damage control resuscitation and damage control surgical principles improves survival. Advances in diagnostics, increasing experience with selective nonoperative management, and use of endovascular and angiographic techniques have all significantly decreased the frequency of laparotomies performed for trauma. This decreasing clinical experience mandates that surgeons dealing with victims of trauma remain facile with the operative approaches and techniques detailed in this chapter to achieve optimal outcomes. Detailed management of specific injuries is covered in other chapters of this text. This review contains 7 figures, 2 tables, and 41 references.  Key Words: abdominal trauma, damage control resuscitation, damage control surgery, endovascular control of hemorrhage, open abdomen, REBOA, supraceliac control of aorta, trauma systems, visceral medial rotation

scholarly journals The Evolution of Damage Control in Concept and Practice

2017 ◽  
Vol 31 (01) ◽  
pp. 030-035 ◽  
Author(s):  
Brian Beldowicz
Keyword(s):  
Medical Decision Making ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Strategy Implementation ◽  
Medical Decision ◽  
Metabolic Dysfunction ◽  
Damage Control Resuscitation ◽  
Hemorrhage Control ◽  
Threat To Life ◽  
Critically Ill Surgical Patients

AbstractDamage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity. This review discusses the evolution of damage control in both concept and practice, summarizing available literature and experience to guide patient selection, medical decision-making, and strategy implementation throughout the preoperative, intraoperative, and early postoperative periods.

scholarly journals Contemporary damage control surgery outcomes: 80 patients with severe abdominal injuries in the right upper quadrant analyzed

2017 ◽  
Vol 44 (1) ◽  
pp. 79-85 ◽  
Author(s):  
M. Hommes ◽  
S. Chowdhury ◽  
D. Visconti ◽  
P. H. Navsaria ◽  
J. E. J. Krige ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Injuries ◽  
Surgery Outcomes ◽  
The Right

Damage Control Surgery in the Era of Damage Control Resuscitation

2015 ◽  
Vol 59 (3) ◽  
pp. 114-115
Author(s):  
C. M. Lamb ◽  
P. MacGoey ◽  
A. P. Navarro ◽  
A. J. Brooks
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Damage Control Resuscitation

Massive Transfusion in a Child

2013 ◽  
Author(s):  
Stefan Sabato
Keyword(s):  
Direct Evidence ◽  
Massive Transfusion ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Supporting Evidence ◽  
Damage Control Resuscitation ◽  
Acute Hemorrhage ◽  
Early Management ◽  
Major Morbidity ◽  
The Core

The traditional early management of hemorrhagic shock is currently being challenged, and many centers around the world have already changed their practice. Damage-control resuscitation, in conjunction with damage-control surgery, has been shown to improve major morbidity and mortality outcomes in adults. In children there is little direct evidence for these new approaches, but supporting evidence is accumulating. This chapter will introduce these concepts while also reinforcing the core principles of managing acute hemorrhage in the trauma setting.

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know

2020 ◽  
Vol 71 (3) ◽  
pp. 352-361
Author(s):  
Siobhán B. O’Neill ◽  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Sadia R. Qamar
Keyword(s):  
American Association ◽  
Nonoperative Management ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Organ Injury ◽  
Solid Organ ◽  
Imaging Findings ◽  
Solid Organ Injury ◽  
Imaging Protocols

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy

2019 ◽  
Vol 39 (6) ◽  
pp. 37-45
Author(s):  
Steven Wiseman ◽  
Ellen M. Harvey ◽  
Katie Love Bower
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Care Practice ◽  
Successful Implementation ◽  
Resuscitation Strategy ◽  
Physiological Benefits ◽  
Procedural Components ◽  
Management Priorities ◽  
Abdominal Compartment

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.

Critical Care Considerations for Damage Control in a Trauma Patient

2021 ◽  
Vol 32 (1) ◽  
pp. 64-75
Author(s):  
Shannon Gaasch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cause Of Death ◽  
Damage Control ◽  
Operative Procedure ◽  
Fixed Ratio ◽  
Damage Control Surgery ◽  
Fluid Restriction ◽  
Damage Control Resuscitation ◽  
Lethal Triad

Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

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