DAMAGE CONTROL FOR THORACIC INJURIES
Review articleOpen access
Abstract:

The early operations for vascular trauma were primarily ligation, thus trading a limb to save a life. Following advances in elective procedures, more aggressive and complex operations for trauma were proposed. In the extreme, procedures such as hepatectomy and pancreaticoduodenectomy have been advocated.23 Although these procedures were often technical successes, patients often exceeded their physiologic limits and died. hus, techniques aimed only at restoring a survivable physiology, terminating the operation, and then returning to the operating room to complete the procedure were developed.1, 9, 18, 20 Although the standard planned reoperation has been the essence of the damage control approach, another variation is to modify an existing operation to make it technically simpler and quicker to perform.The damage control approach has seen significant utility for abdominal trauma when applied primarily to solid-organ and vascular trauma. The unique anatomy of the abdomen permits pressure and counterpressure with packing around the liver, thus arresting venous hemorrhage. Additionally, another thrust of the damage control approach is to deal rapidly with bleeding from major intra-abdominal vascular structures.7 This is a primary objective, and the standard trauma laparotomy must often be modified by using temporizing measures such as ligation, intravascular shunts, and rapid closures.Damage control in the thorax has evolved in a slightly different manner. The damage control philosophy perhaps originated in the chest with the application of emergency center thoracotomy in an attempt to restore physiology to a patient in extremis. Although originally suboptimal from a sterility, instrumentation, and resources standpoint, it allowed the trauma patient to survive to be brought to the operating room for the definitive procedure. It also is an effective triage tool, providing better use of resources so that patients with lethal injuries are not routinely brought to the operating room.Other damage control techniques in the chest have evolved differently from the abdominal approaches. The rapid closure, such as towel-clip closure, may not be as applicable to thoracic injury owing to muscular bleeding. The conditions in which packing is helpful for abdominal trauma may not be present in the thoracic cavity. Thus, rather than focus on planned reoperation, many thoracic damage control techniques emphasize simpler and quicker but definitive procedures.

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