• Mircea Beuran and Florin-Mihail Iordache.
• Department of Surgery, Emergency Clinical Hospital, Bucharest, Romania.
• J Med Life. 2008 Jul 1; 1 (3): 247-53.

AbstractDamage-control surgery is an example of a paradigm shift. The term is borrowed from naval teminology and means gaining the initial control of a damaged ship. Because of the lethal triad the polytrauma patient is at a grave risk. The classical concept of surgically solving all the patient's injuries in the first moment was even theoretically incorrect as a multiple injured patient is a critical patient with depleted reserves. As such, complex procedures were doomed from this point of view. The concept of damage-control surgery emerged in 1992. The core idea was that as minimal as possible had to be done in these critical patients in the first phase, meaning temporary control of a hemorrhage and simple measures for stopping contamination. After 24-48 hours in the ICU, in which time the physiological disturbances were corrected, a further intervention is perfomed for definitively treating the injuries. Further refinements consider five stages and not three in damage-control surgery. The bright side of the concept is an up to 70% survivability rate but with a higher risk of complications, mostly due to the policy of temporary closing the abdomen and sepsis.

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