Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jul 2002
[Pathophysiologic changes in trauma patients and indications of damage control surgery].
Damage control surgery has become an inevitable strategy in the treatment of severely traumatized patients. Rationale for the DCS is the fact that the mortality in surgical patients who developed hypothermia, acidosis, and coagulopathy (lethal triad) is extremely high unless patients' physiologic stability was reestablished. DCS is usually indicated when patient shows signs of lethal triad during surgical operation. As most of patients who subsequently needed DCS could be judged as having most severe injuries during resuscitative phase, it may be more wise to select candidates for DCS during this phase than to indicate DCS during operation.
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A critically injured chest trauma patient showing profound shock or cardiac arrest en route to the trauma center or in the emergency room sometimes requires emergency room thoracotomy and definitive repair. In some patients damage control must be performed because of the appearance of the deadly triad of hypothermia, acidosis, and coagulopathy. ⋯ Damage control procedures for chest injuries include aortic cross-clamping, hilar clamping, major vessel ligation, pulmonary tractotomy, simultaneously stapled pneumonectomy or lobectomy, cardiac stapling, balloon catheter tamponade, temporary intraluminal shunt, towel packing, towel clip closure, single en masse closure of the chest wall, etc. Every surgeon responsible for treating critical chest trauma patients should have knowledge of damage control and also be familiar with the techniques.
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Nihon Geka Gakkai zasshi · Jul 2002
[Paradigm shift from standard surgery to damage control surgery in major trauma].
"Damage control surgery (DCS)" is currently the most commonly used term to describe the surgical strategy for major trauma. Standard surgical approaches to trauma consist of a priority-driven sequence of steps, including exposure, homeostasis, repair, resection, and reconstruction. Patients with massive exsanguination, however, will not survive complex procedures. ⋯ The second step in DCS is systemic management in the ICU, where the care consists of ongoing core rewarming, correction of coagulopathy, fluid resuscitation, and optimization of hemodynamic status, as well as reexamination to diagnose all injuries. When normal physiology has been restored, reoperation is undertaken for definitive repairs of injuries and abdominal closure. In addition to the above three components, an earlier phase before the initial operation, referred to as "DC ground zero" has recently been added.
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"Damage control surgery" is a surgical strategy to cope with the lethal triad of death, i.e., acidosis, hypothermia, and coagulopathy, often seen in severely injured patients. Perihepatic packing was attempted by some trauma surgeons during the 1970s as an alternative to hepatectomy for severe liver injury, with favorable results. The concept of bail-out surgery and reoperation was introduced during the 1980s as a treatment modality for severe abdominal trauma. ⋯ The concept of damage control surgery is now applied not only to severely injured patients but also for other surgical patients in critical condition. Damage control surgery was introduced to Japan during the late 1990s. However, the Japanese experience has been limited because the volume of severe trauma cases is very small.