Last update:
09-Jul-2004

During the past 20 years, it gradually became apparent that the results of prolonged and extensive surgical procedures in the critically injured patient were often poor, even in experienced hands. The triad of hypothermia, coagulopathy and metabolic acidosis effectively marks the limit of the patient’s ability to cope with the physiological consequences of injury. Crossing this limit will frustrate even the most technically successful repair. These observations led to the development of a new surgical strategy that sacrifices the completeness of the immediate repair, in an effort to adequately address the combined physiological impact of trauma and surgery. This approach is unfolded in three phases. During the initial operation, the surgeon does only the absolute minimum necessary to control exsanguination rapidly and to prevent spillage of intestinal content and urine into the peritoneal cavity. Packing is the traditional method for the management of major liver injuries. Examples of simple techniques applied to buy time, besides packing, include temporary closure or exteriorization of the lumen of the injured bowel without resection, tying off or rapid exteriorization of an injured ureter, and balloon tamponade of bleeding cavities or inaccessible vessels. Some patients continue to bleed after surgery, necessitating a decision about the feasibility of re exploration, while in others, increased intra abdominal pressure impairs ventilation and renal function, requiring immediate decompression. The second phase consists of secondary resuscitation in the intensive care unit, under complete ventilatory support, characterized by maximization of hemodynamics, correction of coagulopathy and rewarming. During the third phase, the intraabdominal packing is removed and definitive repair of abdominal injuries is performed. The “damage control” concept has been shown to decrease overall mortality and morbidity and its success is like ly to modify significantly the management of the critically injured patient.

Key words: Abdominal packing, Hemorrhage, Reoperation, Trauma.