Trauma resuscitation and damage control surgery

In recent years the envelope of survivability for victims of high-energy polytrauma has been continuously extended, thanks to advances at all levels of trauma care in both civilian and military practice. The concept of damage control surgery has been embraced by surgeons of various specialities as a paradigm within which to manage these patients, many of whom reach trauma centres alive, having sustained injuries which would until recently have been considered unsurvivable. This paper summarizes the development and application of this approach, and details the latest research evidence and development of this technique to include an integrated 'Damage Control Resuscitation-Damage Control Surgery' (DCR-DCS) protocol. The traditional staged approach to DCS has been superseded by an integrated DCR-DCS approach. This has been driven by a greater understanding of the management of the 'lethal triad' of trauma and by technological advances enabling real-time monitoring of physiological indices. This approach can extend initial safe operating times, with concomitant improvement in rates of survival and limb salvage.