Damage Control Surgery

All figures and tables included in this chapter have been used with permission from Pelagique, LLC, the UCLA Center for International Medicine, and/or the authors, unless otherwise noted. Use of imagery from the Defense Imagery Management Operations Center (DIMOC) does not imply or constitute Department of Defense (DOD) endorsement of this company, its products, or services. Disclaimer The opinions and views expressed herein belong solely to those of the authors. They are not nor should they be implied as being endorsed by the Defense, or any other branch of the federal government. Damage control surgery techniques have evolved within the continuum of military and civilian trauma care since the Napoleonic Wars. Though civilian trauma surgeons now uniformly embrace the relatively contemporary label " damage control, " the techniques have firm foundation within the history of military medicine. In the later part of the 18 th century during the Napoleonic campaign, the French surgeon Larrey succinctly alluded to the rationale for expedited battlefield procedures: " When a limb is so much injured by a gunshot wound that it cannot be saved, it should be amputated immediately. The first 24 hours is the only period during which the system remains tranquil, and we should hasten during this time, as in all dangerous diseases, to adopt the necessary remedy. " 2 Military historical references to the techniques of damage control surgery in the United States (US) appear around the time of the Civil War (Fig. 1). 3 In World War II, the Second Auxiliary Surgery Group treated over 22,000 combat wounded soldiers, including 8,800 " severely wounded, " during a two-year interval from 1943 to 1945. 4 The ensuing 912-page report and scientific publications that were consequent to the operation yielded insight into the surgical treatment of thoracic injury; the reactive lung injury associated with severe trauma denoted " the wet lung of trauma, " which we now know as acute respiratory distress syndrome (ARDS); and the utility of techniques aimed at the " correction of profound physiologic disturbances which immediately endanger life " is now described by the moniker, damage control. In the Vietnam War, it was recognized in several case series that temporizing surgical procedures often demonstrated a survival advantage when compared to definitive surgical therapy. 5 Though apparently temporarily forgotten after the Vietnam War, the technique reappeared in the hallmark publication by Stone in 1983, which advocated abbreviated celiotomy in …