Scribd Logo
Upload

Welcome to Scribd!

  • 66 views

    Damage Control Surgery

    Uploaded by

    dr
    Damage control surgery and temporary abdominal closure techniques are used for trauma patients in critical condition to control hemorrhage and contamination while allowing physiologic recovery before definitive repair. The document outlines indications, procedures, and timelines for temporary closure with plastic barriers and drains, planned re-exploration within 72 hours, and guidelines for closure or planned hernia repair depending on wound status and recovery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Damage Control Surgery

    Uploaded by

    dr
    66 views2 pages
    Damage control surgery and temporary abdominal closure techniques are used for trauma patients in critical condition to control hemorrhage and contamination while allowing physiologic recovery before definitive repair. The document outlines indications, procedures, and timelines for temporary closure with plastic barriers and drains, planned re-exploration within 72 hours, and guidelines for closure or planned hernia repair depending on wound status and recovery.

    Original Description:

    damage control

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Damage control surgery and temporary abdominal closure techniques are used for trauma patients in critical condition to control hemorrhage and contamination while allowing physiologic recovery before definitive repair. The document outlines indications, procedures, and timelines for temporary closure with plastic barriers and drains, planned re-exploration within 72 hours, and guidelines for closure or planned hernia repair depending on wound status and recovery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    66 views2 pages

    Damage Control Surgery

    Uploaded by

    dr
    Damage control surgery and temporary abdominal closure techniques are used for trauma patients in critical condition to control hemorrhage and contamination while allowing physiologic recovery before definitive repair. The document outlines indications, procedures, and timelines for temporary closure with plastic barriers and drains, planned re-exploration within 72 hours, and guidelines for closure or planned hernia repair depending on wound status and recovery.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Damage Control Surgery & Temporizing Abdominal Closure

    Trauma / Emergency General Surgery / Surgical Critical Care


    Division of Trauma and Surgical Critical Care
    Vanderbilt University Medical Center
    2005

    I. Indications for Damage Control Surgery


    1. Trauma & EGS Patient in extremis
    a. Life threatening hemorrhage requiring abdominal packing, or temporizing
    vascular shunts
    b. Bowel resection in the face of dwindling physiologic reserve requiring
    delayed GI reconstruction
    c. Mesenteric ischemia with planned re-look laparotomy
    d. Massive intra-abdominal contamination or visceral edema precluding
    primary fascial closure
    e. Massive volume resuscitation (>15 units pRBC & > 10 L crystalloid)
    expecting significant visceral edema and the development of Abdominal
    Compartment Syndrome.

    II. Temporizing Abdominal Closure


    1. Plastic barrier (bowel isolation bag) to protect the bowels
    2. Surgical towel & 2 Jackson Pratt drains brought out through the wound
    3. Ioban adhesive cover.

    III. Time to subsequent operative procedure.


    1. Unplanned re-exploration should be done in the face of ongoing surgical bleeding
    2. Re-exploration is done when patient has regained physiologic reserve (End-points
    to be determined by Trauma / EGS surgeon: lactic acid, base deficit, correction of
    coagulopathy, normalization of temperature).
    3. Time to unpacking of abdomen should not exceed 72 hours (Incidence of Intra-
    abdominal abscess significantly increased beyond 72 hrs.)
    4. Planned washouts of open abdomen should be everyday for contaminated
    abdomen and every other day for clean-contaminated open abdomen.
    5. Abdominal washouts should be done with warm saline only.

    IV. The Contaminated Dirty Abdomen = Tertiary Peritonitis


    1. Defined as gross purulent fluid in more than one quadrant (Single quadrant =
    Intra-abdominal abscess)
    2. Irrigation to be done with warm saline only
    3. Acetic Acid maybe used to soak laparotomy pads or kerlex rolls of a defined
    abscess cavity with planned serial washouts until visually clean.

    V. Abdominal Fascial Closure


    1. Primary Fascial abdominal closure should be evaluated at each laparotomy.
    2. Indications for continued open abdomen
    a. Visceral Edema with inability for primary closure
    b. Contaminated Dirty abdomen
    c. Significant Extra-abdominal Sepsis with Acute Lung Injury on significant
    ventilatory support.
    Damage Control Surgery & Temporizing Abdominal Closure
    Trauma / Emergency General Surgery / Surgical Critical Care
    Division of Trauma and Surgical Critical Care
    Vanderbilt University Medical Center
    2005

    VI. Planned Ventral Hernia


    1. Once intra-abdominal issued have been corrected and unlikely to obtain primary
    fascial closure by post injury day 8, trauma / EGS surgeon must consider a
    planned ventral hernia course.
    2. Small ventral defect (< 10 cm wide) consider AlloDerm closure with or without
    skin closure (with or without bipedicle flaps)
    3. Large defect (> 10 cm wide) vycril mesh closure with planned STSG when
    granulated bed matured.

    You might also like