Concept Of Damage Control Surgery Research Articles

Peri-operative strategy in resuscitation of unstable injured surgical patients: a primer.

Trauma remains a leading cause of death, both for individuals under 40 in North America, and globally, where it contributes to ~10% of deaths annually. Thoughtful, timely, balanced resuscitation, especially in the peri-operative period for unstable injured surgical patients, is vital for optimizing outcomes. The advanced trauma life support protocol plays a pivotal role in early evaluation and management, emphasizing hemorrhage control and resuscitation strategies. This narrative review provides a structured, evidence-based framework aimed at enhancing the educational experience of surgical trainees. It outlines key principles in peri-operative trauma resuscitation, emphasizing timely intervention, goal-directed fluid therapy, and damage control surgery (DCS) to improve patient outcomes. A comprehensive Scale for Quality Assessment of Narrative Review Articles -guideline compliant literature search was conducted using PubMed and Google Scholar for English-language articles published between January 2000 and February 2024. The search included relevant medical subject headings terms. Additional studies were identified from reference lists. Extracted data were reviewed and organized using thematic analysis, focusing on historical perspectives, evidence-based practices, and the concept of DCS. Key findings from the 55 relevant studies selected underscore the importance of balanced fluid and blood product administration, the use of permissive hypotension in hemorrhagic shock, and the application of DCS principles. This review highlights educational strategies that foster a deeper understanding of trauma resuscitation practices, offering practical insights through case studies and technological innovations. This review serves as an educational resource for surgical trainees, equipping them with a robust understanding of evidence-based trauma resuscitation. By integrating historical context, modern practices, and emerging technologies, the review aims to enhance both the theoretical knowledge and practical skills necessary for managing unstable trauma patients. Emphasis is placed on interdisciplinary teamwork, continuous education, and personalized resuscitation strategies to improve clinical outcomes.

Damage Control in Penetrating Liver Trauma: Fear of the Unknown

The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.

Is Damage Control Surgery Better than Traditional Surgery in Multiple Trauma: A Meta Analysis

ABSTRACT Background: The concept of damage control surgery (DCS) has been proposed and used for many years. In this study, we investigated whether the DCS is more effective than traditional surgery (TS) for treating multiple traumas. Methods: After formulating the retrieval strategy, we searched 12 databases and two clinical trial centers. Data from eligible studies were included and extracted based on the inclusion and exclusion criteria. To analyze the results, we used the risk ratio (RR), weighted mean difference (WMD), and 95% confidence interval (95% CI). The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies. RevMan (version 5.3) and Stata (version 14 and 17) were used for data analysis. Results: First, the mortality rate of DCS group was reduced (RR = 0.27, 95% CI: 0.22 to 0.34, P < 0.001), and the success rate of rescue was improved (RR = 1.36, 95% CI: 1.29 to 1.44, P < 0.001). Second, the DCS group had shorter in-hospital length of stay (WMD = −5.58, 95% CI: −6.83 to −4.32, P < 0.001) and intensive care unit (ICU) length of stay (WMD = −3.54, 95% CI: −4.57 to −2.51, P < 0.001), and significantly reduced the incidence of complications (RR = 0.36, 95% CI: 0.31 to 0.43, P < 0.001), especially disseminated intravascular coagulation (DIC) (RR = 0.27, 95% CI: 0.20 to 0.36, P < 0.001), multiple organ dysfunction syndrome (MODS) (RR = 0.44, 95% CI: 0.31 to 0.61, P < 0.001), and shock (RR = 0.38, 95% CI: 0.25 to 0.56, P < 0.001). Then, the recovery time of body temperature (WMD = −7.68, 95% CI: −9.39 to −5.97, P < 0.001), clearance time of lactic acid (WMD = −17.58, 95% CI: −21.05 to −14.12, P < 0.001), the recovery time of prothrombin time (PT) (WMD = −11.79, 95% CI: −13.67 to −9.91, P < 0.001), activated partial thromboplastin time (APTT) (WMD = −12.69, 95% CI: −14.53 to −10.85, P < 0.001) and base excess (BE) (WMD = −16.07, 95% CI: −16.58 to −15.55, P < 0.001) of DCS group decreased. Finally, the DCS group showed reduced intraoperative blood loss (WMD = −421.53, 95% CI: −494.44 to −348.62, P < 0.001), operation time (WMD = −24.65, 95% CI: −35.50 to −13.80, P = 0.007), and red blood cell transfusion volume (WMD = −5.95, 95% CI: −7.01 to −4.89, P < 0.001). Conclusion: Our research shows that for patients who have suffered multiple trauma, DCS is more efficient than TS for patients who have experienced multiple traumas. In the future, more detailed, large-scale, multicenter, randomized controlled trials are required to verify our findings.

Damage control surgery- abord și implicații multidirecționale

Introduction: Despite the fact that damage control surgery (DCS) is generally accepted to reduce the mortality rate in critically ill patients, morbidity among survivors is still high, which is why it is essential to note that indications must be well established before implementation. The purpose of this paper is to raise awareness of the need for a holistic assessment of the status of the patient and the medical team involved in the Damage Control Surgery process. Material and method: Observational and retrospective studies were selected using the PubMed / MEDLINE database published between 2000-2021, and the keywords used to identify relevant articles were damage control surgery, military medicine, psychological. consequences, trauma. Conclusions: The concept of DCS needs to be used in well-evaluated conditions and it is important to remember that the psychological impact of medical decisions resonated not only among patients but also with the entire medical team.

Endovascular Strategy in Obstetrics

Post-partum hemorrhage (PPH) requires medical resources to resuscitate hemorrhagic shock patients. The concept of damage control surgery in obstetrics has become widespread, and resuscitative endovascular balloon occlusion of the aorta (REBOA) can be a means of resuscitation in PPH. However, the potential benefits of endovascular strategies in obstetrics are not fully understood. This review aims to share the knowledge and experience of the endovascular strategy in the field of obstetrics among both interventional radiologists and obstetricians through the summary of the literature and multi-specialty expert consensus in the Japanese Society of Diagnostic Interventional Radiology in Emergency, Critical care and Trauma (DIRECT). The endovascular strategies include REBOA, arterial embolization, and common or internal iliac artery balloon occlusion (CIABO or IIABO). Uterine artery embolization achieves rapid definitive hemostasis while leaving fertility with a less invasive procedure. N-butyl-2-cyanoacrylate (NBCA) should be chosen as needed for coagulopathy. The obestetrics team (obstetricians and midwives) and the resuscitation team (doctors from emergency medicine, anesthesiology, interventional radiology, and nurses) would each have to develop a command system, and control and cooperate in parallel. The consensus for the timing of arterial access and the patient’s positioning for pelvic examination and femoral arterial access should be established in advance.

Damage Control Surgery after Burn Injury: A Narrative Review

Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of multidisciplinary care. Effective management of severely burned patients, their cutaneous injuries, and the associated systemic disease requires a comprehensive understanding of the pathophysiologic response to trauma, objective indicators of patient status, and an appreciation for the dynamic nature of these parameters. Progress in both clinical and basic science research has advanced our understanding of these concepts and our approach to the management of burn patients. Incorporating concepts such as early total care, damage control surgery (DCS), and safe definitive surgery (SDS) in the polytraumatized patient may further aid in optimizing outcomes and quality of care for burn patients. This article connects current knowledge of the lethal triad, inflammation, immunosuppression, and eschar-derived toxins, with surgical burn care, especially burn wound debridement. The concepts of DCS and SDS for the care and management of burn patients are strongly advocated. Experimental and clinical studies are encouraged to validate these concepts in an effort to optimize patient outcomes.

Management of Maxillofacial Gunshot Injuries With Emphasis on Damage Control Surgery During the Yemen Civil War. Review of 173 Victims From a Level 1 Trauma Hospital in Najran, Kingdom of Saudi Arabia.

Studies on the concept of Damage Control Surgery (DCS) in the management of firearm injuries to the oral and maxillofacial region are still scarce, hence the basis for the current study. The objectives of the current study is to share our experience in the management of maxillofacial gunshot injuries with emphasis on DCS and early definitive surgery. This was a retrospective study of combatant Yemeni patients with maxillofacial injuries who were transferred across the border from Yemen to Najran, Kingdom of Saudi Arabia. Demographics and etiology of injuries were stored. Paths of entry and exit of the projectiles were also noted. Also recorded were types of gunshot injury and treatment protocols adopted. Data was stored and analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY: IBM Corp). A total of 408 victims, all males, were seen during the study period with 173 (42.4%) males sustaining gunshot injuries to the maxillofacial region. Their ages ranged from 21 to 56 years with mean ± SD (27.5 ± 7.6) years. One hundred and twenty-one (70.0%) victims had extraoral bullet entry, while 53 (30.0%) victims had intraoral entry route. Ocular injuries, consisting of 25 (14.5%) cases of ruptured globe and 6 (3.5%) cases of corneal injuries, were the most commonly associated injuries. A total of 78 (45.1%) hemodynamically unstable victims had DCS as the adopted treatment protocol while early definitive surgery was carried out in 47(27.2%) hemodynamically stable victims. ORIF was the treatment modality used for the fractures in 132 (76.3%) of the victims. We observed that 42.4% of the war victims sustained gunshot injuries. DCS with ORIF was the main treatment protocol adopted in the management of the hemodynamically unstable patients.

Damage Control in Penetrating Liver Trauma: Fear of the Unknown.

The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.

Laparostomy and temporary abdominal closure outcomes in emergency non-trauma surgery and parameters affecting early definite primary fascial closure.

The open abdomen or laparostomy is a great advance of surgery based on the concept of damage control surgery. Aim of the study is to review the laparostomy outcomes of non-trauma emergency surgery patients in a district general hospital and identify parameters affecting early definite primary fascial closure. The records of all non-trauma emergency surgical patients who underwent laparostomy in a three-year period in a single institute were studied retrospectively. Outcomes included length of stay, morbidity, mortality, readmission rates, number of re-look operations, rate of definite primary fascial closure and time to closure. Thirty-two patients were included. Morbidity was 84.4% and mortality rates were 21.9% (in-hospital), 18.8% (30-day) and 46.9% (overall). Median length of hospital stay was 22 days. Rate of primary fascial closure was 87.5% and median time to closure was two days. The number of relook operations was the only independent prognostic factor of definite early primary fascial closure, with higher rates of closure in patients with 1-2 relooks. Although the open abdomen has been demonstrated to improve survival, the precise role in abdominal sepsis has not been elucidated. Current consensus does not support use of open abdomen routinely, however in selected situations it becomes unavoidable. Laparostomy is a valid option in non-trauma emergency surgery and can be managed safely in a district hospital. High closure rates can be achieved if one or two re-look operations are performed with an early attempt for closure.

Update: Management of colonic diverticulitis

Update: Management of colonic diverticulitis Abstract. Several classification systems exist for diverticulosis and diverticulitis. We preferably use the "Classification of Diverticular Disease" (CDD) to grade the severity of disease. This classification is based on imaging by CT scan or ultrasound. The CDD system divides patients into categories with a common therapeutic strategy. Acute uncomplicated diverticulitis is treated by oral or intravenous antibiotics. For the majority of patients with uncomplicated diverticulitis, antibiotic therapy might be omitted in favor of a solely symptomatic therapy. Acute diverticulitis complicated by a relevant abscess or a perforation is treated by interventional drainage or surgical therapy. Resection with primary anastomosis replaces more and more resection with end colostomy (Hartmann's procedure). For patients with sepsis, the concept of damage control surgery has been introduced. The indication for elective surgery after conservative treatment of diverticulitis shall be dictated by the degree of the patient's symptoms, rather than the number of conservatively treated episodes of diverticulitis. Persisting complications, as fistulas and stenosis, represent an indication for elective colonic resection.

Deferred anastomosis in severe secondary peritonitis using a temporary intestinal shunt – case report

Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy.
 Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS.
 Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. 
 Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition.

Is Time of the Essence: A Retrospective Analysis of Operating Room Procedure Length for First Phase Damage Control Trauma Surgery

Background:The concept of Damage Control Surgery (DCS) consists of a truncated surgical intervention with main focus on hemorrhage and contamination control. Traditionally,DCS involves limiting operating room (OR) time for patients with multiple life-threatening injuries and coagulopathy who are reaching physiologic exhaustion. However, in the modern era of hemostatic resuscitation, there is a paucity of evidence to support a survival benefit with shorter OR times. The objective of this study was to determine the practice habits of trauma surgeons in the modern era of DCS and to determine if operation length affects mortality in trauma patients with abdominal injuries.
 Methods:An 8-year retrospective review of consecutive adult patients with DCSfor penetrating abdominal trauma at a Level I trauma center was conducted. Patient demographics, injury severity score (ISS), and penetrating abdominal trauma index (PATI) scores were obtained. Average operating room times for initial DCS were determined. Patient outcomes were analyzed with a t-test for univariate analysis and a Cox proportional hazard ratio modeling was used to predict factors for survival. 
 Results:A total of 193 patients were included in the study. The overall patient mortality was 14.0% (n=27/193). Median OR time was 157 minutes (range, 59-573 min). Patients were stratified into short OR group (SHORT, n=95) and long OR group (LORT, n=98) based on the median operative time. Only one patient had an initial DCL less than 60 minutes. The SHORT group received more blood transfusions (52.6% vs. 35.7%, p=0.02) in the ICU. Average operative room time was almost twice as long in the LORT group (214.6+6.2 vs. 121.4+2.6 minutes, p<0.0001). The average hospital length of stay (22.8+2.3 vs. 31.0+3.5 days, p=0.05) and ICU length of stay (10.6+1.2 vs. 12.6+1.4 days, p=0.28) were both lower in the LORT group compared to the SHORT group. The SHORT group had 22 patients with unplanned return to the OR compared to 3 in the LORT group (p<0.0001). On multivariate analysis, OR time was not an independent risk factor for mortality (OR 1.0, 95% CI 0.98-1.0, p=0.48).
 Conclusions: Modern damage control practices should focus on early and effective surgical hemorrhage control in combination with effective intra-op hemostatic resuscitation efforts and not on how time limitations. These findings suggest that OR time restrictions in the era of effective hemostatic resuscitation in combination with DCS does not impact mortality.

Damage control surgery Concept

Damage control surgery concept (DCS) consists of performing a staged surgery and allowing resuscitation in severe trauma patients who require surgical management. Initially, the DCS has been described in severe liver trauma associated with coagulopathy. Over time, Due to the observed advantages, the DSC approach has become standard practice for abdominal trauma with the extent to extra-abdominal trauma and acute abdominal emergencies.

Damage Control Vascular Surgery

Exsanguination is one of the most fearsome sequelae of trauma and is responsible for a large portion of both civilian and military mortality. The concept of damage control surgery is a critical development in the field of trauma largely driven by the growing understanding that coagulopathy and physiologic derangements are the primary cause of death in critically ill trauma patients. Damage control vascular surgery focuses on the rapid temporization of vascular injuries. Balloon occlusion can be utilized for rapid hemorrhage control (REBOA, foley catheter, retrohepatic caval balloon, etc.). In the setting of damage control, most veins can and should be ligated. Consideration of shunting should be made regarding the suprarenal inferior vena cava, the portal vein, and the superior mesenteric vein. The named arteries should be shunted and repaired when possible; however, redundant arterial beds can be safely ligated. Vessels of all sizes can be safely shunted with commercially available or improvised devices. Systemic heparinization is not necessary to maintain patency. More recently, the concept of using endovascular stents as long-term shunts has gained attention. These can be deployed traditionally under angiographic guidance or using the novel direct site endovascular repair (DSER) technique. The rapidly evolving field of endovascular trauma management has afforded a host of new management strategies for the physiologically deranged critically ill trauma patient.

Rethinking on ethics and principle of surgery

Surgery is an important part of medicine, it has undergone huge changes in recent decades in China.The concepts of damage control surgery, minimally invasive surgery, and enhanced recovery after surgery are all new with the date, laparoscopic surgery, robotic surgery, natural orifice transluminalendoscopic surgery are not new words to all of us. Surgical operations are becoming more and more specialized, surgical technique is becoming more and more mature, and surgeons are becoming more and more specialized. Medical ethical issues, as the common language of surgeons and basic principle of surgery, should be recognized and understood more stronger than ever, which will enable surgeons to retrieve original intention of surgery. This paper takes this as starting point and explore the common principles of surgery, aims to arouse some mutual encouragement to growing youth surgeons.

The application of intestinal stomas in mesenteric ischemia

Objective: To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery. Methods: Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n=43) and chronic MI group (CMI, bowel stricture, n=16). The medium time from onset to consult of AMI was 7(12) days (M(Q(R))) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred. Results: In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis (n=8), acute renal failure (n=4), acute respiratory distress syndrome (n=4), short bowel syndrome (n=4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period. Conclusions: According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.

Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma

IntroductionThe modern concept of damage control surgery (DCS) for trauma was first introduced less than three decades ago. This audit aims to describe the spectrum and outcome of patients requiring...

Damage Control Orthopedic Surgery.

The concept of damage control surgery was first described for the purpose of treating medically un-stable patients with abdominal trauma. The purpose of such surgery is rapid control of hemorrhage and contamination, not definitive repair of injuries. The goal is to improve survival of patients with the potentially lethal triad of hypothermia, acidosis and coagulopathy. Definitive repair of injuries and abdominal closure are not performed at the time of initial laparotomy. Rather, the abdominal wound is left open, a dressing is placed, and the patient is transported to the intensive care unit for continued re-suscitation. This includes optimization of hemodynamic condition, respiratory support, warming, and correction of coagulopathy. Following successful resuscitation, when the patient is medically stable, a return to the operating room is scheduled for repair of injuries and abdominal closure.

Clinical effects of damage control surgery in treatment of severe craniocerebral injury combined with multiple extremity fractures

Objective To investigate the effects of damage control surgery (DCS) in the treatment of severe craniocerebral injury patients combined with multiple extremity fractures. Methods The clinical data of 128 patients with severe craniocerebral injury[Glasgow coma scale (GCS) scored 3-8] combined with multiple extremity fractures admitted from May 2011 to August 2015 were retrospectively analyzed by case-control study. There were 81 males and 47 females, with an average age of 37.3 years (range, 19-77 years). The patients were treated with intracranial pressure monitoring in addition to the common administration. The patients were subdivided into two groups: 87 patients treated with DCS concept as damage control group and 41 patients treated with non-DCS routine concept as control group. The DCS group received craniotomy and fracture fixation operation in stage I with selective operation of open reduction and internal fixation. The control group received craniotomy and open reduction and internal fixation in stage I. The postoperative intracranial pressure, operation duration, intraoperative blood loss, hospital stay and prognosis [Glasgow outcome scale (GOS)]were analyzed statistically. Results No intracranial infection was found in all patients during the treatment process. In damage control group, the postoperative intracranial pressure was normal in 44 cases (51%), which was significantly better than that in control group [8 cases (20%)](P<0.05). In damage control group, operation duration [(150.1±12.4)minutes], intraoperative blood loss[(270.6±15.3)ml], and hospital stay [(29.7±9.3)days] were significantly shortened compared with control group, whose operation duration, intraoperative blood loss and hospital stay were (270.6±9.8)minutes, (460.2±17.5)ml, and (34.4±6.2)days, respectively (P<0.05). The GOS rating of damage control group (70%) was notably higher than that in control group (42%) (P<0.05). Conclusion For severe craniocerebral injury patients combined with multiple extremity fractures, the application of DCS contri-butes to control of postoperative intracranial pressure, which can also shorten the duration of hospitalization and improve prognosis. Key words: Craniocerebral injury; Fractures, bone; Decompressive craniectomy; Damage control surgery

Damage Control Radiology in the Severely Injured Patient

In the treatment of severely injured patients, the term 'damage control radiology' has been used to parallel the modern concept of damage control surgery and the allied development of continuous damage control resuscitation from patient retrieval, through all transfers, to appropriate primary treatment. The aims of damage control radiology are (i) rapid identification of life-threatening injuries including bleeding sites, (ii) identification or exclusion of head or spinal injury, and (iii) prompt and accurate triage of patients to the operating theatre for thoracic, abdominal, or both surgeries or the angiography suite for endovascular haemorrhage control. If we are to achieve these aims, patients must have immediate access to modern multidetector computed tomography (MDCT) which is without doubt the most potent weapon in the diagnostic armamentarium. The most severely injured patients are those who have the most to benefit from early diagnosis and life-saving therapies. The traditional teaching that these patients should go immediately to surgery is challenged by technological developments in MDCT and recent clinical evidence.