Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of damage control surgery and resuscitation in patients sustaining severe injury

Babak Sarani, MD, FACS, FCCM
Niels Martin, MD, FACS, FCCM
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Severely injured patients often do not have the physiologic reserve to tolerate definitive repair. The term "damage control" was borrowed from the United States Navy to refer to special teams that are responsible for keeping a severely damaged ship afloat until it can be returned to port for definitive repair. In a similar manner, damage control surgery serves to attend to immediately life-threatening conditions (keeping the patient afloat), while definitive management of these and other non-life-threatening injuries are delayed until after appropriate resuscitation. Although damage control surgery and resuscitation was initially described following abdominal injury, the basic principle has been extended to all aspects of trauma care.

The principles of damage control and resuscitation, as well as the damage control sequence, are reviewed here. The surgical management of specific injuries is discussed in detail in separate topic reviews.

(See "Initial evaluation and management of penetrating thoracic trauma in adults".)

(See "Initial evaluation and management of blunt thoracic trauma in adults".)

(See "Initial evaluation and management of abdominal gunshot wounds in adults".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 26, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg 1983; 197:532.
  2. Rotondo MF, Schwab CW, McGonigal MD, et al. 'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35:375.
  3. Johnson JW, Gracias VH, Schwab CW, et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51:261.
  4. Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am 1997; 77:761.
  5. Sugrue M, D'Amours SK, Joshipura M. Damage control surgery and the abdomen. Injury 2004; 35:642.
  6. Asensio JA, McDuffie L, Petrone P, et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg 2001; 182:743.
  7. Moore EE, Burch JM, Franciose RJ, et al. Staged physiologic restoration and damage control surgery. World J Surg 1998; 22:1184.
  8. Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective review. J Trauma 2000; 49:969.
  9. Seamon MJ, Doane SM, Gaughan JP, et al. Prehospital interventions for penetrating trauma victims: a prospective comparison between Advanced Life Support and Basic Life Support. Injury 2013; 44:634.
  10. Seamon MJ, Fisher CA, Gaughan J, et al. Prehospital procedures before emergency department thoracotomy: "scoop and run" saves lives. J Trauma 2007; 63:113.
  11. Taghavi S, Vora HP, Jayarajan SN, et al. Prehospital intubation does not decrease complications in the penetrating trauma patient. Am Surg 2014; 80:9.
  12. Gonzalez RP, Cummings GR, Phelan HA, et al. On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma. Am Surg 2008; 74:1083.
  13. Bradley JS, Billows GL, Olinger ML, et al. Prehospital oral endotracheal intubation by rural basic emergency medical technicians. Ann Emerg Med 1998; 32:26.
  14. Roberts DJ, Bobrovitz N, Zygun DA, et al. Indications for Use of Damage Control Surgery in Civilian Trauma Patients: A Content Analysis and Expert Appropriateness Rating Study. Ann Surg 2016; 263:1018.
  15. Riha GM, Schreiber MA. Update and new developments in the management of the exsanguinating patient. J Intensive Care Med 2013; 28:46.
  16. Taeger G, Ruchholtz S, Waydhas C, et al. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma 2005; 59:409.
  17. Mathieu L, Ouattara N, Poichotte A, et al. Temporary and definitive external fixation of war injuries: use of a French dedicated fixator. Int Orthop 2014; 38:1569.
  18. Bohman LE, Schuster JM. Decompressive craniectomy for management of traumatic brain injury: an update. Curr Neurol Neurosci Rep 2013; 13:392.
  19. Reilly PM, Rotondo MF, Carpenter JP, et al. Temporary vascular continuity during damage control: intraluminal shunting for proximal superior mesenteric artery injury. J Trauma 1995; 39:757.
  20. Davis TP, Feliciano DV, Rozycki GS, et al. Results with abdominal vascular trauma in the modern era. Am Surg 2001; 67:565.
  21. Schreiber MA. Damage control surgery. Crit Care Clin 2004; 20:101.
  22. Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma 2010; 68:1117.
  23. DuBose J, Inaba K, Barmparas G, et al. Bilateral internal iliac artery ligation as a damage control approach in massive retroperitoneal bleeding after pelvic fracture. J Trauma 2010; 69:1507.
  24. Behrman SW, Bertken KA, Stefanacci HA, Parks SN. Breakdown of intestinal repair after laparotomy for trauma: incidence, risk factors, and strategies for prevention. J Trauma 1998; 45:227.
  25. Torba M, Gjata A, Buci S, et al. The influence of the risk factor on the abdominal complications in colon injury management. G Chir 2015; 36:57.
  26. Burlew CC, Moore EE, Cuschieri J, et al. Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen. J Trauma 2011; 70:273.
  27. Georgoff P, Perales P, Laguna B, et al. Colonic injuries and the damage control abdomen: does management strategy matter? J Surg Res 2013; 181:293.
  28. Ordoñez CA, Pino LF, Badiel M, et al. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. J Trauma 2011; 71:1512.
  29. Ott MM, Norris PR, Diaz JJ, et al. Colon anastomosis after damage control laparotomy: recommendations from 174 trauma colectomies. J Trauma 2011; 70:595.
  30. Hatch QM, Osterhout LM, Podbielski J, et al. Impact of closure at the first take back: complication burden and potential overutilization of damage control laparotomy. J Trauma 2011; 71:1503.
  31. Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 1989; :89.
  32. Has B, Jovanovic S, Wertheimer B, et al. External fixation as a primary and definitive treatment of open limb fractures. Injury 1995; 26:245.
  33. Tejwani N, Polonet D, Wolinsky PR. External fixation of tibial fractures. J Am Acad Orthop Surg 2015; 23:126.
  34. Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364:1493.
  35. Sahuquillo J, Martínez-Ricarte F, Poca MA. Decompressive craniectomy in traumatic brain injury after the DECRA trial. Where do we stand? Curr Opin Crit Care 2013; 19:101.
  36. Aarabi B, Hesdorffer DC, Ahn ES, et al. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104:469.
  37. Grille P, Tommasino N. Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications. Rev Bras Ter Intensiva 2015; 27:113.
  38. McDaniel LM, Neal MD, Sperry JL, et al. Use of a massive transfusion protocol in nontrauma patients: activate away. J Am Coll Surg 2013; 216:1103.
  39. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007; 63:805.
  40. Kashuk JL, Moore EE, Johnson JL, et al. Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer? J Trauma 2008; 65:261.
  41. West MA, Koons A, Crandall M, et al. Whole blood leukocyte mitogen activated protein kinases activation differentiates intensive care unit patients with systemic inflammatory response syndrome and sepsis. J Trauma 2007; 62:805.
  42. del Junco DJ, Holcomb JB, Fox EE, et al. Resuscitate early with plasma and platelets or balance blood products gradually: findings from the PROMMTT study. J Trauma Acute Care Surg 2013; 75:S24.
  43. Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007; 62:307.
  44. Bauer M, Kortgen A, Hartog C, et al. Isotonic and hypertonic crystalloid solutions in the critically ill. Best Pract Res Clin Anaesthesiol 2009; 23:173.
  45. Lira A, Pinsky MR. Choices in fluid type and volume during resuscitation: impact on patient outcomes. Ann Intensive Care 2014; 4:38.
  46. Weinstein PD, Doerfler ME. Systemic complications of fluid resuscitation. Crit Care Clin 1992; 8:439.
  47. Neal MD, Hoffman MK, Cuschieri J, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg 2012; 72:892.
  48. Harvin JA, Mims MM, Duchesne JC, et al. Chasing 100%: the use of hypertonic saline to improve early, primary fascial closure after damage control laparotomy. J Trauma Acute Care Surg 2013; 74:426.
  49. Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 2003; 238:349.