Damage control. The history and modern view on surgical tactics

Introduction. The development of means and methods for the emergency elimination of vital disorders at the stages of intensive care helps to reduce mortality, however, even the use of the latest medical equipment does not guarantee the successful outcome of surgical measures, if this does not take into account the regular features of the course of vital processes in conditions of traumatic shock, the stage of development of traumatic illness. The polysystemic and multiorgan nature of lesions in polytrauma determines the variability of measures to provide medical care to the victims. This is due to the lack of a standardized treatment program for such patients at the hospital and pre–hospital stages. The second reason is the fragmentation and inconsistency of data on this topic. A systematic approach that would fully reflect the specifics of the lesions, taking into account the damaged organs and systems, the severity of the condition and the degree of organ dysfunction, is currently in its infancy. Surgical tactics for the treatment of patients with severe injuries does not have clear algorithms. For more than a century, generalized algorithms of surgical tactics have been helping surgeons, resuscitators and other specialists optimize the processes of polytrauma treatment, save the lives of patients who were previously considered hopeless.

The purpose of this article is to present an analytical review of the surgical tactics for the treatment of polytrauma at the hospital stage, which has received the generally accepted name "damage control surgery" or "surgical damage control" based on scientific literature.

Materials and methods. The analysis of domestic and foreign literary sources by keywords on available Internet resources was carried out. More than 60 scientific publications were studied, 39 of them are listed in this article.

Conclusion. Surgical tactics "Damage control surgery" determines the prospect of reducing the mortality of patients with severe traumatic shock and decompensated blood loss. At the same time, there is an increase in the percentage of survival and an improvement in the long–term results of surgical treatment of patients with severe trauma to the abdomen, chest, pelvis, craniocerebral trauma, combined with damage to tubular bones.

At the same time, the number of postoperative complications remains high, clear indications for the use of multi–stage surgical tactics have not been determined, and the optimal timing for performing the stages of surgical treatment has not been determined.

1. Aghajanyan V.V. Organization of medical care for multiple and combined trauma (polytrauma) Clinical recommendations (treatment protocol) (project). Polytrauma, 2015, № 4, pp. 6–18. (In Russian).

2. Aghajanyan V.V. Organizational problems of providing assistance to victims with polytrauma. Polytrauma, 2012, № 2, pp. 5–9. (In Russian).

3. Apartsin K.A. Surgery of combined injuries. Siberian Medical Journal (Irkutsk), 2014, № 3, pp. 129–133. (In Russian).

4. Apartsin K.A., Vasilyeva N.E., Novozhilov A.V. Assessment of the severity of shock injury in the acute period of traumatic illness. Clinical medicine, 2007, № 2(54), pp. 15–18. (In Russian).

5. Arutyunyan G.R., Charchyan A.G., Erebuni M.C. Damage control is a concept of modern treatment of long tubular bones in victims with polytrauma. Erebuni Medical Bulletin, 2009, № 4, pp. 2–5. (In Russian).

6. Batyrshin I. M., Kizyavka M. I., Sklizkov D. S., Ostroumova Yu. S., Mikhelson E. P., Borodina M. A., Nasser N. R., Tulupov A. N., Shlyapnikov S. A. Application of damage control principles and the use of a local negative pressure system for the prevention of infectious complications in a patient with traumatic separation of the upper limb and massive damage to. Wounds and wound infections. The Prof. B. M. Kostyuchenok Journal, 2019, vol. 6, pp. 22–25. (In Russian).

7. Boyko I.V., Zaft V.B., Lazarenko G.O., Zaslavsky A.Yu. Organization of emergency medical care for victims with polytrauma at the stages of medical evacuation. Emergency medicine, 2013, № 2 (49), pp.77–84. (In Russian).

8. Grigoriev E.V., Lebedinsky K.M., Shchegolevsky A.V., Bobovnik S.V., Bulanov A.Yu., Zabolotskikh I.B., Sinkov S.V., Shen N.P., Kornelyuk R.A. Resuscitation and intensive care in acute massive blood loss in adult patients. Clinical recommendations Anesthesiology and Resuscitation, 2020, № 1, pp. 5–24. (In Russian).

9. Gumanenko E.K. Military field surgery, 2nd edition. M. : GEOTARMED, 2008, 768 p. (In Russian).

10. Dubrov V.E., Blazhenko A.N., Khanin M.Yu., Gorbunov I.A., Blazhenko A.A., Kobritsov G.P., Khashagulgov G.M. Implementation of the principle of dynamic damage control damage control in the acute period of polytrauma. Polytrauma, № 2, 2012, pp. 68–73. (In Russian).

11. Korzhuk M.S., Kozlov K.K., Chernenko S.V., Yudakova T.N., Khamanov A.R. The main provisions of the damage control approach in polytrauma. Omsk Scientific Bulletin, 2015, № 1, pp. 53–57. (In Russian).

12. Seliverstov P.A., Shapkin Yu.G. Assessment of the severity and prediction of the outcome of polytrauma – the current state of the problem. Review of Modern technologies in medicine, 2017, № 5, vol. 9, pp. 207–218. (In Russian).

13. Sokolov V.A. Demage control – a modern concept of treatment of victims with critical polytrauma. Bulletin of Traumatology and Orthopedics named after N.N. Priorov, 2005, № 1, pp. 81–84. (In Russian).

14. Timerbulatov M.V., Timerbulatov Sh.V., Yarmukhametov M.I. Staged surgical interventions damage–control–i–bail–out in emergency abdominal surgery. Creative surgery and oncology, 2012, № 1, pp. 103–107. (In Russian).

15. Shapkin Yu.G., Seliverstov P.A. The phenomenon of mutual aggravation of injuries in polytrauma. Perm Medical Journal, 2016, № 5, pp. 82–94. (In Russian).

16. Shaposhnikov R.A., Manukyan G.V., Scherzinger.G. Modern application of tactics of multi-stage operations and abbreviated laparotomy in emergency surgery. Surgeon, 2009, № 1, pp. 55–59. (In Russian).

17. Edwards MJ, Lustik M, Eichelberger MR, Elster E, Azarow K, Coppola C. Blast injury in children: an analysis from Afghanistan and Iraq, 2002–2010. J. Trauma, 2012, № 73(5), pp. 1278–1283.

18. Feliciano D. V. et al. Abdominal gunshot wounds: an urban trauma center’s experience with 300 consecutive patients. Ann. Surg, 1998, Vol. 208, pp. 362–368.

19. Hirshberg A., Wall M. J., Mattox K. L. Planned reoperation for trauma: a two years experience with 124 consecutive patients. J. Trauma, 1994, vol. 37, pp. 365–369.

20. Holcomb J. B. et al. Damage Control Resuscitation: directly addressing the early coagulopathy of trauma. J. Trauma, 2007, vol. 62, pp. 307–310.

21. Johnson J.W., Gracias V.H., Schwab C.W. et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J. Trauma, 2001, vol. 51, № 2, pp. 261–269.

22. Lucas C., Ledgerwood A. Prospective evaluation of hemostatic techniques for liver injuries. J Trauma,1976, № 16, pp. 442–451.

23. Moore E.E, Burch J.M., Franciose R.J., Offner P.J., Biffl W.L. Staged physiologic restoration and damage control surgery. World J. Surg, 1998, vol. 22, № 12, pp. 1184–1191.

24. Pape HC, Peitzman A.B, Schwab C.W, Giannoudis P.V. Damage control management in the polytrauma patient. Springer, New York, 2008, р. 464.

25. Pringle J.H. Notes on the arrest of hepatic haemorrhage due to trauma. Annals of Surgery, 1908, № 48, p. 541.

26. Przkova R., Bosch U., Zelle et all. Damage control orthopedics: a case Report. J of Trauma, 2002, vol. 53, № 4, pp. 765–769.

27. Rotondo M.F., Schwab C.W., MC Gonigal et all. “Damade contol” an approach for improved survival in exsanguinafing penetrafing abdominal injuries. J. Trauma, 1993, № 35, pp. 375–382.

28. Scalea TM, Boswekk SA, Scott ID et all. External fixation as a bridge to intramedullary nailing for patients with multiple injuries: damage control orthopedics. J Trauma, 2000, № 48, pp. 613–621.

29. Stone H. H., Strom P. R., Mullins R. J. Management of the major coagulopathy with onset during laparotomy. Ann Surg, 1983, vol. 197, pp. 532–536.

30. Talbert S., Trooshkin S.Z., Scalea T. et al. Packing and reexploratior for patients with nonhepatic injures. J. Trauma, 1992, vol. 33, pp. 121–124.