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British Journal of Healthcare and Medical Research - Vol. 12, No. 02
Publication Date: April 25, 2025
DOI:10.14738/bjhmr.1202.18418.
Sánchez, M. A. G., Hernández, J. L. G., Cabello, J. de J. U., Barrón, G. M., Castillo, L. F. F., Salvador, J. R. H., Suárez, I. A. L., Daniel, M.
Y. P., & Oca Ambriz, I. R. M. (2025). Damage Control Surgery: A Strategic Resource! British Journal of Healthcare and Medical
Research, Vol - 12(02). 90-109.
Services for Science and Education – United Kingdom
Damage Control Surgery: A Strategic Resource!
Morelos Adolfo García Sánchez
*Specialist in Surgery and with a Subspecialty in Colon and Rectal Surgery
attached to the Surgery Department of the General Hospital Ministry of Health of
Mexico City. "Dr. Rubén Leñero". Graduated from the National Autonomous
University of Mexico, Mexico City. Country Mexico
José Luis García Hernández
Specialist in Surgery. Attached to the Department of Surgery General Hospital
Iztapalapa “Dr. Juan Ramón de la Fuente" of the Ministry of Health of Mexico City.
Graduated from the National Autonomous University of Mexico. Mexico City.
Country Mexico
José de Jesús Urbina Cabello
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
Gema Méndez Barrón
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
Luis Fernando Flores Castillo
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
Judá Raquel Hernández Salvador
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
Ivonne Alondra León Suárez
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
Mayra Yadira Pérez Daniel
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
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Sánchez, M. A. G., Hernández, J. L. G., Cabello, J. de J. U., Barrón, G. M., Castillo, L. F. F., Salvador, J. R. H., Suárez, I. A. L., Daniel, M. Y. P., & Oca
Ambriz, I. R. M. (2025). Damage Control Surgery: A Strategic Resource! British Journal of Healthcare and Medical Research, Vol - 12(02). 90-109.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18418.
Iñaki Rubén Montes de Oca Ambriz
Specialist in Surgery. Attached to the Department of Surgery General Hospital"
Dr. Rubén Leñero" of the Ministry of Health of Mexico City. Graduated from the
National Autonomous University of Mexico. Mexico City. Country Mexico
ABSTRACT
Introduction: damage control surgery is a surgical strategy, applicable to traumatic
and non-traumatic patients, in a context of severe physiological instability,
addressing a complex surgical situation in stages. Objective: experience of the
strategy of damage control surgery in trauma surgery, complicated elective surgery
or a non-traumatic surgical emergency. Method: retrospective, longitudinal,
observational and descriptive study. Reviewing the records of patients treated
surgically applying damage control surgery, for 5 years. Results: 21 of 221 patients
were documented applying the strategy, 9.95%, 19 were men (90.47%), 2 women
(9.53%) with an average age of 25 years, range 17 to 64 years. Discussion:
hemorrhagic shock is the most common immediate cause of death in trauma and
requires immediate and coordinated action to reverse it. When there are few
resources or limited infrastructure, trauma surgeons take the options of
resuscitative thoracotomy and/or abdominal packing, at lower costs. Observations:
the surgical technique of damage control surgery and the reasons that support it for
the first time are detailed; coining innovative terms such as: "damage control
surgery cycle", "planned hemostatic compression", "infection containment"
Conclusions: damage control surgery is an effective, economic, and ethical strategic
resource, which, if well carried out and allowed by the case, saves human lives and
with an early closure cycle reduces morbidity, without sequelae and mitigates
mortality.
Keywords: Damage control surgery, Planned hemostatic compression, Surgical strategy,
Surgical technique, Infection, Hemorrhagic shock.
INTRODUCTION
Surgery is as old as the human being, the word surgery in its etymological root is derived from
the greek that means "to work with the hands". The technology and innovation in surgery of
these times has been the result of constant evolution, whose origin dates to the Neolithic to the
end of the stone age. In prehistory there were three types of medicine: 1) Instinctive. 2) The
empirical. 3) The magical-religious. It was then empirical medicine that was practiced as a
product of experience: as the trepanation of the skull to relieve pain or as rest after a fracture;
etc. [1] The watershed between prehistory and history occurs in the year 1976 B.C. found in the
Hammurabi code, which describes 10 norms and 282 rules on the practice of medicine, in its
application and punishments for malpractice, especially that referring to surgical interventions.
In the Edwin Smith Papyrus 1540 B.C., it was found that the Egyptians limited themselves to
healing wounds, removing small external tumors or splinting fractures, without going any
deeper. [2] Surgery as a profession from the beginning was classified more as a manual art than
as a science. After almost 300 years of frustrated attempts by surgeons to regulate their
university training, in 1540 king Henry VIII of England accepted that the surgeon-barbers of
the time could enroll in the faculties of medicine, with the aim of acquiring a university and
scientific training. [3] Advances in anesthesia methods, asepsis, antisepsis, the invention of
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gloves, improvements in blood transfusion techniques, and the discovery of antibiotics finally
made surgery safer until just the second half of the twentieth century. [4, 5]
Currently, the surgical evolution focuses on options such as damage control surgery (DCS),
which is defined as a surgical strategy applied to traumatic and non-traumatic patients, in
which, in a context of severe physiological instability, a complex surgical situation is addressed
in stages, aiming in the first intervention to save the patient's life even without solving all the
injuries and [6, 7] that in addition, surgery should be completed quickly after controlling the
bleeding that can threaten life and avoiding contamination (infection and sepsis) and then
reaching the correction of physiological abnormalities and a definitive management, aimed at
avoiding the lethal triad, where massive bleeding ends in acidosis, hypothermia and
coagulopathy. [8] The origin is from an idea resulting from a U.S. Navy military strategy called
"damage control", a coined term that was defined as "the ability of a ship to absorb damage and
maintain mission integrity". [9]
The origin of the DCS strategy in Surgery dates back to 1976 with the publication of Lucas and
Ledgerwood, where they refer to the use of temporary internal compresses with a second to
third subsequent surgical intervention (an experience that was reported only in 3 patients).
Later it was published by Feliciano in 1981 applying this strategy in 10 patients; [10, 11] but it
was not until Retondo in 1993 who coined the term DCS in his publication with a practice
applied in 46 patients during a 3-year study, where overall survival improved markedly in
patients treated with DCS; concluding to be a promising approach to increase survival in
exsanguinating patients with significant vascular penetrating abdominal lesions and/or
visceral multiples. [12]
OBJECTIVE
To present the experience of the Surgery services, of the strategy applied in DCS surgeries, in
the different classes such as: trauma surgery, complicated elective surgery or non-traumatic
surgical emergency, during 5 years of surgical practice, in a multicenter study.
METHOD
It is a study with a retrospective, longitudinal, observational and descriptive design. The
records and files of all patients surgically treated with the DCS strategy in trauma surgery,
complicated elective surgery, and non-traumatic surgical emergency, during a period of 5 years
of surgical practice, are reviewed in a multicenter study in three hospitals in Mexico City and
the State of Mexico, which are:
1. Specialty Hospital of Mexico City "Dr. Belisario Domínguez" of the Ministry of Health.
Mexico City. Country: Mexico. 3rd Level of medical care.
2. "Dr. Rubén Leñero" General Hospital of the Ministry of Health. Mexico City. Country:
Mexico. 2nd Level of medical care.
3. "Las Americas" General Hospital of Ecatepec. State of Mexico, of the Ministry of Health
of the State of Mexico. Country: Mexico. 2nd Level of medical care.
In the study period that comprised from January 2020 to January 2025. Age, sex, etiological and
surgical diagnosis, pathological history and associated factors, previous surgical
treatments/number of surgeries/complications/sequelae, quantified bleeding, surgical time,
days of hospital stay and including the intensive care unit support service, morbidity and
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Sánchez, M. A. G., Hernández, J. L. G., Cabello, J. de J. U., Barrón, G. M., Castillo, L. F. F., Salvador, J. R. H., Suárez, I. A. L., Daniel, M. Y. P., & Oca
Ambriz, I. R. M. (2025). Damage Control Surgery: A Strategic Resource! British Journal of Healthcare and Medical Research, Vol - 12(02). 90-109.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18418.
mortality were documented. With a follow-up of each patient upon discharge from the hospital,
a week, a month or the time necessary until their definitive discharge. The study and
presentation of the results is carried out using descriptive biostatistics procedures.
RESULTS
A total of 211 files were reviewed, of which 168 cases (79.62%) were men and 43 women
(20.37%), with an average age of 28 years, in a bimodal value of 21 and 53 years. Of this study
group, only 21 patients were documented where the DCS strategy is performed, representing
9.95% of these cases 19 were men who represented 90.47% and 2 women who were 9.53%
with an average age of 25 years and range from 17 to 64 years. With a diagnostic etiology as
diverse as that of an elective/or scheduled surgery that becomes urgent due to its evolution,
emergency surgery of first instance in a first surgical time or in a subsequent one, by non- traumatological emergency surgery and/or with open/closed abdominal trauma due to
accident/aggression by third parties. The etiology, diagnosis, number of surgeries, initial or
subsequent, where the previous surgery was scheduled or urgent, the previous surgical
technique if any, and the complications that justified the use of the DCS strategy are specified
in table and graph 1.
Graph 1
Table 1: Etiology/Diagnosis/Previous Surgery/Number of
Surgeries/Initial/Subsequent in the Total Number of Patients Where Damage Control
Surgery is Performed From 2020 to 2025 in the Three Hospitals, Expressed in
Number/Percentage.
Etiology/Diagnosis/Number of Surgeries/Initial/Subsequent/Previous Surgical
Technique/Urgent or Not
Number/%
Blunt Trauma/Liver Injury/3/Si/Hepatic Rafia+Packing/Yes 6/28.57
Penetrating Gunshot Trauma/Mesenteric Injury, Renal, Spleen/5/Si/Bowel
Resection, Nephrectomy + Colon Control With "Drawstring" + Packing/Yes
7/ 33.33
Perforated Duodenal Ulcer/Perforated Gastric Ulcer/6/No/Bilrroth Ii/ Packing/No 2/ 09.52
Penetrating Stab Trauma/3/Si/Suprerenal, Splenic and Renal Cava
Injury/3/Si/Packing/Si
4/ 19.09
Fournier Syndrome/9/Non/Debridement and Surgical Lavage,
Colostomy+Packing/No
1/04.76
0% 20% 40% 60% 80% 100%
BLUNT TRAUMA
PENETRATING TRAUMA BY FIREARM
PERFORATED DUODENAL ULCER
PENETRATING TRAUMA BY WHITE WEAPON
FOURNIER SYNDROME
28.5
33
9
19
4.7
4.7
ETIOLOGY (%)
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Pancreate Pseudocyst/4/No/Yeyunogastroanastosis/Packing+Gastrostomy,
Jejunostomy/No
1/04.76
Total Number of Patients 21 / 100
First, the etiology of the initial diagnosis due to blunt or penetrating trauma where DCS was
applied was carried out in 17 cases, representing 80.95%, and in an urgent/emergency surgery.
The remaining group of patients was performed in 4 patients, which are 19.04%, considered as
complications of an initial emergency surgery (second surgery) or elective surgery.
The pragmatic surgical action or decision to apply DCS was carried out in the 19 cases
representing 90.47%, due to the main cause/factors involved in this strategy, which are:
1. Uncontrollable bleeding or "continuous bleeding in layer".
2. The individual presents with hemodynamic instability due to a state of
hypovolemic/septic shock III/IV.
3. And the great lack/absence of resources or supplies, such as the lack of red blood cells
at that time, substitutes/derivatives/hemostatic agents, systemic/topical, etc.
Only in 3 patients of the DCS, representing 14.28%, it was carried out for infection control, fecal
contamination, septic shock that potentially or with an increased risk, that occurred with
hemodynamic instability and that due to the lack of supplies or resources, temporary closures
or tactical drains were carried out.
A total of 96 patients underwent surgery on a total of 96 occasions, with a range of 2 to 9
procedures, where the average of patients of traumatic etiology in the initial surgery (healthy,
young and uninfected subject) was especially 2 surgical procedures, without added morbidity.
The exponential increase in surgeries was most reflected, with an average of 6 per patient, were
the cases that occurred with a lack of control of the infectious process already installed in a
severe way (septic shock, perforations or the so-called enteroatmospheric fistulas). [13] The
tactics of the surgical techniques of the DCS that were adapted/conditioned in each of the
patients are listed and mentioned, according to the case that is estimated or assessed at that
time of the surgical act, being pointed out in table and graph 2:
Table 2: The Tactics of The Surgical Techniques Applied to Damage Control Surgery in
Patients from 2020 To 2025 of the Three Hospitals, Expressed in Number/Percentage.
Surgical Techniques Applied in Damage Control Surgery Number/%
Packaging 19/90.47
Planned Ventral Hernia 8/ 38.09
Floating Stoma 1/ 04.76
Fecal Containment Drawstring 1/ 04.76
Gastrostomy 1/04.76
Yeyunostomia 2/09.52
Combination of 2 or More Techniques 11/52.38
Total Number of Patients 21 / 100
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Sánchez, M. A. G., Hernández, J. L. G., Cabello, J. de J. U., Barrón, G. M., Castillo, L. F. F., Salvador, J. R. H., Suárez, I. A. L., Daniel, M. Y. P., & Oca
Ambriz, I. R. M. (2025). Damage Control Surgery: A Strategic Resource! British Journal of Healthcare and Medical Research, Vol - 12(02). 90-109.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18418.
Graph 2
In most individuals, a "packing" is planned with an incidence expressed as a percentage of
90.47% and at the same time a giant planned ventral hernia is performed with the technique of
subcutaneous polyethylene bag or "Blanco bag" [14, 15] in 3 cases (37.5%) or only skin closure
in 5 cases (62.5%). See Figure 1.
Figure 1
"Placement of the subcutaneous polyethylene bag. Polyethylene contains the intestinal loops
and is fixed by 4 to 5 total points. The aponeurosis is open, and the skin is closed above the
polyethylene." Figure taken from the reference: Martínez-Ordaz J.L., Cruz-Olivo P.A., Chacón- 0
10
20
30
40
50
60
70
80
90
100
90.4
38
4.7 4.7 4.7 9.5
52.3
SURGICAL TECHNIQUES IN DAMAGE CONTROL SURGERY IN PATIENTS IN %
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Mora E., et al. Management of the abdominal wall in sepsis. Comparison of two techniques.
Journal of Gastroenterology of Mexico. 2004; 69(2): 88-93. [15]
And by frequency, in third place was the creation of jejunostomy in only 2 patients (9.52%).
Two unusual adaptations or surgical techniques, such as the creation of a floating stoma in one
case and the fecal containment jar in the colon in another patient. See Figure 2.
Figure 2
Open abdomen with Bogota bag. A 24-year-old male underwent elective surgery for intestinal
reconnection of the terminal ileus (terminal ileostomy) with transverse colon anastomosis,
with anastomotic leakage at 7 days: with surgical reoperation with primary closure of the
intestinal anastomosis and a third surgery for intestinal perforation in another site with
primary closure of the intestine equally and the abdomen open.
Regarding chronic-degenerative diseases/comorbidities in this study group where the DCS
strategy is established, the first place is occupied by obesity in 5 patients (23.80%), in second
place by diabetes mellitus in 3 patients (14.28%) and third place by arterial hypertension in 2
(9.52%) cases.
Regarding the time of surgical reintervention, it ranged from 48 to 72 hours in the vast majority
of patients, however, one patient lasted up to 30 days (due to a planned ventral hernia and
floating stoma), with a range of 48 to 718 hours, in common reintervention is prioritized until
an average of 60 hours after the initial surgery where the DCS strategy was applied; patients
without trauma etiology and with previous surgery, and where hemodynamic deterioration of
the patient and what causes it is evidenced, are concluded in two options: massive hemorrhage
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Sánchez, M. A. G., Hernández, J. L. G., Cabello, J. de J. U., Barrón, G. M., Castillo, L. F. F., Salvador, J. R. H., Suárez, I. A. L., Daniel, M. Y. P., & Oca
Ambriz, I. R. M. (2025). Damage Control Surgery: A Strategic Resource! British Journal of Healthcare and Medical Research, Vol - 12(02). 90-109.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18418.
(hypovolemic shock) or perforation with secondary infection (septic shock). In addition, the
reinterventions, repacking, bleeding reported by surgery and in total, the effectiveness of the
strategic tactic applied, their combination and the last reintervention that concludes the DCS
surgical strategy closing the cycle, at the discretion of the surgeon, are documented. The eight
patients who were left with giant planned ventral hernias who are reoperated on up to a year
or more are discarded.
Regarding the total documented bleeding, several factors must be considered that alter the total
real values:
1. The blood loss that occurred at the time of the trauma until surgical care.
2. What is sequestered or stored in the virtual spaces of the abdomen or clots (anterior and
retroperitoneal space) or of the extremities in the muscular interfacial spaces or in the
fascicles themselves.
3. Hemorrhage as such in the surgical procedure, as a cause (which is not individualized).
4. The removal of a lower or upper extremity, organs from the abdomen, the blood
calculated or contained as normal within that organ, etc.
The above is expressed in Table 3:
Table 3: Characteristics that are Detailed in Each Surgical Tactic, Where Damage
Control Surgery is Performed on Patients from 2020 to 2025 in the Three Hospitals,
Expressed in Number/Percentage.
Time/Total Bleeding/Effectiveness/Final Reoperation Number/%
60-72 Hours/1,750 Milliliters/If/Packing/Non-Repacking 19/90.47%/0
72 Hours/If/1,300-1,750 Milliliters/If/Controlled Eventration/Priority Wall
Closure
8/
38.09%/3/37.5%
718 Hours/Yes/390 Milliliters/Floating Stoma/Yes/Temporal
Stoma/Colostomy
1/ 04.76%
48 Hours/550 Milliliters/Si/Fecal Containment Colon
Drawstring/Temporary Stoma/Colostomy
1/ 04.76%/1
504 Hours/Yes/250 Milliliters/If/Temporary Gastrostomy 1/04.76%
618 Hours/Yes/380 Milliliters/Yes/Jejunostomy/Temporary 2/09.52%
24-718 Hours/380-1,750 Milliliters/Si/Combination of Two or More
Techniques
11/52.38%
Total Number of Patients 21 / 100%
The quantified bleeding in surgery must be performed correctly, as accurately as possible or as
close to reality as possible; it is imperative to weigh clots, compresses and gauze impregnated
with blood as well as surgical drapes, subtracting the water or fluids entering the surgical field
(which are now made of plastic, they do not absorb, break and drain or transmit any substance
since most are not impermeable or modifiable to size or shape, which greatly limits their
quantification). Scales graduated in milligrams/corrected or adjusted to milliliters must be
available, an aspirator reservoir completely graduated in milliliters; personnel such as
instrumentalists or competent surgical and circulating nurses (who quantify the entry of fluids
into the surgical field such as water or other substances); in addition, it should be taken into
account that it is not real to account for what is spilled on the table and on the floor of the
surgical room, etc. All the above is not done in any operating room known to the authors. In
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addition, in Mexico it is calculated by habit or dogma, by the doctor specializing in
Anesthesiology empirically at his or her discretion, emotion and/or experience. All the above
observations yield values of suspicion or relative quantifications in terms of truth. Table 3
shows hemorrhage values that average 480 milliliters, with ranges from 250 to 1,750 milliliters,
pointing out that 90.47% of the DCS was due to continuous or incoercible bleeding or what is
called in colloquial language "layer hemorrhage". And the surgical technique of "packing" is
performed, which in most cases is combined with a planned/controlled eventration for a
timeless wall closure (planned ventral hernia) in the short term or in the long term at the
discretion of the Surgeon, which was used in up to 38.09%. The effectiveness of the so-called
"packaging" was 100% in all patients, despite the variations in the technique of its applicability.
Finally, DCS tactics were carried out at the time of surgery, which were adopted according to
each specific patient, such as the creation of stomas (colostomy, ileostomy, floating stoma), jars,
gastrostomies and/or jejunostomies, achieving their conjunction with very good results and for
the benefit of the patients. See Figure 3.
Figure 3
The Wittmann patch as a method of late abdominal closure prevents loss of address and
facilitates primary closure of the abdominal wall. Image taken from the reference: Galindo F., et
al. Open abdomen indications, management and closure. Encyclopedia of Digestive Surgery
www.sacd.org.ar Volume I, 148: 1-21 [16]
The DCS cycle in most patients where the strategy was used is explained by the author, in three
possible processes: application, early cycle closure or late cycle closure.
1. The urgent etiology that led to the use of the DCS strategy in the first surgery:
application.
2. Surgical reintervention or second priority surgery at 48 to 72 hours, where the
effectiveness of the applied DCS tactic is evaluated, with complete cure in this second
surgical time: "Early Cycle Closure".
3. The culmination of 100% total hemostasis of the patient, with no slope or surgical
pathology to resolve. > to 2 surgeries: "Late Cycle Closure". It may have been
planned/projected in the long term by the Surgeon in several subsequent surgeries or
also due to the same failure of the surgical tactic for the same cause or consequence,
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DCS is also applied in penetrating head trauma, which is usually treated less aggressively due
to low expectations of a good recovery, where the fundamental concepts in the critical care
management of moderate and severe head injuries focus on relieving intracranial pressure,
avoiding hypotension and hypoxia. Intracranial tamponade is performed in damage control
neurosurgery to mitigate severe intracranial hemorrhages, which can be a neurosurgical
maneuver that saves lives, and then the patient is transferred to be surgically operated on by
the specialty of neurosurgery and treated intensively in a third level of medical care. [35]
OPEN ABDOMEN
Previous work has been reviewed in DCS by means of the open abdomen, where the author (in
the year 2007) Timothy C. Fabian: divides or classifies it into stages, with specific actions for
each of them:
• Stage I: Where the rapid termination of laparotomy before definitive surgical
procedures and to allow resuscitation of the coagulation system, shock and hypothermia
in the intensive care unit are mentioned.
• Stage II: The projection of a planned ventral hernia. When prosthetic material is
inserted in stage I, patients recover, and which will allow gradual closure of the abdomen
or else may develop varying degrees of multiple organ dysfunction or sepsis.
• Stage III: Definitive reconstruction of the abdominal wall. [36]
Similarly, the use of resuscitation in cases of trauma that incorporates endovascular occlusion
with balloon resuscitation of the aorta has been compared to standard care for the management
of severe bleeding with DCS, finding mortality due to hemorrhage without significant
differences. [37] Although DCS has its historical origins in orthopedic pathology, where timely
intervention for wound debridement and joint stabilization plays a crucial role, it is important
to plan multiple surgeries and a multidisciplinary orb. [38] In massive and difficult abdominal
wall defects requiring complex reconstruction of the abdominal wall itself, which pose a major
surgical challenge in the presence of significant comorbidities, the most consistent independent
predictors of adverse outcomes were emergency surgery requiring damage control
laparotomy, extensive adhesion lysis, and severe adhesion lysis. obesity, Centers for Disease
Control and Prevention class of contaminated wound, loss of abdominal dominance and
delayed wound closure. [39]
The first question is, what is the indication to leave the patient with an open abdomen?
Regarding the response of intentionally performing controlled exposure of the viscera of the
abdomen are variable, relative, or with the appropriate infrastructure none, the following
possible causes are listed: [40]
• Abdominal compartment syndrome: absolute indication. [41] It is described as intra- abdominal pressure with a sustained value >20mmHg, associated with multiple organ
failure. However, if the resource is available from the beginning of closure with vacuum- assisted aspiration (VAS), it is no longer an ignominious morbid evolution. Where it has
been successfully achieved the complete fascial closure of the abdomen in up to 76%.
[42]
• The physical loss or impossibility in the patient by technique of a safe or possible closure
of the abdominal wall or by necrotizing fasciitis of the wall; this is relative since it can be
modified with the VAS and by the joint management with reconstructive plastic surgery
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coagulation, and are not predictive in nature. [51] There must be specific regulations for the
use of whole blood, with an established mass transfusion protocol, and then the patients do not
develop the so-called traumatic coagulopathy, where the most appropriate conduct or measure
is to replace blood by blood with the aim of euvolemic resuscitation. [52] Baseline hemoglobin
significantly predicts massive hemorrhage, as part of the massive transfusion protocol and
therefore hemostatic surgery in cases with hemorrhagic shock, where a cut-off value of 11.45
g/dl is used in 79% of cases in a study of 2,731 trauma patients. [53]
Massive transfusion is defined as administering to the patient ≥ 10 units of red blood cells in 24
hours, it is common to apply this strategy as documented in a study that was carried out in
1,029 patients, and where 651 cases (63.3%) did require it. [54]
Rapid and definitive control of bleeding is the main objective in the treatment of patients with
active bleeding. DCR is the current pillar to improve survival in this group of patients. Whole
blood resuscitation and/or balanced component therapy should be initiated in the prehospital
setting and adjuncts, such as early fibrinogen administration (cryoprecipitates) and calcium
replacement, should begin immediately upon arrival in the trauma ward as part of the DCR.
[29]
REMARKS
1. The "Planned Hemostatic Compression" (packing), does not cause any compartment
syndrome, nor any abdominal hypertension, since the volume occupied by 3 to 4 textile
compresses is less than one liter, and the abdomen suddenly has the capacity to purify,
catabolize or have an anabolism of 9 liters on average of gastrointestinal fluids, adding
the intake or increase of the gastric chamber from 500 ml to 1000 milliliters, urine 300
to 500 milliliters, fecal matter in 3 liters. With an average of the sum of all the above in
6 liters circulating, of sudden and adaptive volume increase; all the above supports this
argument.
2. In "Planned Hemostatic Compression", for congruence, no type of drains should be placed
due to the continuous loss of fluid, volume and consequently due to loss of pressure, the
main objective of this strategy. Unless this drainage is isolated, controlled and does not
impact on the volume/pressure loss due to the underlying pathology. (Cecostomy,
jejunostomy, gastrostomy, etc.)
3. "Planned hemostatic compression" (packing), the abdominal cavity should always be
closed for the following reasons:
➢ A planned compression is evident that consequently the objective of hemostasis will
be met, giving the opportunity to improve the patient's conditions and have the
possibility of protocolizing it, of planning and correcting as much as possible or
eliminating the factors that increase morbidity/mortality and thus, gives the
opportunity to definitively resolve the surgical pathology that caused its genesis.
➢ Avoid retraction of the muscle fascia/aponeurosis and resign as much as possible a
planned giant ventral hernia that causes more morbidity and a new long-term
reoperation with an evident permanent physical sequela, even surgically repaired in
the best hands, with the highest technology, with the best supplies and projecting an
adequate evolution.
➢ Protection from complications: perforations (the so-called "enteroatmospheric
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