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Damage Control Surgery and Ballistic Injury to the Trunk

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Ballistic Trauma
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Abstract

The first part of this chapter discusses Damage Control Surgery (DCS), which is the modern approach to the surgical management of seriously injured patients with deranged physiology. DCS was developed for the management of abdominal injuries so this fits naturally with the second part of the chapter, which discusses the presentation and management of specific ballistic injuries to the trunk. Vascular injuries (including junctional trauma) are discussed in Chap. 20, while genitourinary injuries are discussed in Chap. 21.

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References

  1. Rotondo MF, Schwab CW, MD MG, Phillips GR 3rd, Fruchterman TM, Kauder DR, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82, 383

    Article  CAS  PubMed  Google Scholar 

  2. Larrey D-J (1766–1842) A du texte. Mémoires de chirurgie militaire et campagnes de D. J. Larrey, Tome 3 [Internet]. Paris: J. Smith; 1812 [cited 2016 Nov 30]. Available from http://gallica.bnf.fr/ark:/12148/bpt6k57812746.

  3. Lerner EB, Moscati RM. The golden hour: scientific fact or medical ‘urban legend’? Acad Emerg Med. 2001;8:758–60.

    Article  CAS  PubMed  Google Scholar 

  4. Madding GF. Injuries of the liver. AMA Arch Surg. 1955;70:748–56.

    Article  CAS  PubMed  Google Scholar 

  5. Aaron S, Fulton RL, Mays ET. Selective ligation of the hepatic artery for trauma of the liver. Surg Gynecol Obstet. 1975;141:187–9.

    CAS  PubMed  Google Scholar 

  6. Lewis FR, Lim RC, Blaisdell FW. Hepatic artery ligation: adjunct in the management of massive hemorrhage from the liver. J Trauma. 1974;14:743–55.

    Article  CAS  PubMed  Google Scholar 

  7. Ackroyd FW, Pollard J, McDermott WV. Massive hepatic resection in the treatment of severe liver trauma. Am J Surg. 1969;117:442–8.

    Article  CAS  PubMed  Google Scholar 

  8. Mcclelland R, Shires T, Poulos E. Hepatic resection for massive trauma. J Trauma. 1964;4:282–91.

    Article  CAS  PubMed  Google Scholar 

  9. Lucas CE, Ledgerwood AM. Prospective evaluation of haemostatic techniques for liver injuries. J Trauma. 1976;16:442.

    Google Scholar 

  10. Calne RY, Welss FC, Forty J. The management of major liver trauma by primary packing with transfer of the patient for definitive treatment. BJS. 1979;66:338.

    Google Scholar 

  11. Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197:532–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sharp KW, Locicero RJ. Abdominal packing for surgically uncontrollable hemorrhage. Ann Surg. 1992;215:467.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: collective review. J Trauma. 2000;49:969–78.

    Article  CAS  PubMed  Google Scholar 

  15. Pape H-C, Grimme K, van Griensven M, Sott AH, Giannoudis P, Morley J, et al. Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma. 2003;55:7–13.

    Article  PubMed  Google Scholar 

  16. Harwood PJ, Giannoudis PV, van Griensven M, Krettek C, Pape H-C. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma. 2005;58:446–452-454.

    Article  PubMed  Google Scholar 

  17. Rixen D, Grass G, Sauerland S, Lefering R, Raum MR, Yücel N, et al. Evaluation of criteria for temporary external fixation in risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients: ‘evidence-based medicine’ versus ‘reality’ in the trauma registry of the German Trauma Society. J Trauma. 2005;59:1375–94, 1395

    Article  PubMed  Google Scholar 

  18. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30.

    Article  PubMed  Google Scholar 

  19. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65:748–54.

    Article  CAS  PubMed  Google Scholar 

  20. Maegele M, Schöchl H, Cohen MJ. An update on the coagulopathy of trauma. Shock. 2014;41:21–5.

    Article  CAS  PubMed  Google Scholar 

  21. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–9.

    Article  CAS  PubMed  Google Scholar 

  22. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma Inj Infect Crit Care. 2007;63:805–13.

    Article  Google Scholar 

  23. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77:761–77.

    Article  CAS  PubMed  Google Scholar 

  25. Midwinter M. Damage control surgery in the era of damage control resuscitation. J R Army Med Corps. 2009;155:323–6.

    Article  CAS  PubMed  Google Scholar 

  26. Morrison JJ, Oh J, DuBose JJ, O’Reilly DJ, Russell RJ, Blackbourne LH, et al. En-route care capability from point of injury impacts mortality after severe wartime injury. Ann Surg. 2013;257:330–4.

    Article  PubMed  Google Scholar 

  27. O’Reilly DJ, Morrison JJ, Jansen JO, Apodaca AN, Rasmussen TE, Midwinter MJ. Prehospital blood transfusion in the en route management of severe combat trauma: a matched cohort study. J Trauma Acute Care Surg. 2014;77:S114–20.

    Article  PubMed  Google Scholar 

  28. Morrison JJ, Ross JD, Poon H, Midwinter MJ, Jansen JO. Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock. Anaesthesia. 2013;68:846–50.

    Article  CAS  PubMed  Google Scholar 

  29. MacLeod JBA, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma Inj Infect Crit Care. 2003;55:39–44.

    Article  Google Scholar 

  30. Frith D, Goslings JC, Gaarder C, Maegele M, Cohen MJ, Allard S, et al. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. J Thromb Haemost. 2010;8:1919–25.

    Article  CAS  PubMed  Google Scholar 

  31. Doran CM, Woolley T, Midwinter MJ. Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. J Trauma Inj Infect Crit Care. 2010;69:S40–8.

    Article  Google Scholar 

  32. O’Connor T, Papanikolaou V, Keogh I. Safe surgery, the human factors approach. Surgeon. 2010;8:93–5.

    Article  PubMed  Google Scholar 

  33. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, et al. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf. 2011;20(1):102–7.

    Article  PubMed  Google Scholar 

  34. Weiser TG, Haynes AB, Dziekan G, Berry WR, Lipsitz SR, Gawande AA. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg. 2010;251:976–80.

    Article  PubMed  Google Scholar 

  35. Yule S, Flin R, Paterson-Brown S, Maran N. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006;139:140–9.

    Article  CAS  PubMed  Google Scholar 

  36. Arul GS, Pugh HEJ, Mercer SJ, Midwinter MJ. Optimising communication in the damage control resuscitation-damage control surgery sequence in major trauma management. J R Army Med Corps. 2012;158:82–4.

    Article  CAS  PubMed  Google Scholar 

  37. Midwinter MJ, Mercer S, Lambert AW, de Rond MJ. Making difficult decisions in major military trauma: a crew resource management perspective. J R Army Med Corps. 2011;157:S299–304.

    Article  CAS  PubMed  Google Scholar 

  38. Mercer S, Whittle C, Siggers B, Frazer R. Simulation, human factors and defence anaesthesia. J R Army Med Corps. 2010;156:S365–9.

    Article  Google Scholar 

  39. Penn-Barwell JG, Roberts SAG, Midwinter MJ, Bishop JRB. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma Acute Care Surg. 2015;78:1014–20.

    PubMed  Google Scholar 

  40. Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2013:CD007438.

    Google Scholar 

  41. Ferrara A, MacArthur JD, Wright HK, Modlin IM, McMillen MA. Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg. 1990;160:515–8.

    Article  CAS  PubMed  Google Scholar 

  42. Demetriades D, Velmahos GC. Penetrating injuries of the chest: indications for operation. Scand J Surg. 2002;91:41–5.

    Article  CAS  PubMed  Google Scholar 

  43. Morgan BS, Garner JP. Emergency Thoracotomy – the indications, contraindications and evidence. J R Army Med Corps. 2009;155:87–93.

    Article  CAS  PubMed  Google Scholar 

  44. Moore EE, Knudson MM, Burlew CC, Inaba K, Dicker RA, Biffl WL, et al. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma Inj Infect Crit Care. 2011;70:334–9.

    Article  Google Scholar 

  45. Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma—a review. Injury. 2006;37:1–19.

    Article  CAS  PubMed  Google Scholar 

  46. Leigh-Smith S, Harris T. Tension pneumothorax—time for a re-think? Emerg Med J. 2005;22:8–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. O’Connor JV, Adamski J. The diagnosis and treatment of non-cardiac thoracic trauma. J R Army Med Corps. 2010;156:5–14.

    Article  PubMed  Google Scholar 

  48. de Moya MA, Seaver C, Spaniolas K, Inaba K, Nguyen M, Veltman Y, et al. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma. 2007;63:13–7.

    Article  PubMed  Google Scholar 

  49. Degiannis E, Loogna P, Doll D, Bonanno F, Bowley DM, Smith MD. Penetrating cardiac injuries: recent experience in South Africa. World J Surg. 2006;30:1258–64.

    Article  PubMed  Google Scholar 

  50. Symbas PN, Picone AL, Hatcher CR, Vlasis-Hale SE. Cardiac missiles. A review of the literature and personal experience. Ann Surg. 1990;211:639–47.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Miller KR, Benns MV, Sciarretta JD, Harbrecht BG, Ross CB, Franklin GA, et al. The evolving management of venous bullet emboli: a case series and literature review. Injury. 2011;42:441–6.

    Article  PubMed  Google Scholar 

  52. Gunn ML, Clark RT, Sadro CT, Linnau KF, Sandstrom CK. Current concepts in imaging evaluation of penetrating transmediastinal injury. RadioGraphics. 2014;34:1824–41.

    Article  PubMed  Google Scholar 

  53. Burack JH, Kandil E, Sawas A, O’Neill PA, Sclafani SJA, Lowery RC, et al. Triage and outcome of patients with mediastinal penetrating trauma. Ann Thorac Surg. 2007;83:377–82.

    Article  PubMed  Google Scholar 

  54. Swanson JO, Levine MS, Redfern RO, Rubesin SE. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. Am J Roentgenol. 2003;181:415–20.

    Article  Google Scholar 

  55. Asensio JA, Chahwan S, Forno W, MacKersie R, Wall M, Lake J, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2001;50:289–96.

    Article  CAS  Google Scholar 

  56. Pillay TG, Singh B. A review of traumatic chylothorax. Injury. 2016;47:545–50.

    Article  CAS  PubMed  Google Scholar 

  57. Martin MJ, McDonald JM, Mullenix PS, Steele SR, Demetriades D. Operative management and outcomes of traumatic lung resection. J Am Coll Surg. 2006;203:336–44.

    Article  PubMed  Google Scholar 

  58. Haan J, Kole K, Brunetti A, Kramer M, Scalea TM. Nontherapeutic laparotomies revisited. Am Surg. 2003;69:562–5.

    PubMed  Google Scholar 

  59. Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma. 1995;38:350–6.

    Article  CAS  PubMed  Google Scholar 

  60. Mitchell TA, Hutchison T, Becker TE, Aden JK, Blackbourne L, White CE. Nontherapeutic laparotomy in American combat casualties: a 10-year review. J Trauma Acute Care Surg. 2014;77:S171–5.

    Article  PubMed  Google Scholar 

  61. Jansen JO. Selective non-operative management of abdominal injury in the military setting. J R Army Med Corps. 2011;157:237–42.

    Article  PubMed  Google Scholar 

  62. Omoshoro-Jones JAO, Nicol AJ, Navsaria PH, Zellweger R, Krige JEJ, Kahn DH. Selective non-operative management of liver gunshot injuries. Br J Surg. 2005;92:890–5.

    Article  CAS  PubMed  Google Scholar 

  63. Navsaria PH, Nicol AJ, Krige JE, Edu S. Selective nonoperative management of liver gunshot injuries. Ann Surg. 2009;249:653–6.

    Article  PubMed  Google Scholar 

  64. Inaba K, Barmparas G, Foster A, Talving P, David J-S, Green D, et al. Selective nonoperative management of torso gunshot wounds: when is it safe to discharge? J Trauma Inj Infect Crit Care. 2010;68:1301–4.

    Article  Google Scholar 

  65. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244:620–8.

    PubMed  PubMed Central  Google Scholar 

  66. Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D. Gunshot wound of the abdomen: role of selective conservative management. Br J Surg. 1991;78:220–2.

    Article  CAS  PubMed  Google Scholar 

  67. Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg. 2001;234:395–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Nabeel Zafar S, Rushing A, Haut ER, Kisat MT, Villegas CV, Chi A, et al. Outcome of selective non-operative management of penetrating abdominal injuries from the North American National Trauma Database. Br J Surg. 2012;99:155–64.

    Article  PubMed  Google Scholar 

  69. Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg. 2016;80:529–37.

    Article  PubMed  PubMed Central  Google Scholar 

  70. O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR. Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg. 2013;37:113–22.

    Article  PubMed  Google Scholar 

  71. Friese RS, Coln CE, Gentilello LM. Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma. 2005;58:789–92.

    Article  PubMed  Google Scholar 

  72. Matthews BD, Bui H, Harold KL, Kercher KW, Adrales G, Park A, et al. Laparoscopic repair of traumatic diaphragmatic injuries. Surg Endosc Interv Tech. 2003;17:254–8.

    Article  CAS  Google Scholar 

  73. Velmahos GC, Degiannis E, Doll D. Penetrating trauma: a practical guide on operative technique and peri-operative management. Berlin, Heidelberg: Springer; 2016.

    Google Scholar 

  74. Bala M, Gazalla SA, Faroja M, Bloom AI, Zamir G, Rivkind AI, et al. Complications of high grade liver injuries: management and outcomewith focus on bile leaks. Scand J Trauma Resusc Emerg Med. 2012;20:20.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Chinnery GE, Krige JEJ, Kotze UK, Navsaria P, Nicol A. Surgical management and outcome of civilian gunshot injuries to the pancreas. Br J Surg. 2012;99:140–8.

    Article  PubMed  Google Scholar 

  76. Seamon MJ, Pieri PG, Fisher CA, Gaughan J, Santora TA, Pathak AS, et al. A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? J Trauma Inj Infect Crit Care. 2007;62:829–33.

    Article  Google Scholar 

  77. Joseph B, Zangbar B, Pandit V, Vercruysse G, Aziz H, Kulvatunyou N, et al. The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. J Trauma Acute Care Surg. 2014;76:457–61.

    Article  PubMed  Google Scholar 

  78. Boele van Hensbroek P, Wind J, Dijkgraaf MGW, Busch ORC, Carel Goslings J. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33:199–207.

    Article  PubMed  Google Scholar 

  79. Quyn AJ, Johnston C, Hall D, Chambers A, Arapova N, Ogston S, et al. The open abdomen and temporary abdominal closure systems – historical evolution and systematic review: open abdomen and temporary abdominal closure systems. Colorectal Dis. 2012;14:e429–38.

    Article  CAS  PubMed  Google Scholar 

  80. Bee TK, Croce MA, Magnotti LJ, Zarzaur BL, Maish GO, Minard G, et al. Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma. 2008;65:337–42, 344

    Article  PubMed  Google Scholar 

  81. Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma Acute Care Surg. 2000;48:201–7.

    Article  CAS  Google Scholar 

  82. Vargo D. Component separation in the management of the difficult abdominal wall. Am J Surg. 2004;188:633–7.

    Article  PubMed  Google Scholar 

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O’Reilly, D. (2017). Damage Control Surgery and Ballistic Injury to the Trunk. In: Breeze, J., Penn-Barwell, J., Keene, D., O'Reilly, D., Jeyanathan, J., Mahoney, P. (eds) Ballistic Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-61364-2_13

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