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Correspondence and Brief Communications
August 2001

Military Damage Control

Arch Surg. 2001;136(8):966-967. doi:

In reply

The following are 3 points of rebuttal to the spirited critique of our article on damage control surgery. One can always rely on argument among trauma surgeons: it has something to do with the adrenals.

We obviously erred in not defining more clearly how we interpreted the term damage control surgery. As indicated in our article and illustrated in the graphs, we reserve this term for a small number of critically injured patients who deteriorate during the initial operation to the point where further operation will almost certainly result in death. Most of these patients are hypothermic. This is a tiny fraction of those patients for whom a classic staged operation is indicated. In the former the operation is quickly terminated, and the patient is warmed and subjected to intense resuscitation and close observation to determine the precise moment when the original operation must be resumed and completed. The interval between operations in patients undergoing damage control surgery is measured in minutes or a few hours. The interval in staged operations, such as exteriorization of a perforating gastrointestinal tract injury, a contaminated wound, or even a bleeding infraperitoneal or retroperitoneal wound, is measured in hours, days, or even weeks. This differentiates the logistic demands imposed by 2 entirely different clinical strategies. The former requires holding an operating theater, an anesthesia and operating team ready for instant use when the trauma surgeon believes continuance of the original operation is a reasonably safe treatment option. Staged operations are scheduled when an operating room and the supporting team can be spared.

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