Organ-Specific Techniques

• Liver
• Spleen
• Abdominal vasculature
  
• Gastrointestinal tract
• Pancreas
• Lung

Damage Control Surgery

Overview
Metabolic failure
Damage control laparotomy
Organ-specific techniques
Critical Care
Abdominal Compartment Syndrome
Reoperation

Lung
Pulmonary resection may be necessary to control haemorrhage or massive air leaks and to remove devitalised tissue. Formal pulmonary lobar or segmental resection is difficult and unnecessary in the multiply injured patient. The simplest method available should be used. This is usually the linear stapling device which will control most vascular and bronchial injuries. This non-anatomical approach also preserves the maximum amount of functional lung tissue. If necessary the staple line may be overrun with a continuous suture. Take care when controlling superficial injuries with simple suture. Often this controls only superficial haemorrhage and bleeding into deeper tissues continues.

Hilar injuries are best controlled initially with finger pressure. Most patients injuries will then be found to be more distal to the hilum and can be treated accordingly. If hilar control must be achieved this can be done with a vascular clamp (Satinsky) or umbilical tape in the acute setting. Up to 50% of patients will die of acute right heart failure following clamping of hilar structures, so this decision must be based on absolute necessity.

Pulmonary tractotomy may be a useful technique where there is a deep penetrating injury to the lung. Two long clamps are placed through the tract of the injury. The wall of the tract is opened, so exposing the inside of the tract. Any bleeding vessels or bronchi can be tied off. The clamps are then overrun with a suture to control the wound edges.

Critical Care