Abbreviated Thoracotomy: The Evolving Role of Damage Control in Thoracic Trauma

Abstract

Trauma surgeons have evolved the “damage control” approach to abdominal trauma into a well-defined surgical strategy and the use of abbreviated laparotomy is widely accepted. The need for this new approach arose from increasingly complex and devastating injuries arriving at urban trauma centers. The physiology of patients requiring abbreviated procedures is so severely deranged that they are unlikely to survive formal, definitive repairs. The sole aim of the initial “abbreviated” celiotomy is to control bleeding and restore the patient’s physiological envelope. Once in the surgical intensive care unit, correction of hypothermia, coagulopathy and acidosis becomes the centerpiece of the damage control philosophy. The surgeon subsequently plans a definitive operation on a properly resuscitated patient with normal oxygen delivery and intact coagulation mechanisms. This chapter will define damage control as applied to chest trauma and will discuss techniques for the management of pulmonary and vascular injuries as well as temporary closure techniques.