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History of the Innovation of Damage Control for Management of Trauma Patients: 1902–2016

Roberts, Derek J. MD, PhD*,†; Ball, Chad G. MD, MSc*,†,‡; Feliciano, David V. MD§; Moore, Ernest E. MD; Ivatury, Rao R. MD||; Lucas, Charles E. MD**; Fabian, Timothy C. MD††; Zygun, David A. MD, MSc‡‡; Kirkpatrick, Andrew W. MD, MHSc*,†; Stelfox, Henry T. MD, PhD§§,¶¶,||||

doi: 10.1097/SLA.0000000000001803
Original Articles

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients.

Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation.

Methods: We searched bibliographic databases (1950–2015), conference abstracts (2009–2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation.

Results: The “innovation” of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then “developed” into abbreviated laparotomy using “rapid conservative operative techniques.” Subsequent “exploration” resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses (“assessment” stage of innovation). “Long-term study” of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices.

Conclusions: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices.

*Department of Surgery, University of Calgary, Calgary, Alberta, Canada

Regional Trauma Program, Calgary, Alberta, Canada

Department of Oncology, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada

§Department of Surgery, Indiana University Medical Center, Indianapolis, IN

Department of Surgery, University of Colorado Denver, Denver, CO

||Department of Surgery, Virginia Commonwealth University, Richmond, VA

**Department of Surgery, Wayne State University, Detroit, MI

††Department of Surgery, University of Tennessee Health Science Center, Memphis, TN

‡‡Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada

§§Department of Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada

¶¶Department of Medicine, University of Calgary, Calgary, Alberta, Canada

||||Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Reprints: Derek J. Roberts, MD, PhD, Department of Surgery, University of Calgary, 10th Floor North Tower, Foothills Medical Centre, 1403-29th Street Northwest, Calgary, AB T2N 2T9, Canada. E-mail: Derek.Roberts01@gmail.com.

Disclosure: This study was supported by an Alberta Innovates—Health Solutions Clinician Fellowship Award, a Knowledge Translation Canada Strategic Training in Health Research Fellowship, a Knowledge Translation Canada Research Stipend, and funding from the Canadian Institutes of Health Research. These funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. R.R.I. has received funding for consultancy and providing lectures from Kinetic Concepts Incorporated, whereas A.W.K. has received funding from Kinetic Concepts Incorporated for a randomized controlled trial comparing the ABThera Open Abdomen Negative Pressure Therapy System and Barker's vacuum pack temporary abdominal closure techniques. A.W.K. has also received travel funding from LifeCell Corporation, Syntheses, and Innovative Trauma Care. The other authors have no conflicts of interest to declare.

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