Surgical decision-making process and damage control: Current principles and practice

Damage control concepts and techniques have been part of our clinical armamentarium in trauma and emergency surgery for decades. In recent years, the damage control concept has expanded to other surgical disciplines: emergency general surgery, orthopedics, thoracic, vascular, etc. Damage control is characterized by termination of the surgical intervention after control of bleeding and contamination, followed by definitive management. It is a staged approach to take in consideration the physiologic reserve of the patient and it is designed to avoid or treat the lethal triad of hypothermia, acidosis, and coagulopathy. The decision-making process is complex, however, and requires solid knowledge of physiology of the patient as well taking into account the associated injuries or comorbid disease. In this chapter, we aim to highlight the current principles and practices of damage control surgery and the decision-making process into this lifesaving maneuver.