Beyond Damage Control Surgery: Abdominal Wall Reconstruction and Complex Hernia Repair

Abstract

Reconstruction of complex abdominal wall defects and recreating functional abdominal walls following damage control surgery (DCS) that may result in loss of domain or major abdominal wall defects represent a major challenge, often requiring surgical creativity and a strategy that involves different aspects of care along the various stages of treatment. Damage control concepts and techniques have been part of our clinical armamentarium in trauma for decades, but recently DCS has expanded to other surgical disciplines: emergency general surgery; neurosurgery (craniectomies); orthopedics surgery, particularly for trauma; thoracic surgery; vascular surgery; liver transplant surgery; and other surgical fields. DCS is characterized by the termination of the surgical intervention after control of bleeding and contamination, followed by hemostatic resuscitation and definitive management. It is a staged approach that takes into consideration the physiologic reserves of the patient, and it is designed to avoid or treat the lethal triad of hypothermia, acidosis, and coagulopathy. The decision to perform DCS is complex and requires solid knowledge of the physiology of the patient as well as the associated injuries or comorbid disease. Moreover, it takes a complete situational awareness of the patient, his/her physiology, all end-point resuscitation, and surgical team dynamics and skills.