In the damage control laparotomy (DCL) sequence for a haemodynamically unstable polytrauma patient, which sequence correctly describes the three stages?
- A Stage 1: abbreviated laparotomy (haemorrhage control, contamination control, temporary closure); Stage 2: ICU resuscitation (correct lethal triad); Stage 3: definitive repair and abdominal closure ✓
- B Stage 1: complete laparotomy with all definitive repairs; Stage 2: ICU stay; Stage 3: re-exploration only if complications arise
- C Stage 1: DCL with haemorrhage control; Stage 2: immediate re-look at 24 hours for definitive repair; Stage 3: final closure at 72 hours
- D Stage 1: angioembolisation of bleeding vessels; Stage 2: abbreviated laparotomy; Stage 3: ICU and definitive closure at 5 days
Explanation
Damage control surgery follows a three-stage philosophy. Stage 1 (abbreviated laparotomy): haemorrhage control (packing, rapid vascular ligation, bowel clamping), contamination control (suture/staple bowel ends without formal anastomosis), and temporary abdominal closure (negative pressure wound therapy). Stage 2 (ICU resuscitation): correct the lethal triad — hypothermia (rewarm), coagulopathy (FFP/platelets/cryoprecipitate/TXA), and acidosis (buffer, adequate perfusion). Stage 3 (re-look at 24-72 hours): remove packs, reassess bowel viability, perform definitive anastomoses, and close abdomen. This sequence optimises physiological recovery before definitive repair.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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