In damage control surgery (DCS) for abdominal trauma, which sequence of steps correctly describes the three-phase DCS approach?
- A Phase I: full anatomical repair; Phase II: ICU monitoring; Phase III: abdominal closure
- B Phase I: abbreviated laparotomy (haemorrhage + contamination control); Phase II: ICU resuscitation (correct coagulopathy, hypothermia, acidosis); Phase III: definitive repair and fascial closure ✓
- C Phase I: CT staging; Phase II: laparotomy; Phase III: ICU recovery
- D Phase I: ICU resuscitation; Phase II: abbreviated laparotomy; Phase III: repeat imaging
Explanation
Damage control surgery follows three phases: Phase I is an abbreviated laparotomy addressing only immediate life threats — controlling haemorrhage (packing, ligation, shunts) and limiting contamination (bowel stapling without anastomosis), leaving the abdomen open (laparostomy). Phase II is ICU resuscitation targeting the 'lethal triad' of hypothermia, acidosis, and coagulopathy. Phase III, performed 24–72 hours later when physiology has been corrected, involves definitive repair (anastomoses, vascular reconstruction) and fascial closure. This principle is foundational to modern trauma surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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