What is traumaplasty?

Traumaplasty: Damage Control Surgery for Severe Trauma

Traumaplasty is a damage control surgical approach used in severely injured patients presenting with hemorrhagic shock, ongoing bleeding, and coagulopathy to temporarily control life-threatening conditions before definitive repair. 1

Definition and Concept

Traumaplasty, also known as damage control surgery, is a multi-staged surgical approach that includes:

• An abbreviated initial surgery focused on controlling hemorrhage, restoring blood flow, and limiting contamination rather than performing definitive repairs 1
• Temporary closure of surgical sites with packing and stabilization 1
• Intensive care management focused on correcting physiological derangements (acidosis, hypothermia, coagulopathy) 1
• Delayed definitive surgical repair once the patient is physiologically stable 1

Indications

Traumaplasty/damage control surgery should be considered in patients with:

• Severe hemorrhagic shock with signs of ongoing bleeding 1
• Development of coagulopathy (the "lethal triad" of acidosis, hypothermia, and coagulopathy) 1
• Major abdominal injuries requiring adjunctive angioembolization 1
• Multiple injuries requiring evaluation of other body regions 1
• Traumatic limb amputations with major abdominal injuries 1
• Specific physiological triggers including:
  • Temperature ≤34°C 1
  • pH ≤7.2 1
  • Inaccessible major venous injuries 1
  • Need for time-consuming procedures in patients with suboptimal response to resuscitation 1
  • Inability to achieve hemostasis due to recalcitrant coagulopathy 1

Components of Traumaplasty

First Stage: Abbreviated Initial Surgery

• Rapid control of hemorrhage through direct repair, ligation, or packing 1
• Restoration of blood flow to vital organs 1
• Control of contamination (especially in hollow viscus injuries) 1
• Temporary closure techniques (often with negative pressure wound therapy) 1
• Application of external fixation for unstable fractures rather than definitive internal fixation 1

Second Stage: ICU Resuscitation

• Core rewarming to correct hypothermia 1
• Correction of acid-base imbalances 1
• Management of coagulopathy with blood products 1
• Optimization of ventilation and hemodynamic status 1
• Complementary diagnostic procedures (angiography, additional imaging) 1

Third Stage: Definitive Repair

• Performed only when physiological parameters have normalized 1
• Complete repair of all injuries 1
• Definitive closure of surgical sites 1
• Conversion of external fixation to internal fixation for fractures 1

Applications Beyond Abdominal Trauma

Traumaplasty principles have been extended to:

• Orthopedic injuries ("damage control orthopedics") with external fixation as the initial approach 1
• Thoracic trauma 1
• Neurosurgical emergencies 1
• Pelvic fractures with hemorrhage 1

Adjunctive Techniques in Traumaplasty

• Topical hemostatic agents for venous or moderate arterial bleeding associated with parenchymal injuries 1
• Temporary extra-peritoneal packing for pelvic hemorrhage 1
• Resuscitative endovascular balloon occlusion of the aorta (REBOA) for non-compressible torso hemorrhage 1
• Pelvic binders or external fixation for unstable pelvic fractures 1

Outcomes and Evidence Base

• Although no randomized controlled trials exist, retrospective studies support the concept of traumaplasty/damage control surgery 1
• Studies demonstrate reduced morbidity and mortality rates in appropriately selected patients 1
• The only available randomized study for damage control orthopedics shows an advantage for this strategy in "borderline" patients 1

Pitfalls and Considerations

• Traumaplasty should not be performed in hemodynamically stable patients who can tolerate definitive repair 1
• Overuse of damage control techniques can lead to unnecessary additional operations and complications 1
• The decision to employ traumaplasty requires clinical judgment and consideration of the patient's overall condition 1
• Multidisciplinary approach involving trauma surgeons, critical care specialists, and subspecialists is essential 1

Traumaplasty represents a paradigm shift from the traditional approach of immediate definitive repair to a staged approach that prioritizes physiological restoration before anatomic reconstruction, significantly improving outcomes in severely injured patients.