«Damage control» at severe polytrauma: neurosurgical aspects


  • Alexey Trofimov Nizhniy Novgorod Regional Trauma Center, Semashko Nizhniy Novgorod Regional Hospital, Nizhniy Novgorod, Russian Federation
  • Oleg Voennov Nizhniy Novgorod Regional Trauma Center, Semashko Nizhniy Novgorod Regional Hospital, Nizhniy Novgorod, Russian Federation




traumatic brain injury, polytrauma, «Damage control»


Purpose: to estimate results of «Damage control» principles application in surgical treatment of patients with traumatic intracranial hematomas at severe polytrauma.

Materials and methods. In the research 43 patients were included aged in average (45.5±17.6) years, there were 36 men and 7 women. Wakefulness according to GCS was (6.2±1.4) points, state according to ISS scale — (54.3±8.2) points. As a comparison group we examined 41 injured persons, been treated using standard methods according to the Guidelines for Treatment of patients with Severe Traumatic Brain Injury (2007).

Results. Intraoperative mortality in the main group was 7.3%, in the comparison group — 30%. Using «Damage control» principles reduced mortality in the main group — up to 60.9% that was significantly lower than group of comparison (92.5%) and mortality rate, estimated according to APACHE II scale (P<0,05).

Conclusions. We have modified the technology «Damage control», which is applied for the treatment of 43 patients with severe concomitant traumatic brain injury. It is possible to improve the results of treatment.


1. Frayerman AP, Kravets LYa, Sheludyakov AYu. Sdavleniye golovnogo mozga pri izolirovannoy i sochetannoy cherepno-mozgovoy travme [Compression of the brain in isolated and combined brain injury]. Nizhniy Novgorod: OOO Tipografiya “Povolzh'ye”;2008. Russian.

2. Nicola R. Early total care versus damage control: current concepts in the orthopedic care of polytrauma patients. ISRN Orthopedics. 2013;2013:1-9. [CrossRef] [PubMed]

3. Pape H-C. Damage control management in the polytrauma patient. New York: Springer; 2010.

4. Stone H, Strom P, Mullins R. Management of the major coagulopathy with onset during laparotomy. Annf Surg. 1983;197(5):532-5. [CrossRef] [PubMed]

5. Verbeek DO, Sugrue M, Balogh Z, Cass D, Civil I, Harris I, Kossmann T, Leibman S, Malka V, Pohl A, Rao S, Richardson M, Schuetz M, Ursic C, Wills V. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 2008 Aug;32(8):1874-82. [CrossRef] [PubMed]

6. Sagraves SG, Toschlog EA, Rotondo MF. Damage control surgery - the intensivist's role. J Intens Care Med. 2006 Jan-Feb;21(1):5-16. [PubMed]

7. Sokolov VA. Mnozhestvennyye i sochetannyye travmy [Multiple and associated injuries]. Moscow: GEOTAR-Media; 2006. Russian.

8. Giannou C. War surgery. Working with limited resources in armed conflict and other situations of violence. Geneva: ICRC; 2009:1.

9. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S1-106. [PubMed]



How to Cite

Trofimov, A., & Voennov, O. (2013). «Damage control» at severe polytrauma: neurosurgical aspects. Ukrainian Neurosurgical Journal, (3), 49–54. https://doi.org/10.25305/unj.54149



Original articles