Damage Control Packing: How Long Can It Stay?

Authors:
Jihun Cha

Body of Abstract:
Background: Contaminated war wounds are frequently managed with Damage Control Surgery (DCS) with wound packing. The optimal timing for packing removal in injuries of extremities and junctional areas has not been described in literature. This study reviews current principles on packing removal to assess safety of prolonged use of packing in extremity and junctional wounds.

Methods: We searched MEDLINE, PubMed, EMBASE, and additional grey literature using terms related to safety of damage control packing in extremities and junctional areas.

Results: Gauze or hemostatic packing remaining in contaminated wounds is susceptible to infection or sepsis. Existing studies support reoperation and packing removal within 24 to 72 hours to minimize the risk of complications including infection, as most packing culture positive for bacteria after 2 days. Prolonged use of extremity wound packing can be safe if it is preceded by aggressive debridement of contaminated tissue.

Conclusions: There is no robust evidence on optimal timing of damage control packing in injuries of extremities and junctional areas. Surgeons and nonsurgeons in austere environments without evacuation capability should weigh the risks and benefits of packing removal when clinical signs of sepsis and other complications are present. Further studies evaluating the safe range of wound packing duration are necessary to develop a clear clinical guideline.