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Kumar et al. Plast Aesthet Res 2020;7:29 Plastic and
DOI: 10.20517/2347-9264.2019.71 Aesthetic Research

Review Open Access

Secondary damage in trauma and limited access
dressing: a review

Pramod Kumar , Akriti Gupta , Apoorva Gupta 3
2
1
1 Consultant Plastic Surgeon, King Fahd Central Hospital, Jazan 82666, Saudi Arabia.
2 Resident Physician (Pathology), University of Virginia, Charlottesville, VA 22903, USA.
3 Physician (Internal Medicine), Asante Rogue Regional Medical Center, Medford, OR 97504, USA.

Correspondence to: Dr. Pramod Kumar, Department of Plastic Surgery, King Fahad Central Hospital, Jazan 82666, Saudi Arabia.
E-mail: pkiumar 86@hotmail.com
How to cite this article: Kumar P, Gupta A, Gupta A. Secondary damage in trauma and limited access dressing: a review. Plast
Aesthet Res 2020;7:29. http://dx.doi.org/10.20517/2347-9264.2019.71
Received: 7 Dec 2019 First Decision: 21 Apr 2020 Revised: 25 Apr 2020 Accepted: 6 May 2020 Published: 18 Jun 2020

Science Editor: Raúl González-García Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Secondary damage in trauma may increase morbidity, mortality and the cost of treatment considerably. This
article reviews the literature of 46 relevant articles on this topic. We hope to provide a better understanding
of the various mechanisms that can lead to secondary damage following major trauma and aim to improve the
management of such in trauma patients. We also explore the utility of limited access dressing and its ability to
minimize and treat secondary musculoskeletal trauma. Four interdependent cellular mechanisms have been
described that contribute and perpetuate secondary tissue damage - lysosomal, protein/enzyme denaturation,
membrane permeability and mitochondrial. Systemic changes are mainly due to systemic hypoxia and the
systemic inflammatory response syndrome. Limited access dressing appears to be an efficient and cost-effective
method for the management of secondary damage, as evidenced by the reduced number of debridements, shorter
wound coverage time, and reduction in total length of hospital stay while lowering treatment costs and improving
quality of care.

Keywords: Trauma, secondary damage, limited access dressing

INTRODUCTION
Cells are complex interconnected systems that work together to maintain a well-regulated micro-
environment that is indispensable for their survival. Trauma to a single cell can affect overall homeostasis

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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