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Page 6 of 11 Kumar et al. Plast Aesthet Res 2020;7:29 I http://dx.doi.org/10.20517/2347-9264.2019.71

Major Trauma

Release of Pro-inflammatory Cytokines Release of Anti-inflammatory Cytokines
• IL-1 • IL-10
Produced by monocytes and o Secreted by monocytes and
macrophages lymphocytes
• TNF- alpha o Function: down regulation of
o Secreted by monocytes TNF -alpha; increase B-cell survival
o Correlates with poor outcomes time
in sepsis; helps to activate other • IL-13
mediators of inflammation o Secreted by T-helper cells
• IL-6 o Function: stimulates IgE
o Secreted by macrophages secretion from B-cells; lymphocyte
o Key mediator of fever proliferation
• IL-8 o Levels proportional to TNF-
o Mediator of inflammation alpha levels
(IL-1, TNF- alpha and IL-6 are associated
with pathological pain )

Disruption in the regulation between pro- and anti-
inflammatory cytokines

Systemic Inflammatory Response Syndrome [19-22]

Figure 1. Pathogenesis of systemic inflammatory response syndrome

Avoidance leaves natural biochemical mechanism to overcome the damage but in contrast, the insult from
an aggressive approach to counter secondary damage may aggravate the problem.

Hence, to counter secondary damage in trauma cases, the best clinical strategy is to employ temporizing
maneuvers.

In temporizing maneuvers, damage control methodologies include: (1) quick action to stabilize a patient’s
local and systemic conditions; (2) prevention of further secondary damage; and (3) after the acute recovery
phase is over, secondary definitive management is started.

Rapid and temporary stabilization is achieved by using LAD. Delaying the onset and progress of secondary
damage has been attempted by using cryotherapy, but there is a lack of data related to the temperature and
duration of cryotherapy required. Secondary, definitive reconstruction may be performed under LAD.

Cryotherapy (exposure to extreme cold) has been used to delay or prevent secondary injury in trauma or
sports injury, but optimal tissue temperatures, the duration of cryotherapy, and the need for application
[31]
pressure to minimize secondary injury following musculoskeletal trauma have yet to be established .