Damage control surgery is fundamental to operative trauma care. Prophylactic application of open abdomen techniques has led to avoidance of a great deal of the organ dysfunction associated with abdominal compartment syndrome. Surgeons are learning about management of large open abdominal wounds. There seems to be a general consensus regarding acute management of these wounds. Institutions are using staged techniques of management. Getting open wounds closed as soon as possible leads to fewer complications. The acute use of vacuum wound may provide for early secondary closure. There is less study focused on optimal definitive reconstructive techniques. Further study in all of these areas will lead to improved outcomes.