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.