Prevention of infective complications of penetrating injuries to the head

Infective complications often occur after craniocerebral wounds caused by explosive fragments. These dangerous sequelae are, in our experience, the chief cause of delayed death after injury. Initial contamination. The presence of retained bone and metal fragments acting as a nidus for micro growth, and disturbances in cerebrospinal fluid (CSF) circulation, especially when the ventricular system is involved, are challenging problems in the management of missile wounds of the brain. The analysis covers 53 penetrating craniocerebral wounds, treated in ZhuHai and ZhoungShan in the period from 1988 to 1996. In 35 cases the head injuries were produced by explosive fragments and in the remaining 18 cases by low-velocity bullets. We have analysed the significance of these factors in cases undergoing operation within 24 h, the incidence of infection was 12.6%. Rising to 29.3% when delay in execess of 72 h after injury was unavoidable. We formed the opinion that the risk of infection was not significantly increased by failure to remove small inaccessible bone chips. The most formidable complication was CSF leakage which often resulted in infections of the central nervous system. This implies that successfully addressing the risk of infection is, potentially, the most powerful method of improving outcome from penetrating injuries to injuries to brain.