Infections after missile head injury. Experience during the Lebanese civilian war

Objective. - Establish the risk factors for infection following missile head injuries (MHI). Methods. - Between 1975 and 1990, 500 cases of MHI were admitted, with only 272 responding to inclusion criteria. After initial evaluation including CT scan for 177 patients, all underwent craniectorny with debridement and duroplasty. A retrospective study was undertaken in order to identify the risk factors that increase the infection rate. Results. - The global infection rate was 11.39 %. Among the studied factors, those increasing the infection rate were: coma on admission (17.6 % vs 7.6 %), penetrating wounds (12.93 % vs 7 % for tangential wounds), intracerebral trajectory length over 6 cm (18.42 % vs 6.32 %), air sinuses effraction (25.8 % vs 9.54 %), a surgical delay over 72 hours (41.6 % vs 10.6 %), inadequate duroplasty (28 % vs 7.33 %), cerebrospinal fluid (CSF) fistulae (58.62 % vs 5.76 %). The presence of postoperative bone fragments did not increase the infection rate (11.4 % vs 11.2 %). Discussion and conclusion. - Adequate duroplasty and aggressive treatment of CSF fistulae decrease the infection rate. There is no need to reoperate on residual bone fragments after adequate debridment. A delay of 24 to 48 hours should be considered, to facilitate the procedure without increasing the infection risk.